Background: The use of acellular dermal matrix (ADM) in breast reconstruction can inhibit capsular contracture, increasing the success rate of surgery. Adipose-derived stem cells (ADSCs) can effectively suppress foreign body reaction, which is a major cause of capsular contracture. This study aimed to elucidate the synergistic effects of combining ADSCs with ADM on capsule formation, utilizing a rat model. Methods: The study utilized 12 rats, equally divided into two experimental groups. Group A received silicone implants covered with ADM, while Group B was implanted with silicone prostheses wrapped in ADM, pre-seeded with ADSCs. Capsule formation was assessed through visual examination, histological analysis, and reverse transcription-polymerase chain reaction (RT-PCR) at 4 and 8 weeks post-implantation. Results: At 4 weeks, the mean capsular thickness was 177.16 μm in Group A and 170.76 μm in Group B; at 8 weeks, it was 196.69 μm in Group A and 176.10 μm in Group B. Statistical analysis showed no significant difference in capsule thickness between the groups (P>0.05). Histological findings indicated that Group A had more inflammatory cells and collagen fibers and reduced angiogenesis. RT-PCR showed that angiogenesis-promoting gene expression in Group B was 14% higher at 4 weeks and 156% higher at 8 weeks compared to Group A. Conclusion Although no statistically significant reduction in capsule thickness was observed, ADSC-seeded implants showed histological features associated with reduced inflammation and enhanced angiogenesis, suggesting potential benefits in capsule formation management.

Perforation of the pharynx due to external blunt trauma is an uncommon type of pharyngeal injury. It can lead to serious complications such as deep neck infection, sepsis, mediastinitis, and even mortality if not promptly recognized and treated. Therefore, early diagnosis and treatment are crucial to prevent severe consequences and long-term complications. If the size of the injury is less than 2 cm and there is no invasion of the esophagus or mediastinum, conservative, nonsurgical treatment may be appropriate. In this case report, we present a case of retropharyngeal wall perforation following external blunt neck trauma with literature review.

Objective: To evaluate the diagnostic performance of susceptibility map-weighted imaging (SMwI) taken in different acquisition planes for discriminating patients with neurodegenerative parkinsonism from those without. Materials and Methods: This retrospective, observational, single-institution study enrolled consecutive patients who visited movement disorder clinics and underwent brain MRI and 18F-FP-CIT PET between September 2021 and December 2021. SMwI images were acquired in both the oblique (perpendicular to the midbrain) and the anterior commissure-posterior commissure (AC-PC) planes. Hyperintensity in the substantia nigra was determined by two neuroradiologists. 18F-FP-CIT PET was used as the reference standard. Inter-rater agreement was assessed using Cohen’s kappa coefficient. The diagnostic performance of SMwI in the two planes was analyzed separately for the right and left substantia nigra. Multivariable logistic regression analysis with generalized estimating equations was applied to compare the diagnostic performance of the two planes. Results: In total, 194 patients were included, of whom 105 and 103 had positive results on 18F-FP-CIT PET in the left and right substantia nigra, respectively. Good inter-rater agreement in the oblique (κ = 0.772/0.658 for left/right) and AC-PC planes (0.730/0.741 for left/right) was confirmed. The pooled sensitivities for two readers were 86.4% (178/206, left) and 83.3% (175/210, right) in the oblique plane and 87.4% (180/206, left) and 87.6% (184/210, right) in the AC-PC plane. The pooled specificities for two readers were 83.5% (152/182, left) and 82.0% (146/178, right) in the oblique plane, and 83.5% (152/182, left) and 86.0% (153/178, right) in the AC-PC plane. There were no significant differences in the diagnostic performance between the two planes (P > 0.05). Conclusion There are no significant difference in the diagnostic performance of SMwI performed in the oblique and AC-PC plane in discriminating patients with parkinsonism from those without. This finding affirms that each institution may choose the imaging plane for SMwI according to their clinical settings.

