An algorithm for labia minora reduction based on a review of anatomical, configurational, and individual considerations

Lange Maurits DJ,Hage J. Joris,Karim Refaat B,Amant Frederic 대한성형외과학회 2023 Archives of Plastic Surgery Vol.50 No.1

A variety of labiaplasty techniques have been introduced to date, but no single technique will offer the optimal solution for every patient. Rather, the technique should be chosen based on anatomical, configurational, and technical considerations, as well as on patients’ personal preferences regarded maintenance of the labial rim, maintenance of labial sensitivity, and prevention of iatrogenic thickening of the labium. We reviewed, defined, and assessed labial configurational variety, neurovascular supply, reduction techniques, and patient’s preferences as the considerations relevant to the choice of labiaplasty technique. Based on this review, an algorithm was constructed that leads to a choice of reduction technique through five decisions to be made regarding (1) resection or (partial) retention of the labial free rim, (2) the measure of required labial width reduction, (3) labial vascular status, (4) prevention of iatrogenic labial thickening, and (5) preservation of labial sensibility. The choice of techniques includes edge trimming, central spindle form de-epithelialization or full thickness resection, and three modifications of the wedge resection or de-epithelialization technique. These three modifications comprised a modified anterior resection or de-epithelialization combined with posterior flap transposition, a custom flask resection or de-epithelialization, and a modified posterior wedge resection or de-epithelialization combined with anterior flap transposition. Use of the five decisional steps and the inclusion of modifications of all three conventional reduction techniques offer an improved algorithm for the choice of labioplasty technique.

Recognizing the risks of brain stimulation

Noort, Maurits van den,Lim, Sabina,Bosch, Peggy American Association for the Advancement of Scienc 2014 Science Vol.346 No.6215

Monitoring of Optimal Cerebral Perfusion Pressure in Traumatic Brain Injured Patients Using a Multi-Window Weighting Algorithm

Liu, Xiuyun,Maurits, Natasha M.,Aries, Marcel J.H.,Czosnyka, Marek,Ercole, Ari,Donnelly, Joseph,Cardim, Danilo,Kim, Dong-Joo,Dias, Celeste,Cabeleira, Manuel,Smielewski, Peter Mary Ann Liebert, Inc. Publishers 2017 Journal of Neurotrauma Vol. No.

Ipsilateral Putamen and Insula Activation by Both Left and Right GB34 Acupuncture Stimulation: An fMRI Study on Healthy Participants

Yeo, Sujung,van den Noort, Maurits,Bosch, Peggy,Lim, Sabina Hindawi Publishing Corporation 2016 Evidence-based Complementary and Alternative Medic Vol.2016 No.-

<P>The modulatory effects on the brain during right versus left side acupuncture stimulation of the same acupuncture point have been a subject of controversy. For clarification of this important methodological issue, the present study was designed to compare the blood oxygen level-dependent responses of acupuncture stimulation on the right versus left<I> Yanglingquan</I> (GB34). Twenty-two healthy subjects received right or left GB34 acupuncture. Our results show that acupuncture on the left GB34 induced neural responses in the left putamen, caudate body, insula, postcentral gyrus, claustrum, right and left thalamus, right middle frontal gyrus, hypothalamus, and subthalamic nucleus. Acupuncture on the right GB34 induced neural responses in the right middle frontal gyrus, inferior parietal lobule, thalamus, putamen, lateral globus pallidus, medial globus pallidus, and insula. Interestingly, the putamen and insula were ipsilaterally activated by acupuncture on either the left or right GB34; therefore, they seem to be the main target areas affected by GB34 acupuncture. This is the first reported functional magnetic resonance imaging study directly comparing needling on the right and left GB34. Although more replication studies are needed, our preliminary results prove that acupuncture has different modulatory effects on the brain when performed on the right versus left side.</P>

A study of the effects of 8-week acupuncture treatment on patients with Parkinson's disease

Yeo, Sujung,van den Noort, Maurits,Bosch, Peggy,Lim, Sabina Williams & Wilkins Co 2018 Medicine Vol.97 No.50

