Dermatofibrosarcoma protuberans: A 10-year experience

SummaryBackgroundProviding soft-tissue coverage after wide excision of dermatofibrosarcoma protuberans (DFSP) is always challenging; according to the literature, a skin graft is often chosen as the first option. However, possible suboptimal functional and cosmetic results have been noted.Aims and objectivesWe present our 10-year experience using pedicled or free flaps for reconstruction after a wide excision of DFSP to provide adequate soft-tissue augmentation and enhanced esthetic results.Materials and methodsThis was a retrospective study comprising 14 DFSP patients who were treated between February 2003 and December 2013. All patients underwent a wide excision with a 3-cm safe margin with immediate reconstruction, and a negative deep margin confirmed with a frozen section. The reconstruction method included nine pedicled perforator flaps and five free perforator flaps. All patients received adjuvant radiotherapy after surgery.ResultsThe peak incidence that occurred in this series was the highest in patients younger than 30 years. None of the 14 patients exhibited recurrence, and the mean follow-up time was 30 months. Half of the patients exhibited DFSP distributed over the trunk; the patients in the series were predominantly male. A total of 13 flaps were successful except for one pedicled flap that failed from venous congestion; we used it in a salvage procedure by using full-thickness skin graft for coverage.ConclusionA wide excision with a 3-cm margin of safety with immediate reconstruction is a reliable method for DFSP resection. Initiating adjuvant radiotherapy might reduce the chance of local recurrence. To minimize the complications of skin graft, pedicled, or free flaps provide superior functional outcome, soft-tissue augmentation, and esthetic results

Prevalence of metabolic syndrome and related factors in Taiwanese high-tech industry workers

OBJECTIVES: In light of the increasing number of high-tech industry workers and the differences in their working conditions compared to those of the general population, the health status of these workers merits serious attention. This study aimed to explore the prevalence of metabolic syndrome and its correlates among Taiwanese high-tech industry workers. METHODS: This cross-sectional study included 4,666 workers who participated in labor health examinations at a hospital in southern Taiwan in 2008. Participants with metabolic syndrome were defined using the criteria proposed by the Taiwan National Department of Health in 2007. Factors associated with metabolic syndrome were determined using multiple logistic regression analysis. RESULTS: The overall prevalence of metabolic syndrome was 8.2%, and the prevalence was higher in men than in women (14.0% vs. 2.3%,

Anatomical Variations of Recurrent Laryngeal Nerve During Thyroid Surgery: How to Identify and Handle the Variations With Intraoperative Neuromonitoring

Recurrent laryngeal nerve (RLN) palsy is the most common and serious complication after thyroid surgery. Visual identification of the RLN during thyroid surgery has been shown to be associated with lower rates of palsy, and although it has been recommended as the gold standard for RLN treatment, it does not guarantee success against postoperative vocal cord paralysis. Anatomical variations of the RLN, such as extra-laryngeal branches, distorted RLN, intertwining between branches of the RLN and inferior thyroid artery, and non-recurrent laryngeal nerve, can be a potential cause of nerve injury due to visual misidentification. Therefore, intraoperative verification of functional and anatomical RLN integrity is a prerequisite for a safe thyroid operation. In this article, we review the literature and demonstrate how to identify and handle the anatomical variations of the RLN with the application of intraoperative neuromonitoring in the form of high resolution photography, which can be informative for thyroid surgeons. Anatomical variations of the RLN cannot be predicted preoperatively and might be associated with higher rates of RLN injury. The RLN injury caused by visual misidentification can be rare if the nerve is definitely identified early with intraoperative neuromonitoring

Square Key Matrix Management Scheme in Wireless Sensor Networks

In this paper we propose a symmetric cryptographic approach named Square Key Matrix Management Scheme (SKMaS) in which a sensor node named Key Distribution Server (KDS) is responsible for the security of key management. When the system starts up, the KDS sends its individual key and two sets of keys to sensor nodes. With the IDs, any two valid sensor nodes, e.g. i and j, can individually identify the corresponding communication keys (CKs) to derive a dynamic shared key (DSK) for encrypting/decrypting messages transmitted between them. When i leaves the underlying network, the CKs and the individually keys currently utilized by i can be reused by a newly joining sensor, e.g. h. However, when h joins the network, if no such previously-used IDs are available, h will be given a new ID, CKs and the individually key by the KDS. The KDS encrypts the CKs, with which an existing node q can communicate with h, with individual key so that only q rather than h can correctly decrypt the CKs. The lemmas and security analyses provided in this paper prove that the proposed system can protect at least three common attacks

Transarterial detachable coil embolization of direct carotid-cavernous fistula: Immediate and long-term outcomes

