RATIONALE/OBJECTIVE

Simulation-based training allows surgeons to practice technical skills in low-stakes environments. This study aimed to evaluate the appropriateness of a locally developed cephalous tissue analogue model for Z-plasty technique training, addressing the lack of standardized simulation training tools in the Philippines.

Fifteen board-certified plastic surgeons participated, performing the Z-plasty on the cephalous tissue analogue simulator, which was developed using a gelatin, sorbitol, and glycerin mixture reinforced by a mesh base. The participants watched a standardized Zplasty technique video and practiced on the simulator before providing feedback. Face validity was assessed through a Likert-scale questionnaire, with a passing score of 40/50.

Of the participants, 93.3% agreed that the model replicated the visual appearance and anatomical orientation necessary for Z-plasty, while 86.6% affirmed its utility in preprocedural planning. However, only 46.7% found the simulator's tissue elasticity adequate, and 20% agreed that it effectively mimicked the interaction between surgical instruments and tissue. The model was unable to consistently retain sutures, particularly for flap corners.

The cephalous tissue analogue model successfully simulated incision and visual orientation but requires refinements in tissue elasticity and suture retention to fully meet training needs for Z-plasty. Future efforts will focus on prototype improvements and content validation to better support simulation-based surgical training.

BACKGROUND: We investigated the effect of irrigation fluid on coagulation according to the hemodilution level using rotational thromboelastometry (ROTEM). METHODS: Venous blood was taken from 12 healthy volunteers and divided into four specimen tubes that were diluted to various levels (0%, 10%, 20%, and 40%) using an irrigation fluid composed of 2.7% sorbitol and 0.54% mannitol. RESULTS: Significant prolongation of clotting time was observed in the 40% diluted sample using both INTEM (P = 0.009) and EXTEM (P = 0.001) assays. However, the clot formation time was prolonged significantly in the 10%, 20%, and 40% diluted samples using both INTEM (P < 0.001) and EXTEM (P = 0.002, P < 0.001, and P < 0.001, respectively) assays. A significant decrease of α-angle of INTEM and EXTEM were observed in the 10% (P < 0.001), 20% (P < 0.001 and P = 0.001, respectively), and 40% (P < 0.001) groups compared with the 0% dilution group. The maximum clot firmness (MCF) of INTEM decreased significantly in the 20% (P < 0.001) and 40% (P < 0.001) diluted samples. In the MCF of EXTEM and FIBTEM assays, 10% (P = 0.009 and P = 0.015, respectively), 20% (P = 0.001), and 40% (P < 0.001) samples showed a significant decrease compared with the 0% sample. Nevertheless, most of the ROTEM values were within the reference range, except the 40% sample. CONCLUSIONS: Blood became hypocoagulable when it was diluted in vitro with a fluid composed of 2.7% sorbitol and 0.54% mannitol.
Blood Coagulation ; Healthy Volunteers ; Hemodilution ; In Vitro Techniques ; Mannitol ; Reference Values ; Sorbitol ; Thrombelastography

Healing process in scarring inevitably produces a considerable amount of non-organized dense collagen-rich matrix called scar thus impairing the native structure of skin. Connective tissue growth factor (CTGF) overexpression within healing tissues is known to play an imperative role in collagen production stimulated by transforming growth factor-beta in cutaneous wound healing. Undoubtedly, the knockdown of CTGF expression through siRNA-mediated gene silencing could simply impede the scarring process. However, the less stability and low transfection of siRNAs themselves urge a safe carrier to protect and transfect them into cells at a high rate avoiding toxicities. Here, we developed a degradable poly(sorbitol-co-PEI) (PSPEI), prepared by polymerization of sorbitol diacrylate with low molecular weight polyethylenimine, which has high transfection efficiency but low cytotoxicity, and utilized it in siCTGF delivery to silence the expression of CTGF in an animal model of cutaneous wound healing. Unlike contracted scar in normal healing, there was no or less contraction in the healed skin of mice treated with siCTGF using PSPEI. Histologically, the healed tissues also had distinct papillary structures and dense irregular connective tissues that were lacking in the control scar tissues. This study exemplifies a successful treatment of cutaneous wound healing using a polymer system coupled with RNA interference. Hence, the approach holds a great promise for developing new treatments with novel targets in regenerative medicines.
Animals ; Cicatrix* ; Collagen ; Connective Tissue ; Connective Tissue Growth Factor ; Gene Silencing ; Mice ; Models, Animal ; Molecular Weight ; Polyethyleneimine ; Polymerization ; Polymers ; Regenerative Medicine ; RNA Interference ; RNA, Small Interfering* ; Skin ; Sorbitol ; Transfection ; Wound Healing* ; Wounds and Injuries*

