Risk factors for sternal wound infection

Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to 33.6 kg/m2 (mean, 23.1±3.74 kg/m2). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study

Lamivudine treatment in patients with HBV-related hepatocellular carcinoma--using an untreated, matched control cohort.

Lamivudine is widely used to treat patients with hepatitis B. However, the outcomes in patients with hepatocellular carcinoma (HCC) treated with lamivudine have not been established. This study was conducted to evaluate the outcomes of lamivudine treatment for patients with HCC using an untreated, matched control group. Thirty patients with controlled HCC orally received lamivudine. As controls, 40 patients with HCC who were not treated with lamivudine and matched for clinical features were selected. The lamivudine-treated and untreated groups were compared with respect to changes in liver function, HCC recurrence, survival, and cause of death. In the lamivudine-treated group, there was significant improvement in the Child-Pugh score at 24 months after starting treatment, while no improvement was observed in the untreated group. There was no significant difference in the cumulative incidence of HCC recurrence and survival between the groups. However, there was a significant difference in the cumulative incidence of death due to liver failure (P= 0.043). A significant improvement in liver function was achieved by lamivudine treatment, even in patients with HCC. These results suggest that lamivudine treatment for patients with HCC may prevent death due to liver failure. Further prospective randomized studies using a larger number of patients are required.</p

Successful management of preoperatively diagnosed torsion of a subserosal uterine fibroid by pneumoperitoneum laparoscopic single-port surgery

Objective: Preoperative diagnosis and successful management of acute torsion of a subserosal fibroid by using appropriate imaging modalities and single-port laparoscopic surgery. Case report: A 44-year-old nulliparous woman presented with lower abdominal pain. Computed tomography and magnetic resonance imaging with contrast enhancement revealed a tumor in the pouch of Douglas with a low contrast at the center and thin-rim enhancement. Torsion of a uterine subserosal fibroid was diagnosed preoperatively. Laparoscopic single-port surgery by pneumoperitoneum was performed. Torsion of the pedicle attached to the uterine wall was excised by bipolar coagulation and cut with scissors. The extirpated fibroid was extracted from the umbilical wound. The pneumoperitoneum single-port laparoscopic surgery was completed as a gynecologic emergency operation. Conclusion: Torsional uterine fibroids are difficult to diagnose preoperatively as symptoms are nonspecific and need emergent surgical management as an acute abdomen. Preoperative diagnosis using appropriate imaging modalities is important to perform single-port laparoscopic surgery

Tannin-fluoride preparation attenuates prostaglandin E2 production by dental pulp cells

Glass ionomer cements (GICs) are widely used for the operative restoration of dental caries. However, it has been reported that the components of GICs cause pulpal inflammatory responses. Recently, GICs containing tannin-fluoride preparation (HY agent) were developed. In this study, we investigated the effect of HY agent on prostaglandin E2, (PGE2) release from GIC-stimulated rat dental pulp cells (RPC-C2A). Extracts derived from GIC disks were used with HY(+) and without HY(-) agent. After treatment with GIC extracts, ATP contents, COX-2 mRNA and protein expression in RPC-C2A cells, and PGE2 production in culture media were analyzed. HY agent suppressed HY(-)-stimulated PGE2 release from RPC-C2A cells, as well as COX-2 mRNA and protein expression. Moreover, tannic acid attenuated COX-2 mRNA induced by HY(-) extract in a dose-dependent manner. Taken together, these results suggest that tannic acid in HY agent may suppress GIC-induced production of PGE2 by inhibition of COX-2 expression in dental pulp cells

Anthropomorphic “Motion Design” on Non-Holonomic Vehicle for Intuitive Interface

In the case of operating a vehicle, if the interface extracts human intention correctly and naturally, and if the vehicle moves like a human, then the human feels this operation to be intuitive. For realizing intuitive operation, this paper proposes motion design which makes vehicle motion anthropomorphic. The strategy of this motion design is: for making anthropomorphic motion, a certain normative motion for the vehicle is needed. Thus, we measure several subjects' motion in order to create normative motion. But these motions are different due to individual characteristics, because human motions are described in the time domain. Therefore, the human motion in the time domain is plotted to the phase plane. In the phase plane each subjects' motion was almost the same ellipse and then we fitted these ellipses to one ellipse by the least square method. Thus, we adopt this fitted ellipse as normative motion and call it “standard human motion”. The standard human motion is implemented on the actual non-holonomic vehicle and evaluated by the Semantic Differential (SD) method. From the results, we discovered that our motion design can create anthropomorphic vehicle motion

Low dose exposure diagnosis with a transXend detector aiming for iodine-marked cancer detection

The energy resolved computed tomography (CT), which had advantage over conventional CT (twofold higher CT value for iodine contrast agent and being free from beam hardening effect), was shown practical by employing the transXend detector: it measured X-rays as electric current and gave energy distribution of incident X-rays after analysis. This article shows a new application of the transXend detector for estimating the thicknesses of acrylic, iodine, and aluminum in a phantom. For this purpose, the responses of the segment detectors in the transXend detector are changed intentionally with inserting filters. With previously obtained two-dimensional maps for acrylic–iodine and acrylic–aluminum thicknesses, which are shown by the ratios of electric currents measured by the segment detectors, the thickness of materials on the path of the X-rays are obtained by a transmission measurement