Effect of Perioperative Antithrombotics on Postoperative Transfusion and Hematoma in Head and Neck Free Flaps.

Objective: To explore if antiplatelet or anticoagulant therapy increases the risk of transfusion requirement or postoperative hematoma formation in patients undergoing microvascular reconstruction for head and neck defects. Study Design: Retrospective cohort study. Setting: Departments of Otolaryngology-Head and Neck Surgery at the University of Alabama at Birmingham, the University of Colorado, and the University of California Irvine. Methods: A multi-institutional, retrospective review on microvascular reconstruction of the head and neck between August 2013 to July 2021. Perioperative antithrombotic data were collected to examine predictors of postoperative transfusion and hematoma. Results: A total of 843 free flaps were performed. Preoperative hemoglobin, hematocrit, operative time, and flap type were positive predictors of postoperative transfusion in both bivariate (P < .0001) and multivariate analyses (P < .0001). However, neither anticoagulation nor antiplatelet therapy were predictive of postoperative transfusion rates and hematoma formation. Conclusion: Antithrombotic regimens do not increase the risk of postoperative transfusion or hematoma in head and neck microvascular reconstruction. Based on this limited data, perioperative antithrombotic regimens can be considered in patients who may otherwise be at risk for these postoperative complications.

Synthesis and Characterization of Antimicrobial Hydrophobic Polyurethane.

Food borne illness remains a major threat to public health despite new governmental guidelines and industry standards. Cross-contamination of both pathogenic and spoilage bacteria from the manufacturing environment can promote consumer illness and food spoilage. While there is guidance in cleaning and sanitation procedures, manufacturing facilities can develop bacterial harborage sites in hard-to-reach areas. New technologies to eliminate these harborage sites include chemically modified coatings that can improve surface characteristics or incorporate embedded antibacterial compounds. In this article we synthesize a 16 carbon length quaternary ammonium bromide (C16QAB) modified polyurethane and perfluoropolyether (PFPE) copolymer coating with low surface energy and bactericidal properties. The introduction of PFPE to the polyurethane coatings lowered the critical surface tension from 18.07 mN m-1 in unmodified polyurethane to 13.14 mN m-1 in modified polyurethane. C16QAB + PFPE polyurethane was bactericidal against Listeria monocytogenes (>6 log reduction) and Salmonella enterica (>3 log reduction) after just eight hours of contact. The combination of low surface tension from the perfluoropolyether and antimicrobial from the quaternary ammonium bromide produced a multifunctional polyurethane coating suitable for coating on non-food contact food production surfaces to prevent survival and persistence of pathogenic and spoilage organisms.

Reactive Extrusion of Nonmigratory Active and Intelligent Packaging.

The environmental and economic burden of food waste demands new preservation technologies to reduce the degradative actions of spoilage such as moisture, oxygen, and microorganisms. Direct food additives can help maintain product quality; however, the limited life span of these additives combined with consumer desire for "clean label" products has motivated research into new food manufacturing technologies like active and intelligent packaging that can prevent and detect food spoilage. In this work, curcumin was grafted to polypropylene (PP-g-Cur) via reactive extrusion to produce nonmigratory active and intelligent packaging through a solvent-free, efficient, and continuous method. Immobilization of curcumin was confirmed by a standard migration assay exhibiting a maximum of 0.011 mg/cm2 migration, significantly below the EU migratory limit for food contact materials (0.1 mg/cm2). Compared to native PP films, PP-g-Cur films blocked 93% of UV light while retaining 64% transparency in the visible region, allowing for desirable product visibility while inhibiting UV degradation of packaged goods. While the ability of PP-g-Cur to inhibit growth of E. coli and L. monocytogenes was insignificant compared to control PP, free curcumin exhibited poor bacterial inhibition as well, suggesting that without hydrophilic modification, native curcumin has limited antimicrobial efficacy. PP-g-Cur films displayed significant radical scavenging in both organic (11.71 ± 3.02 TroloxEq (nmol/cm2)) and aqueous (3.18 ± 1.04 TroloxEq (nmol/cm2)) matrices, exhibiting potential for antioxidant behavior in both lipophilic and hydrophilic applications. Finally, when PP-g-Cur films were exposed to ammonia, an indicator of microbial growth, the color visually and quantitatively changed from yellow to red, demonstrating potential to indicate spoilage. These findings demonstrate the potential of a scalable technology to produce active and intelligent packaging to limit food waste and advance the capabilities of functional materials in a variety of applications.

