Plasma copolymers (PCPs) of allyl alcohol/1,7-octadiene were prepared and characterized using X-ray photoelectron spectroscopy (XPS), time-of-flight secondary ion mass spectrometry (ToF-SIMS), and ...contact angle measurements. The use of a hydrocarbon diluent in the monomer feed allowed the deposition of films with controlled concentrations of hydroxyl groups. ToF-SIMS data have shown these PCPs to be rich in unsaturation. Dimeric allyl alcohol species were observed in the ToF-SIMS spectra, which reduced in intensity with the proportion of hydrocarbon diluent in the monomer feed. Contact angle measurements have shown the nondispersive component of surface energy to increase with hydroxyl group concentration, while the dispersive component remained approximately constant. Human keratinocytes were cultured on these PCP surfaces and collagen I. The level of keratinocyte attachment over 24 h was measured. Keratinocyte attachment increased with hydroxyl group concentration (the nondispersive component of surface energy). PCP surfaces containing high concentrations of hydroxyl groups (25%) were found to promote levels of keratinocyte attachment similar to that on collagen I, a well-established substratum for keratinocyte attachment.
We retrospectively investigated prophylactic tracheostomy use in head and neck free‐flap reconstruction to identify groups of patients who avoided tracheostomy. Long operative time, resection site, ...number of resected subsites, floor of mouth resection, glossectomy, lingual release, extent of tongue resection and soft palate resection were all significantly associated with tracheostomy use. In a well‐supported, high‐volume centre, a personalized approach can avoid unnecessary tracheostomy use in head and neck free‐flap reconstruction.
Background
Head and neck surgeons are moving away from routine tracheostomy in free‐flap reconstruction. We reviewed prophylactic tracheostomy use in patients undergoing oral cavity or oropharynx free‐flap reconstruction to identify patient groups who avoided tracheostomy. Secondary aims were to describe complications associated with and without tracheostomy.
Methods
A retrospective cohort study was undertaken, using a prospectively maintained database. Inclusion criteria was free‐flap reconstruction for an oral cavity or oropharyngeal defect, excluding partial or total laryngectomy. Variables collected included demographics, comorbidity, American Society of Anesthesiologists grade, Charlson Comorbidity Index, tumour site and subsite, extent of resection, surgery duration, tracheostomy, complications, return to theatre and re‐intubation.
Results
A total of 344 head and neck free‐flap reconstructions were performed between January 2017 and July 2019. A total of 164 (87.7%) oral cavity and 23 (12.3%) oropharyngeal reconstructions were included totalling 187 free flaps. A total of 107 (57.2%) were males and 80 (42.8%) females, mean age 62.4 years (range 21–89). Of 187 patients, 100 (53.5%) underwent prophylactic tracheostomy at time of reconstruction. Longer operative time (P < 0.001), resection site (P < 0.001), number of subsites resected (P = 0.007), segmental mandibulectomy (P = 0.04), lip‐split (P = 0.05), floor of mouth resection (P < 0.001), lingual release (P = 0.007), glossectomy (P < 0.001), extent of tongue resection (P < 0.001), extent of hard palate resection (P = 0.04), soft palate resection (P < 0.001) and double free‐flap reconstruction (P = 0.04) were associated with tracheostomy use.
Conclusion
A personalized approach to postoperative airway management allowed almost half of our cohort to avoid tracheostomy. In high‐volume institutions with the necessary expertise and support, appropriately selected patients may be safely managed without routine tracheostomy.
Background
Microvascular free‐flap reconstruction of the head and neck is a common technique utilized across many ages. The purpose of this study was to identify if advanced age or comorbidity was ...associated with worse post‐operative outcomes in patients undergoing free‐flap reconstruction.
Methods
A retrospective analysis was performed on 344 consecutive patients undergoing free‐flap surgery of the head and neck. Demographic, clinical and pathological factors were considered along with Charlson Comorbidity Index (CCI) scores and American Society of Anesthesiologists (ASA) status. Logistic regression analysis was used to investigate the association of age, CCI or ASA with post‐operative complications.
Results
Elderly patients (≥75 years) had a higher overall complication rate (odds ratio (OR) 1.7, P = 0.04) that was restricted to medical complications (OR 2.1, P = 0.05) and not surgical complications (OR 1.4, P = 0.14). Reconstructions of defects from cutaneous malignancy predominated in the elderly cohort (48% versus 29%, P < 0.01), but there was no difference in complication rate when cutaneous or mucosal subgroups were separated by age. ASA IV status was weakly associated with surgical complications (OR 3.89, P = 0.053), but CCI and elderly age were not associated with any outcome. Median length of stay was similar between age groups.
