Engineering Metal Halide Perovskite Nanocrystals with BODIPY Dyes for Photosensitization and Photocatalytic Applications.

The sensitization of surface-anchored organic dyes on semiconductor nanocrystals through energy transfer mechanisms has received increasing attention owing to their potential applications in photodynamic therapy, photocatalysis, and photon upconversion. Here, we investigate the sensitization mechanisms through visible-light excitation of two nanohybrids based on CsPbBr3 perovskite nanocrystals (NC) functionalized with borondipyrromethene (BODIPY) dyes, specifically 8-(4-carboxyphenyl)-1,3,5,7-tetramethyl-4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BDP) and 8-(4-carboxyphenyl)-2,6-diiodo-1,3,5,7-tetramethyl-4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (I2-BDP), named as NC@BDP and NC@I2-BDP, respectively. The ability of I2-BDP dyes to extract hot hole carriers from the perovskite nanocrystals is comprehensively investigated by combining steady-state and time-resolved fluorescence as well as femtosecond transient absorption spectroscopy with spectroelectrochemistry and quantum chemical theoretical calculations, which together provide a complete overview of the phenomena that take place in the nanohybrid. Förster resonance energy transfer (FRET) dominates (82%) the photosensitization of the singlet excited state of BDP in the NC@BDP nanohybrid with a rate constant of 3.8 ± 0.2 × 1010 s-1, while charge transfer (64%) mediated by an ultrafast charge transfer rate constant of 1.00 ± 0.08 × 1012 s-1 from hot states and hole transfer from the band edge is found to be mainly responsible for the photosensitization of the triplet excited state of I2-BDP in the NC@I2-BDP nanohybrid. These findings suggest that the NC@I2-BDP nanohybrid is a unique energy transfer photocatalyst for oxidizing α-terpinene to ascaridole through singlet oxygen formation.

Influence of Crystallographic Structure and Metal Vacancies on the Oxygen Evolution Reaction Performance of Ni-based Layered Hydroxides.

Nickel-based layered hydroxides (LHs) are a family of efficient electrocatalysts for the alkaline oxygen evolution reaction (OER). Nevertheless, fundamental aspects such as the influence of the crystalline structure and the role of lattice distortion of the catalytic sites remain poorly understood and typically muddled. Herein, we carried out a comprehensive investigation on ɑ-LH, ß-LH and layered double hydroxide (LDH) phases by means of structural, spectroscopical, in-silico and electrochemical studies, which suggest the key aspect exerted by Ni-vacancies in the ɑ-LH structure. Density functional theory (DFT) calculations and X-ray absorption spectroscopy (XAS) confirm that the presence of Ni-vacancies produces acute distortions of the electroactive Ni sites (reflected as the shortening of the Ni-O distances and changes in the O-Ni-O angles), triggering the appearance of Ni localised electronic states on the Fermi level, reducing the Egap, and consequently, increasing the reactivity of the electroactive sites in the ɑ-LH structure. Furthermore, post-mortem Raman and XAS measurements unveil its transformation into a highly reactive oxyhydroxide-like phase that remains stable under ambient conditions. Hence, this work pinpoints the critical role of the crystalline structure as well as the electronic properties of LH structures on their inherent electrochemical reactivity towards OER catalysis. We envision Ni-based ɑ-LH as a perfect platform for hosting trivalent cations, closing the gap toward the next generation of benchmark efficient earth-abundant electrocatalysts.

Hexagonal Hybrid Bismuthene by Molecular Interface Engineering.