Effect of Perioperative Antithrombotics on Head and Neck Microvascular Free Flap Survival After Anastomotic Revision.

OBJECTIVE: To determine if antithrombotic therapy improves head and neck microvascular free flap survival following anastomotic revision. STUDY DESIGN: A retrospective review of all patients with microvascular free tissue transfer to the head and neck between August 2013 and July 2021. SETTING: Otolaryngology-Head and Neck Surgery Departments at University of Alabama at Birmingham, University of Colorado, and University of California Irvine. METHODS: Perioperative use of anticoagulation, antiplatelets, intraoperative heparin bolus, tissue plasminogen activator (tPA) and vasopressor use, and leech therapy were collected plus microvascular free flap outcomes. The primary endpoint was free flap failure. Analyses of free flaps that underwent anastomotic revision with or without thrombectomy were performed. RESULTS: A total of 843 microvascular free flaps were included. The overall rate of flap failure was 4.0% (n = 34). The overall rate of pedicle anastomosis revision (artery, vein, or both) was 5.0% (n = 42) with a failure rate of 47.6% (n = 20) after revision. Anastomotic revision significantly increased the risk of flap failure (odds ratio [OR] 52.68, 95% confidence interval [CI] [23.90, 121.1], p < .0001) especially when both the artery and vein were revised (OR 9.425, 95% CI [2.117, 52.33], p = .005). Free flap failure after the anastomotic revision was not affected by postoperative antiplatelet therapy, postoperative prophylactic anticoagulation, intraoperative heparin bolus, tPA, and therapeutic anticoagulation regardless of which vessels were revised and if a thrombus was identified. CONCLUSION: In cases of microvascular free tissue transfer pedicle anastomotic revision, the use of antithrombotic therapy does not appear to significantly change free flap survival outcomes.

A high-throughput expression and screening platform for applications-driven PETase engineering.

The environmental consequences of plastic waste have impacted all kingdoms of life in terrestrial and aquatic ecosystems. However, as the burden of plastic pollution has increased, microbes have evolved to utilize anthropogenic polymers as nutrient sources. Of depolymerase enzymes, the best characterized is PETase, which hydrolyzes aromatic polyesters. PETase engineering has made impressive progress in recent years; however, further optimization of engineered PETase toward industrial application has been limited by lower throughput techniques used in protein purification and activity detection. Here, we address these deficiencies through development of a higher-throughput PETase engineering platform. Secretory expression via YebF tagging eliminates lysis and purification steps, facilitating production of large mutant libraries. Fluorescent detection of degradation products permits rapid screening of depolymerase activity in microplates as opposed to serial chromatographic methods. This approach enabled development of more stable PETase, semi-rational (SR) PETase variant containing previously unpublished mutations. SR-PETase releases 1.9-fold more degradation products and has up to 7.4-fold higher activity than wild-type PETase over 10 days at 40°C. These methods can be adapted to a variety of chemical environments, enabling screening of PETase mutants in applications-relevant conditions. Overall, this work promises to facilitate advancements in PETase engineering toward industrial depolymerization of plastic waste.

Consumers Respond Positively to the Sensory, Health, and Sustainability Benefits of the Rare Sugar Allulose in Yogurt Formulations.

Increased added sugar consumption is associated with type II diabetes, metabolic syndrome, and cardiovascular disease. Low and no-calorie alternative sweeteners have long been used as an aid in the reduction of added sugar. Unfortunately, these alternative sweeteners often have notable sensory deficits when compared to sucrose. Furthermore, many alternative sweeteners have synthetic origins, while consumers are increasingly turning to foods from natural origins, and from more sustainable sources. Such sweeteners include the rare sugar allulose, which can be manufactured from common agricultural waste and dairy co-product streams, and is reported to have a sensory profile similar to sucrose. This study aimed to determine the influence of the rare sugar allulose on consumer perception of sweetened vanilla yogurt. Participants were recruited to evaluate 4 vanilla yogurts sweetened with either sucrose, allulose, stevia or sucralose, and to rate their liking of the samples overall, and for flavor, texture, and their purchase intent. Statistical analysis of hedonic data from 100 consumers suggested that allulose performed similarly to sucrose in liking and purchase intent, and superior to other sweeteners tested in this study, with fewer off-flavors. Moreover, when consumers were queried on their purchase intent after learning details on the sweetener for each formulation, allulose scored significantly higher than all other formulations in purchase intent. This study highlights the potential of the rare sugar allulose as a low calorie, zero glycemic index, natural and better tasting sugar replacement in sweetened yogurt.

