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Medial elbow pain is a common musculoskeletal problem among individuals engaging in repetitive activities. Medial epicondylitis is the predominant cause of this pain. However, other potential causes must be considered as part of the differential diagnosis. This article discusses several etiologies of medial elbow pain, including medial epicondylitis, ulnar neuropathy, snapping triceps syndrome, ulnar collateral ligament injury, medial antebrachial cutaneous neuropathy, and diseases of the elbow joint, with an emphasis on ultrasound (US) findings. Awareness of possible diagnoses and their US features can assist radiologists in establishing a comprehensive diagnosis for medial elbow pain.
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BACKGROUND: Multi-organ segmentation is a critical task in medical imaging, with wide-ranging applications in both clinical practice and research. Accurate delineation of organs from high-resolution 3D medical images, such as CT scans, is essential for radiation therapy planning, enhancing treatment outcomes, and minimizing radiation toxicity risks. Additionally, it plays a pivotal role in quantitative image analysis, supporting various medical research studies. Despite its significance, manual segmentation of multiple organs from 3D images is labor-intensive and prone to low reproducibility due to high interoperator variability. Recent advancements in deep learning have led to several automated segmentation methods, yet many rely heavily on labeled data and human anatomy expertise. PURPOSE: In this study, our primary objective is to address the limitations of existing semi-supervised learning (SSL) methods for abdominal multi-organ segmentation. We aim to introduce a novel SSL approach that leverages unlabeled data to enhance the performance of deep neural networks in segmenting abdominal organs. Specifically, we propose a method that incorporates a redrawing network into the segmentation process to correct errors and improve accuracy. METHODS: Our proposed method comprises three interconnected neural networks: a segmentation network for image segmentation, a teacher network for consistency regularization, and a redrawing network for object redrawing. During training, the segmentation network undergoes two rounds of optimization: basic training and readjustment. We adopt the Mean-Teacher model as our baseline SSL approach, utilizing labeled and unlabeled data. However, recognizing significant errors in abdominal multi-organ segmentation using this method alone, we introduce the redrawing network to generate redrawn images based on CT scans, preserving original anatomical information. Our approach is grounded in the generative process hypothesis, encompassing segmentation, drawing, and assembling stages. Correct segmentation is crucial for generating accurate images. In the basic training phase, the segmentation network is trained using both labeled and unlabeled data, incorporating consistency learning to ensure consistent predictions before and after perturbations. The readjustment phase focuses on reducing segmentation errors by optimizing the segmentation network parameters based on the differences between redrawn and original CT images. RESULTS: We evaluated our method using two publicly available datasets: the beyond the cranial vault (BTCV) segmentation dataset (training: 44, validation: 6) and the abdominal multi-organ segmentation (AMOS) challenge 2022 dataset (training:138, validation:16). Our results were compared with state-of-the-art SSL methods, including MT and dual-task consistency (DTC), using the Dice similarity coefficient (DSC) as an accuracy metric. On both datasets, our proposed SSL method consistently outperformed other methods, including supervised learning, achieving superior segmentation performance for various abdominal organs. These findings demonstrate the effectiveness of our approach, even with a limited number of labeled data. CONCLUSIONS: Our novel semi-supervised learning approach for abdominal multi-organ segmentation addresses the challenges associated with this task. By integrating a redrawing network and leveraging unlabeled data, we achieve remarkable improvements in accuracy. Our method demonstrates superior performance compared to existing SSL and supervised learning methods. This approach holds great promise in enhancing the precision and efficiency of multi-organ segmentation in medical imaging applications.
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PURPOSE: Effective radiation therapy requires accurate segmentation of head and neck cancer, one of the most common types of cancer. With the advancement of deep learning, people have come up with various methods that use positron emission tomography-computed tomography to get complementary information. However, these approaches are computationally expensive because of the separation of feature extraction and fusion functions and do not make use of the high sensitivity of PET. We propose a new deep learning-based approach to alleviate these challenges. METHODS: We proposed a tumor region attention module that fully exploits the high sensitivity of PET and designed a network that learns the correlation between the PET and CT features using squeeze-and-excitation normalization (SE Norm) without separating the feature extraction and fusion functions. In addition, we introduce multi-scale context fusion, which exploits contextual information from different scales. RESULTS: The HECKTOR challenge 2021 dataset was used for training and testing. The proposed model outperformed the state-of-the-art models for medical image segmentation; in particular, the dice similarity coefficient increased by 8.78% compared to U-net. CONCLUSION: The proposed network segmented the complex shape of the tumor better than the state-of-the-art medical image segmentation methods, accurately distinguishing between tumor and non-tumor regions.