High-quality devices based on layered heterostructures are typically built from materials obtained by complex solid-state physical approaches or laborious mechanical exfoliation and transfer. Meanwhile, wet-chemically synthesized materials commonly suffer from surface residuals and intrinsic defects. Here, we synthesize using an unprecedented colloidal photocatalyzed, one-pot redox reaction a few-layers bismuth hybrid of "electronic grade" structural quality. Intriguingly, the material presents a sulfur-alkyl-functionalized reconstructed surface that prevents it from oxidation and leads to a tuned electronic structure that results from the altered arrangement of the surface. The metallic behavior of the hybrid is supported by ab initio predictions and room temperature transport measurements of individual nanoflakes. Our findings indicate how surface reconstructions in two-dimensional (2D) systems can promote unexpected properties that can pave the way to new functionalities and devices. Moreover, this scalable synthetic process opens new avenues for applications in plasmonics or electronic (and spintronic) device fabrication. Beyond electronics, this 2D hybrid material may be of interest in organic catalysis, biomedicine, or energy storage and conversion.

Presbylarynx: validation of a classification based on morphological characteristics.

PURPOSE: Validation of a classification to stratify presbylarynx into three types. METHODS: Evaluate the reproducibility of this classification. 30 video recordings of rigid laryngostroboscopies were presented to 20 otorhinolaryngologists from five tertiary hospitals: 10 residents and 10 specialists. Specialists with different differentiations were included. RESULTS: Among 1200 evaluations performed (30 video recordings × 20 raters, twice), average intra-rater agreement rate was 0.847 (p < 0.001). The average inter-rater reliability was 0.67 ± 0.179 on the first evaluation, and 0.691 ± 0.131 on the second evaluation. CONCLUSIONS: This study presented the validation of a classification that allows stratifying laryngeal endoscopic signs in elderly patients with presbyphonia. We believe that this classification will enrich the diagnostic protocol of the aging voice and will improve the documentation of treatment outcomes.

Geriatric otorhinolaryngology: reasons for outpatient referrals from generalists to ENT specialists.

PURPOSE: To determine the main symptoms leading to referral of geriatric patients from primary care to otorhinolaryngology. METHODS:  Retrospective, observational study performed on patients aged 65 and older, referred from Primary Care to the Otorhinolaryngology and Head and Neck Surgery department of a tertiary centre during 2019 and 2020. Symptoms leading to otorhinolaryngological referral were categorized as "Oto-neurological symptoms", "Nasal symptoms", "Pharyngolaryngeal symptoms", "Other Head and Neck symptoms" and "Other Reasons". Data regarding age, gender and whether patients maintain follow-up or have been discharged was also collected. RESULTS:  The study population included a total of 1304 patients (697 female; 607 male). Oto-neurological symptoms were found to be the most prevalent symptoms, with 65% of patients reporting oto-neurological symptoms as at least one of the reasons for referral. Hearing loss was the most commonly reported symptom, with an association found between this symptom and age (p < 0.001). Results also showed an association between the female gender and vertigo/dizziness (p < 0.001) and tinnitus (p = 0.007). An association between the male gender and nasal symptoms was also found (p = 0.018), particularly nasal obstruction (p = 0.003) and epistaxis (p = 0.028). No statistically significant associations were found among the pharyngolaryngeal group. CONCLUSIONS:  This retrospective observational study allowed for a better understanding of the type of otorhinolaryngological symptoms affecting elderly patients and driving otorhinolaryngology evaluation, cementing hearing loss as one of the major complaints among older adults and allowing for a better preparation by otorhinolaryngologists for the changing needs of this subset of the population.

Development and validation of a simple web-based tool for early prediction of COVID-19-associated death in kidney transplant recipients.

