Production of Designer Xylose-Acetic Acid Enriched Hydrolysate from Bioenergy Sorghum, Oilcane, and Energycane Bagasses

Xylan accounts for up to 40% of the structural carbohydrates in lignocellulosic feedstocks. Along with xylan, acetic acid in sources of hemicellulose can be recovered and marketed as a commodity chemical. Through vibrant bioprocessing innovations, converting xylose and acetic acid into high-value bioproducts via microbial cultures improves the feasibility of lignocellulosic biorefineries. Enzymatic hydrolysis using xylanase supplemented with acetylxylan esterase (AXE) was applied to prepare xylose-acetic acid enriched hydrolysates from bioenergy sorghum, oilcane, or energycane using sequential hydrothermal-mechanical pretreatment. Various biomass solids contents (15 to 25%, w/v) and xylanase loadings (140 to 280 FXU/g biomass) were tested to maximize xylose and acetic acid titers. The xylose and acetic acid yields were significantly improved by supplementing with AXE. The optimal yields of xylose and acetic acid were 92.29% and 62.26% obtained from hydrolyzing energycane and oilcane at 25% and 15% w/v biomass solids using 280 FXU xylanase/g biomass and AXE, respectively.

Cas9-Based Metabolic Engineering of Issatchenkia orientalis for Enhanced Utilization of Cellulosic Hydrolysates

Issatchenkia orientalis, exhibiting high tolerance against harsh environmental conditions, is a promising metabolic engineering host for producing fuels and chemicals from cellulosic hydrolysates containing fermentation inhibitors under acidic conditions. Although genetic tools for I. orientalis exist, they require auxotrophic mutants so that the selection of a host strain is limited. We developed a drug resistance gene (cloNAT)-based genome-editing method for engineering any I. orientalis strains and engineered I. orientalis strains isolated from various sources for xylose fermentation. Specifically, xylose reductase, xylitol dehydrogenase, and xylulokinase from Scheffersomyces stipitis were integrated into an intended chromosomal locus in four I. orientalis strains (SD108, IO21, IO45, and IO46) through Cas9-based genome editing. The resulting strains (SD108X, IO21X, IO45X, and IO46X) efficiently produced ethanol from cellulosic and hemicellulosic hydrolysates even though the pH adjustment and nitrogen source were not provided. As they presented different fermenting capacities, selection of a host I. orientalis strain was crucial for producing fuels and chemicals using cellulosic hydrolysates.

High solids loading biorefinery for the production of cellulosic sugars from bioenergy sorghum

A novel process applying high solids loading in chemical-free pretreatment and enzymatic hydrolysis was developed to produce sugars from bioenergy sorghum. Hydrothermal pretreatment with 50% solids loading was performed in a pilot scale continuous reactor followed by disc refining. Sugars were extracted from the enzymatic hydrolysis at 10% to 50% solids content using fed-batch operations. Three surfactants (Tween 80, PEG 4000, and PEG 6000) were evaluated to increase sugar yields. Hydrolysis using 2% PEG 4000 had the highest sugar yields. Glucose concentrations of 105, 130, and 147 g/L were obtained from the reaction at 30%, 40%, and 50% solids content, respectively. The maximum sugar concentration of the hydrolysate, including glucose and xylose, obtained was 232 g/L. Additionally, the glucose recovery (73.14%) was increased compared to that of the batch reaction (52.74%) by using two-stage enzymatic hydrolysis combined with fed-batch operation at 50% w/v solids content.

Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study

Healthcare workers involved in aerosol‐generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID‐19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID‐19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self‐reporting. The primary endpoint was the incidence of laboratory‐confirmed COVID‐19 diagnosis or new symptoms requiring self‐isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure‐related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow‐up of 32 (18–48 [0–116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID‐19 subsequently reported a COVID‐19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID‐19 transmission.

Production of xylose enriched hydrolysate from bioenergy sorghum and its conversion to β-carotene using an engineered Saccharomyces cerevisiae

A new bioprocess has been developed that allows for producing β-carotene from the xylose portion of bioenergy sorghum. Bioenergy sorghum was pretreated in a pilot-scale continuous hydrothermal reactor followed by disc refining. Xylose was extracted using low-severity dilute acid hydrolysis. A xylose yield of 64.9% (17.4 g/L) was obtained by hydrolyzing at 120 °C for 5 min with 2% sulfuric acid. The xylose-enriched syrup was separated and concentrated to either 32 g xylose/L (medium-concentrated hydrolysate, MCB) or 66 g xylose/L (high-concentrated hydrolysate, HCB). The non- (NCB), medium-, and high-concentrated xylose syrup were neutralized and fermented to β-carotene using Saccharomyces cerevisiae strain SR8B, which had been engineered for xylose utilization and β-carotene production. In HCB, MCB, and NCB cultures, the yeast produced β-carotene titers of 114.50 mg/L, 93.56 mg/L, and 82.50 mg/L, which corresponds to specific yeast biomass productions of 7.32 mg/g DCW, 8.10 mg/g DCW, and 8.29 mg/g DCW, respectively.

Sugar production from bioenergy sorghum by using pilot scale continuous hydrothermal pretreatment combined with disk refining

Chemical-free pretreatments are attracting increased interest because they generate less inhibitor in hydrolysates. In this study, pilot-scaled continuous hydrothermal (PCH) pretreatment followed by disk refining was evaluated and compared to laboratory-scale batch hot water (LHW) pretreatment. Bioenergy sorghum bagasse (BSB) was pretreated at 160-190 °C for 10 min with and without subsequent disk milling. Hydrothermal pretreatment and disk milling synergistically improved glucose and xylose release by 10-20% compared to hydrothermal pretreatment alone. Maximum yields of glucose and xylose of 82.55% and 70.78%, respectively were achieved, when BSB was pretreated at 190 °C and 180 °C followed by disk milling. LHW pretreated BSB had 5-15% higher sugar yields compared to PCH for all pretreatment conditions. The surface area improvement was also performed. PCH pretreatment combined with disk milling increased BSB surface area by 31.80-106.93%, which was greater than observed using LHW pretreatment.