A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC.

Five-year survival for human papilloma virus-unrelated head and neck squamous cell carcinomas remain below 50%. We assessed the safety of administering combination hypofractionated stereotactic body radiation therapy with single-dose durvalumab (anti-PD-L1) neoadjuvantly (n = 21) ( NCT03635164 ). The primary endpoint of the study was safety, which was met. Secondary endpoints included radiographic, pathologic and objective response; locoregional control; progression-free survival; and overall survival. Among evaluable patients at an early median follow-up of 16 months (448 d or 64 weeks), overall survival was 80.1% with 95% confidence interval (95% CI) (62.0%, 100.0%), locoregional control and progression-free survival were 75.8% with 95% CI (57.5%, 99.8%), and major pathological response or complete response was 75% with 95% exact CI (51.6%, 100.0%). For patients treated with 24 Gy, 89% with 95% CI (57.1%, 100.0%) had MPR or CR. Using high-dimensional multi-omics and spatial data as well as biological correlatives, we show that responders had: (1) an increase in effector T cells; (2) a decrease in immunosuppressive cells; and (3) an increase in antigen presentation post-treatment.

Trehalose and its applications in the food industry.

Trehalose is a nonreducing disaccharide composed of two glucose molecules linked by α, α-1,1-glycosidic bond. It is present in a wide variety of organisms, including bacteria, fungi, insects, plants, and invertebrate animals. Trehalose has distinct physical and chemical properties that have been investigated for their biological importance in a range of prokaryotic and eukaryotic species. Emerging research on trehalose has identified untapped opportunities for its application in the food, medical, pharmaceutical, and cosmetics industries. This review summarizes the chemical and biological properties of trehalose, its occurrence and metabolism in living organisms, its protective role in molecule stabilization, and natural and commercial production methods. Utilization of trehalose in the food industry, in particular how it stabilizes protein, fat, carbohydrate, and volatile compounds, is also discussed in depth. Challenges and opportunities of its application in specific applications (e.g., diagnostics, bioprocessing, ingredient technology) are described. We conclude with a discussion on the potential of leveraging the unique molecular properties of trehalose in molecular stabilization for improving the safety, quality, and sustainability of our food systems.

Directed Immobilization of PETase on Mesoporous Silica Enables Sustained Depolymerase Activity in Synthetic Wastewater Conditions.

Microplastic accumulation in terrestrial and aquatic environments is a growing environmental challenge. Biodegradation has shown promise as an intervention strategy for reducing the spread of microplastics. The wastewater treatment system is a key intervention point in microplastic biodegradation due to its pivotal role in the water cycle at the interface between human activity and the environmental. However, the best characterized microplastic degradation enzyme, PETase, lacks the stability to perform at scale in wastewater treatment. In this work, we show that genetic fusion of PETase to a silica binding peptide enables directed immobilization of the enzyme onto silica nanoparticles. PETase activity in simulated wastewater conditions is quantified by linear regression from time zero to the time of maximum fluorescence of a fluorescent oxidized product of PETase degradation of PET microfibers. Mesoporous silica is shown to be a superior support material to nonporous silica. The resulting biocatalytic nanomaterial has up to 2.5-fold enhanced stability and 6.2-fold increased activity compared to free enzyme in unbuffered, 40 °C simulated influent (ionic strength ∼15 mM). In unbuffered, 40 °C simulated effluent (ionic strength ∼700 µM), reaction velocity and overall catalytic activity were increased by the biocatalytic material 2.1-fold relative to free PETase. All reactions were performed in 0.2 mL volumes, and enzyme concentrations were normalized across both free and immobilized samples to 9 µg/mL. Site-directed mutagenesis is shown to be a complementary technique to directed immobilization, which may aid in optimization of the biomaterial for wastewater applications. PETase stabilization in application-relevant environments as shown here enables progress toward application of PETase for microplastic biodegradation in wastewater treatment.

