The distribution and fine structure of lymphatic vessels associated with nerves was studied by immunohistochemistry in the murine craniofacial region. The tissue sections and blocks were immunostained for LYVE-1, protein gene product 9.5, CD34 and aquaporin-1 to demonstrate the lymphatic vessels, nerves, blood vessels and water channel protein, respectively. Transmission electron microscopic examination was also performed to investigate the relationship between the lymphatics and nerves. In the nasal area, the lymphatics were found in dura mater on the cribriform plate and beneath the nasal mucosa, this supposedly supplying the cerebrospinal fluid drainage route along the olfactory nerves. The proximal portions of the cranial nerves were equipped with the lymphatics in the epineurium. In the distal portions of the nerves, the lymphatics were distributed in close proximity of the perineural sheath, and thus might contribute to maintenance of microenvironment suitable for the nerves by an absorptive activity of the lymphatic endothelial cells. The present findings suggest that the lymphatic system associated with the cranial nerves provides the pathway for transport of cerebrospinal fluid, tissue fluid, and free cells involved in immune response and tumor metastasis in the craniofacial region.

This study aimed to investigate whether belt electrode skeletal muscle electrical stimulation (B-SES) would improve postoperative lower limb function and walking ability in patients with diabetes who have undergone minor amputations. Diabetic patients who had undergone minor amputations were assigned randomly to a B-SES or control group. The B-SES group underwent conventional physical therapy for 20 min and B-SES for 20 min. The control group underwent only the 20-min conventional physical therapy. In both groups, rehabilitation was introduced by the physical therapists for 14 days from postoperative day 1. The outcome measures were range of motion in the ankle joint, knee extension muscle strength, ambulation status, and quality of life score. All these were evaluated before the intervention and 2 and 4 weeks after the intervention. From the 84 patients initially assessed, 32 were assigned to either the B-SES ( N = 16) or control ( N = 16) group. Preoperatively, there were no significant differences in all endpoints. The B-SES group showed significant improvement in the ankle dorsiflexion angle at 2 weeks postoperatively and knee joint extension strength at 4 weeks postoperatively. Postoperative B-SES with standard physical therapy might improve the range of motion of dorsiflexion of the ankle joint and extensor strength of the knee joint in patients with diabetes who have undergone minor amputations. B-SES is a useful tool to improve postoperative physical function in diabetic patients who have undergone minor amputations. A multicenter study is needed to determine the effective B-SES combined with regular physiotherapy for minor amputation.

The authors report the use of free groin flaps to close intraoral defects in 24 patients following ablative tongue cancer surgery. The lateral thin portion of the flap was used for tongue reconstruction, and the deepithelialized medial thick portion for filling the mandibular defect and for covering the important vessels in the neck. In lean patients, if the medial deepithelialized portion was too thin for adequate coverage, the proximal sartorius muscle was included to prevent postoperative orocervical fistula. The advantages of the groin flap in reconstructing the tongue and oral floor after hemiglossectomy include the following: (1) a suitable amount of tissue is available for both the tongue and oral floor; (2) the important vessels in the neck may be protected with the flap; (3) the proximal sartorius muscle can be included with the flap, if necessary; (4) donor-site morbidity is less than with other flaps; and (5) flap elevation can be done concurrently with the hemiglossectomy and radical neck dissection.

Aicardi syndrome is a rare congenital anomaly characterized by infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae. This syndrome has been observed only in females. A case of Aicardi syndrome with cleft palate is reported. A six-month-old girl was given a diagnosis of Aicardi syndrome with cleft palate. At 3 years 4 months of age, when the patient weighed 11.3kg, we performed a push-back operation without complications. She is now 8 years old and is not able to use intelligent words. Nearly 200 patients with Aicardi syndrome have been described in the literature. This report is the seventh case associated with cleft lip and palate, and the second case to undergo palatoplasty.

This study investigated the effect of early rehabilitation on gait restoration, wound healing, and home discharge in patients with lower extremity (LE) chronic wounds. This multicenter, retrospective cohort study included 233 Japanese inpatients who received treatment for LE chronic wounds from April 2012 to March 2015. A multivariate analysis was conducted using outcomes of gait restoration, wound healing, and home discharge as dependent variables. Other survey items were used as independent variables. Early rehabilitation was extracted as an independent factor with gait restoration (hazard ratio [HR] 1.82, P < .01) and home discharge (HR 1.77, P < .001) as dependent factors by the stepwise method in Cox proportional-hazards regression analysis, but it was not extracted as an independent factor with wound healing as the dependent factor by the stepwise method as well as the forced entry method ( P = .44). A significant relationship between the presence of gait restoration and home discharge was observed in the chi-square test ( P<.001), and the duration from admission to gait restoration was significantly correlated to the duration from admission to home discharge (Pearson's product-moment correlation coefficient; r=.89, P<.0001). Early rehabilitation was a positive factor for gait restoration and home discharge in chronic LE wound patients.