BackgroundThe ankle brachial pressure index (ABI) is a simple, useful method for diagnosing peripheral artery disease (PAD). Although the ABI is an objective diagnostic method, it has limited reliability in certain scenarios. The aim of the present study was to determine the accuracy and reliability of the toe brachial index (TBI) as a diagnostic tool for detecting stenosis in PAD, associated with normal or low ABI values.MethodsABI and TBI values were measured in 15 patients with diabetic gangrene who were suspected of having lower extremity arterial insufficiency. The ABI and TBI values were measured using a device that allowed the simultaneous measurement of systolic blood pressure in the upper and lower extremities. In addition, the ABI and TBI values were compared pre- and post-angiography.ResultsPatients with an ABI of 0.9-1.3 showed almost no difference between the 2 measurements. The patients with TBI >0.6 had no arterial insufficiency. The patients with TBI <0.6 required vascular intervention with ballooning. After the angiography, the gangrenous wounds decreased in size more rapidly than they did prior to the intervention.ConclusionsOur findings suggest that TBI is the method of choice for evaluating lower limb perfusion disorders. This result requires further studies of TBI in a larger number of patients. Future long-term studies should therefore evaluate the utility of TBI as a means of screening for PAD and the present findings should be regarded as preliminary outcomes.

Introduction: One of the most frequently performed anti-aging surgical procedures is thread facelift. Since the 2010s, thread lifts using absorbable polydioxanone (PDO) thread were developed and have become increasingly popular. This research aims to identify the changes in and the mechanisms of absorbable thread-lifting components, namely, PDO (polydioxanone) and PCL (polycaprolactone), with varied absorption periods in the body.Methods: Four different types of threads, namely, single-stranded thread, 4-stranded thread, 12-stranded thread, and barbed Cog thread, were used for each component.Histological changes in the thread and neighboring tissue of rat model were investigated for 2-week interval, and PCR was conducted for genes related to fibroblast proliferation including type 1α1 collagen, type 3α1 collagen, transforming growth factor beta 1 (TGF-β1).Results: An increase in the collagen formation in all types of PDO and PCL groups was observed during the first 12 weeks and decreased afterward. Collagen formation decreased later in the PCL thread group significantly than the POD group. PCL thread remained logner in the tissue for over a year regarding POD requiring around 24 weeks of absorption-degradation. A larger surface area between the thread and the tissue induces a greater response in the tissue, resulting in an increase in inflammatory cells, myofibroblasts, and fibroblasts. Results showed a similar pattern of increase in type 1α1 collagen and TGFβ in the PDO thread group. This suggests that TGFβ signal transduction leads to fibroblast proliferation that stimulates collagen formation and tissue re-formation. In contrast, only type 3α1 collagen increased in the PCL thread group. Conclusion:More collagen formation and tissue responses are induced by PCL thread, remaining longer in the tissue than PDO, leading to more tissue tightening effects that is one of the most important points of face lifting. Morphological comparison of threads shows that not only an increase in surface area between thread and tissue but also multi-strand increase tissue response, which in turn increases tissue maintenance effects.

The purpose of this study is to discuss several approaches to addressing naso-orbito-ethmoidal (NOE) fracture. Orbital fracture, especially infraorbital fracture, can be treated through the transconjunctival approach easily. However, in more severe cases, for example, fracture extending to the medial orbital wall or zygomatico-frontal suture line, only transconjunctival incision is insufficient to secure good surgical field. And, it also has risk of tearing the conjunctiva, which could injure the lacrimal duct. Also, in most complex types of facial fracture such as NOE fracture or panfacial fracture, destruction of the structure often occurs, for example, trap-door deformity; a fracture of orbital floor where the inferiorly displaced blowout facture recoils to its original position, or vertical folding deformity; fractured fragments are displaced under the other fragments, causing multiple-packed layers of bone.

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