Automated tongue diagnosis on the smartphone and its applications

Tongue features are important objective basis for clinical diagnosis and treatment in both western medicine and Chinese medicine. The need for continuous monitoring of health conditions inspires us to develop an automatic tongue diagnosis system based on built-in sensors of smartphones. However, tongue images taken by smartphone are quite different in color due to various lighting conditions, and it consequently affects the diagnosis especially when we use the appearance of tongue fur to infer health conditions. In this paper, we captured paired tongue images with and without flash, and the color difference between the paired images is used to estimate the lighting condition based on the Support Vector Machine (SVM). The color correction matrices for three kinds of common lights (i.e., fluorescent, halogen and incandescent) are pre-trained by using a ColorChecker-based method, and the corresponding pre-trained matrix for the estimated lighting is then applied to eliminate the effect of color distortion. We further use tongue fur detection as an example to discuss the effect of different model parameters and ColorCheckers for training the tongue color correction matrix under different lighting conditions. Finally, in order to demonstrate the potential use of our proposed system, we recruited 246 patients over a period of 2.5 years from a local hospital in Taiwan and examined the correlations between the captured tongue features and alanine aminotransferase (ALT)/aspartate aminotransferase (AST), which are important bio-markers for liver diseases. We found that some tongue features have strong correlation with AST or ALT, which suggests the possible use of these tongue features captured on a smartphone to provide an early warning of liver diseases.

Cultivation of auricular chondrocytes in poly(ethylene glycol)/poly(ε-caprolactone) hydrogel for tracheal cartilage tissue engineering in a rabbit model

Tissue engineering has the potential to overcome the limitations of tracheal reconstruction. To tissue-engineer a tracheal cartilage, auricular chondrocytes were encapsulated in a photocurable poly(ethylene glycol)/poly(ε-caprolactone) (PEG/PCL) hydrogel. Chondrogenic genes, including Sox9, Acan and Col2a1, were up-regulated in auricular chondrocytes after 2 weeks of in vitro cultivation in the PEG/PCL hydrogel. Co-cultivation of 70 % auricular chondrocytes and 30 % bone marrow mesenchymal stem cells (BMSCs) accelerated the chondrogenic genes' expression in the PEG/PCL hydrogel. Cartilaginous matrix markers, including proteoglycans and collagen type II, were detected in the chondrocytes-encapsulated PEG/PCL hydrogel after 4 weeks of in vitro cultivation. The higher expression level of cartilaginous matrix markers was observed in the PEG/PCL hydrogel with co-cultivation of 70 % chondrocytes and 30 % BMSCs. After 4 weeks of ectopic cultivation in rabbits, the cylindrical PEG/PCL structure was sustained with the use of a luminal silicon stent. However, without the stent, the construct collapsed under a compression force. No fibrosis or vessel ingrowth were found in the PEG/PCL hydrogel after 4 weeks of ectopic cultivation, whereas the auricular chondrocytes showed proteoglycans' accumulation and collagen type II production. Rabbit auricular chondrocytes could survive and retain chondrogenic ability in the PEG/PCL hydrogel under both in vitro and in vivo conditions. While the PEG/PCL hydrogel did not show sufficient mechanical properties for supporting the cylindrical shape of the construct, the high chondrogenesis level of chondrocytes in the PEG/PCL hydrogel displayed the potential of this material for tracheal tissue engineering.

Profitability Analysis of Soybean Oil Processes

Soybean oil production is the basic process for soybean applications. Cash flow analysis is used to estimate the profitability of a manufacturing venture. Besides capital investments, operating costs, and revenues, the interest rate is the factor to estimate the net present value (NPV), break-even points, and payback time; which are benchmarks for profitability evaluation. The positive NPV and reasonable payback time represent a profitable process, and provide an acceptable projection for real operating. Additionally, the capacity of the process is another critical factor. The extruding-expelling process and hexane extraction are the two typical approaches used in industry. When the capacities of annual oil production are larger than 12 and 173 million kg respectively, these two processes are profitable. The solvent free approach, known as enzyme assisted aqueous extraction process (EAEP), is profitable when the capacity is larger than 17 million kg of annual oil production.

Effects of stimulus intensity on latency and conduction time of short-latency somatosensory evoked potentials

We studied the effect of stimulus intensity on latencies of short-latency somatosensory evoked potentials (SSEP) by measuring both onset and peak latencies individually. The latencies of N9, N13, N20 and N9-N13 peripheral conduction time (PCT) of median nerve (MN) SSEP, and N8, N23, P37 and N8-N23 PCT of tibial nerve (TN) and sural nerve (SN) SSEP significantly shortened with increasing stimulus intensity by onset latency measurement. However, those latencies by peak latency measurement were less significantly shortened or had only a trend of latency shortening without statistical significance. In contrast to PCT, N13-N20 central conduction time (CCT) of MN-SSEP and N23-P37 CCT of TN- or SN-SSEP showed no latency changes with the increased stimulus intensity by both onset and peak latencies measurement. As peak latencies had greater interindividual variability than onset latencies shown by larger standard deviation, shortening of onset latencies were more consistent than that of peak latencies. We think shortening of onset latencies indicates the recruitment of faster conduction fiber along with increased stimulus intensity. As the degree of latency shortening was less if stimulus intensity was above 2.5 times sensory threshold, the stimulus intensity greater than 2.5 times the sensory threshold should be used for clinical application.

