Bacteria inhabiting spider webs enhance host silk extensibility.

Spider silk is a promising material with great potential in biomedical applications due to its incredible mechanical properties and resistance to degradation of commercially available bacterial strains. However, little is known about the bacterial communities that may inhabit spider webs and how these microorganisms interact with spider silk. In this study, we exposed two exopolysaccharide-secreting bacteria, isolated from webs of an orb spider, to major ampullate (MA) silk from host spiders. The naturally occurring lipid and glycoprotein surface layers of MA silk were experimentally removed to further probe the interaction between bacteria and silk. Extensibility of major ampullate silk produced by Triconephila clavata that was exposed to either Microbacterium sp. or Novosphigobium sp. was significantly higher than that of silk that was not exposed to bacteria (differed by 58.7%). This strain-enhancing effect was not observed when the lipid and glycoprotein surface layers of MA silks were removed. The presence of exopolysaccharides was detected through NMR from MA silks exposed to these two bacteria but not from those without exposure. Here we report for the first time that exopolysaccharide-secreting bacteria inhabiting spider webs can enhance extensibility of host MA silks and silk surface layers play a vital role in mediating such effects.

Culturally adapted translation of LYMPH-Q upper extremity module from English to Mandarin Chinese.

BACKGROUND: Breast cancer-related lymphedema (BCRL) is one of the debilitating complications after breast cancer treatment. Several forms of patient-reported outcome measures (PROMs) were developed to evaluate the severity of BCRL based on the patients' perspective. LYMPH-Q Upper Extremity Module is a newly developed questionnaire for BCRL. This study aimed to demonstrate the process of translation and cultural adaption from English to Mandarin Chinese. METHODS AND RESULTS: The translation process followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) best-practice guidelines for the translation and cultural adaption of PROM. The process included four steps: forward translation, back translation, back translation review, and patient interviews. In total, five patients with BCRL were recruited for patient interviews. The forward translation step involved two professional translators whose native language was Mandarin Chinese. A reconciled translated version was produced. In the back translation step, the reconciled translated version in Mandarin Chinese was sent to another professional translator whose native language was English. The back-translated version in English was sent back to the developer of LYMPH-Q for review. In this step, 22 items were revised. In the final step of patient interviews, 15 items were revised based on the patients' feedback. CONCLUSION: The development of Mandarin Chinese version of LYMPH-Q Upper Extremity Module and its utilization in conjunction with the existing objective measures could provide a more well-rounded picture of the status of patients with BCRL worldwide.

Is Immediate Lymphatic Reconstruction on Breast Cancer Patients Oncologically Safe? A Preliminary Study.

Background: In breast cancer patients receiving axillary lymph node dissection (ALND), immediate lymphatic reconstruction (ILR) with lymphovenous anastomosis is an emerging technique for reducing the risk of arm lymphedema. However, the oncologic safety of surgically diverting lymphatic ducts directly into venules in a node-positive axilla is still a concern of inadvertently inducing metastasis of remaining cancer cells. This study aimed to assess the oncologic safety of ILR. Methods: From January 2020 to January 2022, 95 breast cancer patients received ALND, and 45 of them also received ILR. Patients with recurrent cancer, with follow-up less than 12 months, and with missed data were excluded. Variables were compared between ILR and non-ILR groups, and the outcome of interest was the rate of distant recurrence after follow-up for at least 1 year. Results: Thirty-four patients in the ILR group and 32 patients in the non-ILR group fulfilled the inclusion criteria for analysis. No statistically significant difference was noted between groups in terms of age, body mass index, type of breast surgery, pathologic cancer staging, histologic type and grade of breast cancer, molecular subtypes, frequency of axillary lymph node metastasis, or adjuvant therapy. For the patients receiving follow-up for at least 1 year, no statistically significant difference was found in terms of distant recurrence rates between ILR and non-ILR groups (P = 0.44). Conclusion: For breast cancer patients receiving ALND, ILR with lymphovenous anastomosis is oncologically safe, within an average follow-up period of 21 months.