<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P><B>Background:</B></P><P>Parkinson's disease (PD) is a degenerative brain disorder, resulting in decreased neural responses in the supplementary motor area, putamen, and thalamus. Previous research showed that acupuncture was able to improve the motor dysfunction. The primary aim of this study is to assess the efficacy of longer acupuncture treatment for preventing brain degeneration in patients with PD.</P><P><B>Methods:</B></P><P>Ten outpatients with PD were recruited from Kyung Hee Medical Hospital. Behavioral and neural responses were examined before and after 8 weeks of acupuncture treatment. A semi-individualized treatment approach was used; patients were treated for 15 minutes with 120-Hz electro-acupuncture at the right GB34 and Taechung (LR3), followed by manual acupuncture based on the individual symptoms of the patient.</P><P><B>Results:</B></P><P>Immediately after 8 weeks of acupuncture treatment, the Unified Parkinson's Disease Rating Scale (UPDRS) sub-scores and the depression scores for the patients had statistically decreased compared to the scores before acupuncture treatment; moreover, 8 weeks later, these scores remained stable. Compared to the neural responses before the acupuncture stimulation, those after the acupuncture treatment were significantly higher in the thalamus, cingulate gyrus, anterior cingulate, lingual gyrus, parahippocampal gyrus, lateral globus pallidus, mammillary body, middle temporal gyrus, cuneus, and fusiform gyrus. Finally, a positive correlation was found between the UPDRS and the mean magnetic resonance signal change for the thalamus.</P><P><B>Conclusion:</B></P><P>This study found beneficial clinical effects of 8-week acupuncture treatment in the brains of patients with PD.</P></▼2>

Consecutive Acupuncture Stimulations Lead to Significantly Decreased Neural Responses

Yeo, Sujung,Choe, Il-Hwan,van den Noort, Maurits,Bosch, Peggy,Lim, Sabina Mary Ann Liebert 2010 Journal of Alternative & Complementary Medicine Vol.16 No.4

<P>OBJECTIVE: Functional magnetic resonance imaging (fMRI), in combination with block design paradigms with consecutive acupuncture stimulations, has often been used to investigate the neural responses to acupuncture. In this study, we investigated whether previous acupuncture stimulations can affect brain activations of later acupuncture stimulations. DESIGN: All subjects were measured twice in the same scanning session and a block design was used. SETTING: The study was conducted at Kyung Hee University, Seoul, Republic of Korea. SUBJECTS: Fifteen (15) healthy right-handed male volunteers participated in the study. INTERVENTION: The subjects received two acupuncture stimulations on BL62 (Shenmai) on the right foot with a time interval of 5 minutes. In addition, sham stimulations were tested with the same paradigm. OUTCOME MEASURES: One-sample t tests were conducted in order to map the brain activations induced by the acupuncture and sham stimulations. Moreover, paired-sample t tests were conducted to investigate the signal changes between the first and second acupuncture stimulation. RESULTS: During the first acupuncture stimulation, in the left hemisphere, significant foci of activation were found in the hypothalamus, thalamus, claustrum, cerebellum, inferior frontal gyrus, and the superior temporal gyrus. In the right hemisphere, a significant focus of activation was found in the middle frontal gyrus. In addition, in both hemispheres, a significant focus of activation was found in the inferior parietal lobule. Interestingly, however, during the second acupuncture stimulation, the only areas that were also significantly activated were the cerebellum in the left hemisphere and the inferior parietal lobule in the right hemisphere. CONCLUSIONS: We found that consecutive acupuncture stimulations on BL62 affected the neural responses in a significant way, resulting in decreased activations during the second acupuncture stimulation. This is an important finding, suggesting that in future fMRI studies on acupuncture, researchers should take this methodological issue more seriously.</P>

Cross-Cultural Adaptation and Psychometric Validation of the Dutch Version of the Core Outcome Measures Index for the Neck in Patients Undergoing Surgery for Degenerative Disease of the Cervical Spine

Pravesh S. Gadjradj,Timothy C. Chin-See-Chong,Daphne Donk,Paul Depauw,Maurits W. van Tulder,Biswadjiet S. Harhangi 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

Objective: To perform the psychometric validation of the Dutch version of the Core Outcome Measures Index (COMI) for the neck. Methods: A total of 178 patients, who had an indication for surgery due to degenerative cervical spinal disease, were enrolled in the study. They filled in a baseline booklet containing the Dutch version of the COMI-neck, Likert-scales for neck and arm/shoulder pain, the Neck Disability Index (NDI), the EuroQol-5 dimensions (EQ-5D) and the 12-item Short Form health survey (SF-12). Aside from analyzing construct validity using the Spearman correlation test, test-retest reliability, and responsiveness at 3 months were assessed using the intraclass correlation coefficient (ICC) and the receiver-operating characteristic (ROC) curve, respectively. Results: The COMI-neck showed good acceptability with missing data ranging from 0% to 4.5% and some floor/ceiling effects for 3 of the domains at baseline. The COMI-summary score showed good to very good correlation with the EQ5D (ρ=-0.43), the physical component summary of the SF-12 (ρ=-0.47) and the NDI (ρ=0.73). Individual domains showed correlations of -0.28 to 0.85 with the reference questionnaires. Test-retest reliability analysis showed an ICC of 0.91 with a minimal detectable change of 1.7. Responsiveness analysis of the COMI-neck showed an area under 0.79 under the ROC-curve. The standardized response mean for a good outcome was 1.24 and for a poor outcome 0.37. Conclusion: The current study shows that the Dutch version of the COMI-neck is a valid, reliable and responsive Patient-Reported Outcome Measure, among patients undergoing surgery for degenerative cervical spinal disorders.