The outcome of failed free flaps in head and neck and extremity reconstruction: what is next in the reconstructive ladder?

The indications for free flaps have been more or less clarified; however, the course of reconstruction after the failure of a free flap remains undetermined. Is it better to insist on one's initial choice, or should surgeons downgrade their reconstructive goals? To establish a preliminary guideline, this study was designed to retrospectively analyze the outcome of failed free-tissue transfers performed in the authors hospital. Over the past 8 years (1990 through 1997), 3361 head and neck and extremity reconstructions were performed by free-tissue transfers, excluding toe transplantations. Among these reconstructions, 1235 flaps (36.7 percent) were transferred to the head and neck region, and 2126 flaps (63.3 percent) to the extremities. A total of 101 failures (3.0 percent total plus the partial failure rate) were encountered. Forty-two failures occurred in the head and neck region, and 59 in the extremities. Evaluation of the cases revealed that one of three following approaches to handling the failure was taken: (1) a second free-tissue transfer; (2) a regional flap transfer; or (3) conservative management with debridement, wound care, and subsequent closure by secondary intention, whether by local flaps or skin grafting. In the head and neck region, 17 second free flaps (40 percent) and 15 regional flaps (36 percent) were transferred to salvage the reconstruction, whereas conservative management was undertaken in the remaining 10 cases (24 percent). In the extremities, 37 failures were treated conservatively (63 percent) in addition to 17 second free flaps (29 percent) and three regional flaps (5 percent) used to salvage the failed reconstruction. Two cases underwent amputation (3 percent). The average time elapsed between the failure and second free-tissue transfer was 12 days (range, 2 to 60 days) in the head and neck region and 18 days (range, 2 to 56 days) in the extremities. In a total of 34 second free-tissue transfers at both localizations, there were only three failures (9 percent). However, in the head and neck region, seven of the regional flaps transferred (47 percent) and four cases that were conservatively treated (40 percent) either failed or developed complications that lengthened the reconstruction period because of additional procedures. Six other free-tissue transfers had to be performed to manage these complicated cases. Conservative management was quite successful in the extremities; most patients' wounds healed, although more than one skin-graft procedure was required in 10 patients (27 percent). In conclusion, a second free-tissue transfer is, in general, a relatively more reliable and more effective procedure for the treatment of flap failure in the head and neck region, as well as failed vascularized bone flaps in the reconstruction of the extremities. Conservative treatment may be a simple and valid alternative to second (free) flaps for soft-tissue coverage in extremities with partial and even total losses.

[The cloning of apple ferritin gene (Apfl) from Malus xiaojinensis Cheng et Jiang and its structure analysis]

The special primers were designed based on the sequence information of plant ferritin genes reported in the literature and used for polymerase chain reaction (PCR) with the genomic DNA of Malus xiaojinensis Cheng et Jiang in an attempt to clone apple ferritin gene. A single fragment of 771 bp was successfully obtained from the PCRs and cloned in this study. The sequence and homology analysis results of the fragment showed that the deduced amino acids of the fragment had a ninety-nine percent homology to that of the soybean ferritin gene reported by Lescure et al. (1991). A comparison in details of the nucleotide sequence of the clone and that of the soybean ferritin gene showed that they consisted of the same open reading frame (ORF, 753 bp) and that the cloned fragment had complete initial and stop codes. Within the ORF no introns were found and there were no nucleotide difference in the transit peptide region (TP) of the gene, but five nucleotide mutations were found in the mature peptide region (MP), among which four were synonymous mutations.

Stereocontrolled synthesis of acyclic 1,3-diols via condensation of tungsten-syn-pi-pentadienyl complexes with aldehydes. A new Prins reaction via s-trans-diene cationic intermediates

In the presence of BF(3).Et(2)O, condensation of CpW(CO)(2)(syn-pi-2-methoxycarbonylpentadienyl) with aldehydes generated tungsten-eta(4)-trans-diene cation in cold toluene, and hydrolysis of this salt afforded tungsten-pi-allyl-anti-1,3-diols in good yields. This new synthesis of anti-1,3-diols represents an atypical Prins reaction that is applicable to normal aldehydes. The anti/syn ratios of 1,3-diols increased with an increase in the size of the aldehydes. These anti-1,3-diols were transformed into various complex oxygen heterocycles based on two demetalations: (1) conversion to an allyl cation followed by nucleophilic attack and (2) condensation with aldehydes via its CpW(NO)Cl derivative, to give functionalized alpha-methylene butyrolactones. A semi-emperical calculation was performed to deduce the transition-state structure to rationalize the anti-stereoselectivity.

One-stage posterior decompression and fusion using a Luque rod for occipito-cervical instability and neural compression

STUDY DESIGN

Original article.

OBJECTIVE

The authors present seven cases who underwent one-stage suboccipital, C1 and/or C2 posterior decompression and fusion by Luque rod, wiring and autogenic bone graft for occipito-cervical instability and neural compression.

SETTING

Chang Gung University and Medical Center at Kaohsiung, Taiwan.

METHOD

Since January 1996, 20 cases of craniovertebral and upper cervical spinal instability were encountered. Seven of these cases had no neurological improvment under Cone-Barton Skeletal traction. Imaging studies revealed poor reduction with persistent neural compression. One patient underwent unsuccessful anterior trans-oral vertebrectomy for decompression. All patients underwent posterior suboccipital craniectomy, C1 and/or C2 laminectomy for decompression. Contoured Luque rod with wiring and autogeneic bone graft was used for craniocervical fusion. After surgical treatment, halo-vest or sterno-occipito-mandibular immobilizer (SOMI) was used for 3-6 months.