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Hepatocellular carcinoma frequently recurs after surgery, necessitating personalized clinical approaches based on tumor avatar models. However, location-dependent oxygen concentrations resulting from the dual hepatic vascular supply drive the inherent heterogeneity of the tumor microenvironment, which presents challenges in developing an avatar model. In this study, tissue samples from 12 patients with hepatocellular carcinoma are cultured directly on a chip and separated based on preference of oxygen concentration. Establishing a dual gradient system with drug perfusion perpendicular to the oxygen gradient enables the simultaneous separation of cells and evaluation of drug responsiveness. The results are further cross-validated by implanting the chips into mice at various oxygen levels using a patient-derived xenograft model. Hepatocellular carcinoma cells exposed to hypoxia exhibit invasive and recurrent characteristics that mirror clinical outcomes. This chip provides valuable insights into treatment prognosis by identifying the dominant hepatocellular carcinoma type in each patient, potentially guiding personalized therapeutic interventions.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Oxigênio , Microambiente Tumoral , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/metabolismo , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/metabolismo , Animais , Camundongos , Oxigênio/metabolismo , Linhagem Celular Tumoral , Masculino , Feminino , Ensaios Antitumorais Modelo de Xenoenxerto , Pessoa de Meia-Idade , Dispositivos Lab-On-A-ChipRESUMO
BACKGROUND: This study aimed to examine the associations of leisure time physical activity (LTPA) and occupational physical activity (OPA) with the prevalence of hypertension, while exploring the sex disparities in these associations. METHODS: A cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey between 2014 and 2019 (n = 26,534). Hypertension was defined as the use of antihypertensive drugs or systolic and diastolic blood pressure ≥ 140/90 mm Hg. Self-reported physical activity (PA), assessed by the global PA questionnaire, was categorized into three domains: total PA, LTPA and OPA. Each PA domain was classified based on METs-min/wk and intensity. RESULTS: In a multivariable adjusted model, the odds ratio (OR) with 95% confidence intervals (CIs) for the prevalence of hypertension in the active versus inactive group, based on METs, was 0.92 (95% CI 0.85-0.99) for total PA, 0.90 (95% CI 0.83-0.98) for LTPA and 1.21 (95% CI 1.05-1.38) for OPA. Compared to the inactive group, moderate to vigorous intensity was associated with a lower odds of hypertension for total PA and LTPA (total PA: OR 0.95, 95% CI 0.89-1.00 and LTPA: OR 0.92, 95% CI 0.86-0.98), but a higher odd for OPA (OR 1.17, 95% CI 1.05-1.30). Subgroup analyses showed significant evidence of effect modification by sex on the associations of total PA and LTPA (METs and intensity) with hypertension prevalence (p-values for interaction < 0.01); the associations were generally stronger for women. OPA was associated with a higher prevalence of hypertension in women, but not in men (p-value for interaction > 0.05). CONCLUSIONS: Higher levels of total PA and LTPA were associated with lower prevalence of hypertension in both men and women, with slightly stronger associations for women. However, higher OPA was associated with a higher prevalence of hypertension in women. These findings support the PA health paradox hypothesis and highlight the sex disparities in the association between OPA and hypertension prevalence.
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INTRODUCTION: The use of tissue expanders (TE) in post-mastectomy breast reconstruction is a widely accepted practice, especially in patients desiring implant-based breast reconstruction. It has become the standard of care to perform a two-staged breast reconstruction using tissue expanders for the past 50 years due to its reliability, safety, cost-effectiveness, and versatility. Due to its popularity, there are numerous types and features of breast tissue expanders and various surgical approaches available for plastic surgeons. AREAS COVERED: In this article, we will review the role of tissue expanders in breast reconstruction, the types and features of breast tissue expanders, and technical considerations. EXPERT OPINION: The use of tissue expanders in breast reconstruction offers significant advantages of preserving the breast skin envelope and reestablishing the breast mound. With evolving approaches to breast reconstruction, tissue expander design, and application underwent several refinements and modifications. Due to these advances, studies on its long-term efficacy and safety profile typically fall behind and more studies with higher levels of evidence are needed to better evaluate the efficacy and safety profile of tissue expanders. With increased understanding, reconstructive surgeons can minimize complications and maximize reconstructive, aesthetic outcomes with high patient satisfaction.