To enhance the production of glucose oxidase by recombinant Pichia pastoris, two strategies were developed, which were namely co-feeding of methanol and sorbitol and co-expressing of the protein disulfide isomerase (PDI) and Vitreoscialla hemoglobin (VHb). The volumetric activity reached 456 U/mL by using the strain X33/pPIC9k-GOD, in 5 liter fermentator, with the co-feeding of methanol and sorbitol, it was 0.2 fold higher than that only feeding by methanol. The improved strain was obtained by co-expressing PDI-VHb with GOD. While fermented in a 5 liter fermentator by feeding methanol and sorbitol, the activity of the improved strain reached 716 U/mL with a yield of 7 400 mg/L total soluble protein concentration. These results indicated that heterologous protein expression level can be enhanced by optimizing fermentation condition and co-expression molecular chaperon in Pichia pastoris.
Bioreactors ; Fermentation ; Glucose Oxidase ; biosynthesis ; Methanol ; Pichia ; metabolism ; Recombinant Proteins ; biosynthesis ; Sorbitol

PURPOSE: Telemedical maritime assistance service (TMAS) is performed in several ways when a seafarer falls sick under circumstances where the ship is far away from shore without possibility of medevac. The current methods operating in Korea are described and compared in order to grasp the actual circumstances in terms of importance. METHODS: From June 2012 to July 2013, a total of 523 cases were consulted roughly by means of satellite-phone, e-mail, and website homepage at TMAS center of Busan metropolitan city fire safety headquarters and the final clinical outcomes of these registered cases according to illness or injury after a certain period of time was studied retrospectively. RESULTS: Statistically significant differences in classification of ship company, headquarters of ship company informed, added photos, added drug-list, and final clinical outcome (p<0.001, p<0.001, p<0.001, p<0.001, p=0.027, respectively) according to whether or not homepage-consultation were observed between crossed-analyzed groups; and significant differences in age-group, consult through satellite-phone, added photos, and final clinical outcome according to illness or injury were observed between crossed-analyzed groups (p<0.001, p=0.046, p=0.017, p<0.001, respectively). CONCLUSION: The website designated for TMAS is expected to play a positive role. In addition, education of seafarers should also be implemented at the same time because the off-shore circumstances are quite different from those of onshore.
Busan ; Classification ; Education ; Electronic Mail ; Fires* ; Hand Strength ; Korea ; Retrospective Studies ; Ships ; Sorbitol ; Telemedicine

The aim of the current study was to analyze the active ingredients and to screen the pharmacological properties of freshwater laver, Prasiola japonica, the only species grown in Korea. According to results of gas chromatography-mass spectrometry assay, components from P. japonica were more diverse than those from sea laver. Of particular interest, our results indicated that ethanol extract of P. japonica (PJE) contained loliolide, sorbitol, mannitol, and alverine, which were known to have an anti-oxidant, anti-oral microbial, osmotic diuresis, and smooth muscle relaxant, respectively. In addition, five solvent fractions of PJE (water, butanol, chloroform, ethyl acetate, and hexane) significantly inhibited the production of lipopolysaccharide-induced nitric oxide and a higher amount (>100 microg/mL) of chloroform, ethyl acetate, and hexane fraction were considered to play a specific role in cancer cell death. PJE and its solvent fractions found to be effective scavengers of free radicals, particularly, hydroxyl radicals. Glucose uptake in L6 myoblast cell line that stably expresses the glucose transporter type 4 (GLUT4) proteins was also remarkably enhanced upon treatment with solvent fractions, remarkably chloroform fraction. Taken together, we concluded that P. japonica may have potent pharmacological properties and thus contribute to development of novel natural candidates for various disease targets.
Acetates ; Benzofurans ; Cell Death ; Cell Line ; Chloroform ; Diuresis ; Ethanol ; Free Radicals ; Fresh Water* ; Gas Chromatography-Mass Spectrometry ; Glucose ; Glucose Transporter Type 4 ; Korea ; Mannitol ; Mass Screening* ; Muscle, Smooth ; Myoblasts ; Nitric Oxide ; Porphyra ; Propylamines ; Proteins ; Sorbitol

Glucose oxidase (GOD) is an important industrial enzyme with many potential applications. In order to increase the production and productivity of GOD by recombinant Pichia pastoris GS115, we investigated the feeding strategies of mixed carbon sources during induction phase, based on results of the optimization of initial cell and methanol concentration on GOD production. The optimal initial cell and methanol concentration were 100 g/L and 18 g/L. During induction phase, the mixed-carbon-sources strategies showed that glycerol, sorbitol or mannitol co-feeding with methanol could enhance GOD production. With mannitol co-feeding (20:1(W/W)), the maximum GOD production and maximum GOD productivity reached 711.3 U/mL and 4.60 U/(mL x h) after an induction period of 156 h. Compared to the control, the enhancements of GOD production and productivity were 66.3% and 67.9%, respectively. Meanwhile, we found an appropriate mannitol co-feeding strategy that would not inhibit the expression of promote. The activity of alcohol oxidase was 8.8 U/g, which was enhanced by 69.2% compared to the control (5.2 U/g). We can use the same optimization process to improve the production of other proteins from recombinant Pichia pastoris by changing the fermentation parameters.
Carbon ; metabolism ; Fermentation ; Glucose Oxidase ; biosynthesis ; Glycerol ; metabolism ; Industrial Microbiology ; Mannitol ; metabolism ; Methanol ; metabolism ; Pichia ; metabolism ; Sorbitol ; metabolism