RESULTS

Suboccipital craniectomy and C1 laminectomy could afford a 30-50% increment of anteroposterior diameter in the neural canal and effective decompression of the low medulla and cord. All patients made neurological improvement. The ASIA-MIS scores improved from pre-operative 49 (mean) to 78. Four patients can walk without any support. There were no major complications except for one case requiring readjustment of the halo-vest brace.

CONCLUSION

The authors recommend this procedure as one choice for relieving craniocervical instability with neurological compromise. A programmed rehabilitation will afford better neurological improvement.

Clinical application of NMP22 and urinary cytology in patients with hematuria or a history of urothelial carcinoma

For evaluation of the clinical application of immunoassay for nuclear matrix protein 22 (NMP22 immunoassay) and urinary cytology for early diagnosis and detection of bladder cancer in patients with hematuria and/or a previous history of bladder cancer, 209 urine samples obtained from 137 patients presenting episodes of hematuria or a history of bladder cancer were assayed for NMP22 levels and/or prepared for cytology examination. Biopsy was performed when any visible tumor was identified during cystoscopy examination. The median NMP22 concentrations measured in samples taken from patients with active bladder cancer, from patients with a history of bladder cancer but no active disease, from patients with hematuria, and from healthy volunteers were 18.95, 5.45, 6.39, and 3.75 U/ml, respectively. The urinary NMP22 level recorded for patients with urothelial carcinoma was significantly higher than that noted for individuals without active disease. The sensitivity of the NMP22 assay and of urinary cytology in diagnosing bladder cancer was 69% and 67%, respectively. In contrast, the specificity of these two diagnostic modalities reached 72% and 93%, respectively. The NMP22 assay is slightly more sensitive but less specific than urinary cytology in detecting bladder cancer. This study indicates that determination of urinary NMP22 levels is a useful and noninvasive tool for the detection of bladder cancer because of its high sensitivity. The urinary NMP22 assay may be used as a first-line routine screening method; however, it cannot replace the use of urinary cytology because of its lower specificity.

Atlantal stenosis: a rare cause of quadriparesis in a child. Case report

The authors report the case of a 3-year-old boy who suffered from quadriparesis and respiratory distress after failing to execute a somersault properly. Neuroimaging revealed spinal cord contusion with marked spinal canal stenosis at the level of the atlas. No subtle instability, occult fracture, or other congenital abnormalities were confirmed. Spinal cord contusion with marked canal stenosis is rare, and only several adult cases have been reported. Severe stenosis at the level of the atlas may predispose individuals to severe spinal cord contusion, as occurred in our patient after sustaining trivial trauma.

Current seroprevalence of hepatitis A virus infection among kindergarten children and teachers in Taiwan

Taiwan was a hyperendemic area for hepatitis A virus (HAV) infection before the late 1980s. The seroprevalence of HAV infection was higher than 90% with most HAV infection occurring during childhood. This study was to estimate the seroprevalence of HAV infection among preschool children in central Taiwan. A community-based survey was carried out in 54 kindergartens in 10 urban areas, 10 rural areas and 2 aboriginal areas randomly selected through stratified sampling. Serum samples of 2,549 healthy preschool children and 104 teachers in study kindergartens were screened for the HAV antibodies (anti-HAV) by means of a commercially available microparticle enzyme immunoassay (AxSYM HAVAB). Among aboriginal kindergarten children, more than 96% of them were anti-HAV seropositive due to a mass HAV vaccination program. In urban and rural areas, kindergarten children had a very low prevalence of anti-HAV (0.4%) in contrast to a high seroprevalence in their teachers (78%). There was no gender difference in seroprevalence of anti-HAV, while the anti-HAV seroprevalence was significantly higher in urban areas than in rural areas. Crowdedness of living in urban areas might facilitate the person-to-person transmission of infectious agents.

Devices for ischemic preconditioning of the pedicled groin flap

BACKGROUND

Early division of the pedicled groin flap can be achieved by using ischemic preconditioning. The goal of this study was to investigate the devices available for ischemic preconditioning and determine which device is the most effective and results in lowest patient discomfort.

METHODS

Rubber bands, custom-made Orthoplast sheets, long-nose locking pliers, intestinal clamps, and a pneumatic tourniquet device were used for ischemic preconditioning on 13 patients who sustained severe hand injuries with reconstruction of pedicled groin flaps. The devices were compared by using laser Doppler flowmetry and the patient's local pain levels.

RESULTS

Twelve of 13 flaps were successfully divided at a mean period of 8.3 days by using a custom-made Orthoplast sheet or a pneumatic tourniquet device. All devices except the rubber bands could result in a biologic zero flow level.

CONCLUSION

The pneumatic tourniquet device is the most desirable ischemic preconditioning device, having the advantages of excellent ischemic effect, easy application, and minimal discomfort.

Target-dependent axonal sprouting following vagal-hypoglossal nerve anastomosis in cats

PURPOSE

To investigate the relationships between the axonal sprouting and target neurotization by central neurons after nerve heteroconnection.

METHODS

Unilateral (right) vagal-hypoglossal nerve anastomosis (VHA) was performed in adult cats. Following 3-315 days postoperation (dpo), quantitative analyses and ultrastructural changes in the proximal portion of the vagal-hypoglossal heteroconnected nerve as well as the time course of neuronal regeneration were studied. Along with this, horseradish peroxidase (HRP) retrograde tracing technique was used to label the neurons of dorsal motor vagal nucleus (DMV) and nucleus ambiguus (NA) to ascertain if target neurotization was established.

