BACKGROUND
Multiple free tissue transfer from the same donor site is not well described for microsurgical head and neck reconstruction.
METHODS
Between (8/2011 and 11/2012), 103 patients received 103 ...free ALT flaps for head and neck reconstruction; flaps were called first‐time ALT flaps. Intra‐operative findings were used to assess the presence of a favorable anatomy for a future second flap from the same donor site. And, between 9/2009 and 12/2013, second‐time flaps from previously used anterior thighs were attempted either freely or guided by the intra‐operative data from the previous surgery.
RESULTS
A favorable anatomy for a future second‐time flap was noted in (n: 96/103). Future second‐time flaps were ALT, AMT, and TFL flaps (n: 32, n: 91, n: 96, respectively). The second‐time flap was attempted (n: 11) and was successful (n: 8, 72.7%). Harvested second‐time flaps were (5 ALT, 2 AMT, 1TFL). All flaps survived. The donor site was closed primarily (n: 6) and skin grafted (n: 2).
CONCLUSION
Thorough exploration of the anatomy of the anterior thigh during the first‐time ALT flap surgery with detailed documentation in addition to meticulous surgery are essential for success. The proposed concept limits morbidity to one site, and serves as an alternative donor site or a life‐boat.
Stroke is an important risk factor for dementia. Epidemiological studies have indicated a high incidence of dementia in stroke patients. There is currently no effective biomarker for the diagnosis of ...post-stroke dementia (PSD). D-amino acid oxidase (DAO) is a flavin-dependent enzyme widely distributed in the central nervous system. DAO oxidizes D-amino acids, a process which generates neurotoxic hydrogen peroxide and leads to neurodegeneration. This study aimed to examine post-stroke plasma DAO levels as a biomarker for PSD. In total, 53 patients with PSD, 20 post-stroke patients without dementia (PSNoD), and 71 age- and gender-matched normal controls were recruited. Cognitive function was evaluated at more than 30 days post-stroke. Plasma DAO was measured using the enzyme-linked immunosorbent assay. White matter hyperintensity (WMH), a neuroimaging biomarker of cerebral small vessel diseases, was determined by magnetic resonance imaging. We found that plasma DAO levels were independently higher in PSD subjects than in PSNoD subjects or the controls and were correlated with the WMH load in stroke patients. Using an area under the curve (AUC)/receiver operating characteristic analysis, plasma DAO levels were significantly reliable for the diagnosis of PSD. The sensitivity and specificity of the optimal cut-off value of 321 ng/ml of plasma DAO for the diagnosis of PSD were 75 and 88.7%, respectively. In conclusion, our data support that plasma DAO levels were increased in PSD patients and correlated with brain WMH, independent of age, gender, hypertension, and renal function. Plasma DAO levels may therefore aid in PSD diagnosis.
Background
We compared the clinical outcomes of patients with oral cavity squamous cell carcinoma (OCSCC) with cN+pN0 versus cN0pN0 disease.
Methods
A total of 1309 OCSCC patients with pN0 disease ...were included. Of them, 1019 and 290 cases had cN0pN0 and cN+pN0 disease, respectively. For comparison purposes, we also examined 799 patients with pN+disease (cN0pN+/cN+pN+, n = 239/560). Subgroup analysis was performed in a propensity score‐matched cohort with cN0pN0 and cN+pN0 disease (n = 284 each).
Results
Compared with cN0pN0, patients with cN+pN0 had a higher prevalence of the following variables: betel chewing, pT3−4, depth ≥10 mm, perineural invasion, and treatment with surgery and adjuvant therapy. The prognosis of patients with cN+pN0 (mean: 52 nodes) and cN0pN0 (mean: 39 nodes) disease was similar both in the original cohort and after propensity score matching. However, the 5‐year outcomes were more favorable for cN+pN0/cN0pN0 compared with cN0pN+/cN+pN+ (local control, 88%/88%/83%/81%; neck control, 94%/93%/82%/76%; distant metastases, 4%/3%/13%/31%; disease‐free survival, 84%/83%/68%/52%; disease‐specific survival, 92%/92%/77%/57%; overall survival, 81%/82%/59%/42%; all p values <0.001; cN+pN0 versus cN0pN0, all p values >0.05). cN+pN0 disease (vs. cN0pN0) was not significantly associated with local control, neck control, distant metastases, and survivals either in univariable or multivariable analyses.
Conclusions
Despite a higher risk factor burden, the prognosis of patients with cN+pN0 disease did not differ from that of cases with cN0pN0. The higher nodal yield and the more frequent use of adjuvant therapy in cN+pN0 disease may explain the lack of significant differences in terms of neck control compared with cN0pN0 disease.
