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Purpose: Digital replantation has dramatically changed the fate of mutilated injuries of hand. But in case of severe crushing injury in Tamai zone I, it is a contraindication of replantation. This study aims to determine the replantation survival rate in cases with crushing injury.Methods: We retrospectively evaluated patients’ charts and photos from January 2015 to December 2019. There were 294 patients (331 fingers) with digital amputation who underwent surgery. Cases with crushing were divided into petechiae-in-skin group and red-line-sign group and compared with the group without crushing. The relationship of survival rate with factors was evaluated using chi-square analysis.Results: Of these, 199 fingers were defined as severe crushed, and 140 cases with petechiae in skin and 59 cases with red line sign. There was no statistically significant difference in survival rate compared with the group without crushing (p=0.227). Additional surgery was performed more in crushed injury. However, necrotized soft tissue was mainly on margin of amputation, not on crushed area.Conclusion: The presence of crushing did not affect survival rate in Tamai zone I replantation. However, as the degree of crushing was severe, the need for additional surgery increased. We found that the number of anastomosed arteries and veins influences the survival rate. According to our analysis, even if it’s difficult, finding and doing anastomosis as many vessels as possible can make good results.

Reconstruction of amputated fingertips is extremely challenging when the amputee is very small and severely crushed. Moreover, there are not many options if distal phalanx is exposed due to defects of soft tissue. We report a case of successful fingertip reconstruction in a 10-month-old girl using a subcutaneous island flap with a composite graft. Her fingertip of the right little finger was amputated stuck by the air purifier. Some soft tissue was lost from the stump and the bone was exposed. There was a very small amputee, and soft tissue was extremely little inside. Replantation was not possible because of the soft tissue defect. The composite graft was inadequate due to the exposure of distal phalanx and defect of soft tissue. Soft tissue island flap based terminal branch of the digital artery was transposed to cover the distal phalanx. After then, the amputee was grafted over the flap. After debridement, most of the soft tissue survived and 0.2×0.2 cm of skin defect was found, which was healed through secondary intention.

Fingertip injuries with nail bed defects have traditionally been covered with full- or split-thickness nail bed grafts. However, it was widely understood, without sufficient evidence, that graft take is difficult if the nail bed is grafted directly on the distal phalanx. This study reports two successful cases of nail bed graft on sterile matrix defects with exposed bare cortical bone. Two patients suffered a crush injury on their fingers. While there was no fracture, the distal phalanx was exposed with a nailbed defect. As the defect was too large for primary closure and too small for flap coverage, a sterile matrix nailbed graft was performed using the ipsilateral big toe. In both cases, damaged nails have grown fully, identical to the contralateral finger with smooth and flat regrowth of the nail and adherence of the growing nail. Both outcomes were graded as excellent according to Zook’s criteria. No major complication was found except for a minor ingrown nail on donor site in both cases. Even if there is a nail bed defect with exposure of cortical bone, successful nail reconstruction could be obtained through immediate nailbed graft on the exposed distal phalanx.

Purpose The hand has unique skin characteristics. Intrinsic flap donors are limited due to functional specificity and compactly connected structures. The hypothenar area is a reliable option for the reconstruction of finger defects. We performed anatomic studies elucidating the blood supply of this area and hypothesized that the fourth common palmar digital artery perforator free flap can be used to reconstruct soft tissue defects in fingers with minimal donor site morbidity. Methods From November 2017 to February 2020, 30 procedures of fourth common digital artery perforator free flaps were performed to cover digital skin defects . A retrospective chart review was performed, and the cases were analyzed. Results The mean patient age was 42.4 years (range, 1–75 years; median age, 40 years). Defects were located at the fingertip (n = 12), the dorsum (n = 3), the palmar (n = 9) aspect of the finger, and both the dorsal and palmar aspects of the finger (n = 6). Indications included emergent coverage (n = 13), coverage after necrosis (n = 11), oncological resection (n = 1), and contracture release (n = 5). The defect size ranged from 1.5 × 0.8 cm (1.2 cm 2) to 6 × 2.5 cm (15 cm2 ). The perforator was located approximately 1 cm proximal to the distal palmar crease as it arose from the fourth common digital artery at a right angle. It continued to the ulnar border of the hand through the superficial fascia of the hypothenar muscles before running in a proximoulnar direction toward the dorsum of the hand. The diameter of the perforator was between 0.5 and 0.7 mm. All flaps survived. One case required a split-thickness skin graft for donor site closure, and all others could be closed primarily. Conclusions The fourth common digital artery perforator is a versatile flap and can be used for both palmar and dorsal defects, including for the fingertip. The location of the perforator used differs from previous descriptions but is routinely and reliably located. Type of study/level of evidence Therapeutic IV.