This analysis, using data from the Brazilian kidney transplant (KT) COVID-19 study, seeks to develop a prediction score to assist in COVID-19 risk stratification in KT recipients. In this study, 1379 patients (35 sites) were enrolled, and a machine learning approach was used to fit models in a derivation cohort. A reduced Elastic Net model was selected, and the accuracy to predict the 28-day fatality after the COVID-19 diagnosis, assessed by the area under the ROC curve (AUC-ROC), was confirmed in a validation cohort. The better calibration values were used to build the applicable ImAgeS score. The 28-day fatality rate was 17% (n = 235), which was associated with increasing age, hypertension and cardiovascular disease, higher body mass index, dyspnea, and use of mycophenolate acid or azathioprine. Higher kidney graft function, longer time of symptoms until COVID-19 diagnosis, presence of anosmia or coryza, and use of mTOR inhibitor were associated with reduced risk of death. The coefficients of the best model were used to build the predictive score, which achieved an AUC-ROC of 0.767 (95% CI 0.698-0.834) in the validation cohort. In conclusion, the easily applicable predictive model could assist health care practitioners in identifying non-hospitalized kidney transplant patients that may require more intensive monitoring. Trial registration: ClinicalTrials.gov NCT04494776.

A single injection of pregabalin induces short- and long-term beneficial effects on fear memory and anxiety-like behavior in rats with experimental type-1 diabetes mellitus.

Anxiety Disorders and Posttraumatic Stress Disorders (PTSD) associated with type-1 diabetes mellitus (T1DM) are increasingly common comorbidities and the treatment is quite challenging. In that sense, evidence indicates that the anticonvulsant pregabalin is highly effective in treating severe cases of anxiety, as well as PTSD and diabetic neuropathic pain which is also very prevalent in T1DM. Herein, the short- and long-term effects of a single injection of pregabalin on the acquisition of a fear extinction memory and parameters of anxiety in induced-T1DM animals were investigated. For that, we used the contextual fear conditioning (CFC) and elevated plus maze paradigms, respectively. A putative antioxidant activity was also evaluated. Our findings demonstrated that induced-T1DM animals presented greater expression of fear memory, difficulty in extinguishing this fear memory, associated with a more pronounced anxiety-like response. Pregabalin was able to induce a short and long-lasting effect by facilitating the acquisition of the fear extinction memory and inducing a later anxiolytic-like effect. Also, the increased lipid peroxidation levels in the hippocampus and prefrontal cortex of induced-T1DM rats were reduced after pregabalin injection, while the decreased levels of reduced glutathione were increased in the hippocampus. Despite the need for more studies to understand the mechanism of action of pregabalin under these conditions, our data demonstrate for the first time that a single injection of pregabalin in a specific time window was able to improve behavioral parameters in addition to inducing neuroprotective effect. Thus, pregabalin has potential worth exploring for the treatment of PTSD and/or Anxiety associated with T1DM.

Frontotemporal Lipofilling for Plagiocephaly Sequelae.

ABSTRACT: Plagiocephaly patients generally undergo corrective surgery in the first years of life, but during their growth malformative sequelae become apparent and can have a negative psychological and social impact. Volumetric filling techniques have been used to improve social balance and minimize such negative effects.We present a case of a 25 years old male with a history of plagiocephaly corrected by 8 months of age. He kept a bilateral frontotemporal defect and we performed a lipofilling of the affected areas. The aesthetic results were very satisfactory and 6 months and 1 year after the procedure he maintained a good volumetric filling. There were no complications during or after the procedure.Lipofilling provides good contouring results and has low complication rates. Its major inconvenient is adipose tissue resorption.As illustrated by this case, this type of treatment significantly improves facial appearance, raising patients' self-esteem and quality of life.

Exploring the causes of the high incidence of delayed graft function after kidney transplantation in Brazil: a multicenter study.

This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1-year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014-2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors (lower-bound-95%CI OR upper-bound-95%CI ) were male gender (1.066 1.2491.463 ), diabetic kidney disease (1.053 1.2961.595 ), time on dialysis (1.005 1.0071.009 ), retransplantation (1.035 1.3971.885 ), preformed anti-HLA antibodies (1.011 1.3831.892 ), HLA mismatches (1.006 1.0661.130 ), donor age (1.011 1.0171.023 ), donor final serum creatinine (sCr) (1.239 1.3171.399 ), cold ischemia time (CIT) (1.031 1.0431.056 ), machine perfusion (0.401 0.5420.733 ), and induction therapy with rabbit antithymocyte globulin (rATG) (0.658 0.8000.973 ). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers.