Patients with oral cavity squamous cell carcinoma and cN+pN0 disease are characterized by a higher prevalence of adverse risk factors. However, this was not found to translate into a less favorable prognosis; therefore, the presence of cN+pN0 disease should not be considered as an adverse prognostic factor
Patients with diabetes are at increased risk of cancer development and osteoporosis. Metformin is an effective agent for diabetes management. Epidemiological studies have identified an association ...between metformin use and cancer prevention. This article outlines the potential for metformin to attenuate the rate of osteoporosis in diabetic patients with carcinoma in situ (CIS). From the National Health Insurance Research Database of Taiwan, 7827 patients with diabetes with CIS who were receiving metformin therapy were selected, along with 23,481 patients as 1:3 sex-, age- and index year-matched controls, who were not receiving metformin therapy. A Cox proportional hazard analysis was used to compare the rate of osteoporosis during an average of 15-year follow-up. Of the subjects who were enrolled, 801 (2.56%) had osteoporosis, including 168 from the metformin group (2.15%) and 633 from the without metformin group (2.70%). The metformin group presented a lower rate of osteoporosis at the end of follow-up (p = 0.009). The Cox proportional hazard regression analysis revealed a lower rate of osteoporosis for the metformin group (adjusted hazard ratio of 0.820; 95% confidence interval = 0.691–0.972, p = 0.022). Diabetic patients with CIS under metformin therapy presented lower osteoporosis rate than those who were not receiving metformin therapy.
•The prognosis of pN3b oral squamous cell carcinoma (OCSCC) remains heterogeneous.•SUV-nodal-max, LNR, and level IV/V metastases were independent prognosticators.•A scoring system based on these ...three factors improves prognostic stratification.Our results are expected to inform treatment and follow-up of this patient group.
The prognosis of pN3b oral cavity squamous cell carcinoma (OCSCC) remains heterogeneous. We sought to improve the prognostic stratification of patients with pN3b OCSCC through a combined analysis of FDG-PET parameters and clinicopathological risk factors (RFs).
From 2001 to 2019, complete data on maximum standardized uptake values derived from FDG-PET of neck metastatic nodes (SUV-nodal-max) and clinicopathological RFs were available for 257 patients with pN3b disease.
Using the 5-year disease-free survival (DFS) as the outcome of interest, the optimal cutoff points for SUV-nodal-max and lymph node ratio (LNR) were 15.9 and 0.17, respectively. The 5-year DFS rates/(number of cases) for patients with pN3b disease were as follows: SUV-nodal-max < 15.9 versus ≥ 15.9, 49%(226)/21%(31), p = 0.000003; LNR < 0.17 versus ≥ 0.17, 49%(230)/17%(27), p = 0.000117; absence versus presence of neck level IV/V metastases, 49%(230)/15%(27), p = 0.000004. Multivariable analyses revealed that SUV-nodal-max ≥ 15.9, LNR ≥ 0.17, and level IV/V metastases were independent prognosticators for 5-year distant metastases (DM), DFS, disease-specific survival (DSS), and overall survival (OS) rates. Based on these variables, we devised a scoring system that identified three distinct prognostic subgroups at low (score 0, n = 190), intermediate (score 1, n = 51), and high (scores 2–3, n = 16) risk. The 5-year rates of patients with pN3b disease deemed to be at low/intermediate/high risk were as follows: DM, 31%/52%/89%; DFS, 54%/26%/0%; DSS, 59%/36%/8%; OS, 42%/31%/6%, respectively; all p < 0.001.
A scoring system based on SUV-nodal-max, LNR, and level IV/V metastases improves the prognostic stratification of OCSCC patients with pN3b disease.
In the big data era, a huge number of services has placed a fast-growing demand on the capacity of DRAM-based main memory. However, due to the high hardware cost and serious leakage power/energy ...consumption, the growth rate of DRAM capacity cannot meet the increased rate of the required main memory space when the energy or hardware cost is a critical concern. To tackle this issue, hybrid main-memory devices/modules have been proposed to replace the pure DRAM main memory with a hybrid main memory module that provides a large main memory space by integrating a small-sized DRAM and a large-sized non-volatile memory (NVM) into the same memory module. Although NVMs have high-density and low-cost features, they suffer from the low read/write performance and low endurance issue, compared to DRAM. Thus, inside the hybrid main-memory module, it also includes a memory management design to use DRAM as the cache of NVMs to enhance its performance and lifetime. However, it also introduces new design challenges in both the OS and the memory module. In this work, we rethink the interactivity of OS and hybrid main-memory module, and propose a cross-layer cache design that (1) utilizes the information from the operating system to optimize the hit ratio of the DRAM cache inside the memory module, and (2) takes advantage of the bulk-size (or block-based) read/write feature of NVM to minimize the time overhead on the data movement between DRAM and NVM. At the same time, this cross-layer cache design is very lightweight and only introduces limited runtime management overheads. A series of experiments was conducted to evaluate the effectiveness of the proposed cross-layer cache design. The results show that the proposed design could improve access performance for up to 88%, compared to the investigated well-known page replacement algorithms.