In Vivo Capsid Engineering of Bacteriophages for Oriented Surface Conjugation.

The current state-of-the-art in bacteriophage (phage) immobilization onto magnetic particles is limited to techniques that are less expensive and/or facile but nonspecific or those that are more expensive and/or complicated but ensure capsid-down orientation of the phages, as necessary to preserve infectivity and performance in subsequent applications (e.g., therapeutics, detection). These cost, complexity, and effectiveness limitations constitute the major hurdles that limit the scale-up of phage-based strategies and thus their accessibility in low-resource settings. Here, we report a plasmid-based technique that incorporates a silica-binding protein, L2, into the T7 phage capsid, during viral assembly, with and without inclusion of a flexible linker peptide, allowing for targeted binding of the phage capsid to silica without requiring the direct modification of the phage genome. L2-tagged phages were then immobilized onto silica-coated magnetic nanoparticles. Inclusion of the flexible linker between the phage capsid protein and the L2 protein improved immobilization density compared to both wild type T7 phages and L2-tagged phages without the flexible linker. Taken together, this work demonstrates phage capsid modification without engineering the phage genome, which provides an important step toward reducing the cost and increasing the specificity/directionality of phage immobilization methods and could be more broadly applied in the future for other phages for a range of other capsid tags and nanomaterials.

Lactulose production from lactose isomerization by chemo-catalysts and enzymes: Current status and future perspectives.

Lactulose, a semisynthetic nondigestive disaccharide with versatile applications in the food and pharmaceutical industries, has received increasing interest due to its significant health-promoting effects. Currently, industrial lactulose production is exclusively carried out by chemical isomerization of lactose via the Lobry de Bruyn-Alberda van Ekenstein (LA) rearrangement, and much work has been directed toward improving the conversion efficiency in terms of lactulose yield and purity by using new chemo-catalysts and integrated catalytic-purification systems. Lactulose can also be produced by an enzymatic route offering a potentially greener alternative to chemo-catalysis with fewer side products. Compared to the controlled trans-galactosylation by ß-galactosidase, directed isomerization of lactose with high isomerization efficiency catalyzed by the most efficient lactulose-producing enzyme, cellobiose 2-epimerase (CE), has gained much attention in recent decades. To further facilitate the industrial translation of CE-based lactulose biotransformation, numerous studies have been reported on improving biocatalytic performance through enzyme mediated molecular modification. This review summarizes recent developments in the chemical and enzymatic production of lactulose. Related catalytic mechanisms are also highlighted and described in detail. Emerging techniques that aimed at advancing lactulose production, such as the boronate affinity-based technique and molecular biological techniques, are reviewed. Finally, perspectives on challenges and opportunities in lactulose production and purification are also discussed.

Severe Diesel Injection Injury to the Face, Neck and Orbit: Surgical Management and Critical Care Considerations.

The purpose of this report is to discuss high-pressure injection injuries involving the face and orbit and discuss factors affecting prognosis and management as these injuries are rare and uniquely challenging to manage given the complex anatomy and extensive damage that may occur. In this case, we present severe injury to the left orbit, maxillofacial region, and neck of a 29-year-old male who suffered a high-pressure diesel injection injury requiring several surgical debridements, intensive care unit (ICU) level care, and ultimately sub-total exenteration. Initial management involved systemic antibiotics, steroids, and surgical debridement; however, our patient experienced subsequent rapid deterioration resulting in admission for more aggressive subspecialty intervention. Decision-making was guided by serial CT of the face and orbits, and C-reactive protein (CRP) levels in addition to the physical examination. His course was complicated by progressive extensive soft tissue necrosis requiring 8 surgical debridements and optic nerve tenting despite orbital decompression resulting in loss of the OS. Ultimately, definitive treatment required sub-total exenteration and negative wound pressure therapy over the orbit followed by eyelid reconstruction as an outpatient. We conclude that without prompt recognition and meticulous debridement, the resultant injury from high-pressure injection injuries can be devastating and lead to permanent vision loss, loss of an eye, loss of facial function, and airway compromise depending on the location of the injury. A multi-disciplinary team involving oculoplastics, otolaryngology, infectious disease, and ICU should be assembled based on the complexity of this injury and its sequela. CRP can be useful to monitor patient recovery and the need for further surgical intervention. When debridement results in complex wounds over the orbit and face, negative pressure wound therapy should be considered.