RESULTS

The contralateral (left) intact vagus nerve proximal to the level of ansa cervicalis showed an average of 33 ± 1 myelinated and 74 ± 4 unmyelinated axons in 727 μm2 sectional area of the nerve. In the heteroconnected nerve at the corresponding level just proximal to the anastomosis site, there was a marked increase in the number of small axons sprouting from the unmyelinated nerve fibers between 18 and 25 dpo. The number of these axonal sprouts appeared to decline at 32 dpo but its increase of 131 % was sustained until the late regeneration stage at 315 dpo when compared with the contralateral nerve serving as a control. The mean number of myelinated axons per area unit (727 μm2) was reduced to 18 at 3 dpo but was immediately restored to the normal range at 7 dpo. The retrograde labelling of neurons in both the DMV and NA was first detected at 22 dpo and was progressively increased peaking by about 67 dpo.

CONCLUSIONS

We conclude that compared with the unmyelinated axons, the myelinated axons may acquire a superior interaction with the new target. Furthermore, the postoperative neurotization of tongue muscles may initiate and facilitate the retraction of the redundant axonal sprouts.

Microsurgical combined scapular/parascapular flap for reconstruction of severe neck contracture: case report and literature review

OBJECTIVE

The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck.

METHODS

A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily.

RESULTS

Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results.

CONCLUSION

The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap.

Role of fibronectin deposition in cystogenesis of Madin-Darby canine kidney cells

BACKGROUND

Madin-Darby canine kidney (MDCK) cells cultured within collagen I gel exhibit clonal growth and form spherical multicellular cysts. The cyst-lining epithelial cells are polarized with the basolateral surface in contact with the collagen gel and the apical surface facing the lumen. To understand whether MDCK cysts construct the basal lamina, we characterized the composition of the extracellular matrix deposited by MDCK cysts. The cyst-lining cells produced an apparently incomplete basal lamina containing a discontinuous laminin substratum. In addition, the basal cell surface of the cyst was surrounded by a thick layer of fibronectin. This study was conducted to delineate the role of fibronectin deposition in cystogenesis.

METHODS

MDCK cells cultured in collagen gel were employed. We first used Arg-Gly-Asp (RGD) peptides containing disintegrin rhodostomin to disturb the interaction between fibronectin and the cell surface integrin. We then established several stable transfectants expressing the fibronectin antisense RNA and with which to directly examine the role of fibronectin in cystogenesis.

RESULTS

Rhodostomin markedly decreased the growth rates of the MDCK cyst, suggesting the importance of a normal interaction between fibronectin and integrins. The stable transfectants overexpressing the fibronectin antisense RNA exhibited relatively lower levels of fibronectin and markedly lower cyst growth rates than the control clone. The lower growth rate was correlated with an increase in collagen gel-induced apoptosis.

CONCLUSIONS

The results indicate that the deposition of fibronectin underlying the cyst-lining epithelium serves to prevent apoptosis induced by three-dimensional collagen gel cultures, and hence facilitates cyst growth of MDCK cells.

Combined ischemic preconditioning and laser Doppler measurement for early division of pedicled groin flap

OBJECTIVES

The main disadvantage of the pedicled groin flap for hand reconstruction is the long period of immobilization required. Early division of the pedicled groin flap is desirable for both patients and surgeons. The aims of this study were to investigate whether ischemic preconditioning can effectively accelerate the neovascularization of the junction between the donor and recipient sites in the pedicled flap, and the most objective method of judging the timing of early division of the pedicled groin flap. This report is the first prospective study to use ischemic preconditioning for early division of pedicled cutaneous flap combined with laser Doppler measurement.

METHODS

The severe hand injuries of 12 patients were reconstructed by using the pedicled groin flap method. The ischemic preconditioning program was prospectively performed as scheduled for 5 to 7 days postoperatively. The pedicled groin flap was monitored with laser Doppler when the flap was elevated, inset, with clamping and nonclamping postoperatively.

RESULTS

Eleven of the 12 pedicled groin flaps were divided safely and survived completely. Only one pedicled groin flap with a simultaneous harvest of iliac bone graft had partial flap loss, giving a success rate of 90.1%.

CONCLUSION

With ischemic preconditioning, the pedicled groin flap can be safely divided postoperatively at a mean period of 8.4 days according to the laser Doppler measurement, especially when the perfusion unit ratio of clamping over nonclamping reaches more than 36.6%.

Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects

Lateral composite mandibular defects resulting from excision of advanced oral carcinoma often require mandible, intra-oral lining, external face, and soft-tissue bulk reconstruction. Ignorance of importance soft-tissue deficit in those patients may cause significant morbidity and functional loss. Such defects, therefore, can be reconstructed best with a double free flap technique. However, this procedure may not be feasible for every patient or surgeon. An alternative procedure is a free fibula osteoseptocutaneous flap combined with a pedicled pectoralis major myocutaneous flap. This combination was used in reconstruction of extensive composite mandibular defects in 14 patients with T3/T4 oral squamous cell carcinoma. All patients were men, and the average age was 54.3 years. The septocutaneous paddle of the fibula flap was used for the mucosal lining of the defects while the bony part established the rigid mandibular continuity. The pectoralis major flap then covered the external skin defect in the face and cheek, and the dead spaces left by the extirpated masticator muscles, buccal fat, and parotid gland. One free fibula flap failed totally, and one pectoralis major flap developed marginal necrosis. At the time of final evaluation, nine patients (64.3 percent) were alive, surviving an average of 25.7 months. All patients eventually regained their oral continence and an acceptable cosmetic appearance. In conclusion, the fibula osteoseptocutaneous flap plus regional myocutaneous flap choice is a successful and technically less demanding alternative to the double free flap procedures in reconstruction of extensive lateral mandibular defects.