First Molecular Detection and Genotype Identification of Toxoplasma gondii in Chickens from Farmers' Markets in Fujian Province, Southeastern China.

Toxoplasma gondii is an opportunistic pathogenic protozoan that can infect all nucleated cells in almost all warm-blooded animals, including humans. T. gondii infection has been reported in many food animals worldwide. However, the prevalence and genotypes of T. gondii in chickens from farmers' markets in Fujian province in southeastern China remain unreported. In the present study, four tissue samples from each of the 577 chickens (namely, the heart, liver, lungs, and muscles) were collected from farmers' markets in five regions of Fujian province (Zhangzhou, Sanming, Quanzhou, Fuzhou, and Longyan). We first analyzed the prevalence and genotypes of T. gondii using PCR targeting of the B1 gene of T. gondii. Of the 577 chickens, thirty-two (5.5%) tested positive for the B1 gene. Among the five regions, Sanming had the highest infection rate (16.8%, 16/95), followed by Quanzhou (8.0%, 8/100), Longyan (5.0%, 5/100), Zhangzhou (1.1%, 2/182), and Fuzhou (1.0%, 1/100). Among these thirty-two T. gondii-positive chickens, the infection rates of the lungs, heart, liver, and muscles were 68.8% (22/32), 34.4% (11/32), 28.1% (9/32), and 9.4% (3/32), respectively. Significant differences in prevalence were found among the different regions (χ2 = 35.164, p < 0.05) and tissues (χ2 = 25.874, p < 0.05). A total of 128 tissue and organ samples of the thirty-two T. gondii-positive chickens from the different regions were analyzed using PCR-restriction fragment length polymorphism (PCR-RFLP) on the basis of 10 genetic markers. Seven tissue samples (lung samples from five chickens, heart samples from one chicken, and liver samples from one chicken) underwent successful amplification at all the genetic markers, and all the T. gondii genotypes were identified as genotype I (ToxoDB #10). These findings serve as a foundation for evaluating the risk of T. gondii contamination in chicken products intended for human consumption and offer insight into preventing the transmission of the parasite from chickens to humans.

The Deciding Factors of Flow Direction in Lymphovenous Anastomosis for Extremity Lymphedema.

BACKGROUND: While using lymphovenous anastomosis (LVA) to treat extremity lymphedema, an antegrade lymphatic-to-venous flow is usually considered to indicate a functional and effective anastomosis. The authors analyzed the characteristics of lymphovenous anastomoses in patients with extremity lymphedema to look for the deciding factors of the flow direction. METHODS: A total of 45 patients (15 arms and 42 legs) undergoing LVA for extremity lymphedema were reviewed. Only the anastomoses with intraoperatively confirmed patent flow or clear visualization of vessel lumens during anastomosis were included for analysis. Multivariate logistic regression was used to identify the contributing factors of intraoperative washout phenomenon or venous reflux. RESULTS: A total of 105 eligible LVAs were included for analysis. Anastomosis with a more sclerotic lymphatic duct is statistically significantly associated with more venous reflux (OR, 2.82; P = 0.003). Larger diameter difference between lymphatic duct and recipient vein (OR, 12.8; P = 0.02) and less sclerotic lymphatic duct (OR, 0.47; P = 0.03) are statistically significantly associated with more washout phenomena. CONCLUSIONS: The deciding factors of flow direction in LVA are difference of diameters between lymphatic duct and recipient vein, and the severity of lymphosclerosis. To obtain favorable antegrade lymph-to-vein flow, a less sclerotic lymphatic duct with larger diameter and a recipient vein with smaller diameter should be chosen for anastomosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Management of an Unusual Avulsion Trauma of Total Esophagus During Upper Gastrointestinal Endoscopy.