AbstractBackgroundTransarterial embolization is a standard method for management of direct carotid-cavernous fistula (DCCF). The purpose of this study was to report our experiences, and immediate and long-term outcomes of endovascular embolization of DCCFs by using detachable coils (DCs).MethodsOver 8 years, 24 patients with 25 DCCFs underwent endovascular DC embolization. There were 15 men and nine women; age ranged from 8 to 82 years (mean, 39 years). Immediate and long-term angiographic as well as clinical outcomes after endovascular DC embolization were retrospectively analyzed. The number and the length of DCs used to occlude the fistula were also evaluated.ResultsEighteen DCCFs were successfully occluded by single-session endovascular embolization with preservation of the parent artery. Retreatments by transvenous (n = 5) and/ or transorbital routes (n = 3) had to be performed in seven patients because of residual fistula (n = 4) or recurrent fistula (n = 4) occurring within 3 weeks after embolization. The average numbers and length of coils to occlude the fistulas were 14 (range, 2–31) and 189 cm (range, 16–756 cm), respectively. Four patients had small residual fistulas with spontaneous thrombosis on follow-up angiography. Three patients had transient cranial nerve impairment of the third (n = 1) or sixth (n = 2) nerve. There was no significant procedure-related neurological complication. The follow-up period was 3–48 months (mean, 19 months)ConclusionEndovascular DC embolization of DCCFs was proved both efficacious and safe in managing high-flow fistulas with sustained angiographic and clinical effects, particularly in those DCCFs with small fistula track and/or cavernous sinus. However, retreatment via various routes may be necessary in some patients because of residual or recurrent fistulas

Overexpression of Nuclear Protein Kinase CK2 α Catalytic Subunit (CK2α) as a Poor Prognosticator in Human Colorectal Cancer

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignancies but the current therapeutic approaches for advanced CRC are less efficient. Thus, novel therapeutic approaches are badly needed. The purpose of this study is to investigate the involvement of nuclear protein kinase CK2 α subunit (CK2α) in tumor progression, and in the prognosis of human CRC. METHODOLOGY/PRINCIPAL FINDINGS: Expression levels of nuclear CK2α were analyzed in 245 colorectal tissues from patients with CRC by immunohistochemistry, quantitative real-time PCR and Western blot. We correlated the expression levels with clinicopathologic parameters and prognosis in human CRC patients. Overexpression of nuclear CK2α was significantly correlated with depth of invasion, nodal status, American Joint Committee on Cancer (AJCC) staging, degree of differentiation, and perineural invasion. Patients with high expression levels of nuclear CK2α had a significantly poorer overall survival rate compared with patients with low expression levels of nuclear CK2α. In multi-variate Cox regression analysis, overexpression of nuclear CK2α was proven to be an independent prognostic marker for CRC. In addition, DLD-1 human colon cancer cells were employed as a cellular model to study the role of CK2α on cell growth, and the expression of CK2α in DLD-1 cells was inhibited by using siRNA technology. The data indicated that CK2α-specific siRNA treatment resulted in growth inhibition. CONCLUSIONS/SIGNIFICANCE: Taken together, overexpression of nuclear CK2α can be a useful marker for predicting the outcome of patients with CRC

Graphene-Complex-oxide Nanoscale Device Concepts

The integration of graphene with complex-oxide heterostructures such as LaAlO$_3$/SrTiO$_3$ offers the opportunity to combine the multifunctional properties of an oxide interface with the electronic properties of graphene. The ability to control interface conduction through graphene and understanding how it affects the intrinsic properties of an oxide interface are critical to the technological development of novel multifunctional devices. Here we demonstrate several device archetypes in which electron transport at an oxide interface is modulated using a patterned graphene top gate. Nanoscale devices are fabricated at the oxide interface by conductive atomic force microscope (c-AFM) lithography, and transport measurements are performed as a function of the graphene gate voltage. Experiments are performed with devices written adjacent to or directly underneath the graphene gate. Unique capabilities of this approach include the ability to create highly flexible device configurations, the ability to modulate carrier density at the oxide interface, and the ability to control electron transport up to the single-electron-tunneling regime, while maintaining intrinsic transport properties of the oxide interface. Our results facilitate the design of a variety of nanoscale devices that combine unique transport properties of these two intimately coupled two-dimensional electron systems.Comment: 27 pages, 10 figure

Is the whole greater than the sum of its parts? De novo assembly strategies for bacterial genomes based on paired-end sequencing

Number of misassemblies for different assembly strategies. Number of misassemblies for the de novo assembly results for E. coli DH1 and S. Parasanguinis FW213 are shown together with their standard errors of the mean. Group A [PE] and Group A [SE] represent all reads assembled as paired-end reads and single end reads, respectively. Group A [PE + SE] represents all the non-overlapped paired-end reads assembled together with merged reads. Group M [PE] and Group M [SE] represent Group M reads assembled as paired-end reads and single end reads, respectively. The numbers of misassemblies fluctuate a lot when depths of read number are low and gradually decreases until they reach a steady number. The paired-end reads (Group A [PE] and Group M [PE]) in S. Parasanguinis FW213 gave the lowest number of misassemblies when depths of read number are high. (TIFF 669 kb