Simultaneous pectoralis major-latissimus dorsi myocutaneous flap: An option of reconstruction for open sternal wounds

SummaryManagement of the open sternal wound after surgery is a challenge. We report a retrospective series of cases with regard to the management of sternal wounds according to our own experience and a review of the related literature. A retrospective chart review from June 2007 to February 2010 of patients with infective and open sternal wounds after surgery was performed. There were seven patients with a previous history of type A aortic dissection treated with the Bentall operation, thymoma with excision, mitral and tricuspid regurgitation with double valve replacement, and acute myocardial infarction with a ventricular-assist device or coronary artery bypass graft. All wound cultures of the seven patients showed positive findings. All patients received the latissimus dorsi (LD) myocutaneous flap for lower sternal wound reconstruction under the decubitus position and a contralateral pedicled rotated pectoralis major (PM) myocutaneous flap for the upper sternal wound. The residual wound was covered with a split-thickness skin graft. The mean age of the seven patients, including four males and three females, was 58.1 years (range: 33–73 years). The mean follow-up was 37.7 months (range: 30–44 months). The average time span between the final débridement and the flap reconstruction procedure was 5.2 ± 1.8 days. The harvested area of LD myocutaneous flap ranged from 25 × 10 cm2 to 15 × 8 cm2, and the area of PM myocutaneous flap ranged from 15×15 cm2 to 10 × 5 cm2. Four of seven patients had an omental flap initially, but salvage surgery was performed using a simultaneous pectoralis major-LD flap. Three cases underwent simultaneous PM-LD flap directly. One patient expired on postoperative Day 4 because of sudden ventricular fibrillation, but no postoperative complications were noted in the other six patients. With long-term follow-up, all patients survived without significant complications. The simultaneous PM-LD myocutaneous flap is a reliable option for open sternal wound reconstruction

The association of molecular typing, vancomycin MIC, and clinical outcome for patients with methicillin-resistant Staphylococcus aureus infections

AbstractBackground/PurposeThere are reports of an increase in vancomycin minimum inhibitory concentration (MIC) against methicillin-resistant Staphylococcus aureus (MRSA) over time, a phenomenon referred to as “MIC creep”, but some studies have conflicting results. The aim of this study is to evaluate the association of molecular typing, vancomycin MIC, and clinical outcome for patients with MRSA infections.MethodsThirty-two MRSA isolates from Taichung Veterans General Hospital (TCVGH), Taichung, Taiwan during the period of 2003 to 2008 were analyzed for the association of sequence typing, vancomycin MIC, and the correlated clinical outcome for patients with MRSA infections. The vancomycin MICs of 28 additional isolates from 2014 were used for the detection of MIC creep.ResultsAmong the genotypes of 32 isolates, there were 17 (53.1%) isolates with ST239-SCCmecIII, seven (21.9%) isolates with ST5-SCCmecII, six (18.8%) isolates with ST59-SCCmecIV, and two (6.2%) isolates with ST59-SCCmecVT. Two isolates had an MIC of 2 μg/mL and were identified as ST239-SCCmecIII. No statistically significant change in the distribution of MICs of all isolates was observed between 2003 and 2014 (p = 0.263). There was no significant difference in the mortality rates between two groups of patients with vancomycin MICs < 2 μg/mL and ≥ 2 μg/mL (p = > 0.99).ConclusionThere was no vancomycin MIC creep in the period from 2003 to 2014 in this study. Appropriate prognostic models for assessment of the association among sequence types, vancomycin MICs, and clinical outcome warrant further investigation

Web-based computer adaptive assessment of individual perceptions of job satisfaction for hospital workplace employees

<p>Abstract</p> <p>Background</p> <p>To develop a web-based computer adaptive testing (CAT) application for efficiently collecting data regarding workers' perceptions of job satisfaction, we examined whether a 37-item Job Content Questionnaire (JCQ-37) could evaluate the job satisfaction of individual employees as a single construct.</p> <p>Methods</p> <p>The JCQ-37 makes data collection via CAT on the internet easy, viable and fast. A Rasch rating scale model was applied to analyze data from 300 randomly selected hospital employees who participated in job-satisfaction surveys in 2008 and 2009 via non-adaptive and computer-adaptive testing, respectively.</p> <p>Results</p> <p>Of the 37 items on the questionnaire, 24 items fit the model fairly well. Person-separation reliability for the 2008 surveys was 0.88. Measures from both years and item-8 job satisfaction for groups were successfully evaluated through item-by-item analyses by using <it>t</it>-test. Workers aged 26 - 35 felt that job satisfaction was significantly worse in 2009 than in 2008.</p> <p>Conclusions</p> <p>A Web-CAT developed in the present paper was shown to be more efficient than traditional computer-based or pen-and-paper assessments at collecting data regarding workers' perceptions of job content.</p