BACKGROUND: An esophageal defect usually resulted from surgical ablation of tumors or corrosive injury. Staged reconstructions are required usually in extensive defects. AIM AND OBJECTIVES: This study aimed to present a rare iatrogenic complication of total esophageal avulsion injury during upper gastrointestinal endoscopic treatment and to perform staged reconstructions to create a neoesophagus. MATERIALS AND METHODS: In the presented case, staged reconstructions with a tubed deltopectoral flap and a supercharged colon interposition flap were performed to reconstruct the hypopharynx and esophagus. However, recurrent choking occurred because of the extent of injury involving the epiglottis. A tubed free radial forearm flap connected to the lower buccogingival sulcus was used to create a new route for food passage. RESULTS: The patient resumed oral intake after rehabilitation. CONCLUSIONS: The avulsion injury of the total esophagus is rare and devastating. Staged reconstructions with a tubed deltopectoral flap, a supercharged colon interposition flap, and a tubed free radial forearm flap would be a safe and reliable method.

The effect of immediate lymphatic reconstruction on the post-operative drain output after axillary lymph node dissection for breast cancer: A retrospective comparative study.

INTRODUCTION: Axillary lymph node dissection (ALND) for breast cancer has been considered to be associated with a variety of complications, such as excessive postoperative wound drainage, prolonged drain placement, or seroma formation in the short term, or arm lymphedema in the long run. Immediate lymphedema reconstruction (ILR) has been proposed to reduce the occurrence of arm lymphedema by anastomosing the transected arm lymphatics to nearby branches of the axillary vein immediately after ALND. This study aims to demonstrate that ILR can also reduce the postoperative drainage amount. PATIENTS AND METHODS: Between April 2020 and January 2022, a total of 76 breast cancer patients receiving ALND were reviewed. Forty four of them also received ILR immediately after ALND. The assignment of ILR surgery was non-random, based on patients' willingness and plastic surgeons' availability. The lymphatic vessels in the axillary wound were anastomosed with nearby terminal branches of the axillary vein under surgical microscope. Patients' characteristics, including age, body mass index (BMI), neoadjuvant therapy, type of breast surgery, the occurrence of seroma formation, number of removed lymph nodes, number of positive nodes, and the drainage amount from the operative wounds were compared between ILR and non-ILR groups. RESULTS: No statistically significant difference was noted between groups in terms of age (56.5 ± 9.8 vs. 60.9 ± 10.7, p = .09), BMI (22.6 ± 3.7 vs. 23.7 ± 3.8, p = .27), type of breast surgery (p = .32), the occurrence of seroma formation (p = 1.0), the likelihood of receiving neoadjuvant therapy (p = .12), number of lymph nodes removed (17.5 ± 7.6 vs. 17.4 ± 8.3, p = .96), or number of positive nodes on final pathology (3.7 ± 5.4 vs. 4.8 ± 8.5, p = .53) except the ILR group had statistically significantly less drainage amount than non-ILR group (39.3 ± 2.6 vs. 48.3 ± 3.7, p = .046). CONCLUSION: For breast cancer patients receiving ALND, the immediate lymphatic reconstruction can reduce the postoperative drainage amount from the operative wound.

Promoting the Efficiency and Stability of Nonfullerene Organic Photovoltaics by Incorporating Open-Cage [60]Fullerenes in the Nonfullerene Nanocrystallites.

The device efficiency of PM6:Y6-based nonfullerene organic solar cells is fast advanced recently. To maintain organic solar cells (OSCs) with high power conversion efficiency over 16% in long-term operation, however, remains a challenge. Here, a novel non-volatile additive, an open-cage [60]fullerene (8OC60Me), is incorporated into PM6:Y6-based OSCs for high-performance with high durability. With optimized addition of 1.0 wt % 8OC60Me, the PCE value of PM6:Y6/8OC60Me OSCs can be promoted to 16.5% from 15.0%. Most strikingly, such a high PCE performance can maintain nearly 100% for over 500 h at room temperature; at an elevated operation temperature of 80 °C, the PCE can be stabilized above 15.0% after 45 h of operation. Grazing incidence small- and wide- angle X-ray scattering studies reveal improved orientation and crystallinity of Y6 in a fractal-like network structure of PM6 in PM6:Y6/8OC60Me films under in situ annealing, parallel to the enhanced electron mobility. Analysis of charge distributions lines up possible van der Waals interaction between the thienyl/carbonyl moiety of 8OC60Me and difluorophenyl-based FIC-end groups of Y6. This result is of great contrast to those devices with the best-selling PC61BM as the additives─8OC60Me might be of interest to be incorporated into future Y6-based OSCs for concomitantly improved PCE and excellent stability.