Background: Immediate breast reconstruction after mastectomy can be challenging in some patients for medical or oncological reasons. Delayed two-stage tissue expander/implant breast reconstruction is a reliable option for these patients. However, data regarding surgical techniques, outcomes, and complication rates are limited. This study reports our experience using the two-stage tissue expander/implant procedure for delayed breast reconstruction. Methods: This retrospective study included 32 patients (34 breasts) who underwent delayed two-stage tissue expander/implant breast reconstruction at our institution from January 2018 to July 2022. We summarized the techniques used in the procedure and evaluated the 1-year postoperative outcomes and complication rates. Results: The mean time from mastectomy to expander insertion was 210±25 days, and 8.2±2.3 additional expansions were required prior to the implant insertion. The mean time of tissue expansion was 187±15 days, and the mean volume of expansion was 495±31 mL. No major complications occurred that required reoperation, and the patients were highly satisfied with the surgical results. Conclusions Although delayed two-stage tissue expander/implant breast reconstruction resulted in satisfactory outcomes, consensus regarding the operative technique is still needed. Two-stage tissue expander/implant breast reconstruction is a safe and effective option for delayed breast reconstruction.

Purpose: This study investigated the immediate biomechanical effects of unilateral mastication for 10 minutes on the temporomandibular joint (TMJ) with 21 healthy adult participants. Methods: The gum group chewed gum on the right side for 10 minutes, and the control group rested for 10 minutes. Biomechanical data were obtained using a three-dimensional infrared camera before and after intervention. An independent t-test assessed the variation of kinematic data to identify differences between before and after intervention. Results: Among biomechanical variables, the gum group’s length of the left forehead middle region and the temporomandibular joint angle decreased compared to the control group (p<0.05). Conclusion Caution with unilateral masticatory activity is recommended, as unilateral mastication causes biomechanical changes due to excessive load on the soft tissues of the contralateral TMJ.

Background: In addition to vascular endothelial cells, vascular smooth muscle cells (VSMCs) are subject to continuous shear stress because of blood circulation. The angiogenic properties of VSMCs in extracranial arteriovenous malformations (AVMs) may exceed those of normal blood vessels if the body responds more sensitively to mechanical stimuli. This study was performed to investigate the hypothesis that rapid angiogenesis may be achieved by mechanical shear stress. Methods: VSMCs were obtained from six patients who had AVMs and six normal controls. The target genes were set to angiopoietin-2 (AGP2), aquaporin-1 (AQP1), and transforming growth factor-beta receptor 1 (TGFBR1). Reverse-transcriptase polymerase chain reaction (RT-PCR) and real-time PCR were implemented to identify the expression levels for target genes. Immunofluorescence was also conducted. Results: Under the shear stress condition, mean relative quantity values of AGP2, AQP1, and TGFBR1 in AVM tissues were 1.927±0.528, 1.291±0.031, and 2.284±1.461 when compared with neutral conditions. The expression levels of all three genes in AVMs were higher than those in normal tissue except for AQP1 under shear stress conditions. Immunofluorescence also revealed increased staining of shear stress-induced genes in the normal tissue and in AVM tissue. Conclusions Shear stress made the VSMCs of AVMs more sensitive. Although the pathogenesis of AVMs remains unclear, our study showed that biomechanical stimulation imposed by shear stress may aggravate angiogenesis in AVMs.

Background and Objectives: A large-scale community-based study of the general population has not been conducted. There have been no studies on the relationship between decreased renal function and the degree of hearing loss. Thus, the purpose was to evaluate the relationship between hearing loss and impaired renal function with a large number of populations.Subjects and Method We performed a cross-sectional population-based cohort study by enrolling 470718 adults, 18 to 80 years old with pure tone audiometry tests who had regular health screening between 2013 and 2018. Hearing loss was defined as a pure-tone average of thresholds at 500, 1000, and 2000 Hz in both right and left ears. Kidney function was evaluated based on eGFR. Chronic kidney disease (CKD) was diagnosed as an eGFR<60 mL/ min/1.73 m². Other predictor variables including noise and age that can affect hearing were also used to evaluate correlation factors. Results: Of Participants with CKD, 14.2% had any hearing loss (>25 dB) and 5.0% had above moderate hearing loss (>40 dB). But those with normal kidney function, 2.0% either had any hearing loss and 0.4% had above moderate hearing loss. The odds ratio (OR) of above moderate hearing loss for participants with CKD was 1.51 (95% confidence interval [CI]: 1.15-2.00, p=0.003) but the OR of mild hearing loss for participants with CKD was 0.82 (95% CI: 0.67- 1.02, p=0.073). The result suggested that CKD and above moderate hearing loss were related even after correcting for potential confounders, but had no statistical significance with mild hearing loss. Conclusion Decreased kidney function is associated with above moderate hearing loss.

