One-stage reconstruction of large lower lip defect and oral competence with free composite anterolateral thigh-tensor fasciae latae flap

SummaryReconstruction for a large lower lip defect is a challenge to reconstructive surgeons. The most challenging problem is to maintain oral competence and prevent sialorrhea. We present three cases of such a defect reconstructed with composite anterolateral thigh-tensor fascia lata free flaps in one stage. The patients reported in this communication had advanced squamous cell carcinoma in the lower lip. A large lower lip defect (>90%) resulted in each case from wide excision of the tumor. A composite anterolateral thigh-tensor fasciae latae free flap was used to reconstruct the defect and to restore the dynamic oral competence in one stage. A tensor fasciae latae sling was attached by two strips sutured together to the upper orbicularis oris muscle in the first case. The four-strip method, a modification of the method described by Serkan,1 was adopted in the second case. The upper two strips bilaterally sutured to the orbicularis oris muscles in a mode somewhat different from Serkan’s method. The tensor fasciae latae sling was attached by two strips sutured to the periosteum of both zygomatic eminences in the third case. The tensor fasciae latae sling of Case 1 failed with persistent sialorrhea. The second case had good oral competence and comprehensible speech ability without sialorrhea. The third case had an acceptable result before he was lost to follow-up. A composite anterolateral thigh-tensor fasciae latae free flap is a good choice for a large lower lip defect to achieve oral competence reconstruction in one stage. Simultaneous dynamic and static suspensions are suggested to maintain oral competence and prevent sialorrhea

The upper limits of risk ratios and recommendations for reporting risk ratios, odds ratios, and rate ratios

Background Relative measures, including risk ratios (RRs) and odds ratios (ORs), are reported in many epidemiological studies. RRs represent how many times a condition is likely to develop when exposed to a risk factor. The upper limit of RRs is the multiplicative inverse of the baseline incidence. Ignoring the upper limits of RRs can lead to reporting exaggerated relative effect sizes. Objectives This study aims to demonstrate the importance of such upper limits for effect size reporting via equations, examples, and simulations and provide recommendations for the reporting of relative measures. Methods Equations to calculate RRs and their 95% confidence intervals (CIs) were listed. We performed simulations with 10,000 simulated subjects and three population variables: proportions at risk (0.05, 0.1, 0.3, 0.5, and 0.8), baseline incidence (0.05, 0.1, 0.3, 0.5, and 0.8), and RRs (0.5, 1.0, 5.0, 10.0, and 25.0). Subjects were randomly assigned with a risk based on the set of proportions-at-risk values. A disease occurred based on the baseline incidence among those not at risk. The incidence of those at risk was the product of the baseline incidence and the RRs. The 95% CIs of RRs were calculated according to Altman. Results The calculation of RR 95% CIs is not connected to the RR upper limits in equations. The RRs in the simulated populations at risk could reach the upper limits of RRs: multiplicative inverse of the baseline incidence. The upper limits to the derived RRs were around 1.25, 2, 3.3, 10, and 20, when the assumed baseline incidence rates were 0.8, 0.5, 0.3, 0.2, and 0.05, respectively. We demonstrated five scenarios in which the RR 95% CIs might exceed the upper limits. Conclusions Statistical significance does not imply the RR 95% CIs not exceeding the upper limits of RRs. When reporting RRs or ORs, the RR upper limits should be assessed. The rate ratio is also subject to a similar upper limit. In the literature, ORs tend to overestimate effect sizes. It is recommended to correct ORs that aim to approximate RRs assuming outcomes are rare. A reporting guide for relative measures, RRs, ORs, and rate ratios, is provided. Researchers are recommended to report whether the 95% CIs of relative measures, RRs, ORs, and rate ratios, overlap with the range of upper limits and discuss whether the relative measure estimates may exceed the upper limits

Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan

AbstractEndometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long-term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, four on links with chronic liver disease, four on links with rheumatoid arthritis, four on links with chronic renal disease, five on links with diabetes mellitus, and five on links with cardiovascular diseases (hypertension, hyperlipidemia, etc.). The data available to date support that women with endometriosis might be at risk of some chronic illnesses and certain malignancies, although we consider the evidence for some comorbidities to be of low quality, for example, the association between colon cancer and adenomyosis/endometriosis. We still believe that the risk of comorbidity might be higher in women with endometriosis than that we supposed before. More research is needed to determine whether women with endometriosis are really at risk of these comorbidities

Вихретоковый анизотропный термоэлектрический первичный преобразователь лучистого потока

Представлена оригинальная конструкция первичного преобразователя лучистого потока, который может служить основой для создания приемника неселективного излучения с повышенной чувствительностью

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Genome-wide association study of lung adenocarcinoma in East Asia and comparison with a European population

Lung adenocarcinoma is the most common type of lung cancer. Known risk variants explain only a small fraction of lung adenocarcinoma heritability. Here, we conducted a two-stage genome-wide association study of lung adenocarcinoma of East Asian ancestry (21,658 cases and 150,676 controls; 54.5% never-smokers) and identified 12 novel susceptibility variants, bringing the total number to 28 at 25 independent loci. Transcriptome-wide association analyses together with colocalization studies using a Taiwanese lung expression quantitative trait loci dataset (n = 115) identified novel candidate genes, including FADS1 at 11q12 and ELF5 at 11p13. In a multi-ancestry meta-analysis of East Asian and European studies, four loci were identified at 2p11, 4q32, 16q23, and 18q12. At the same time, most of our findings in East Asian populations showed no evidence of association in European populations. In our studies drawn from East Asian populations, a polygenic risk score based on the 25 loci had a stronger association in never-smokers vs. individuals with a history of smoking (P interaction  = 0.0058). These findings provide new insights into the etiology of lung adenocarcinoma in individuals from East Asian populations, which could be important in developing translational applications

Genome-wide association study of lung adenocarcinoma in East Asia and comparison with a European population.

Lung adenocarcinoma is the most common type of lung cancer. Known risk variants explain only a small fraction of lung adenocarcinoma heritability. Here, we conducted a two-stage genome-wide association study of lung adenocarcinoma of East Asian ancestry (21,658 cases and 150,676 controls; 54.5% never-smokers) and identified 12 novel susceptibility variants, bringing the total number to 28 at 25 independent loci. Transcriptome-wide association analyses together with colocalization studies using a Taiwanese lung expression quantitative trait loci dataset (n = 115) identified novel candidate genes, including FADS1 at 11q12 and ELF5 at 11p13. In a multi-ancestry meta-analysis of East Asian and European studies, four loci were identified at 2p11, 4q32, 16q23, and 18q12. At the same time, most of our findings in East Asian populations showed no evidence of association in European populations. In our studies drawn from East Asian populations, a polygenic risk score based on the 25 loci had a stronger association in never-smokers vs. individuals with a history of smoking (Pinteraction = 0.0058). These findings provide new insights into the etiology of lung adenocarcinoma in individuals from East Asian populations, which could be important in developing translational applications