Microvascular vastus lateralis muscle flap for chronic empyema associated with a large cavity

Thoracic empyema can be disabling and may need microvascular free flaps in some intractable cases. After repeated failure of conventional thoracic surgical procedures, 2 patients with empyema were treated with microvascular free vastus lateralis muscle flaps for obliteration of the large empyema cavity. The reconstruction was successful in wound closure and eradication of infection. The donor site morbidity was minimal, and the patients resumed normal daily activities. Microvascular vastus lateralis muscle flap is the best option if free flaps are required for reconstruction of empyema.

Biphasic subcellular localization of the DAZL-related protein boule in Drosophila spermatogenesis

The Drosophila boule gene is expressed exclusively in the male germline and encodes an RNA binding protein closely related to the mammalian fertility factors encoded by the DAZ (Deleted in Azoospermia) and DAZL (DAZ-like) genes. Mutation of boule blocks both meiotic divisions. Differentiation nonetheless continues, resulting in tetraploid spermatids that fail to mature into sperm. We have found that Boule localizes premeiotically to a perinucleolar region and then translocates to the cytoplasm at the onset of meiosis. We show that deletion of the Y chromosome ks-1 fertility locus eliminates Boule nuclear localization, although it does not perturb entry into meiosis. Based on these observations we propose that Boule acts in the cytoplasm to regulate the stability or translation of messenger RNA encoding an essential meiotic factor.

Single versus double arterial anastomoses in combined second- and third-toe transplantation

Combined second and third toe transplantation is one good option for reconstruction of multiple digit amputation. However, the use of one or two arteries for pedicle anastomoses, which may influence the vascular complication and success rate, has never been addressed in the literature. This study includes a retrospective review of 57 combined second and third toe transplantation in 54 patients performed from February of 1983 through December of 1996. Group I, composed of 41 transplantations, underwent one arterial anastomosis, and group II, composed of 16 transplantations, underwent double arterial anastomoses during surgery if there were two recipient arteries available or whenever the second and third toes showed inadequate blood perfusion after one arterial anastomosis. In group I, 10 transplantations (24.4 percent) required re-exploration with a success rate of 92.7 percent (38 out of 41 transplantations). In group II, only one transplantation (6.2 percent) required re-exploration with successful flap salvage. The success rate was 100 percent for group II. Because the re-exploration and success rates between groups I and II were not statistically significant according to two-tailed Fisher's exact test, the combined second and third toe transplantation is a reliable procedure using either single or double arterial anastomoses.

Posterior interosseous flap and its variations for coverage of hand wounds

BACKGROUND

Conventional posterior interosseous flap has the disadvantage of partial or even complete necrosis of the flap when there is anatomical variation or contusion around its distal pedicle. To make it a more reliable flap, three types of auxiliary procedures were designed.

METHODS

(1) When there is congestion after inset of the distally based flap, an additional venous anastomosis was carried out. (2) When there is anatomical variation so that a distally based flap could not be raised without compromising the nerve branches, or when contusion was found around the distal pedicle, the flap was changed into a free flap. This design is also indicated for coverage of the distal fingers. (3) When the patient is elderly with possible peripheral arterial disease, the flap was raised with a wide base, incorporating the branches of both the anterior and posterior interosseous arteries. There were eight, 36, and five patients in each group, respectively.

RESULTS

There was only one failure in the free flap group. No partial necrosis of the flap was found. Other complications were analyzed.

CONCLUSION

With these backup procedures, the posterior interosseous flap can be more widely used with safety. By combining various reconstructive armaments, the result of a conventional procedure can be improved.

In vitro evaluation of the cytotoxicity and genotoxicity of root canal medicines on human pulp fibroblasts

An intracanal medicine is often required because microorganisms in the dentinal tubes may be difficult to eliminate completely by instrumentation. Phenolic compounds are widely used in dental treatment as sedatives for the dental pulp or as disinfectants for caries and the root canal. In this study, propidium iodide fluorescence and DNA precipitation assay were used to investigated the cytotoxic and genotoxic effects of camphorated phenol and camphorated parachlorophenol on cultured human pulp fibroblasts in vitro. Both medicines reduced the content of double-stranded polynucleic acid of fibroblasts over a 24-h culture period in a concentration-dependent manner. Camphorated parachlorophenol was more cytotoxic than camphorated phenol. But, both medicines did not cause genotoxicity on pulp cells. The advantage of these experimental methods are simplicity and rapidity. Furthermore, this experimental system may be useful for preliminary cytotoxicity and genotoxicity screening of various dental medicines in vitro.

Cytotoxic and non-genotoxic effects of arecoline on human buccal fibroblasts in vitro

Betel quid chewing has been linked to oral submucous fibrosis and oral cancer. Cytotoxicity and genotoxicity assays were used to investigate the pathobiological effects of arecoline on cultured human buccal fibroblasts. Arecoline increased double-stranded polynucleic acid at the concentration of 0.1 to 10 micrograms/ml in a concentration-dependent manner. At a concentration higher than 50 micrograms/ml, arecoline was cytotoxic to cultured fibroblasts and the cytotoxicity was dose-dependent. No genotoxicity for arecoline was found even at a concentration of 400 micrograms/ml. On the other hand, 600 micrograms/ml glutathione (GSH) and 200 micrograms/ml glycyrrhizin could prevent the arecoline-induced cytotoxicity. These results indicate that arecoline is a cytotoxic agent and no genotoxicity was found to human buccal fibroblasts. Furthermore, increasing consumption of GSH- and glycyrrhizin-rich foods may reduce the oral diseases associated with betel quid chewing.

