Risk of congestive heart failure and mortality following lymphovenous anastomosis: a nationwide population-based retrospective cohort study.

BACKGROUND: Lymphovenous anastomosis (LVA) enables lymphatic fluid to drain into the venous system. However, no study has investigated the association between LVA and heart failure (HF) caused by fluid overload in the blood circulating system. The purpose of our study was to determine whether LVA increases the risk of HF and mortality. MATERIAL AND METHODS: This nationwide retrospective study evaluated a total of 1400 lymphedema patients who underwent LVA and two control cohorts with 28 000 lymphedema who did not undergo LVA and 70 000 age-matched and sex-matched participants from the Korean National Health Insurance database were included. Blood pressure, body mass index (BMI), glucose and cholesterol levels, smoking history, and comorbidities were obtained during National Health Insurance Service - Health Screening (NHIS-HealS). The incidence, adjusted risk for HF, and mortality were evaluated. RESULTS: Adjusted HRs for HF were 1.20 (confidence interval [CI], 1.03-1.40) and 1.30 (CI, 1.12-1.50), referenced by the general population control cohort and patients with lymphedema without LVA, respectively. In age, sex, BMI, and smoking status-stratified analyses, heightened risk of HF was evident across all sexes, spanning both young and old age groups, encompassing individuals with various smoking statuses, and those with a BMI of 18.5 or higher. Among these groups, the risk was notably greater in males compared to females, higher in younger individuals as opposed to older ones, and further elevated within the BMI range of 18.5-25. CONCLUSIONS: LVA is associated with an increased HF risk, independent of cardiovascular risk factors and associated comorbidities. This association is prominent in participants aged <50 years, in males, and in the normal-to-obese (BMI ≥18.5 kg/m 2 ) group. Among patients with lymphedema, LVA did not significantly affect mortality.

Postoperative Scar Management Using Laser Therapy for Breast Reconstruction With Latissimus Dorsi Flap.

BACKGROUND: Postoperative scar formation is inevitable, and a gold standard management has not been established to date. Due to the fact long and large scar formation occurs in reconstructive surgery, this study analyzed the relationship between various factors in patients who received breast reconstruction using latissimus dorsi (LD) flap to investigate appropriate and effective management approaches. PATIENTS AND METHODS: Twenty-seven patients who underwent breast reconstruction between June 2014 and January 2015 received laser therapy on their LD donor site at the Kyungpook National University Chilgok Hospital. Scar evaluation was performed on both the surgical scar and intact skin on the contralateral side. Scar evaluation was conducted at five specific points, 2 cm from the midpoint of the scar on each side. Laser treatment was performed at 4-week intervals, and patients were then followed-up for 6 months. To assess scars, gross images were taken using the same settings. In addition, spectrophotometry was used for color assessment, durometer for texture and pressure evaluation, and Vernier calipers and height gauges for a more precise and objective approach. RESULTS: The mean age of the participants was 45.7 years, and the mean body mass index was 22.1 kg/m2 The operator-evaluated scar scale scores were 107.2 and 97.3 in the experimental and control groups, respectively. In the patient-rated questionnaire, the scores were 62.3 and 59.4 in the experimental and control groups, respectively. CONCLUSION: When analyzing early-stage postoperative scars based on various factors, laser therapy is considered a very useful scar management approach. Additionally, when performing reconstructive surgery, tension force is regarded as a significant factor to take into account since it affects scar widening.

Chemical Resistance of Diaporthe citri against Systemic Fungicides on Citrus.

Citrus melanose, caused by Diaporthe citri, has been one of the serious diseases, and chemical fungicides were used for protection in many citrus orchards of Jeju Island. Establishing a disinfectant resistance management system and reducing pesticide usage would be important for contributing to safe agricultural production. In this study, monitoring of chemical resistance was performed with 40 representative D. citri isolates from many citrus orchards in Jeju Island. Four different fungicides, kresoxim-methyl, benomyl, fluazinam, and prochloraz manganese, with seven different concentrations were tested in vitro by growing the mycelium of the fungal isolates on the artificial medium potato dextrose agar. Among the 40 fungal isolates, 12 isolates were investigated as resistant to kresoxim-methyl which could not inhibit the mycelium growth to more than 50%. Especially isolate NEL21-2 was also resistant against benomyl, whose hyphae grew well even on the highest chemical concentration. However, any chemical resistance of fungal isolates was found against neither fluazinam nor prochloraz manganese. On the other hand, in vivo bio-testing of some resistant isolates was performed against both kresoxim-methyl and benomyl on young citrus leaves. Typical melanose symptoms developed on the citrus leaves pre-treated with both agrochemicals after inoculation with the resistant isolates. However, no or less symptoms were observed when the susceptible isolates were inoculated. Based on these results, it was suggested that some resistant isolates of D. citri occurred against both systemic fungicides, which may be valuable to build a strategy for protecting citrus disease.