The study of biocompatibility and tissue response for PLGA/TiO2 dressing

Poly-lactic-co-glycolic acid(PLGA)has been applied extensively for bio-medicine field due to its degrading property. Titanium dioxide(TiO2) have photocatalytic activity and antimicrobial efficacy. In this study, the PLGA/TiO2 dressing was created by mixing PLGA and TiO2. The wound healing effect was evaluated and the biocompatibility was tested. The results were presented in many methods. The antimicrobial test of PLGA/TiO2 dressing reveals that it could significantly inhibit the growth of bacteria with antimicrobial activity (R) 0.516 . The antimicrobial efficiency has moderate ability. In cell toxicity test, PLGA/TiO2 dressing does not induce the cell morphologic change. The cell number was not influenced which confirms non-cytoxicity in the PLGA/TiO2 dressing. In free oxygen radical study, the H2O2 concentration level is the same in the early phase of wound healing and in the late phase of wound healing. There is no significant difference between PLGA and PLGA/TiO2 dressing. The SOD concentration level for PLGA/TiO2 dressing is the same level in the early phase and in the late phase. There is also no significant difference between the three groups. The wound healing efficiency reveals healing rate for PLGA dressing and PLGA/TiO2 is better than control in the early stage. The healing rate has no significant difference in the late phase. From histopathologic examination, the wound did not heal and no epithelization, few granulation, and markable inflammation response in the early stage. In the late phase of wound healing, the epithelization is complete and granulation formation is revealed. The scale for PLGA/TiO2 dressing has no significant difference in epidermis growing score, granulation score and inflammation score. From this study, the PLGA/TiO2 dressing has non-toxicity properties and is biocompatible. It provides antibacterial efficiency and giving its feasibility of medicine application.聚乳酸/聚甘醇酸共聚物(PLGA)為逐漸普遍使用之生物可降解生醫材料，二氧化鈦(TiO2)光觸媒則是具備極佳之抗菌功能。本研究之主要目的是以PLGA為主成分，混合二氧化鈦光觸媒，製備成本低廉同時兼具通透性奈米抗菌光觸媒之新型人工敷料。如此材料能否在傷口癒合上發揮其功效，值得探討；再者此新型人工敷料的使用對生物體的相容性(biocompatibility)，更是我們研究重點所在。 經由PLGA/TiO2光觸媒敷料的抗菌效能測試結果顯示，此光觸媒敷料相對於PLGA敷料及無敷料者，有明顯降低培養皿內金黃色葡萄球菌的菌落生成數目，達到抗菌效果，其抗菌活性值(R)值為0.516，雖然其抑菌率並非最高程度，但已能達到一般抗菌效果要求。 在細胞毒性試驗上，PLGA/TiO2光觸媒敷料在細胞形態上的變化及細胞附著定性評估，與對照組無顯著差異，對細胞數量的增減，所測定量評估，亦無顯著差異；證實PLGA/TiO2光觸媒敷料並無細胞毒性。在生物體反應上，對游離氧自由基及細胞激素檢測發現， PLGA/TiO2光觸媒敷的過氧化氫(H2O2)值在傷口癒合早期，傷口癒合晚期時相似，與PLGA敷料無顯著差異， 與對照組則有顯著差異。IL-6 值在癒合早期及晚期時，與PLGA敷料無顯著差異。傷口癒合效能測試結果顯示: 測量早期傷口大小時，PLGA敷料、PLGA/TiO2光觸媒敷料對對早期傷口癒合速率，遠優於對照組，對照組甚至於有負成長的情形，但一周後，傷口癒合速率就無明顯差異。傷口組織反應測試結果顯示: 在早期因傷口未癒合故表皮生長較少，發炎反應明顯，肉芽生成較少，在晚期，有些傷口已完全癒合，表皮生長較佳，發炎反應仍明顯，肉芽生成也快速長成，統計傷口組織評分，PLGA/TiO2光觸媒敷料在三項評分，皆與對照组無明顯差異。 故PLGA/TiO2光觸媒敷料為無毒性，符合生物相容性敷料，並具抗菌性，提供醫療使用之可行性。誌 謝…………………………………………………………………i 中文摘要……………………………………………………………… ii 英文摘要……………………………………………………………… iii 目 次……………………………………………………………………iv 圖目次………………………………………………………………… vii 表目次……………………………………………………………… viii 第一章. 緒論……………………………………………………………1 一. 傷口癒合機轉……………………………………………………1 (一) 傷口癒合過程…………………………………………………1 (二) 傷口癒合方式…………………………………………………2 (三) 傷口癒合結果…………………………………………………2 二. 