In the light of recent trends toward introducing Artificial Intelligence (AI) to enhance Human-Robot Interaction (HRI), intelligent virtual assistants (VA) driven by Natural Language Processing (NLP) receives ample attention in the manufacturing domain. However, most VAs either tightly bind with a specific robotic system or lack efficient human-robot communication. In this work, we implement a layer of interaction between the robotic system and the human operator. This interaction is achieved using a novel VA, called Max, as an intelligent and robust interface. We expand the research work in three directions. Firstly, we introduce a RESTful style Client-Server architecture for Max. Secondly, inspired by studies of human-human conversations, we embed conversation strategies into human-robot dialog policy generation to create a more natural and humanized conversation environment. Finally, we evaluate Max over multiple real-world scenarios from the exploration of an unknown environment to package delivery, with the means of an industrial robot.

INTRODUCTION AND OBJECTIVE:The overexpression of hypoxia induced factor 1a/2a in ccRCC leads to up-regulation of vascular endothelial growth factor (VEGF) that results in increased angiogenesis, tu...

This paper investigates the cost behavior in the Korean defense industry. Managers in the defense industry tend to have motivation to manage earnings because the costs incurring in the production process of defense articles are reimbursed based on cost plus contracts. Results are as follows. First, in the sample of the defense sector, SG&A costs and total manufacturing costs exhibited anti-stickiness whereas labor costs exhibited cost stickiness. Other cost components displayed symmetric cost behavior. Next, in the commercial sector, material costs, direct material costs, total * This paper is partially drawn from Hong-Jung Yong’s dissertation at Seoul National University ** Defense Acquisition Program Administration, e-mail: afdragon@hanmail.net *** Business School, Seoul National University, e-mail: ahnts@snu.ac.kr **** Correspondent Author. School of Management, Kyung Hee University, e-mail: jhrjhr@khu.ac.kr ***** Department of Accounting, Soongsil University, e-mail: parkjh04@ssu.ac.kr 32 Seoul Journal of Business manufacturing costs, cost of goods sold, and total costs exhibited antistickiness. Labor costs showed cost stickiness whereas SG&A costs, overhead costs, and indirect production costs had symmetric cost behavior. Overall, the results reveals that the change rate of labor costs of the defense sector exhibits more cost stickiness to changes in sales than the commercial sector.

Tumor heterogeneity influences the clinical outcome of patients with cancer, and the diagnostic method to measure the tumor heterogeneity needs to be developed. We analyzed genomic features on pairs of primary and multiple metastatic lymph nodes from six patients with lung cancer using whole-exome sequencing and RNA sequencing. Although somatic single-nucleotide variants were shared in primary lung cancer and metastases, tumor evolution predicted by the pattern of genomic alterations was matched to anatomic location of the tumors. Four of six cases exhibited a branched clonal evolution pattern. Lymph nodes with acquired somatic variants demonstrated resistance to the cancer treatment. In this study, we demonstrated that multiple biopsies and sequencing strategies for different tumor regions are required for a comprehensive understanding of the landscape of genetic alteration and for guiding targeted therapy in advanced primary lung cancer. Cancer Res; 76(22); 6568–76. ©2016 AACR.