Conclusion
Free‐flap reconstruction in older patients was associated with increased medical complications, and surgical complications were weakly associated with ASA status. Advanced age or comorbidity should not preclude microvascular reconstruction, but comorbid status should be optimized pre‐operatively and factors predisposing to medical complications minimized where possible.
In this study, 344 head and neck patients undergoing reconstructive surgery were investigated if elderly age or comorbidity predicted poor outcome. Elderly age (>75 years) was associated with medical complications, and surgical complications were weakly associated with American Society of Anesthesiologist IV status. Advanced age or comorbidity should not preclude microvascular reconstruction, but comorbid status should be optimized pre‐operatively and factors predisposing to medical complications minimized where possible.
Oral Antiviral (OAV) COVID-19 treatments are widely used, but evidence for their effectiveness against the Omicron variant in higher risk, vaccinated individuals is limited.
Retrospective study of ...two vaccinated cohorts of COVID-19 cases aged ≥70 years diagnosed during a BA.4/5 Omicron wave in Victoria, Australia. Cases received either nirmatrelvir-ritonavir or molnupiravir as their only treatment. Data linkage and logistic regression modelling was used to evaluate the association between treatment and death and hospitalisation and compared with no treatment.
Of 38,933 individuals in the mortality study population, 13.5% (n = 5250) received nirmatrelvir-ritonavir, 51.3% (n = 19,962) received molnupiravir and 35.2% (n = 13,721) were untreated. Treatment was associated with a 57% (OR = 0.43, 95% CI 0.36–0.51) reduction in the odds of death, 73% (OR = 0.27, 95% CI 0.17–0.40) for nirmatrelvir-ritonavir and 55% (OR = 0.45, 95% CI 0.38–0.54) for molnupiravir. Treatment was associated with a 31% (OR = 0.69, 95% CI 0.55–0.86) reduction in the odds of hospitalisation, 40% (OR = 0.60, 95% CI 0.43–0.83) for nirmatrelvir-ritonavir and 29% (OR = 0.71, 95% CI 0.58–0.87) for molnupiravir. Cases treated within 1 day of diagnosis had a 61% reduction in the odds of death (OR = 0.39, 95% CI 0.33–0.46) compared with 33% reduction for a delay of 4 or more days (OR = 0.67, 95% CI 0.44–0.97).
Treatment with both nirmatrelvir-ritonavir or molnupiravir was associated with a reduction in death and hospitalisation in vaccinated ≥70 years individuals during the Omicron era. Timely, equitable treatment with OAVs is an important tool in the fight against COVID-19.
There was no funding for this study.
Numerous difficulties are associated with the conduct of preclinical studies related to skin and wound repair. Use of small animal models such as rodents is not optimal because of their physiological ...differences to human skin and mode of wound healing. Although pigs have previously been used because of their human-like mode of healing, the expense and logistics related to their use also renders them suboptimal. In view of this, alternatives are urgently required to advance the field. The experiments reported herein were aimed at developing and validating a simple, reproducible, three-dimensional ex vivo de-epidermised dermis human skin equivalent wound model for the preclinical evaluation of novel wound therapies. Having established that the human skin equivalent wound model does in fact "heal," we tested the effect of two novel wound healing therapies. We also examined the utility of the model for studies exploring the mechanisms underpinning these therapies. Taken together the data demonstrate that these new models will have wide-spread application for the generation of fundamental new information on wound healing processes and also hold potential in facilitating preclinical optimization of dosage, duration of therapies, and treatment strategies prior to clinical trials.
This study examined the associations between pesticide exposure, genetic polymorphisms for NAD(P)H:quinone oxidoreductase I (NQO1) and superoxide dismutase 2 (SOD2), and urinary bladder cancer risk ...among male agricultural workers in Egypt. Logistic regression was used to analyze data from a multicenter case-control study and estimate adjusted odds ratio (OR) and 95% confidence interval (CI). Exposure to pesticides was associated with increased bladder cancer risk (odds ratio (95% confidence interval): 1.68 (1.23-2.29)) in a dose-dependent manner. The association was slightly stronger for urothelial (1.79 (1.25-2.56)) than for squamous cell (1.55 (1.03-2.31)), and among participants with combined genotypes for low NQO1 and high SOD2 (2.14 (1.19-3.85)) activities as compared with those with high NQO1 and low SOD2 genotypes (1.53 (0.73-3.25)). In conclusion, among male agricultural workers in Egypt, pesticide exposure is associated with bladder cancer risk and possibly modulated by genetic polymorphism.
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