Kazuo Kishi

Alignment of Skeletal Muscle Cells Cultured in Collagen Gel by Mechanical and Electrical Stimulation

For in vitro tissue engineering of skeletal muscle, alignment and fusion of the cultured skeletal muscle cells are required. Although the successful alignment of skeletal muscle cells cultured in collagen gel has been reported using a mechanical force, other means of aligning cultured skeletal muscle cells have not been described. However, skeletal muscle cells cultured in a two-dimensional dish have been reported to align in a uniform direction when electrically stimulated. The purpose of this study is to determine if skeletal muscle cells cultured three-dimensionally in collagen gels can be aligned by an electrical load. By adding direct current to cells of the C2C12 skeletal muscle cell line cultured in collagen gel, it was possible to align C2C12 cells in a similar direction. However, the ratio of alignment was better when mechanical force was used as the means of alignment. Thus for tissue engineering of skeletal muscle cells, electrical stimulation may be useful as a supplementary method.

A New Classification of Zygomatic Fracture Featuring Zygomaticofrontal Suture: Injury Mechanism and a Guide to Treatment

The researchers establish a new classification system for zygomatic fractures based on computed tomography and mechanism of injury, which could be used to inform treatment options. Patients treated for isolated zygomatic fracture at the Keio University Hospital between 2004 and 2011 were recruited for this study. The cases were classified into 4 types based on the fracture pattern of the zygomaticofrontal suture and inferior orbital rim. In total, 113 patients aged 16 to 82 years (mean age (SD) = 39.8 (17.0) years), including 74 men and 39 women, were analyzed. Overall, 54 patients had shear fractures and 59 patients had greenstick type fractures. In both shear and greenstick fractures, the ratio of medial type fractures was significantly higher than that of lateral type fractures (p < 0.001). Furthermore, the number of shear type fractures in those <20 years old was lower than that in other age groups (p < 0.05). In conclusion, this classification is an epoch-making classification based on the mechanism of facial injury, and may be used to inform treatment options to achieve optimal biomechanical stability.

Efficacy and Safety of the Skin Adhesive EpinexusTM in Surgical Patients

This single-center, randomized, and controlled intervention study compared an acrylate skin adhesive, EpinexusTM (Mitsui Chemicals, Inc., Tokyo) with Dermabond AdvancedR (Ethicon, Inc., Somerville, New Jersey). The primary endpoint was cosmetic outcome at 52 weeks after treatment (Manchester Scar Scale), and the secondary endpoints were cosmetic outcome at 4 and 26 weeks after treatment (Manchester Scar Scale), wound closure, and usability. We evaluated 59 patients (29 cases and 30 controls). Failures and adverse events were also evaluated, and 8 adverse events (5 cases and 3 controls) were reported (epidermolysis, n = 4; contact dermatitis, n = 1; eczema, n = 1; and surgical wound dehiscence, n = 2). No difference was observed between groups in cosmetic outcome at 52 and 24 weeks; however, at 4 weeks, cases showed better cosmetic outcome compared with controls. With regard to usability, the treatment duration and application time were significantly longer with EpinexusTM, and ease of application was significantly better with Dermabond AdvancedR.

A biomechanical study of relationship between sternum defect patterns and thoracic respiration

Abstract Background: Various types of sternum defects are produced after the removal of thoracic tumors involving the sternum. The present study aims to elucidate the relationship between the defect patterns and their effects on thoracic respiration. Methods: Ten sets of finite element models were produced simulating thoraces of 10 persons and termed normal models. With each of the 10 normal models, the sternum was removed in six different ways to produce new models termed defect models. Defect models were categorized into hemi-superior (H-S), hemi-inferior (H-I), hemi-whole length (H-W), bilateral-superior (B-S), bilateral-inferior (B-I), and bilateral-whole length (B-W) defect types, depending on the locations of the defects. Respiratory movement was dynamically simulated with these models. The volume change the thoraces present during respiration was measured to evaluate the effectiveness of thoracic respiration. This value – defined as ΔV – was calculated and was compared between normal and defect models. Results: With H-W and B-W type models, ΔV dropped to around 20% of normal values. With H-S and B-S type models, ΔV dropped to around 50% of normal values. With H-I and B-I type models, ΔV presented values almost equivalent to those of normal models. Conclusion: Effectiveness of thoracic respiration is seriously impaired when the whole length of the sternum is absent. Reconstruction of the defect is essential for these cases. However, since the upper part of the sternum is most important for effective thoracic respiration, priority should be placed on the upper part in performing reconstruction.

QOL of the Patients with Lymph Edema: Evaluation of Japanese Patients using SF-36

Purpose: This cross-sectional study aimed at evaluating the healthrelated quality of life (QOL) of Japanese patients with lymphedema. Methods: A cross-sectional, descriptive study was conducted. Twenty-seven patients with lymphedema of the upper or lower limb(s) who presented the two institutions between January and December 2010 completed the Short Form 36 (SF-36: a generic health-related QOL measure). Results: All components and summary scores of the generic health-related QOL reported by the patients were statistically worse than that of the Japanese norms. The patients with symptom duration of longer than 1 year, who underwent radiation therapy, or those undergoing chemotherapy reported significantly lower QOL. Conclusion: Lymphedema significantly deteriorates the QOL of the patients. Further evaluation with longitudinal design, increased number of cases and disease-specific QOL scale is warranted to better understand the QOL of the patients.

The Fixation and Dressing for Meshed and Sheet Skin Graft

When a graft is placed on a recipient bed, the process of accepting the graft begins. For some hours, the graft is bathed and nourished by plasmatic circulation or serum imbibition. Si‐ multaneously, fortuitous and accidental apposition of the vessels in the bed and those in the graft allows blood to be sucked into the graft. Soon afterwards, active penetration of the graft by blood vessels from the bed begins and is well-established by the fifth day. These 5 days are the most important period for skin graft acceptance. In other words, to improve the survival of the transplanted skin graft, it is important to en‐ sure that the graft is not misaligned with the recipient bed and that moderate pressure is applied on the transplanted skin so that it is in contact with and adheres to the recipient bed. These measures are achieved through fixation and dressing. This chapter will cover various types of fixations and dressings.