傷口敷料 …………………………………………………………3 (一) 傷口覆蓋方式…………………………………………………3 (二) 生物性敷料……………………………………………………4 (三) 合成性敷料……………………………………………………5 三. 抗菌性敷料………………………………………………………5 四. PLGA/TiO2光觸媒敷料……………………………………………5 (一) PLGA生物降解性材料…………………………………………5 (二) 二氧化鈦( TiO2)光觸媒………………………………………7 (三) PLGA/TiO2光觸媒敷料…………………………………………8 五. 生物免疫及組織反應……………………………………………8 (一) 游離自由基檢測…………………………………………………8 (二) 細胞激素檢測………………………………………………9 六. 生物相容性 ……………………………………………………10 (一) 細胞毒性……………………………………………………11 (二) 刺激反應……………………………………………………12 (三) 過敏反應…………………………………………………………12 七. 研究方向及動機…………………………………………………13 第二章. 材料與方法……………………………………………………14 一. 聚乳酸/聚甘醇酸共聚物(PLGA)及二氧化鈦(TiO2)光觸媒敷料的製備 (一) PLGA的製備…………………………………………………14 (二) TiO2光觸媒的製……………………………………………14 (二) PLGA/TiO2光觸媒敷料的製備………………………………14 二. PLGA/TiO2光觸媒敷料的抗菌效能……………………………15 (一) 送測樣品規格及測試片製備程序…………………………15 (二) 抗菌測試準備事項…………………………………………16 (三) 抗菌測試步驟………………………………………………19 三. PLGA/TiO2光觸媒敷料的細胞毒性………………………22 (一) 細胞培養……………………………………………………22 (二) 試驗細胞的微觀組織觀察…………………… ………23 (三) 細胞計數……………………………………………………23 四. PLGA/TiO2光觸媒敷料的生物體反應…………………………25 (一) 游離自由基檢測……………………………………………25 (二) 細胞激素檢測………………………………………………27 五. PLGA/TiO2光觸媒敷料的傷口癒合效能………………………28 (一) 傷口癒合動物模式…………………………………………28 (二) 傷口大小之觀察……………………………………………28 六. PLGA/TiO2光觸媒敷料的傷口組織反應………………………29 (一) 組織切片製作………………………………………………29 (二) 顯微鏡觀察…………………………………………………33 (三) 組織病理特性………………………………………………33 第三章 結果與討論……………………………………………………36 一. PLGA/TiO2光觸媒敷料的抗菌效能……………………………36 (一) 二氧化鈦敷料的菌落生成數………………………………36 (二) 二氧化鈦敷料的抗菌活性值………………………………36 二. PLGA/TiO2光觸媒敷料的細胞毒性…………………………….37 (一) 二氧化鈦敷料的細胞毒性定性評估………………………37 (二) 二氧化鈦敷料的細胞毒性定量評估………………………38 三. PLGA/TiO2光觸媒敷料的生物體反應……………………………40 (一) 游離自由基…………………………………………………40 (二) 細胞激素……………………………………………………41 四. PLGA/TiO2光觸媒敷料的傷口癒合效能 ………………………42 (一) 傷口癒合動物模式…………………………………………42 (二) 傷口大小之觀察……………………………………………43 五. PLGA/TiO2光觸媒敷料的傷口組織反應…………………………44 (一) 組織病理變化觀察…………………………………………44 (二) 組織病理特徵評分…………………………………………45 第四章 結論……………………………………………………………49 第五章 未來展望………………………………………………………51 第六章 參考文獻………………………………………………………5

On the Behavior of a Stuck Curved Pipe-Jacking

The influences of coefficient of friction (COF) and contact condition on the soil-pipe interaction have been analyzed and discussed by different related studies. However, the assessments of various jacking forces in literatures rarely explore the impact of changes in the COF caused by alterations in the geological conditions or construction situations. This paper investigated common construction problems in two curved pipejacking cases from Chiayi and Kaohsiung, and one case of straight, long-distance pipejacking in Taichung. We discovered that the actual jacking force often exceeded the pre-construction calculations. To examine the impact of a stuck pipe on the jacking force, this study sets different contact properties between the soil and the pipe within the area of the stuck pipe. Finite element method was used to simulate a horizontal curved pipejacking with a stuck condition. In the stuck pipe simulation, we found that because of the intense interactions between the pipe and the soil, the distribution of stress increased, and the jacking force also increased along with an increase in the area of stuck pipe