Power consumption now becomes the most critical performance limiting factor to solid state disk (SSD) in embedded systems. It is imperative to devise design methods and architectures for power efficient SSD designs. In our work, we present the first step towards low power SSD design, i.e., power estimation of SSD. We present a practical approach of SSD power estimation which tries to keep the advantage of real measurement, i.e., accuracy, while overcoming its limitations, i.e., long execution time and lack of repeatability (and high cost) by a trace-based simulation. Since it is based on real measurements, it takes into account the power consumption of SSD controller as well as that of Flash memories. We show the effectiveness of the presented method in designing a dynamic power management policy for SSD.

Background: Cancers are composed of cells with distinct genetic and phenotypic characteristics. Tumor heterogeneity in each patient may influence on personalized medicine strategies that depend on results from single tumor-biopsy samples. However, tumor heterogeneity in advanced primary lung cancer has not been well studied. The purpose of this study was to investigate the tumor heterogeneity in advanced primary lung cancer. Methods: We sequenced fourteen regions from four patients who were suspicious for primary lung cancer with multiple lymph node metastasis. Tumor samples were obtained from primary tumor and metastatic lymph node(s) or distant metastasis using bronchoscopic forcep biopsy, endobronchial ultrasound-guided transbronchial needle aspiration, and percutaneous needle biopsy. The profiles of somatic mutations, copy number alterations and gene expression were compared among primary tumor and metastatic sites in each patient. Clonal evolution was evaluated using the concept of cancer cell fraction by SciClone analysis. Results: We performed multiregion whole exome sequencing and RNA sequencing on three non-small cell lung cancers (2 adenocarcinomas [TH1 and TH4] and 1 squamous cell carcinoma [TH2]) and one small cell lung cancer (TH3). EML4-ALK fusion was noticed in TH1 and TH4. There was profound tumor heterogeneity in terms of somatic mutation, copy number alteration, or gene expression in each patient. The frequency of private somatic mutation from spatially distinct regions were 59% in TH1, 44% in TH2, 13% in TH3, and 30% in TH4. Known driver mutation was also heterogeneous in TH1 and TH2. Analysis of the clonal architecture confirmed the presence of clonal heterogeneity in each patient. Phylogenetic reconstruction revealed the evidence of branched clonal evolution. Conclusions: Tumor heterogeneity was noticed from spatially distinct regions from advanced primary lung cancers. The single biopsy specimens may not represent the whole landscape of genetic alteration in advanced primary lung cancers. Citation Format: Sang-Won Um, Je-Gun Joung, Su Yeon Lee, Joon Seol Bae, Jinha Park, Woong-Yang Park. Tumor heterogeneity of advanced primary lung cancer evaluated by multiregion sequencing. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4815. doi:10.1158/1538-7445.AM2015-4815

Background Although a number of risk factors for fatal stroke are well established in Western populations, this is less true for Asian countries, many of which have stroke mortality rates that are historically high. In a prospective study in Shanghai, China, we determined whether the same factors predict risk for fatal stroke as in the West. We also studied a number of potential dietary associations, particularly those with dietary antioxidants because these have been suggested to reduce atherogenesis. Methods and Results Between 1986 and 1989, 18 244 men aged 45 to 64 years living in four geographically defined areas of Shanghai, China were recruited to participate in a prospective study of diet and cancer. All participants completed an in-person, structured interview and provided blood and urine samples. As of March 1994, fatal stroke accounted for 245 of the 980 observed deaths. The most important risk factor for stroke mortality was a history of hypertension (multivariate relative risk, 4.5; 95% confidence interval, 3.3, 6.2). Cigarette smoking was not strongly associated with risk, and alcohol consumption increased risk only in the extreme categories of lifetime consumption. Educational level was strongly, inversely associated with fatal stroke, and this could not be explained by adjustment for any other risk factors. No macronutrient was associated with risk, including total energy, fat consumption, or any component of fat. There also were no significant inverse associations for stroke mortality with several micronutrients of interest, including vitamin C, carotene, vitamin E, riboflavin, or calcium. Conclusions Our data demonstrate that hypertension is by far the most important contributor to stroke mortality in Shanghai and that among dietary factors, only alcohol consumption shows any evidence whatsoever of being a risk factor.