Physical properties of UHT light cream: impact of the high-pressure homogenization and addition of hydrocolloids.

The beneficial effects of a healthy diet on the quality of life have prompted the food industry to develop low-fat variants, but fat content directly affects the physicochemical and sensory properties of food products. The utilization of high-pressure homogenization (HP) and incorporation of hydrocolloids have been suggested as strategies to improve the physical stability and rheological properties of light cream. Thus, this study aims to analyze the associated effect of high-pressure homogenization (80 MPa) and three different hydrocolloids: microcrystalline cellulose, locust bean gum and xanthan gum, on emulsion stability and rheological properties of ultra-high-temperature (UHT) light cream (ULC) with a 15% w/w fat content. The stability of ULC was determined by the ζ potential of oil droplets and emulsion stability percentage. Rheological characterization was based on flow behavior tests and dynamic oscillatory measurements, which were carried out in a rheometer. Results showed that the high-pressure homogenization process did not influence the emulsion stability of the treatments. Moreover, the hydrocolloids added to systems present weak interactions with milk proteins since all ULC showed macroscopical phase separation. The samples presented the same rheological behavior and were classified as pseudoplastic fluids (n < 1). ULC treated at 80 MPa was significantly (P ≤ 0.05) more consistent than the treatments at 20 MPa. All ULC showed a predominant elastic behavior (G' > G″), and a remarkable increase in both G' and G″ at 80 MPa. The results presented in this study highlight the potential of HP for altering some rheological characteristics of UHT light cream, for example, to increase its consistency. These results are important for the dairy industry and ingredient suppliers, in the standardization of UHT light cream and/or to develop low-fat products.

Comprehensive analysis of peptides and low molecular weight components of the giant ant Dinoponera quadriceps venom.

Ants (Hymenoptera, Apocrita, Aculeata, Formicoidea) comprise a well-succeeded group of animals. Like bees and wasps, ants are mostly venomous, having a sting system to deliver a mixture of bioactive organic compounds and peptides. The predatory giant ant Dinoponera quadriceps belongs to the subfamily Ponerinae that includes one of the largest known ant species in the world. In the present study, low molecular weight compounds and peptides were identified by online peptide mass fingerprint. These include neuroactive biogenic amines (histamine, tyramine, and dopamine), monoamine alkaloid (phenethylamine), free amino acids (e.g. glutamic acid and proline), free thymidine, and cytosine. To the best of our knowledge, most of these components are described for the first time in an ant venom. Multifunctional dinoponeratoxin peptide variants (pilosulin- and ponericin-like peptides) were characterized that possess antimicrobial, hemolytic, and histamine-releasing properties. These venom components, particularly peptides, might synergistically contribute to the overall venom activity and toxicity, for immobilizing live prey, and for defending D. quadriceps against aggressors, predators, and potential microbial infection.

Fundamental Insights into the Covalent Silane Functionalization of NiFe Layered Double Hydroxides.

Layered double hydroxides (LDHs) are a class of 2D anionic materials exhibiting wide chemical versatility and promising applications in different fields, ranging from catalysis to energy storage and conversion. However, the covalent chemistry of this kind of 2D materials is still barely explored. Herein, the covalent functionalization with silanes of a magnetic NiFe-LDH is reported. The synthetic route consists of a topochemical approach followed by anion exchange reaction with surfactant molecules prior to covalent functionalization with the (3-aminopropyl)triethoxysilane (APTES) molecules. The functionalized NiFe-APTES was fully characterized by X-ray diffraction, infrared spectroscopy, electron microscopy, thermogravimetric analysis coupled with mass spectrometry and 29 Si solid-state nuclear magnetic resonance, among others. The effect on the electronic properties of the functionalized LDH was investigated by a magnetic study in combination with Mössbauer spectroscopy. Moreover, the reversibility of the silane-functionalization at basic pH was demonstrated, and the quality of the resulting LDH was proven by studying the electrochemical performance in the oxygen evolution reaction in basic media. Furthermore, the anion exchange capability for the NiFe-APTES was tested employing CrVI , resulting in an increase of 200 % of the anion retention. This report allows for a new degree of tunability of LDHs, opening the door to the synthesis of new hybrid architectures and materials.