Anti-Fatigue Effect of Aqueous Extract of Anisomeles indica (L) Kuntze in Mice

Purpose: To determine the anti-fatigue effect of Anisomeles indica (L.) Kuntze, an herb traditionally used for health improvement in Taiwan.Methods: Three groups (n = 10 per group) of Balb/c female mice were administered A. indica aqueous extract orally for 28 days at 125 (low dose A. indica, LA), 250 (medium dose A. indica, MA), and 500 (high dose A. indica, HA) mg/kg/day, respectively, while a control group received distilled water. After 28 days, a forced swimming test was performed, and biochemical parameters including plasma triglyceride (TG), glucose, lactate and ammonia levels related to fatigue were examined.Results: No mice died during the study period. Physical examinations did not reveal any treatmentrelated adverse effects after dosing, in terms of food and water consumption. Moreover, no obvious peptic ulcers, haemorrhage, or pathological changes in the liver or kidney were observed in A. indica treated mice, and there were no significant differences in body weight between the control and treatment groups (p &gt; 0.05). Mice treated with A. indica extract in the MA and HA groups showed significantly prolonged exhaustive swimming time (p &lt; 0.05), increased hepatic glycogen and muscle glycogen levels (p &lt; 0.05), and decreased triglyceride and plasma ammonia levels (p &lt; 0.05) in a dosedependent manner, compared with the controls. However, plasma glucose and lactic acid levels were not significantly changed (p &gt; 0.05).Conclusion: These results provide the first in vivo evidence supporting the anti-fatigue claims associated with A. indica treatment, indicating that this traditional herb may be of therapeutic use as an ergogenic and anti-fatigue agent.Keywords: Anisomeles indica, Exhaustive swimming test, Fatigue, Glycogen, Plasma ammonia, Lactic aci

False Data Injection Attack on Atmospheric Electric Field in Thunderstorm Warning

Thunderstorm warning plays an important role in lightning prevention and disaster mitigation. In practical applications, thunderstorm warning system is also vulnerable to attacks, such as False Data Injection Attack (FDIA). However, there is a lack of research on False Data Injection Attack for thunderstorm warning. Therefore, this paper put forwards a FDIA method based on principal component analysis (PCA) for atmospheric electric field (AEF), which is usually used for thunderstorm warning. In the FDIA scenario, the AEF-based thunderstorm warning algorithm is also introduced with electric field differential index (EFDI). Finally, experiments are conducted based on AEF data collected by an atmospheric electric field meter (AEFM) about the real thunderstorm. The experimental results show that FDIA seriously interferes with the results of the AEF-based thunderstorm warning

The 3D-tomography of the nano-clusters formed by Fe-coating and annealing of diamond films for enhancing their surface electron field emitters

[[abstract]]The Fe-coating and H2-annealed processes markedly increased the conductivity and enhanced the surface electron field emission (s-EFE) properties for the diamondfilms. The enhancement on the s-EFE properties for the diamondfilms is presumably owing to the formation of nano-graphite clusters on the surface of the films via the Fe-to-diamond interaction. However, the extent of enhancement varied with the granular structure of the diamondfilms. For the microcrystalline (MCD)films, the s-EFE process can be turned on at (E0)MCD = 1.9 V/μm, achieving a large s-EFE current density of (Je)MCD = 315 μA/cm2 at an applied field of 8.8 V/μm. These s-EFE properties are markedly better than those for Fe-coated/annealed ultrananocrystalline diamond(UNCD)films with (E0)UNCD = 2.0 V/μm and (Je)UNCD = 120 μA/cm2. The transmission electron microscopy showed that the nano-graphite clusters formed an interconnected network for MCDfilms that facilitated the electron transport more markedly, as compared with the isolated nano-graphitic clusters formed at the surface of the UNCDfilms. Therefore, the Fe-coating/annealing processes improved the s-EFE properties for the MCDfilms more markedly than that for the UNCDfilms. The understanding on the distribution of the nano-clusters is of critical importance in elucidating the authentic factor that influences the s-EFE properties of the diamondfilms. Such an understanding is possible only through the 3D-tomographic investigations.[[journaltype]]國外[[ispeerreviewed]]Y[[booktype]]電子版[[countrycodes]]US

Pain sensitivities predict prophylactic treatment outcomes of flunarizine in chronic migraine patients: A prospective study

Abstract Background We aimed to assess the differences in quantitative sensory testing between chronic migraine and healthy controls and to explore the association between pain sensitivities and outcomes in chronic migraine following preventive treatment. Methods In this prospective open-label study, preventive-naïve chronic migraine and healthy controls were recruited, and cold, heat, mechanical punctate, and pressure pain thresholds over the dermatomes of first branch of trigeminal nerve and first thoracic nerve were measured by quantitative sensory testing at baseline. Chronic migraines were treated with flunarizine and treatment response was defined as ≥50% reduction in the number of monthly headache days over the 12-week treatment period. Results Eighty-four chronic migraines and fifty age-and-sex-matched healthy controls were included in the analysis. The chronic migraine had higher cold pain thresholds over the dermatomes of the first branch of trigeminal nerve and the first thoracic nerve (p  158 g (p = 0.020) or heat pain threshold over the dermatome of the first branch of the trigeminal nerve > 44.9°C (p = 0.002) were more likely to be responders. Conclusions Chronic migraine were generally more sensitive compared to healthy controls. Preventive treatment with flunarizine should be recommended particularly for chronic migraine who have relatively normal sensitivity to mechanical punctate or heat pain. Trial registration: This study was registered on ClinicalTrials.gov (Identifier: NCT02747940)