Achieving Accurate Automatic Sleep Apnea/Hypopnea Syndrome Assessment Using Nasal Pressure Signal.

Automatic assessment of sleep apnea/ hypopnea syndrome (SAHS) based on fewer physiological signals is critical for the success of healthcare at home. However, previous studies that use such settings only achieve a lower assessment accuracy, causing fewer syndromes to be separated for effective diagnosis. This paper presents a 3-stage support vector machines (SVM)-based algorithm for SAHS assessment using a single-channel nasal pressure (NP) signal. In this work, NP signal is utilized for feature extraction. Amplitude features, as well as those extracted using discrete Fourier transform and discrete wavelet transform, are used for machine learning. A total of 58 sets of polysomnography recordings, each with approximately 7 h in duration, were analyzed. This work achieves a sensitivity of 95.7% and a positive predictive value of 90.9%, outperforming previous works using NP signal. Compared with prior studies using only SpO2 signal, this work still achieves better performance and supports more classification levels. Thanks to the low-complexity settings based only on the NP signal, the proposed approach provides a promising solution to SAHS assessment for remote healthcare.

ENERGI-F703 gel, as a new topical treatment for diabetic foot and leg ulcers: A multicenter, randomized, double-blind, phase II trial.

Background: Diabetic foot and leg ulcers are a major cause of disability among patients with diabetes mellitus. A topical gel called ENERGI-F703, applied twice daily and with adenine as its active pharmaceutical ingredient, accelerated wound healing in diabetic mice. The current study evaluated the safety and efficacy of ENERGI-F703 for patients with diabetic foot and leg ulcers. Methods: This randomized, double-blind, multicenter, phase II trial recruited patients from eight medical centers in Taiwan. Patients with intractable diabetic foot and leg ulcers (Wagner Grade 1-3 without active osteomyelitis) were randomly assigned (2:1) to receive topical ENERGI-F703 gel or vehicle gel twice daily for 12 weeks or until complete ulcer closure. The investigator, enrolled patients and site personnel were masked to treatment allocation. Intention to treat (ITT) population and safety population were patient to primary analyses and safety analyses, respectively. Primary outcome was complete ulcer closure rate at the end of treatment. This trial is registered with ClinicalTrials.gov, number NCT02672436. Findings: Starting from March 15th, 2017 to December 26th, 2019, 141 patients were enrolled as safety population and randomized into ENERGI-F703 gel (n = 95) group or vehicle gel (n = 46) group. In ITT population, ENERGI-F703 (n = 90) and vehicle group showed ulcer closure rates of 36.7% (95% CI = 26.75% - 47.49%) and 26.2% (95% CI = 13.86% - 42.04%) with difference of 9.74 % (95 % CI = -6.74% - 26.23%) and 25% quartiles of the time to complete ulcer closure of 69 days and 84 days, respectively. There were 25 (26.3%) patients in ENERGI-F703 group and 11 (23.9%) patients in vehicle group experiencing serious adverse events and five deaths occurred during the study period, none of them related to the treatment. Interpretation: Our study suggests that ENERGI-F703 gel is a safe and well-tolerated treatment for chronic diabetic foot and leg ulcers. Further studies are needed to corroborate our findings in light of limitations. Funding: Energenesis Biomedical Co., Ltd.

Free Colon Tissue Transfer for the Management of Xerostomia in Head and Neck Cancer Patients: A Bacteriological Study and Clinical Case Series.