Localization of protein kinase C alpha and zeta during the decidualization in pseudopregnant rats

Our previous data showed that at least five PKC isoforms (alpha, delta, zeta, lambda and tau) were present in the decidualization. In this study, we then localized the PKC alpha and zeta by immunohistochemistry in the decidualized uterine tissues. The decidualized uterine tissues were induced by trauma-stimulation and fixed in formalin. The immunofluorescence were photographed by confocal microscope. The data revealed that the fluorescence of PKC alpha was present in the deciduomata and myometrium. In the deciduomata, PKC alpha was mainly located in the surrounding nuclear. This phenomenon of localization was especially performed on day 2 and 3 of the decidualization, just on the time of higher frequence of cell mitosis. Since the myometrium with hypertrophy did not display the phenomenon of perinuclear localization, these suggested that the expression and localization of PKC alpha may be associated with the cell proliferation. On the other hand, the PKC zeta was also present and distributed broadly in the deciduomata and myometrium. This expression was increased and similar to the previous Western blot studies. Thus, the data confirmed that the various expression and localization of PKC isoforms may be correlated with the development of deciduomata.

Malignant fibrous histiocytoma degeneration in a patient with facial fibrous dysplasia

Seventy-two patients with craniofacial fibrous dysplasia were treated during a period of 18 years. Only 1 patient (1.4%) developed malignant degeneration into malignant fibrous histiocytoma. Total excision including the gross mass and adjacent facial bone was performed at that time, however the patient refused an orbital exenteration and postoperative adjuvant therapy. Tumor recurrence developed 2 years later and the patient died. To our knowledge this is the first report describing malignant fibrous histiocytoma degeneration from a fibrous dysplasia localized to the facial bones. Although complete curative treatment could not be undertaken in this case, some conclusions can be drawn regarding the clinical course of this uncommon entity.

Preoperative ultrasound Doppler study and clinical correlation of free posterior interosseous flap

BACKGROUND

Conventional pedicled posterior interosseous flap has a relatively high rate of partial flap loss which may result in ultimate failure to provide coverage of this important structure. The goal of this study was to delineate the posterior interosseous flap as a reliable free tissue transfer.

METHODS

From 1991 to 1995, 34 patients undergoing free posterior interosseous flap had preoperative Doppler mapping to determine the point of emergence of the skin perforators of the posterior interosseous artery. This finding was correlated intraoperatively with the number of perforators nourishing the posterior interosseous flap. The anatomic variations in the posterior interosseous artery were also identified.

RESULTS

These results showed (1) the main skin perforator was consistent and reliable in all of the posterior interosseous flaps both in the preoperative Doppler evaluation and intraoperative findings; (2) the main skin perforator arose from the posterior interosseous artery, the ascending interosseous recurrent artery or the common interosseous artery in 26 cases (76%), 6 cases (17.6%) or 2 cases (5.9%) respectively; (3) the success rate with the use of the free posterior interosseous flap was 97% without any partial flap loss.

CONCLUSION

It is concluded that the free posterior interosseous flap is a reliable flap with adequate arterial flow from constant main skin perforators and large antegrade venous drainage. A less reliable distally based pedicle flap can be changed into a reliable free flap, with the aid of preoperative non-invasive Doppler evaluation. This principle could be applied in the design of other "free skin perforator flaps".

Intracranial meningioma with intratumoral hemorrhage

Meningiomas associated with intracranial hemorrhage are rare. Clinical presentation is frequently sudden. We present two patients with intracranial meningioma and intratumoral hemorrhage. One patient suffered concomitant intracerebral hemorrhage, which resulted in a decreased level of consciousness and hemiparesis. There was no evidence of coagulopathy in either patient. The patients underwent surgery for evacuation of the hematoma and tumor excision resulting in good recovery of neurologic function. The pathology reports revealed meningiomas; one was a syncytial type and the other was angioblastic. We reviewed 22 cases of meningioma associated with intratumoral hemorrhage, including our own, and found that death occurred in 55% (12/22) of patients with hemorrhagic complications. In the computed tomography (CT) era, there were 13 patients; of these, seven (58%) had recovered, and five (38%) died. There were nine cases from the pre-CT era; of these, seven (78%) died, and none had a good recovery. Early diagnosis with definitive surgery can bring about a more favorable outcome.

Intraspinal extradural arachnoid cyst with spinal cord herniation

A 17-year-old male presented with thoracic myelopathy 12 months after a stab injury to the thoracic spine. The patient reported that symptoms and signs had gradually worsened in the 3 months prior to his examination. Magnetic resonance imaging depicted not only an extradural arachnoid cyst but severe spinal cord compression. The cerebrospinal fluid pressure and dynamics associated with herniation of the spinal cord resulted in the formation and enlargement of an extradural arachnoid cyst. The pressure effect of the cyst accounted for the thoracic myelopathy.

Ganglion cyst in the ligamentum flavum of the cervicothoracic junction

A case of thoracic myelopathy secondary to a ganglion cyst originating from the ligamentum flavum at the C7 T1 level is reported. Magnetic resonance imaging (MRI) demonstrated an extradural oval mass at the C7/T1 level with thecal sac and cord compression. Surgical decompression and excision of the ganglion cyst resulted in a good neurologic recovery. Intraspinal ganglion cysts are rare entities. We review the literature and discuss the pathologic findings, pathogenesis and radiologic presentation of ganglion cysts.