Gender Differences in the Neural Response to Acupuncture: Clinical Implications

Yeo, Sujung,Rosen, Bruce,Bosch, Peggy,van den Noort, Maurits,Lim, Sabina SAGE Publications 2016 Acupuncture in medicine Vol.34 No.5

Decreased expression of serum- and glucocorticoid-inducible kinase 1 (SGK1) promotes alpha-synuclein increase related with down-regulation of dopaminergic cell in the Substantia Nigra of chronic MPTP-induced Parkinsonism mice and in SH-SY5Y cells

Yeo, Sujung,Sung, Backil,Hong, Yeon-Mi,van den Noort, Maurits,Bosch, Peggy,Lee, Sook-Hyun,Song, Jongbeom,Park, Sang-Kyun,Lim, Sabina Elsevier 2018 Gene Vol.661 No.-

<P><B>Abstract</B></P> <P>Parkinson's disease (PD) is a chronically progressive neurodegenerative disease, with its main pathological hallmarks being a dramatic loss of dopaminergic neurons predominantly in the Substantia Nigra (SN), and the formations of intracytoplasmic Lewy bodies and dystrophic neurites. Alpha-synuclein (α-syn), widely recognized as the most prominent element of the Lewy body, is one of the representative hallmarks in PD. However, the mechanisms behind the increased α-syn expression and aggregation have not yet been clarified. To examine what causes α-syn expression to increase, we analyzed the pattern of gene expression in the SN of mice intoxicated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), where down-regulation of dopaminergic cells occurred. We identified serum- and glucocorticoid-dependent kinase 1 (SGK1) as one of the genes that is evidently downregulated in chronic MPTP-intoxication. The results of Western blot analyses showed that, together with the down-regulation of dopaminergic cells, the decrease in SGK1 expression increased α-syn expression in the SN in a chronic MPTP-induced Parkinsonism mouse. For an examination of the expression correlation between SGK1 and α-syn, SH-5YSY cells were knocked down with SGK1 siRNA then, the downregulation of dopaminergic cells and the increase in the expression of α-syn were observed. These results suggest that decreased expression of SGK1 may play a critical role in increasing the expression of α-syn, which is related with dopaminergic cell death in the SN of chronic MPTP-induced Parkinsonism mice and in SH-SY5Y cells.</P> <P><B>Highlights</B></P> <P> <UL> <LI> SGK1 expression decreased by microarray and Western blot analysis in chronic MPTP parkinsonism mouse model. </LI> <LI> Decreased SGK1 demonstrated α-syn increase, accompanied with dopaminergic cell death in SH-SY5Y induced by MPP+ treatment. </LI> <LI> Decreased SGK1 may play a critical role in α-syn increase in MPTP induced chronic parkinsonism model. </LI> </UL> </P>

Schizophrenia, Depression, and Sleep Disorders: Their Traditional Oriental Medicine Equivalents

Peggy Bosch,Peter de Rover,Heike Staudte,임사비나,Maurits van den Noort 사단법인약침학회 2015 Journal of Acupuncture & Meridian Studies Vol.8 No.1

Psychiatric disorders can be described and treated from both a Western (allopathic) and an Eastern perspective, which should be taken into account when conducting research. Patients with schizophrenia or depression are likely to be undergoing Western treatment when they are referred to an acupuncturist for (add-on) treatment, and knowledge of both types of treatments is necessary to integrate them successfully. In this study, the different traditional Oriental medicine (TOM) diagnostic patterns in patients with a Western diagnosis of schizophrenia, depression, or sleep disorders are described from a literature and a clinical perspective. The data on 30 depression and 30 schizophrenia patients from a German study are presented. Our results show that if a psychiatric group, sorted in accordance to Western diagnostic principles, is diagnosed on the basis of TOM diagnostic patterns, it can be categorized into different groups of patients with psychiatric disorders; this finding has far-reaching consequences in scientific research on acupuncture. Moreover, we found a high prevalence of sleep disorders in patients with both schizophrenia and depression, which could be explained from the perspective of a TOM diagnostic pattern. Finally, we discuss sleep quality as a treatment objective that may play a crucial role in mediating acupuncture-induced treatment effects in patients with schizophrenia and depression.