Murine osteoclastogenesis suppression using conditioned media produced by melanoma or activated and non-activated Jurkat-E6 cells.

Conditioned medium (CM) (cell secretome) is a cocktail of growth factors, cytokines, and other soluble mediators secreted by cells into a culture medium. These growth factors are fundamental in many cellular processes such as cell growth, differentiation, and others and the composition of these factors is individual for each cell type. Osteoclasts are large multinucleated cells that are responsible for bone resorption. Immune and cancer cells are known to produce different growth factors, which are able to induce or inhibit osteoclast differentiation. Herein, we evaluated the effect of CM obtained from the supernatant of activated and non-activated Jukart-E6 cells, as well as from one murine (B16-F10) and one human melanoma cell line (SK-MEL-28). To induce osteoclast differentiation, murine bone marrow mononuclear cells were cultured in the presence and absence of differentiation factors (DF), such as macrophage colony-stimulating factor, prostaglandin E2, receptor activator of nuclear factor-κB ligand, and CM. We measured the concentration of interleukin 6, tumor necrosis factor-α and interferon γ (IFN-γ) in CM that can inhibit or induce osteoclastogenesis. Our study demonstrated that CM obtained from each cell line suppresses or inhibits osteoclasts formation at early and intermediate stages of differentiation in the absence or presence of DF. CM obtained from activated Jurkat-E6 cells demonstrates a stronger effect when compared with CM from naïve Jurkat-E6 cells or human and murine melanoma cells. Moreover, CM obtained from activated Jurkat-E6 cells shows higher secretion of IFN-γ, which is an inhibitor of osteoclastogenesis, in comparison with CM obtained from the three other cell lines. On the other hand, CM derived from B16-F10 cells showed a smaller inhibitory effect when compared with CM derived from the other cells.

Comparative Analysis of the Collapsibility Index and Distensibility Index of the Inferior Vena Cava Through Echocardiography with Pulse Pressure Variation That Predicts Fluid Responsiveness in Surgical Patients: An Observational Controlled Trial.

OBJECTIVE: The objective for the present study was to compare the collapsibility (IcIVC) and distensibility (IdIVC) indices of the inferior vena cava with pulse pressure variation (PPV) and determine the accuracy and cutoff points of IcIVC and IdIVC that best predict response to intravenous fluid therapy in surgical patients. DESIGN: Observational, prospective, nonblinded, single center. SETTING: Hospital do Servidor Público Estadual de São Paulo, in São Paulo, Brazil. PARTICIPANTS: Volunteer surgical patients. INTERVENTIONS: This prospective study evaluated adult surgical patients before and after they underwent mechanical ventilation. IcIVC and IdIVC measurements were obtained with echocardiography and PPV through arterial catheterization. MEASUREMENTS AND MAIN RESULTS: Twenty-two patients with a mean age of 55.7 ± 10.9 years were included; 31.8% of the study participants had PPV values >13% and were shown to be responsive to fluid. A good correlation was detected between PPV and icIVC (R2 = 0.71; p < 0.001) and between PPV and idIVC (R2 = 0.79; p < 0.001). The area under the receiver operating characteristic curve was 0.98 for icIVC (95% confidence interval 0.81-0.99; p < 0.001) and 0.88 for idIVC (95% confidence interval 0.67-0.98; p < 0.001). CONCLUSIONS: PPV was found to have good correlation with the inferior vena cava diameter variation using echocardiography in surgical patients undergoing spontaneous and artificial ventilation. The cutoff values that best predicted PPV >13% were >40% for icIVC and >17.6% for idIVC.