Background: Reversal of neuromuscular blockade (NMB) at the end of surgery is important for reducing postoperative residual NMB; this is associated with an increased risk of postoperative pulmonary complications (PPCs). Moreover, PPCs are associated with poor prognosis after video-assisted thoracoscopic surgery (VATS) for lobectomy. We compared the effects of two reversal agents, sugammadex and neostigmine, on the incidence of PPCs and duration of hospital stay in patients undergoing VATS lobectomy. Methods: After VATS lobectomy was completed under neuromuscular monitoring, the sugammadex group (n = 46) received sugammadex 2 mg/kg, while the neostigmine group (n = 47) received neostigmine 0.05 mg/kg with atropine 0.02 mg/kg after at least the third twitch in response to the train of four stimulation. The primary outcome was incidence of PPCs. The secondary outcomes were duration of hospital stay and intensive care unit (ICU) admission. Results: There was no significant difference in the incidence of PPCs for both the sugammadex and neostigmine groups (32.6% and 40.4%, respectively; risk difference = 0.08; 95% confidence interval = [−0.12, 0.27]; P = 0.434). The lengths of hospital (P = 0.431) and ICU (P = 0.964) stays were not significantly different between the two groups. Conclusions The clinical use of sugammadex and neostigmine in NMB reversal for patients undergoing VATS lobectomy was not significantly different in the incidence of PPCs and duration of hospital and ICU stay.

Background: Only a few studies have evaluated the differences between varying concentrations of a fixed dose of local anesthetics. This study was conducted to compare the effects of two different concentrations of a fixed dose of ropivacaine used in ultrasound-guided interscalene brachial plexus block. Methods: This prospective, randomized, double-blind study included 62 patients who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned to receive ultrasound-guided interscalene block with 75 mg of ropivacaine at one of two concentrations: 0.75% (10 ml; group C) or 0.375% (20 ml; group V). Time to onset of sensory blockade, degree of blockade, pulmonary function changes, analgesic duration of the interscalene block, postoperative opioid requirement within 24 h, postoperative pain scores, satisfaction, and incidence of complications were recorded. Results: Although the time to onset of sensory blockade was shorter for group C (P = 0.015), successful blockade was achieved at 30 min after the interscalene block in both groups. The analgesic duration of the interscalene block was not significantly different between the groups. The amount of opioid used within 24 h after surgery was significantly reduced for group V compared with group C (P = 0.016). The rest of the parameters did not show any significant differences between the two groups. Conclusion Compared with 10 ml of 0.75% ropivacaine, interscalene block with 20 ml of 0.375% ropivacaine could be effective for the reduction of postoperative opioid requirement within 24 h after surgery despite it might not prolong the analgesic duration.

Objectives: Body protective compound-157 (BPC-157) is a stable gastric pentadecapeptide that has been effective in trials aiming to increase wound healing capabilities and decrease inflammatory cell influx, including studies on the healing of muscles and tendons. There are no studies about the effect of BPC-157 on pain transmission via nociception. This study examined the antinociceptive effects of BPC-157 using formalin tests and immunohistochemistry. Methods: Rats were randomly divided into the control, morphine and BPC-157 groups. Pain behavior was quantified periodically at 5- and 35- min intervals (representative values of phases 1 and 2) by counting the number of flinches exhibited by the injected paw after injection. The dorsal root ganglia (DRG) and spinal cords (SC) were collected, and then, the number of cytokine-positive cells was determined via immunostaining. Results: BPC-157 dose-dependently decreased the number of flinches during phase 1 but did not decrease the number of flinches during phase 2. During phase 1, interleukin-1β (IL-1β) in the DRG tissue was significantly different in the morphine, 10 μg/kg BPC-157, and 20 μg/kg BPC-157 groups. During phase 2, statistical significance was achieved in the DRG tissue in the morphine, 20 μg/kg BPC-157, and 40 μg/kg BPC-157 groups. During phase 1, interleukin-6 was significantly different in the DRG tissue in the morphine group and the SC tissue in the 10 μg/kg BPC-157 group. During phase 2, statistical significance was achieved in the morphine group and the BPC-157 20 μg/kg group in both the DRG and SC tissues. There were no significant differences in tumor necrosis factor-α between the DRG and SC tissues. Conclusions BPC-157 was effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 decreased the expression of IL-1β in the DRG tissue in phases 1 and 2.