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Implantes de Mama , Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Dispositivos para Expansão de Tecidos , Mastectomia , Expansão de Tecido , Reprodutibilidade dos Testes , Estudos Retrospectivos , Desenho de EquipamentoRESUMO
OBJECTIVE: This study examined the relationship between changes in physical activity and their impact on exercise capacity and health-related quality of life over a 3-year span in patients with CHD. METHODS: We evaluated 99 young patients with CHD, aged 13-18 years at the outset. Physical activity, health-related quality of life, and exercise capacity were assessed via questionnaires and peak oxygen uptake measurements at baseline and after 3 years; changes in measures were estimated between the two time points and categorised into quartiles. Participants were stratified according to achieved (active) or not-achieved (inactive) recommended levels of physical activity (≥150 minutes/week) at both time points. RESULTS: Despite increases in physical activity, exercise capacity, and health-related quality of life over 3 years, the changes were not statistically significant (all p > 0.05). However, a positive association was found between physical activity changes and exercise capacity (ß = 0.250, p = 0.040) and health-related quality of life improvements (ß = 0.380, p < 0.001). Those with the most pronounced physical activity increase showed notable exercise capacity (p < 0.001) and health-related quality of life increases (p < 0.001) compared with patients with the largest decline in physical activity. The active-inactive category demonstrated a notable decline in exercise capacity compared to the active-active group, while the inactive-active group showed health-related quality of life improvements. CONCLUSIONS: Over 3 years, increased physical activity was consistently linked to increases in exercise capacity and health-related quality of life in patients with CHD, highlighting the potential of physical activity augmentation as an intervention strategy.
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Autologous breast reconstruction is an increasingly popular method of reconstruction for breast cancer survivors. While deep inferior epigastric perforator (DIEP) flaps are the gold standard, not all patients are ideal candidates for DIEP flaps due to low BMI, body habitus, or previous abdominal surgery. In these patients, complex autologous breast reconstruction can be performed, but there is a limited number of programs around the world due to high technical demand. Given the increased demand and need for complex autologous flaps, it is critical to build programs to increase patient access and teach future microsurgeons. In this paper, we discuss the steps, pearls, and preliminary experience of building a complex autologous breast reconstruction program in a tertiary academic center. We performed a retrospective chart review of patients who underwent starting the year prior to the creation of our program. Since the start of our program, a total of 74 breast mounds have been reconstructed in 46 patients using 87 flaps. Over 23 months, there was a decrease in median surgical time for bilateral reconstruction by 124 min (p = 0.03), an increase in the number of co-surgeon cases by 66% (p < 0.01), and an increase in the number of complex autologous breast reconstruction by 42% (p < 0.01). Our study shows that a complex autologous breast reconstruction program can be successfully established using a multi-phase approach, including the development of a robust co-surgeon model. In addition, we found that a dedicated program leads to increased patient access, decreased operative time, and enhancement of trainee education.
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Ovarian aging is a major obstacle in assisted reproductive medicine because it leads to ovarian dysfunction in women of advanced age. Currently, there are no effective treatments to cure age-related ovarian dysfunction. In this study, we investigated the effect of MIT-001 on the function of aged ovaries. Young and old mice were utilized in this study. MIT-001 was intraperitoneally administered, and the number of follicles and oocytes was analyzed. Each group was then retrieved for RNA and protein isolation. Total RNA was subjected to mRNA next-generation sequencing. Protein extracts from ovarian lysates were used to evaluate various cytokine levels in the ovaries. MIT-001 enhanced follicles and the number of oocytes were compared with non-treated old mice. MIT-001 downregulated immune response-related transcripts and cytokines in the ovaries of old mice. MIT-001 modulates the immune complex responsible for generating inflammatory signals and has the potential to restore the function of old ovaries and improve female fertility.
