Osseointegrated Finger Prostheses Using a Tripod Titanium Mini-Plate

Manrique, Oscar J.,Ciudad, Pedro,Doscher, Matthew,Torto, Federico Lo,Liebling, Ralph,Galan, Ricardo Korean Society of Plastic and Reconstructive Surge 2017 Archives of Plastic Surgery Vol.44 No.2

Background Digital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients. Methods A retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded. Results Seven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported. Conclusions When autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.

Osseointegrated Finger Prostheses Using a Tripod Titanium Mini-Plate

Oscar J Manrique,Pedro Ciudad,Matthew Doscher,Federico Lo Torto,Ralph Liebling,Ricardo Galan 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.2

Background Digital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients. Methods A retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded. Results Seven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported. Conclusions When autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.

Evaluation of Micro EV's Spreading to Local Community by Multinomial Logit Model

Seki, Yoichi,Manrique, Luis C.,Amagai, Kenji,Takarada, Takayuki Korean Institute of Industrial Engineers 2012 Industrial Engineeering & Management Systems Vol.11 No.2

Micro Electric Vehicles are considered as a solution for reducing $CO_2$ emissions, however, it is difficult to evaluate its impact in a local community when it has been introduced. In this study, we evaluated how to spread the Micro EV within the community, using the utility derived from a multinomial logit model, and analyze the effect on $CO_2$ emissions. The householder's utility model is based on an investigation about Kiryu citizen's activities of shopping, transportation methods, etc. Using the geographic information system, we get the distances of each householder and the stores, and estimate a multinomial logit model about the combination choices of shopping stores and transportation method.

Recurrent Advanced Lower Extremity Lymphedema Following Initial Successful Vascularized Lymph Node Transfer: A Clinical and Histopathological Analysis

Ciudad, Pedro,Date, Shivprasad,Manrique, Oscar J,Chang, Wei-Ling,Huang, Tsung-Chun,Chen, Tsung-Wei,Nicoli, Fabio,Maruccia, Michelle,Chen, Hung-Chi Korean Society of Plastic and Reconstructive Surge 2017 Archives of Plastic Surgery Vol.44 No.1

Evaluation of Micro EV’s Spreading to Local Community by Multinomial Logit Model

Yoichi Seki,Luis C. Manrique,Kenji Amagai,Takayuki Takarada 대한산업공학회 2012 Industrial Engineeering & Management Systems Vol.11 No.2

Micro Electric Vehicles are considered as a solution for reducing CO₂ emissions, however, it is difficult to evaluate its impact in a local community when it has been introduced. In this study, we evaluated how to spread the Micro EV within the community, using the utility derived from a multinomial logit model, and analyze the effect on CO₂ emissions. The householder’s utility model is based on an investigation about Kiryu citizen"s activities of shopping, transportation methods, etc. Using the geographic information system, we get the distances of each householder and the stores, and estimate a multinomial logit model about the combination choices of shopping stores and transportation method.

Recurrent Advanced Lower Extremity Lymphedema Following Initial Successful Vascularized Lymph Node Transfer: A Clinical and Histopathological Analysis

Pedro Ciudad,Shivprasad Date,Oscar J Manrique,Wei-Ling Chang,Tsung-Chun Huang,Tsung-Wei Chen,Fabio Nicoli,Michelle Maruccia,Hung-Chi Chen 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.1

Lessons Learnt from an 11-year Experience with Lymphatic Surgery and a Systematic Review of Reported Complications: Technical Considerations to Reduce Morbidity

Ciudad Pedro,Escandón Joseph M.,Manrique Oscar J.,Bustos Valeria P. 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.2

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

Diversification Benefits from the Introduction of REITs in Korea

Chan-Wung Kim,Young-Ghon Kim,Gabriel Manrique 한국산업경제학회 2010 산업경제연구 Vol.23 No.3

본 연구는 REITs의 한국도입이 한국투자자들에 부동산 간접투자에 따른 잠재적 이익을 제공하는 지에 대해 실증분석 하는 데 있다. 분석기간은 2002년 11월 11일에서 2007년 11월 8일까지 설정하였으며, 실증분석에서는 전체표본을 REITs의 도입기간(2002년 11월 11일부터 2003년 11월 7일까지)과 정착기간(2004년 1월 8일부터 2007년 11월 8일까지)으로 나누어 보다 보편 타당한 결과를 얻고자 하였다. 주요 분석결과는 다음과 같다. 도입기간에서는 REITs가 한국부동산 투자자들에게 통계적으로 유의한 수준에서 이익을 제공하지 못하는 것으로 나타났다. 반면 정착기간에서는 한국투자자들에게 통계적 유의수준에서 이익을 제공함을 보였다. 이러한 결과로부터 REITs의 한국진출이 투자자들에게 부동산 분산투자에 대한 유용성을 제공하는 것으로 추론해 볼 수 있다. 따라서 본 연구는 한국에서 REITs진출의 유용성과 성과를 실증 분석한 최초의 연구로써 의미가 클 것으로 사료된다. This study investigated the potential diversification benefits for Korean investors from the introduction of REITs in Korea. We found that during the first period (2002), the REITs could not provide Korean investors with any diversification gains. However, during the latter period (2004-2007), we found that REITs could have provided Korean investors with significant diversification gains. The portfolio with REITs could improve 59% based on the Sharpe ratio and 11.6% based on the M2measure. It appears that REITs have proven usefulness in a diversified portfolio. This study would be the first to document such a benefit from the introduction of REITs in Korea.