Bacteriophage Capsid Modification by Genetic and Chemical Methods.

Bacteriophages are viruses whose ubiquity in nature and remarkable specificity to their host bacteria enable an impressive and growing field of tunable biotechnologies in agriculture and public health. Bacteriophage capsids, which house and protect their nucleic acids, have been modified with a range of functionalities (e.g., fluorophores, nanoparticles, antigens, drugs) to suit their final application. Functional groups naturally present on bacteriophage capsids can be used for electrostatic adsorption or bioconjugation, but their impermanence and poor specificity can lead to inconsistencies in coverage and function. To overcome these limitations, researchers have explored both genetic and chemical modifications to enable strong, specific bonds between phage capsids and their target conjugates. Genetic modification methods involve introducing genes for alternative amino acids, peptides, or protein sequences into either the bacteriophage genomes or capsid genes on host plasmids to facilitate recombinant phage generation. Chemical modification methods rely on reacting functional groups present on the capsid with activated conjugates under the appropriate solution pH and salt conditions. This review surveys the current state-of-the-art in both genetic and chemical bacteriophage capsid modification methodologies, identifies major strengths and weaknesses of methods, and discusses areas of research needed to propel bacteriophage technology in development of biosensors, vaccines, therapeutics, and nanocarriers.

Genome Sequence of Acetobacter tropicalis DmPark25_167, a Bacterium Isolated from a Drosophila melanogaster Genetic Model of Parkinson's Disease.

Here, we report the genome of Acetobacter tropicalis DmPark25_167, a bacterial strain isolated from a Drosophila melanogaster park25 mutant. The park25 mutant is an established genetic model of Parkinson's disease. DmPark25_167 has duplicated methionine metabolism and type IV secretion gene alleles compared with another strain of A. tropicalis.

Comparative effectiveness of posttreatment imaging modalities for Medicare patients with advanced head and neck cancer.

BACKGROUND: Persistent controversy exists with regard to how and when patients with head and neck cancer should undergo imaging after definitive therapy. The current study was conducted to evaluate whether the type of imaging modality used in posttreatment imaging impacts cancer-specific survival for patients with advanced head and neck squamous cell carcinoma. METHODS: A retrospective study of National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program-Medicare-linked data in patients with an advanced stage of the 3 most common head and neck malignancies (oral cavity, oropharynx, and larynx) was conducted. Hazard ratios and 95% CIs for cancer-specific survival were estimated for patients diagnosed with any of these cancers between 2006 and 2015. RESULTS: Significant improvement with regard to cancer-specific survival was observed among patients with American Joint Committee on Cancer stage III and stage IVA laryngeal cancer who underwent positron emission tomography (PET) and/or computed tomography (CT) imaging during the first 6 months after receipt of definitive treatment (hazard ratio, 0.517; 95% CI, 0.33-0.811) compared with those who underwent CT. There was a trend toward an improvement in cancer-specific survival among patients with oral cavity or oropharyngeal malignancies who underwent PET/CT imaging, but it did not reach statistical significance. CONCLUSIONS: Compared with CT imaging, posttreatment imaging with PET was associated with improved survival in patients with advanced laryngeal carcinoma.

General method for emulsion polymerization to yield functional terpolymers.