Indications for Furlow's double-opposing Z-plasty in patients with velopharyngeal insufficiency following two-flap palatoplasty.

BACKGROUND: Various surgical methods have been developed for treating velopharyngeal insufficiency (VPI); however, the choice of surgical treatment is controversial. Pharyngeal flap, which is commonly used, has a high success rate but frequently leads to airway complications. Furlow's double-opposing Z-plasty (DOZ) does not deform the velopharyngeal port; therefore, it is expected to show good speech outcomes while reducing airway complications if an appropriate indication is noted. This study aimed to identify indications for DOZ in cases of VPI following palatoplasty. METHODS: Non-syndromic patients who underwent palatoplasty were prospectively followed from 2008 to 2016, and those diagnosed with VPI were treated with DOZ. Preoperative facial computed tomography (CT) and postoperative nasometric assessment results were examined. Surgical indication was set based on a 30% threshold value for postoperative nasalance. RESULTS: Comparing the preoperative CT parameters of both groups, high Need's ratio (NR), wide width of the nasopharynx (WNP), and long velopharyngeal depth (VPD) were contributing factors to VPI occurrence (p < 0.05). Analyzing preoperative CT and postoperative speech evaluation results, a linear relationship was observed between preoperative NR, WNP, VPD, and postoperative nasalance. In cases where NR < 0.81, WNP < 27.64 mm, and VPD < 20.34 mm, DOZ shows favorable outcomes (p < 0.05). CONCLUSION: Preoperative CT evaluation should be performed in patients with VPI. When WNP, VPD, and NR values are small, DOZ can achieve sufficient correction of VPI and reduce the risk of airway complications. In cases where the indication range is exceeded, pharyngeal flap is considered.

Spark Plasma Sintering Behavior of Nb-Mo-Si Alloy Powders Fabricated by Hydrogenation-Dehydrogenation Method.

In this study, the sintering behaviors of Nb-6Mo-20Si-3Cr (at percentage) in situ composite powders were studied. The Nb alloy powder was fabricated by a hydrogenation-dehydrogenation method, and both the alloy ingot and powders consisted of two phases: An Nb metal phase and the α-Nb5Si3 phase. Consolidation of the alloy powders was performed at 1500, 1600, and 1700 °C using spark plasma sintering, and the microstructures and phases formed at various sintering temperatures were analyzed. Micropores were observed in the compact sintered at 1500 °C due to the lack of complete densification at that temperature. The densification was completed at 1600 °C and the microstructure was slightly coarsened at 1700 °C compared to the microstructure of the compact sintered at 1600 °C. The microstructures prepared by the powder metallurgy method were finer than the microstructure of the ingot prepared by the casting method. The phase formation behavior varied according to the sintering temperature. Specifically, the α-Nb5Si3 phase, which is a stable structure of the Nb5Si3 phase at a low temperature, was transformed to the ß-Nb5Si3 phase (which is stable at a high temperature) with an increasing sintering temperature.

Mechanochemical Synthesis and Rapid Consolidation of Nanostructured CoTi-Al2O3 Composite by Pulsed Current Activated Sintering and Its Mechanical Properties.

Nano-powders of CoTi and Al2O3 were synthesized from CoTiO3 and 2Al powders by high energy ball milling. Nanocrystalline Al2O3 reinforced composite was consolidated by pulsed current activated sintering within one minute from mechanochemically synthesized powders of CoTi and Al2O3. The relative density of the composite was 97%. The average hardness and fracture toughness values obtained were 1180 kg/mm2 and 8.5 MPa · m1/2, respectively.

High Frequency Induction Heated Synthesis and Consolidation of Nanostructured TaSi2-WSi2 Composite.

A dense nanostructured TaSi2-WSi2 composite was simultaneously synthesized and sintered by the high frequency induction heating method within 2 minutes from mechanically activated powder of Ta, W and Si. A highly-dense TaSi2-WSi2 composite was produced under simultaneous application of a 80 MPa pressure and the induced current. The mechanical properties and microstructure were investigated.