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Oócitos , Doenças Ovarianas , Feminino , Camundongos , Animais , Humanos , Idoso , Envelhecimento , Citocinas/farmacologia , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , RNA/farmacologiaRESUMO
PURPOSE: To assess the relief of dentin hypersensitivity of the new toothpaste with stabilized stannous fluoride (SnF2) versus a marketed standard fluoride toothpaste as a negative control and a marketed anhydrous SnF2 toothpaste as a positive control. METHODS: This was a single-centered, randomized, controlled, double blind, clinical trial. 96 participants with hypersensitivity were enrolled in this 4-week clinical study. Electrical stimulation and evaporative air tests were performed to evaluate the desensitization efficacy. Clinical assessments were made at baseline, and after 3 days, 1 week, 2 weeks and 4 weeks of twice-daily brushing. Additionally, the influence of Sn² ⺠species on desensitization was evaluated using bovine dentin specimens treated with toothpaste. RESULTS: All 96 enrolled participants were randomized. 96 participants completed all evaluations. Participants had an average age (SD) of 47.0 (10.5) years; 45% of participants were female. Both SnF2 toothpastes showed superior desensitization efficacy compared to the negative control toothpaste, the conventional sodium monofluorophosphate (SMFP) toothpaste, after a week. The new stabilized SnF2 toothpaste demonstrated improved electrical stimulation benefits compared to the negative control toothpaste, with increases of 15.1% after 3 days, 34.2% after 1 week, 66.3% after 2 weeks, and 111.6% after 4 weeks. Additionally, it showed relative verbal evaluation scale (VES) benefits of 14.2% after 3 days, 37.6% after 1 week, 28.9% after 2 weeks, and 37.4% after 4 weeks. The stabilized SnF2 toothpaste exhibited desensitization properties comparable to those of a commercial anhydrous SnF2 toothpaste, which typically produces undesirable side effects in the mouth. Toothpastes containing 0.454 % SnF2 exhibited perfect occlusion of dentin tubules. CLINICAL SIGNIFICANCE: The stabilized 0.454% SnF2 toothpaste exhibited significantly greater dentin hypersensitivity relief within only a week and comparable property to commercial anhydrous SnF2 toothpaste.
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Sensibilidade da Dentina , Fluoretos de Estanho , Animais , Bovinos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade da Dentina/tratamento farmacológico , Fluoretos/uso terapêutico , Fluoretos de Estanho/farmacologia , Fluoretos de Estanho/uso terapêutico , Cremes Dentais/farmacologia , Cremes Dentais/uso terapêuticoRESUMO
BACKGROUND: Desmoid tumors occur throughout the body, presenting as aggressive, locally invasive lesions that can impede quality of life. Many controversies remain regarding the optimal surgical treatment of desmoid. This article presents a systematic review and meta-analysis on surgical management, focusing on risk of recurrence and the utility of reconstruction within this unique patient population. METHODS: A systematic review was conducted to search for articles. The clinical course of patients diagnosed with desmoid tumors and treated by our institution's multidisciplinary team was retrospectively reviewed over a 13-year period. Meta-analysis study findings were compared with our cohort. RESULTS: From the systematic review, 10 studies with level of evidence III were found, which resulted in 981 patients. Twenty patients from our institution met the inclusion criteria for our study. In both our study cohort and the pooled results, recurrence was significantly higher in patients with positive microscopic margin after resection. In our study cohort, patients with recurrence had higher rates of positive margins compared with those without recurrence (83.3% vs 7.1%, P = 0.004), whereas the pooled study showed a difference of margin positivity of 50% vs 40% ( P = 0.01). No patients who underwent reconstruction in our study cohort had a recurrence during the study period. CONCLUSION: In both our cohort and pooled results, recurrence was significantly higher in patients with positive margins after initial resection. Reconstruction was not found to be a risk factor for recurrence. Reconstruction following desmoid tumor resection should be considered a viable option if a large and aggressive resection is required to obtain negative margins.
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Fibromatose Agressiva , Humanos , Fibromatose Agressiva/cirurgia , Fibromatose Agressiva/patologia , Estudos Retrospectivos , Recidiva Local de Neoplasia/patologia , Qualidade de Vida , Fatores de RiscoRESUMO
BACKGROUND: Despite the extensive use of various imaging modalities, there is limited literature on comparing the reliability between indocyanine green (ICG) lymphography, MR Lymphangiogram (MRL), and high frequency color Doppler ultrasound (HFCDU) to identify lymphatic vessels. METHOD: In this study of 124 patients, the correlation between preoperative image findings to the actual lymphatic vessel leading to lymphovenous anastomosis (LVA) was evaluated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and simple detection were calculated. Subgroup analysis was also performed according to the severity of lymphedema. RESULTS: Total of 328 LVAs were performed. The HFCDU overall had significantly higher sensitivity for identifying lymphatic vessels (99%) over MRL (83.5%) and ICG lymphography (82.3%)(p < 0.0001). Both ICG lymphography and HFCDU had 100% specificity and PPV. The NPV was 3.6%, 6.5% and 57.1% respectively for MRL, ICG lymphography, and HFCDU. All modalities showed high sensitivity for early stage 2 lymphedema while HFCDU showed a significantly higher sensitivity for late stage 2 (MRL:79.7%, ICG:83.1%, HFCDU:97%) and stage 3 (MRL:79.7%, ICG:79.7%, HFCDU:100%) over the other two modalities (p < 0.0001). CONCLUSION: This study demonstrated while all three modalities are able to provide good information, the sensitivity may alter as the severity of lymphedema progresses. The HFCDU will provide the best detection for lymphatic vessels throughout all stages of lymphedema. However, as each modality provides different and unique information, combining and evaluating the data according to the stage of lymphedema will be able to maximize the chance for a successful surgical outcome.