Novel anti-corrosive coatings were prepared by replicating the fresh leaves of Xanthosoma sagittifolium, a species of tropical flowering plant. These coatings have the synergistic effect of ...superhydrophobicity and gas barrier properties. The superhydrophobic epoxy/organophilic clay (SEC) coating, prepared by a 3D-bioprinting technique based on the surface of fresh Xanthosoma sagittifoliumleaves, serves to protect cold-rolled steel (CRS) from corrosion. Initially, a negative-PDMS template was replicated from the hierarchical structure of fresh Xanthosoma sagittifoliumfoliage. Subsequently, SEC was coated on to a CRS electrode utilizing a 3D-bioprinting method with a negative-PDMS template and an epoxy/organophilic clay matrix solution as the ink. The CRS electrode coated with SEC was found to have a water contact angle (WCA) of 153 degree , which was much higher than that of a flat epoxy/organophilic clay (FEC) spin-coated CRS electrode (WCA = 94 degree ). Not only does the SEC coating exhibit superhydrophobicity, but it has gas barrier properties as well. It was expected that the introduction of an organophilic clay into an epoxy matrix would result in the anticorrosion properties being ameliorated because of the prolonged diffusion pathways of water vapor and oxygen. When the superhydrophobic structures of Xanthosoma sagittifoliumleaves are replicated on the epoxy/organophilic clay, the SEC coatings were found to have prominently enhanced corrosion protection compared to the corresponding CRS coated with a pristine epoxy resin and FEC, on the basis of a series of electrochemical corrosion measurements performed under both saline and acidic conditions.
•NCCN guidelines maintain that T4b OCSCC should be treated with non-surgical approach.•The 5-year survival rates were more favorable in patients with pT4a than pT4b OCSCC.•Compared with pT4a, pT4b ...tumors had a higher burden of pathological risk factors.•After PS matching, no outcome difference between pT4b and pT4a OCSCC was observed.•T4b OCSCC should undergo initial surgical excision if adequate resection is possible.
While the NCCN guidelines maintain that T4b oral cavity squamous cell carcinoma (OCSCC) should undergo either non-surgical treatments or clinical trials, promising outcomes of T4b OCSCC having surgical excision have been reported. We analyzed and compared the clinical outcomes of Taiwanese patients with pT4a and pT4b OCSCC who had undergone surgical treatment.
From 2011 to 2017, a total of 4031 and 355 patients with first primary pT4a and pT4b OCSCC were identified. A propensity score (PS)-matched analysis of patients (n = 351 each) for pT4a and pT4b tumors was also performed.
The 5-year disease-specific and overall survival (DSS/OS) rates were more favorable in patients with pT4a than in those with pT4b OCSCC (64%/55%, p < 0.0001; 55%/43%, p < 0.0001, respectively). Compared with pT4a, those with pT4b tumors had a higher burden of the following risk factors: buccal/retromolar/hard palate subsite, male sex, depth ≥ 10 mm, and positive margins. Before PS matching, multivariable analyses revealed that pT4b tumors (versus pT4a) were an adverse prognosticator for both 5-year DSS and OS (hazard ratios: 1.32 and 1.39, respectively). However, in the PS-matched cohort, no significant differences in 5-year DSS and OS rates were observed between pT4a and pT4b OCSCC (57%/56%, p = 0.4024; 48%/44%, p = 0.1807, respectively)
No significant outcome differences were evident between pT4b and pT4a OCSCC after PS matching. The most plausible hypothesis for the observed survival difference between T4a and T4b tumors is that it was driven by positive margins. We suggest that T4b OCSCC should undergo initial surgical excision if adequate resection is possible.
Indoor utilization of emerging photovoltaics is promising; however, efficiency characterization under room lighting is challenging. We report the first round-robin interlaboratory study of ...performance measurement for dye-sensitized photovoltaics (cells and mini-modules) and one silicon solar cell under a fluorescent dim light. Among 15 research groups, the relative deviation in power conversion efficiency (PCE) of the samples reaches an unprecedented 152%. On the basis of the comprehensive results, the gap between photometry and radiometry measurements and the response of devices to the dim illumination are identified as critical obstacles to the correct PCE. Therefore, we use an illuminometer as a prime standard with a spectroradiometer to quantify the intensity of indoor lighting and adopt the reverse-biased current–voltage (I–V) characteristics as an indicator to qualify the I–V sampling time for dye-sensitized photovoltaics. The recommendations can brighten the prospects of emerging photovoltaics for indoor applications.
Flexible electronics has recently captured extensive attention due to its intriguing functionalities and great potential for influencing our daily life. In addition, with the increasing demand for ...green energy, photoelectrochemical (PEC) water splitting is a clean process that directly converts solar energy to chemical energy in the form of hydrogen. Thus the development of flexible green energy electronics represents a new domain in the research field of energy harvesting. In this work, we demonstrate the BiVO
(BVO)/WO
/ITO/muscovite heterostructure photoelectrode for water splitting with flexible characteristics. The performance of BVO was modified by specific crystal facets, and the BVO/WO
bilayer exhibited superior performance of 33% enhanced PEC activity at 1 V vs Ag/AgCl compared with pure BVO due to the proper staggered band alignment. Moreover, excellent mechanical stability was verified by a series of bending modes. This study demonstrates a pathway to a flexible photoelectrode for developing innovative devices for solar fuel generation.
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