Functional facial reconstruction in a patient with severe burn sequelae with a prelaminated parascapular free flap based on a three-dimensional model: A case report.

Significant evolution has been made concerning resuscitation and emergency management of severely burned patients, and nowadays most patients will survive and deal with burns sequelae. They constitute a reconstructive challenge, mainly because options and donor areas are frequently compromised, results are often limited, and other options should then be considered. A 27-year-old male patient with 55% total burn surface area, presented with severe facial disfigurement including ectropion, upper/lower lip retraction, and partial loss of the nose. In order to improve the patient's condition, autologous reconstruction was considered. The only unburned area in the body was the left dorsal region, and a three-stage reconstruction was planned using a paraescapular flap. In a first stage, an elective surgery was performed to identify and tag the recipient vessels in the neck. After 3 months, the prelamination process was initiated with the drawing of a facial model, and a nose and lips were opened inside the flap. This was based on a three-dimensional latex model as a print of the patient's face, which allowed us to calculate distances and estimate the length of the vascular pedicles. After 3 months, the flap (18 × 8 cm) was transferred and microvascular anastomoses were performed. No major complications were seen after surgeries, and after 28 months, an extremely important functional gain was obtained. Despite the number of surgeries required and less than optimal aesthetic results, this method may offer a satisfactory solution for complex acquired facial burn sequelae when other local or distant flap options are not available.

Facial Reconstruction Based on Combined Three-Dimensional Printing and Microsurgical Free Transfer.

There are patients with craniofacial deformity that can lead to extensive bone loss and severe disfigurement. Autologous reconstruction may be challenging in these patients, and it is usually associated with flap donor area morbidity and unfavorable aesthetic and functional results. A 51-year-old patient with human immunodeficiency virus infection, developed in the context of immunosuppression a fulminant fungal rhino-sinusitis with the need for surgical debridement, and in consequence extensive destruction of the nasal cavity and upper jaw, resulting in severe disfigurement due to nasal deformity and maxillary collapse. Human immunodeficiency virus disease was controlled and the complex craniofacial defect was posteriorly reconstructed with direct 3-dimensional (3D) printing combined with microsurgical free tissue transfer. The 3D facial implant, in titanium, was individualized and fabricated based on computed tomography images of the patient. A radial forearm free flap was used since a soft-tissue defect was anticipated after scar release and implant placement. It allowed simultaneous coverage of the palate, the anterior surface of maxilla and intranasal lining. The flap survived despite flap venous congestion in the postoperative period probably facilitated because of the complex 3D flap configuration and pedicle tunneling into the neck. After 9 months, the patient showed a tremendous aesthetic and functional improvement. The 3D printing was useful in our patient with craniofacial reconstruction. Its combination with free tissue transfer may improve the surgeon's armamentarium when dealing with complex patients.

Comprehensive analysis of peptides and low molecular weight components of the giant ant Dinoponera quadriceps venom.

Ants (Hymenoptera, Apocrita, Aculeata, Formicoidea) comprise a well-succeeded group of animals. Like bees and wasps, ants are mostly venomous, having a sting system to deliver a mixture of bioactive organic compounds and peptides. The predatory giant ant Dinoponera quadriceps belongs to the subfamily Ponerinae that include one of the largest known ant species in the world. In the present study, low molecular weight compounds and peptides were identified by on-line peptide mass fingerprint. These include neuroactive biogenic amines (histamine, tyramine, and dopamine), monoamine alkaloid (phenethylamine), free amino acids (e.g., glutamic acid and proline), free thymidine and cytosine. To the best of our knowledge most of these components are described for the first time in an ant venom. Multifunctional dinoponeratoxin peptides variants (pilosulin- and ponericin-like peptides) were characterized that possess antimicrobial, hemolytic, and histamine-releasing properties. These venom components, particularly peptides, might synergistically contribute to the overall venom activity and toxicity, for immobilizing live prey, and defending D. quadriceps against aggressors, predators and potential microbial infection.

