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Mioton, Lauren M.,Jordan, Sumanas W.,Hanwright, Philip J.,Bilimoria, Karl Y.,Kim, John Y.S. Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.5
Background Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery. Methods We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. Results A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. Conclusions Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.
Saranya Ganapathy,Megha N. Parajulee,Michael San Francisco,Hong Zhang,Shan L. Bilimoria 한국식물생명공학회 2021 Plant biotechnology reports Vol.15 No.1
Insect pests are a serious threat to agricultural productivity. Genetically-modifed crops ofer a promising alternative, and Bacillus thuringiensis endotoxin genes have played a major role in this respect. However, to overcome insect tolerance issues and to broaden the target range, it is critical to identify alternative insecticidal toxins working through novel mechanisms. In our previous study, a kinase from Chilo iridescent virus (CIV) that has insecticidal activity was identifed and designated as Iridovirus Serine/Threonine Kinase (ISTK). A 35 kDa truncated form of ISTK, designated iridoptin, was obtained during expression and purifcation of ISTK in the yeast system. This yeast-expressed CIV toxin induced 50% mortality in cotton aphids and 100% mortality in green peach aphids (GPA). In this study, codon optimized ISTK gene and iridoptin fragment (designated oISTK and oIRI, respectively) were designed by altering the codon usage features that are seldom present in plant exons. Codon-optimized gene(s) cloned into plant expression vectors were used to stably transform Arabidopsis plants. PCR analysis of genomic DNA of transformed plants confrmed the presence of the DNA insert (oISTK/oIRI) in selected transgenic lines. Further screening was performed by selecting the PCR positive lines, which showed expression of respective toxins at the polypeptide level, using Western blot analyses. Codon-optimized gene constructs resulted in signifcant improvement in levels of expression of ISTK and iridoptin polypeptide and confrmed its stability in planta. The stable lines expressing either of the two toxin forms induced moderate to very high mortality in GPAs and signifcantly afected GPA development and fecundity.
Davila, Armando A.,Seth, Akhil K.,Wang, Edward,Hanwright, Philip,Bilimoria, Karl,Fine, Neil,Kim, John Y.S. Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.1
Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). Conclusions The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.
Armando A. Davila,Akhil K. Seth,Edward Wang,Philip Hanwright,Karl Bilimoria,Neil Fine,John YS Kim 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.1
Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermisassisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). Conclusions The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.
Lauren M Mioton,Sumanas W Jordan,Philip J Hanwright,Karl Y Bilimoria,John YS Kim 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.5
Background Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated,dirty) and SSI rates in plastic surgery. Methods We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression. Results A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%,with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated,and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality. Conclusions Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification,plastic surgery had lower overall rates than the surgical population at large.