Transthoracic endoscopic sympathectomy for primary palmar hyperhidrosis in children

Primary palmar hyperhidrosis often starts in childhood. It usually causes academic and social disabling at the age children begin primary school. This study included 65 children (44 girls and 21 boys, mean age 13.5 years) who underwent one-stage bilateral transthoracic endoscopic sympathectomy. The proper sympathetic segment was visualized in almost all cases and electrocautery ablation was performed. The immediate postoperative course was uneventful in all cases and no major morbidity was encountered. Horner's syndrome did not occur in any case. All patients were discharged the day of surgery or after an overnight stay. The duration of follow-up was from 6 months to 3 years. Although compensatory sweating was found in 40% of the patients, long-term satisfaction was reported in 63 cases (96%). This procedure is effective, simple, and is recommended as the method of choice for surgical treatment of severe upper extremity hyperhidrosis in children.

Unstable fracture of thoracolumbar spine treated with pedicle screw plating. A report of 90 cases

Ninety cases of unstable fracture of thoracolumbar spine treated with a modified Roy-Camille type of pedicle screw plating are reported. They were followed up for an average of 2 years and 5 months. Comparing the pre- and postoperative X-ray films for the angles of kyphosis, degrees of compression of anterior vertebral height and degrees of displacement, the results were quite satisfactory. A complete reduction was obtained in 74% of the unstable fractures at the levels between the T11 and L3 vertebrae. This kind of internal fixation has been proved to be strong and safe allowing for early mobilization with few complications. The operative technique is described and the causes of complication are analyzed.

Synchronous neurite branchings in single goldfish retinal ganglion cells

We have examined the time course of branch formation in neurites of retinal ganglion cells isolated from adult goldfish (Carassius auratus). These neurites elongate at approximately 13 microns/h, and usually branch by bifurcation of growth cones at their tips. The times elapsed between branchings in different neurites of single cells can be described by a Poisson distribution with a mean interval of approximately 2 h. As predicted by this distribution, a relatively large number of branchings occur simultaneously in different neurites of individual cells. Simultaneous branchings of neurites elongating at a common rate generate branch points that lay equidistant from their soma. Since similar branching patterns can be seen in dendrites of retinal ganglion and amacrine cells in situ, these results are consistent with the possibility that dendrites of individual neurons branch synchronously and grow at common rates during development.

Cold inhibits neurite outgrowth from single retinal ganglion cells isolated from adult goldfish

We have studied the growth of neurites from single retinal ganglion cells isolated from adult goldfish and maintained under various primary cell culture conditions. In 10% Leibovitz's L-15 medium at 23 degrees C, these ganglion cells remained viable for up to 10 days and generated extensive fields of neurites. We found two patterns of neuritic fields. In one, a pair of neurites exited from opposite sides of the cell soma, forming a bipolar pattern. In the second pattern, three to five neurites exited from several points around the soma, forming a multipolar pattern. Characteristically, each neurite of this latter type tapered and branched two to seven times, whereas neurites forming bipolar patterns showed less branching and little or no taper. The fields subtended by the neurites in multipolar patterns ranged in size from 33,000 to 204,000 microns 2. Finally, although these neurites grew as fast as 35 microns hr-1 at 23 degrees C and individually reached lengths of up to 735 microns, they showed essentially no growth at 13 degrees C. Neurite outgrowth at 23 degrees C was vigorous even in cells whose growth had previously been suppressed for as long as 8 hr at 13 degrees C.

Capillary plasma ammonia concentration in neonates receiving total parenteral nutrition. Comparison with arterial and venous concentrations

Plasma ammonia concentration in neonates has routinely been determined using arterial or venous blood. Expected plasma ammonia values in capillary blood obtained by heelstick have not been determined. We compared ammonia levels in 20 sets of plasma from simultaneously drawn arterial, venous, and capillary blood in a group of neonates receiving total parenteral nutrition. Mean ammonia concentrations in venous (107 +/- 44) and capillary blood (112 +/- 33) were 45% and 51% higher, respectively, than corresponding arterial (74 +/- 22) values (P less than .001). Ammonia levels in blood obtained by venipuncture (Ven), however, did not correlate consistently with arterial (Art) values (r = .43; Art = 51 + 0.21 Ven; P greater than .05). In contrast, ammonia levels in capillary blood (Cap) correlated well with arterial values (r = .86; Art = 10.3 + 0.6Cap; P less than .001). Ammonia levels in neonates may be reliably interpreted using the latter regression equation when blood for analysis is obtained by a properly performed heelstick, allowing the preservation of arteries and veins, and sparing the infant from repetitive needle punctures. Ammonia levels in blood obtained by venipuncture do not adequately correlate with arterial values and therefore may be therapeutically misleading.

Simultaneous liquid-chromatographic determination of prednisone and prednisolone in plasma

This high-performance liquid-chromatographic (HPLC) method for simultaneous determination of prednisone and its metabolite, prednisolone, in plasma is a modification of the method of Frey et al. (Clin Chem 1979;25:1944-7). Heparinized plasma (1.0 mL) with 0.1 mL of internal standard solution (11-deoxy-17-hydroxycorticosterone, 2 mg/L) is extracted with 7.0 mL of dichloromethane, then washed sequentially with 0.1 mol/L HCl, 0.1 mol/L NaOH, and deionized water, 2.0 mL each. The extract is evaporated and the residue reconstituted with 75 microL of mobile phase, methanol/H2O (40/60 by vol). Thirty microliters of this is injected onto a reversed-phase C6 column, which is eluted at 1.4 mL/min. Analytical recoveries of prednisone and prednisolone were 94-98% and 102-106%, respectively. Day-to-day precision (CV) was 3.8% for prednisone, 6.1% for prednisolone. We encountered no interference from the 21 other steroids and 25 drugs tested. This method is simple, accurate, and precise.