Chronic nonspecific diarrhea (CNSD) or toddler's diarrhea is the most frequent cause of chronic diarrhea in young children of developed countries. The pathogenesis of CNSD remains unclear. It has been associated with drinking large amounts of fluids and fruit juices that contain large amounts of fructose and sorbitol. Reduction in the intake of fat and fiber can also be the cause of CNSD. Children with CNSD do not show signs of malnutrition or growth retardation. They experience watery stools four to more than ten times daily. Stools are foul smelling, occasionally with undigested food remnants because of the short transit time. The patients do not normally suffer from their ailment; however, diarrhea may cause parents to be extremely worried. Pediatricians and primary physicians have to diagnose CNSD with clinical symptoms and exclusion of specific illness. Proper dietary manipulation improves the condition of most patients.
Child ; Developed Countries ; Diarrhea ; Drinking ; Fructose ; Fruit ; Humans ; Malnutrition ; Parents ; Smell ; Sorbitol

Porcine interferon-alpha (pIFN-alpha) fermentative production by recombinant Pichia pastoris was carried out in a 10-L bioreactor to study its metabolism changes and effects on fermentation under different inducing strategies, by analyzing the change patterns of the corresponding metabolism and energy regeneration. The results show that the specific activities of alcohol oxidase (AOX), formaldehyde dehydrogenase (FLD) and formate dehydrogenase (FDH) largely increased when reducing temperature from 30 degrees C to 20 degrees C under pure methanol induction, leading significant enhancements in methanol metabolism, formaldehyde dissimilatory energy metabolism and pIFN-alpha antiviral activity. The highest pIFN-alpha antiviral activity reached 1.4 x 10(6) IU/mL, which was about 10-folds of that obtained under 30 degrees C induction. Using methanol/sorbitol co-feeding strategy at 30 degrees C, the major energy metabolism energizing pIFN-alpha synthesis shifted from formaldehyde dissimilatory energy metabolism pathway to TCA cycle, formaldehyde dissimilatory pathway was weakened and accumulation of toxic intermediate metabolite-formaldehyde was relieved, and methanol flux distribution towards to pIFN-alpha synthesis was enhanced. Under this condition, the highest pIFN-alpha antiviral activity reached 1.8 x 10(7) IU/mL which was about 100-folds of that obtained under pure methanol induction at 30 degrees C. More important, enhanced pIFN-alpha production with methanol/sorbitol co-feeding strategy could be implemented under mild conditions, which greatly reduced the fermentation costs and improved the entire fermentation performance.
Animals ; Energy Metabolism ; Fermentation ; Interferon-alpha ; biosynthesis ; genetics ; Methanol ; pharmacology ; Pichia ; genetics ; metabolism ; Recombinant Proteins ; biosynthesis ; genetics ; Sorbitol ; pharmacology ; Swine

OBJECTIVE: To determine the 9 month period effect of botulinum toxin A (BoNT-A) injection into the salivary gland in children with neurologic disorders and sialorrhea by qualified parent/caregiver-administered questionnaires. METHOD: A total of 17 patients (age 7.6+/-4.24 years) were enrolled in this study. The degree of sialorrhea was assessed at the baseline, 2 weeks, 1, 2, 4, 6 and 9 months after injection. The Drooling Count (DC) was assessed as an objective measurement. The Drooling Frequency and Severity Scale (DFS) and the Teacher Drooling Scale (TDS) were evaluated as a subjective measurement. BoNT-A (0.5 unit/kg) was injected into each submandibular and parotid gland under ultrasonography-guidance. RESULTS: DC, DFS and TDS showed significant improvement at 2 weeks, 1, 2, 4, 6, and 9 months follow-up (p<0.05). Twelve of 17 cases (70.5%) showed more than 50% reduction in DC from the baseline value. CONCLUSION: Ultrasonography-guided BoNT-A injection into the submandibular and parotid gland was a safe and effective method to treat sialorrhea in children with neurologic disorders.
Botulinum Toxins ; Botulinum Toxins, Type A ; Child ; Follow-Up Studies ; Humans ; Nervous System Diseases ; Parotid Gland ; Salivary Glands ; Sialorrhea ; Sorbitol ; Tyramine