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Vasos Linfáticos , Linfedema , Humanos , Verde de Indocianina , Linfografia/métodos , Reprodutibilidade dos Testes , Anastomose Cirúrgica/métodos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgiaRESUMO
Since its introduction, virtual surgical planning (VSP) has been rapidly adopted as a part of reconstructive surgeon's armamentarium. VSP allows reconstructive surgeons to simulate resection, plan osteotomies, and design custom plates. These unique advantages have been especially beneficial for head and neck reconstructive surgeons as there is small room for error and high technical demand in head and neck reconstruction. Despite its popularity, most surgeons have limited experience in using VSP for orbito-maxillary reconstruction as tumors that involve the midface are relatively rare compared with other head and neck oncologic defects. In our institution, we routinely use VSP for orbito-maxillary reconstruction using free fibula flap to provide support for orbit, to restore normal dental occlusion, and to restore midface projection. In this chapter, we will discuss the role of virtual surgical planning and our algorithmic approach of performing orbito-maxillary reconstruction using free tissue transfer.
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Aging is a complex feature and involves loss of multiple functions and nonreversible phenotypes. However, several studies suggest it is possible to protect against aging and promote rejuvenation. Aging is associated with many factors, such as telomere shortening, DNA damage, mitochondrial dysfunction, and loss of homeostasis. The integrity of the cytoskeleton is associated with several cellular functions, such as migration, proliferation, degeneration, and mitochondrial bioenergy production, and chronic disorders, including neuronal degeneration and premature aging. Cytoskeletal integrity is closely related with several functional activities of cells, such as aging, proliferation, degeneration, and mitochondrial bioenergy production. Therefore, regulation of cytoskeletal integrity may be useful to elicit antiaging effects and to treat degenerative diseases, such as dementia. The actin cytoskeleton is dynamic because its assembly and disassembly change depending on the cellular status. Aged cells exhibit loss of cytoskeletal stability and decline in functional activities linked to longevity. Several studies reported that improvement of cytoskeletal stability can recover functional activities. In particular, microtubule stabilizers can be used to treat dementia. Furthermore, studies of the quality of aged oocytes and embryos revealed a relationship between cytoskeletal integrity and mitochondrial activity. This review summarizes the links of cytoskeletal properties with aging and degenerative diseases and how cytoskeletal integrity can be modulated to elicit antiaging and therapeutic effects.