Copolymerization methods are used to impart specific, desired functional properties (e.g. mechanical or bioactive) to a material for targeted applications in biomedicine, food and agriculture, consumer products, advanced manufacturing, and more. Many polymerization methods exist to achieve tailored copolymer architectures. Of them, emulsion polymerization offers unique and industrially convenient features that make for easily scalable processes because the synthesis occurs in water and the latexes usually do not need further purification. Because of the breadth of copolymer architectures and thus wide range of potential applications for latexes produced by emulsion polymerization, there is great value in defining general methods for emulsion polymerizations to yield copolymers, including routes for synthesis of functional monomer building blocks, to permit consistency and optimization of these processes. Herein we present a general emulsion polymerization method for synthesis of a copolymer consisting of three functional monomers, suitable for adaptation to alternate base chemistries, curing chemistries, and functional ligands. This protocol includes the synthesis of the functional monomers glycidyl methacrylate-iminodiacetic acid (GMA-IDA) and 4-benzolylphneyl methacrylate (BPM).•Our synthesized copolymer includes a glycidyl methacrylate (GMA) monomer functionalized with a metal-chelating iminodiacetic acid (IDA) ligand, a UV-curable monomer, 4-benzoylphenyl methacrylate (BPM), and an inert hydrophobic monomer, n­butyl acrylate (BA).•The presented synthesis route demonstrates a general polymerization method that can be modified to copolymerize alternative functional monomers to create multi-functional polymers.

Elderly Black Non-Hispanic Patients With Head and Neck Squamous Cell Cancer Have the Worst Survival Outcomes.

BACKGROUND: In this population study, we compared head and neck cancer (HNC) prognosis and risk factors in 2 underserved minority groups (Hispanic and Black non-Hispanic patients) with those in other racial/ethnicity groups. METHODS: In this SEER-Medicare database study in patients with HNC diagnosed in 2006 through 2015, we evaluated cancer-specific survival (CSS) between different racial/ethnic cohorts as the main outcome. Patient demographics, tumor factors, socioeconomic status, and treatments were analyzed in relation to the primary outcomes between racial/ethnic groups. RESULTS: Black non-Hispanic patients had significantly worse CSS than all other racial/ethnic groups, including Hispanic patients, in unadjusted univariate analysis (Black non-Hispanic patients: hazard ratio, 1.48; 95% CI, 1.33-1.65; Hispanic patients: hazard ratio, 1.12; 95% CI, 0.99-1.28). To investigate the association of several variables with CSS, data were stratified for multivariate analysis using forward Cox regression. This identified socioeconomic status, cancer stage, and receipt of treatment as predictive factors for the survival differences. Black non-Hispanic patients were most likely to present at a later stage (odds ratio, 1.62; 95% CI, 1.38-1.90) and to receive less treatment (odds ratio, 0.67; 95% CI, 0.55-0.81). Unmarried status, high poverty areas, increased emergency department visits, and receipt of healthcare at non-NCI/nonteaching hospitals also significantly impacted stage and treatment. CONCLUSIONS: Black non-Hispanic patients have a worse HNC prognosis than patients in all other racial/ethnic groups, including Hispanic patients. Modifiable risk factors include access to nonemergent care and prevention measures, such as tobacco cessation; presence of social support; communication barriers; and access to tertiary centers for appropriate treatment of their cancers.

Reactive Extrusion of Nonmigratory Antioxidant Poly(lactic acid) Packaging.

Reactive extrusion of bio-derived active packaging offers a new approach to address converging concerns over environmental contamination and food waste. Herein, metal-chelating nitrilotriacetic acid (NTA) ligands were grafted onto poly(lactic acid) (PLA) by reactive extrusion to produce metal-chelating PLA (PLA-g-NTA). Radical grafting was confirmed by attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy with the introduction of secondary alkyl stretches (2919 and 2860 cm-1) and by X-ray photoelectron spectroscopy (XPS) with an increase in the atomic percentage of nitrogen. Compared to films prepared from native, granular PLA (gPLA), PLA-g-NTA films had lower contact angles and hysteresis values (86.35° ± 2.49 and 31.89° ± 2.27 to 79.91° ± 1.58 and 21.79° ± 1.72, respectively), supporting the surface orientation of the NTA ligands. The PLA-g-NTA films exhibited a significant antioxidant character with a radical scavenging capacity of 0.675 ± 0.026 nmol Trolox(eq)/cm2 and an iron chelation capacity of 54.09 ± 9.36 nmol/cm2. PLA-g-NTA films delayed ascorbic acid degradation, retaining ∼45% ascorbic acid over the 9-day study compared to <20% for control PLA. This research makes significant advances in translating active packaging technologies to bio-derived materials using scalable, commercially translatable synthesis methods.