Lessons Learnt from an 11-year Experience with Lymphatic Surgery and a Systematic Review of Reported Complications: Technical Considerations to Reduce Morbidity

Ciudad Pedro,Escandón Joseph M.,Manrique Oscar J.,Bustos Valeria P. 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.1

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

The Wnt Receptor Ryk Reduces Neuronal and Cell Survival Capacity by Repressing FOXO Activity During the Early Phases of Mutant Huntingtin Pathogenicity

Tourette, Cendrine,Farina, Francesca,Vazquez-Manrique, Rafael P.,Orfila, Anne-Marie,Voisin, Jessica,Hernandez, Sonia,Offner, Nicolas,Parker, J. Alex,Menet, Sophie,Kim, Jinho,Lyu, Jungmok,Choi, Si Ho,C Public Library of Science 2014 PLoS biology Vol.12 No.6

<▼1><P>A study of Huntington's disease reveals that neurons might fail to cope with maintaining their function during the pre-symptomatic, pathogenic phases of HD, possibly due to the early repression of key longevity-promoting transcription factors by abnormal developmental signaling.</P></▼1><▼2><P>The Wnt receptor Ryk is an evolutionary-conserved protein important during neuronal differentiation through several mechanisms, including γ-secretase cleavage and nuclear translocation of its intracellular domain (Ryk-ICD). Although the Wnt pathway may be neuroprotective, the role of Ryk in neurodegenerative disease remains unknown. We found that Ryk is up-regulated in neurons expressing mutant huntingtin (HTT) in several models of Huntington's disease (HD). Further investigation in <I>Caenorhabditis elegans</I> and mouse striatal cell models of HD provided a model in which the early-stage increase of Ryk promotes neuronal dysfunction by repressing the neuroprotective activity of the longevity-promoting factor FOXO through a noncanonical mechanism that implicates the Ryk-ICD fragment and its binding to the FOXO co-factor β-catenin. The Ryk-ICD fragment suppressed neuroprotection by <I>lin-18</I>/Ryk loss-of-function in expanded-polyQ nematodes, repressed FOXO transcriptional activity, and abolished β-catenin protection of mutant htt striatal cells against cell death vulnerability. Additionally, Ryk-ICD was increased in the nucleus of mutant htt cells, and reducing γ-secretase PS1 levels compensated for the cytotoxicity of full-length Ryk in these cells. These findings reveal that the Ryk-ICD pathway may impair FOXO protective activity in mutant polyglutamine neurons, suggesting that neurons are unable to efficiently maintain function and resist disease from the earliest phases of the pathogenic process in HD.</P></▼2><▼3><P><B>Author Summary</B></P><P>Neuronal cell decline in neurodegenerative disease can be caused by inherited mutations and involves neuronal dysfunction followed by neuronal death. The ability of neurons to cope with the chronic stress induced by mutant protein expression may determine the course of their decline and eventual demise. Although the pathophysiological importance of these stress responses has been previously shown, very little is known about the signaling networks that regulate neuronal homeostasis during the early presymptomatic—but pathogenic—phases of a neurodegenerative disorder such as Huntington's disease (HD). In particular, it remains unclear whether neuronal differentiation factors regulate stress response pathways during neurodegenerative disease and how this might impact the overall capacity of neurons to cope with stress and maintain their function. Here, we show that the Wnt receptor Ryk, a protein known to be important for neurogenesis, is increased in different animal models of HD, before or during the early phases of the disease process. Interestingly, increased levels of Ryk repress activity of the FOXO proteins—a family of transcription factors that play a role in cell survival/longevity and in neuronal homeostasis and protection. Ryk represses FOXO protective activity, possibly directly, through its intracellular domain, a product of γ-secretase–mediated cleavage previously implicated in the birth of new cortical neurons. This highlights the regulation of HD neuron survival by a Ryk-dependent pathway that is distinct from canonical Wnt/Ryk signaling. From our findings, we postulate that neurons are unable to develop an efficient FOXO-mediated survival response during the very early, pathogenic phases of HD.</P></▼3>