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Citoesqueleto , Demência , Senescência Celular/fisiologia , Citoesqueleto/fisiologia , Humanos , Encurtamento do TelômeroRESUMO
BACKGROUND: This retrospective case series compares the outcomes and postoperative oxygen levels in patients who underwent free flap versus primary closure/local flap reconstruction for ischemic diabetic foot wounds to determine the influence of free flap on the surrounding ischemic tissues. The authors hypothesized that the free flap would benefit the surrounding ischemic tissue as a nutrient flap by increasing the tissue oxygen content. METHODS: The patients were divided into two groups: group 1 underwent free flap reconstruction, and group 2 underwent partial foot amputation with primary closure/local flap. Patient demographics, endovascular intervention, surgical outcome, postreconstruction intervention, and prereconstruction and postreconstruction transcutaneous oximetry were analyzed. RESULTS: Among 54 patients, 36 were in group 1 and 18 were in group 2. There were no differences in patient demographics between the two groups. All patients had successful angioplasty. Statistical significance was noted in postreconstruction intervention in which group 2 required 2.8 ± 2.9 débridements (versus 1.2 ± 2.5 for group 1) and seven of 18 below-knee amputations (versus three of 36 for group 1) (p < 0.05). Transcutaneous partial pressure of oxygen levels were significantly higher in group 1 at 6 months after reconstruction (61.6 ± 7.5 versus 32.6 ± 5.8 mmHg) (p < 0.01). CONCLUSION: This study shows that the role of the free flap in ischemic diabetic limb may expand beyond that of providing coverage over the vital structures, and it supports the use of the free flap as a nutrient to increase oxygen content in the ischemic diabetic foot. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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Diabetes Mellitus , Pé Diabético , Retalhos de Tecido Biológico , Amputação Cirúrgica , Pé Diabético/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Nutrientes , Oxigênio , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We examined the efficacy of ankle bathing versus aerobic exercise to improve vascular function in young adults who were randomized to aerobic exercise (AE) (n = 13, 40%-60% of heart rate reserve), ankle bathing (AB) (n = 15, 43 °C), or a control condition (CON) (n = 14, ankle bathing, 36 °C) for 40 min. Conduit vessel function [brachial artery flow-mediated dilation (FMD)], carotid and femoral artery blood flow and shear rate (SR), and arterial stiffness [carotid-to-femoral pulse wave velocity (cf-PWV), augmentation index (AIx@75), ß-stiffness index, and arterial compliance] were evaluated. Compared with CON, AE and AB increased FMD at 30 min and 90 min (interaction: p < 0.05); AB decreased carotid artery blood flow and SR at 30 min, while both AE and AB increased femoral artery blood flow and SR at 30 min and 90 min (interaction: p < 0.05); AE and AB decreased cf-PWV and AIx@75 at 30 min and 90 min (interaction: p < 0.05); and AE improved both carotid and femoral ß-stiffness index and arterial compliance, while AB reduced ß-stiffness index and increased arterial compliance only in the femoral artery (interaction: p < 0.05). These findings suggest that ankle bathing may serve as an alternative strategy for enhancing vascular function. Novelty: We observed similar improvements in conduit vessel function, femoral artery blood flow and shear rate, and arterial stiffness following ankle bathing and acute aerobic exercise in young adults. These findings have identified ankle bathing as a potential therapeutic strategy for enhancing vascular function, which may be particularly relevant for those with limited ability to engage in regular aerobic exercise.
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Análise de Onda de Pulso , Rigidez Vascular , Tornozelo , Pressão Sanguínea/fisiologia , Artéria Braquial/fisiologia , Exercício Físico/fisiologia , Humanos , Rigidez Vascular/fisiologia , Adulto JovemRESUMO
Chewing ability is also related to activities of daily living (ADLs) and nutritional status; however, these associations have not been firmly established. We examined chewing ability as a predictor variable and explored its relationship with cognitive functioning as mediated by ADLs and nutritional status data were collected by face-to-face interviews. Patients were receiving home healthcare service in Mun-gyeong city, Gyung-buk, Korea. Participants comprised 295 patients aged 81.35 ± 6.70 years. Structural equation modeling (SEM) was performed using AMOS 18.0 (SPSS Inc., Chicago, IL, USA). The model fit was based on absolute fit index and incremental fit index. Data were collected to assess cognitive functioning (using the Korean version of the Mini-Mental Status Examination for dementia screening (MMSE-DS)), ADL, a mini-nutritional assessment (MNA) questionnaire, and a chewing ability test. Participants with better chewing ability had significantly better cognitive functioning, ADLs, and nutritional status (p < 0.001). Chewing ability directly affected cognitive functioning and indirectly affected how ADLs and MNA affected MMSE-DS. Chewing ability is an important factor influencing the cognitive functioning of elderly adults in Korea, both directly and indirectly through mediating variables such as nutritional status and ADLs. Efforts to help older adults maintain their chewing ability are necessary for preventing cognitive impairment.
