Classification of the Conjoined Latissimus Dorsi-Groin Flap and Indications for the Four Types of the Flap.

SUMMARY: The conjoined latissimus dorsi-groin flap is a versatile flap that not only can serve as an osteocutaneous flap to provide large soft tissue and bone for reconstruction of extensive defects but also can offer functioning muscle transfer and lymph node transfer for prevention of lymphedema after wide excision of tumors or major trauma. Over the past 24 years, the authors have classified the conjoined latissimus dorsi-groin flap into four categories. They propose precautions for application of the conjoined flaps.

Does postoperative non-sedation improve outcomes for patients after head and neck cancer reconstruction?: A STROBE compliant study.

Whether a strategy of postoperative non-sedation produces better outcomes compared with sedation in patients after head and neck reconstruction remains controversial. Therefore, we retrospectively investigated outcomes in 150 of these patients in our institution.Patients with head and neck cancer that received free anterolateral thigh flap were studied retrospectively, and were categorized in terms of their postoperative care into "sedation" and "non-sedation" groups. The related parameters of each patient were collected for analysis.Overall, 150 patients were included (sedation protocol (N = 56) and non-sedation strategy (N = 94)). No significant differences were observed between groups in patient demographics or postoperative outcomes. Significantly shorter durations of mean and median intensive care unit (ICU) length of stay, mechanical ventilation, hospitalization, and operative time were observed in the non-sedation group than in the sedation group. Among all patients, the sedation and flap reopen were the common variables related to prolonged ICU stay, mechanical ventilator duration, and hospitalization.The current study suggested the strategy of postoperative non-sedation is associated with a significant decrease in the duration of mechanical ventilation, ICU length of stay, hospitalization. Regardless of hospital stay, there were no differences in postoperative outcome between 2 groups.

Novel noninvasive approach for detecting arteriovenous fistula stenosis.

Hemodialysis is the most common treatment for patients with end-stage renal disease. For hemodialysis, consistently functional vascular access must be surgically created with an anastomosis of artery and vein, referred to as an arteriovenous fistula (AVF). However, AVF dysfunction may occur over time. Angiography and Doppler ultrasound are usually used to detect the flow or the diameter of the AVF. But they require well-trained operators and are expensive, and even angiography is invasive. In this study, a noninvasive approach based on stethoscope auscultation for monitoring AVF stenosis was proposed. Here, a wireless blood flow sound recorder was designed to record blood flow sounds wirelessly. In order to effectively extract the varying feature of blood flow sounds for AVF stenosis, the 2-D feature pattern built from S-transform was also proposed as the feature in the AVF stenosis detecting algorithm. Different from other frequency-related coefficients, the feature pattern can contain the information of blood flow sounds in time and frequency domains simultaneously. Preliminary findings showed that the proposed approach can provide high-quality estimation of AVF stenosis (positive predictive value = 87.84% and sensitivity = 89.24%).

Characterization of the 5' regulatory region of the human Glycine N-methyltransferase gene.

Glycine N-methyltransferase (GNMT) is a tumor susceptibility gene for both hepatocellular carcinoma and prostate cancer. We have previously characterized GNMT genomic structure and mapped its chromosomal localization to 6p12. For this study we identified a GNMT transcriptional start site at the 14th position upstream of the ATG codon. Electrophoretic mobility shift assay results indicate binding of the nuclear factor-Y (NF-Y) transcription factor to the CCAAT box (-71/-67) of the GNMT gene. Mutation assay results suggest that the nucleotide sequence in the -56/-47 region is a binding site for a putative transcriptional factor. The TATA-less core promoter (-133/+14) contains three major elements: an Sp1 site, CCAAT box, and a novel box within the CTGTCGGCTG sequence. One functional xenobiotic response element (XRE) located at the -104/-82 region is inducable by benzo[a]pyrene treatment. We believe our results have value for the study of GNMT transcriptional regulation.