Optimizing the clinical utility of sirolimus-based immunosuppression for kidney transplantation.

While calcineurin inhibitors (CNIs) are effective for preventing acute rejection in kidney transplant recipients, long-term use may cause chronic kidney injury and is associated with increased risks of cardiovascular events, cancer, and infection-associated death. Immunosuppression strategies are needed to balance risks of acute and subclinical rejection with long-term benefits of improved kidney function. Sirolimus, an inhibitor of mammalian target of rapamycin, is used for immunosuppression in kidney transplantation. Its clinical utility has evolved, over more than 15 years, including de novo sirolimus with and without concomitant CNIs and conversion from CNI-based regimens to sirolimus. Sirolimus-containing regimens are associated with preservation of good renal function, with promising characteristics for improving long-term graft and patient survival, including antiviral and anticancer effects. Based on clinical evidence, use of low-dose sirolimus in a de novo approach with tacrolimus/steroids in the immediate posttransplantation period is appropriate. A feasible alternative is a long term, CNI-free combination with mycophenolate mofetil (following CNI-to-sirolimus conversion at 3-6 months). These strategies are appropriate for a broad range of patients with various levels of immunologic risk, including those receiving expanded criteria donor kidneys or at increased risk of delayed graft function, particular challenges in Latin America and other global regions.

Giant Tongue in a Patient With Chiari Malformation and Neuroleptic-Induced Tardive Dyskinesia.

A 68-year-old woman, presented with a squamous cell carcinoma of the malar region, and underwent wide local excision. During her clinical examination, repetitive protrusion and intrusion of the tongue as well as stereotypic, abnormal movements of the mouth and lips were observed, in a pattern that resembled chewing, sucking or lip pursing; dyskinesias ceased when she was speaking or bringing food to the mouth. She was unaware of the movements and the tongue was observed to move similar to choreiform movements, while revealing a giant "snake-like" macroglossia. She had history of mental retardation and alcohol abuse, and was under classic antipsychotic medications for several years. During a previous neurological investigation, type I Chiari malformation was diagnosed. In this case, concomitant Chiari malformation and neuroleptic-induced tardive dyskinesia, may together have been responsible for giant macroglossia, and to our best knowledege no similar observation has been reported in the literature.

The Facial Artery Perforator Flap as a New Option for Reconstruction of Intraoral Defects: Surgical Tips and Clinical Series.

BACKGROUND: The authors have recently 1st described the use of the facial artery perforator flap (FAP) for intraoral reconstruction. In this study, they discuss technical notes and surgical tips associated with the procedure and the application of this flap in 4 patients with intraoral defects resulting from cancer or osteoradionecrosis. METHODS: A retrospective study of 4 consecutive patients was performed on all patients who underwent reconstruction of an intraoral defect with a FAP flap, over a 12-month period from March 2017 to March 2018.The flap was designed according to the size of the defect centered on the perforator and was tunneled intraorally by means of a 90° rotation or advanced medially. The most constantly encountered perforator 1.5 cm lateral to the oral commissure was used in 3 cases; a cranial perforator was selected in 1 patient. RESULTS: Four FAP flaps were used in 4 patients with intraoral defects. Follow-up was 6 to 12 months. Median defect size was 9.15 cm (range, 3.4-21.5 cm). All reconstructions were successful, without major flap loss or infections. One patient with severe osteoradionecrosis and fungal infection developed minor flap loss and dehiscence, which was treated conservatively. There were no signs of local recurrence and functional outcomes were satisfactory. CONCLUSIONS: The FAP flap is an effective and versatile solution for reconstruction of intraoral defects until 5 cm × 4 cm (20 cm) without significant donor-site morbidity. It may be considered a new reconstructive option for intraoral defects, which warrants further study in a larger series or patients.