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Atividades Cotidianas , Disfunção Cognitiva , Idoso , Idoso de 80 Anos ou mais , Cognição , Humanos , Mastigação , Estado NutricionalRESUMO
BACKGROUND: As the use of stacked flaps and options for autologous breast reconstruction increase, the level of complexity in autologous breast reconstruction has risen. Frequently, these reconstruction types present technical challenges such as vessel mismatches and short pedicle length. In this study, the authors introduce their five steps of harvesting composite deep inferior epigastric artery (DIEA) and deep inferior epigastric vein (DIEV) grafts to overcome such challenges. METHODS: The authors performed a retrospective review of patients who underwent microvascular reconstruction using DIEA/DIEV grafts from 2012 to 2020. The grafts were harvested using the five steps, as follows: step 1, a transverse, paramedian skin incision was made at the level of suprapubic crease; step 2, an oblique fasciotomy was made on the lateral rectus border; step 3, DIEA/DIEV vessels were identified and exposed past the confluence of two venae comitantes; step 4, DIEA/DIEV grafts were harvested while sparing motor nerves; and step 5, fascial closure was performed. RESULTS: A total of 40 DIEA/DIEV grafts were used in 25 patients (lumbar artery perforator flaps, n = 25; lateral thigh flaps, n = 1; superficial inferior epigastric artery flaps, n = 12; and flap salvage, n = 2) for breast reconstruction. The average time of harvest was 28 minutes, and there were two flap losses. CONCLUSIONS: In the authors' experience, DIEA/DIEV grafts can be safely harvested and used in flaps with short pedicles and small vessel size. Although the authors' experience was limited to breast reconstruction, the DIEA/DIEV grafts can be used for other types of reconstruction, especially for head and neck reconstruction.
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Artérias Epigástricas/transplante , Mamoplastia/métodos , Coleta de Tecidos e Órgãos/métodos , Veias/transplante , Humanos , Estudos RetrospectivosRESUMO
BACKGROUND: Elderly people with dementia, who are increasing at a rate comparable to the rate at which theelderly population is growing, are becoming a serious social problem in Korea. Therefore, the purpose of this study was to investigate the association between molar occlusal balance and cognitive function among Koreans aged 65 years and older. METHODS: A total of 308 participants aged 65 years and older who attended a senior center were recruited for the study with their consent. The Korean version of the Mini-Mental State Examination (MMSE-DS) was used to assess cognitive function, and masticatory ability was measured according to the ability to chew food, the number of remaining teeth, and the self-perceived perceived masticatory function. Relative molar occlusal balance was measured using the T-scan â ¢ system. All collected data were analysed using SPSS version 23.0. RESULTS: There was a significant association between cognitive function and molar masticatory ability (P < .05). The participants with relative molar occlusal balance had a higher MMSE-DS score when compared to those with relative incision occlusal balance, adjusted for sociodemographic factors and number of remaining teeth, subjective masticatory ability, chewing ability, occlusion time, and denture use. Cognitive function was higher when relative molar occlusion was greater compared to anterior occlusion in anterior-posterior teeth balance. CONCLUSIONS: Cognitive function in elderly people was higher when the relative molar occlusal balance was greater. Mastication with posterior teeth may have a more important effect on stimulation of cognitive function. Therefore, oral health care focusing on maintenance of molar teeth may be crucial for elderly persons.
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Oclusão Dentária , Mastigação , Idoso , Cognição , Humanos , Mastigação/fisiologia , Dente Molar , República da CoreiaRESUMO
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are effective in decreasing hospital length of stay and inpatient opioid consumption. Implementation of these protocols in abdominally based breast reconstruction has been successful. When a patient is a poor candidate for abdominally based flaps a popular secondary option is the profunda artery perforator (PAP) flap. We present our experience with implementation of our ERAS protocol in patients treated with PAP flaps for breast reconstruction. METHODS: Retrospective review of patients treated with autologous breast reconstruction using PAP flaps before and after ERAS implementation were performed. Patient characteristics, postoperative oral morphine equivalents (OMEs), and flap data were collected. RESULTS: A total of 87 patients were included in this study (58 patients in pre-ERAS and 29 patients in ERAS group). There was no statistical difference in patient age, comorbidities, smoking, and radiation between two groups. The ERAS group had statistically lower hospital length of stay (2.6 vs. 3.8 days), procedure time (315 vs. 433 minutes), postoperative day 0 (54.8 vs. 96.3), postoperative day 1 (29.9 vs. 57.7), and total opioid consumption (103.7 vs. 192.1). There was no statistical difference in average pain scores between two groups. Multivariate analysis revealed that procedure time significantly increased the amount of opioid consumption while ERAS implementation significantly reduced LOS and opioid consumption. CONCLUSION: Use of an ERAS protocol in PAP flap breast reconstruction has not been previously studied. Our work shows that ERAS implementation in PAP flap breast reconstruction significantly reduces inpatient opioid use and length of hospital stay.