INTRODUCTION: Patients with head and neck cancer may suffer from xerostomia after repetitive surgery or radiation therapy. Free colon tissue transfer was used to restore the lubrication of the oral cavity, and a bacteriological study in mice was conducted to evaluate how the intestine transfer from the intra-abdominal to extra-abdominal locations may affect bacterial colonization. PATIENTS AND METHODS: Twelve patients received free colon transfer for the reconstruction of their intraoral mucosal defect following trismus release. Thirty-five patients received ileocolon flap transfer to fill the pharyngeal defects. In an animal study with mice, a pedicled ileum segment was transferred to the subcutaneous space of the abdominal wall. The transferred ileum segments were biopsied for bacterial genome analysis after 3 months. RESULTS: All but one transferred flap survived. Colon secretion was suitable for oral lubrication without the unpleasant smell 1 month postoperatively. In an animal study, genome analysis showed that the same bacterial species still existed in the transferred intestinal tissue. CONCLUSIONS: No unpleasant smell or infections were noted in this clinical series despite the animal study showing that the bacterial spectrum did not change in the transferred intestine. Therefore, free colon tissue transfer could safely provide lubrication in patients with xerostomia.

Predictors of severity of lymphosclerosis in extremity lymphedema.

BACKGROUND: Lymphovenous anastomosis (LVA) is an accepted method for treating lymphedema, and its efficacy could be greatly affected by the severity of lymphosclerosis. In the present study, we analyzed the intraoperative findings of lymphatic ducts in our patients who had undergone LVA to find predictive factors for the severity of lymphosclerosis. METHODS: The medical records of the patients who had undergone LVA for managing extremity lymphedema from September 2017 to December 2020 were reviewed. The severity of lymphosclerosis was evaluated intraoperatively under a surgical microscope and stratified using the NECST (normal, ectasia, contraction, sclerosis type) classification. Patient age, gender, body mass index (BMI), lymphoscintigraphy stage, and lymphatic duct locations were included for analysis. RESULTS: Multivariate linear regression analysis showed that location in a lower extremity (regression coefficient, -0.38; P = .03) and more advanced Taiwan lymphoscintigraphy stage (regression coefficient, 0.27; P < .001) were associated with more severe lymphosclerosis. In a subgroup analysis of lower extremity lymphedema, in addition to the Taiwan lymphoscintigraphy stage (regression coefficient, 0.24; P < .001), age (regression coefficient, 0.02; P = .001), and BMI (regression coefficient, 0.04; P = .005) were also associated with the severity of lymphosclerosis. CONCLUSIONS: The severity of lymphosclerosis in extremity lymphedema correlated positively with the Taiwan lymphoscintigraphy stage and was more severe in lower limb lymphedema. In lower limb lymphedema, a higher BMI and older age also contributed to more severe lymphosclerosis.

Electrocatalytic Reduction of NO3- to Ultrapure Ammonia on {200} Facet Dominant Cu Nanodendrites with High Conversion Faradaic Efficiency.

Nitrate (NO3-) reduction reaction (NtRR) is considered as a green alternative method for the conventional method of NH3 synthesis (Haber-Bosch process), which is known as a high energy consuming and large CO2 emitting process. Herein, the copper nanodendrites (Cu NDs) grown along with the {200} facet as an efficient NtRR catalyst have been successfully fabricated and investigated. It exhibited high Faradaic efficiency of 97% at low potential (-0.3 V vs RHE). Furthermore, the 15NO3- isotope labeling method was utilized to confirm the formation of NH3. Both experimental and theoretical studies showed that NtRR on the Cu metal nanostructure is a facet dependent process. Dissociation of NO bonding is supposed to be the rate-determining step as NtRR is a spontaneously reductive and protonation process for all the different facets of Cu. Density functional theory (DFT) calculations revealed that Cu{200} and Cu{220} offer lower activation energy for dissociation of NO compared to that of Cu{111}.

Spherical Hole-Transporting Interfacial Layer Passivated Defect for Inverted NiOx-Based Planar Perovskite Solar Cells with High Efficiency of over 20.

In this study, we achieved a facile and low-cost (18-22 USD/g) synthesis of spiro[fluorene-9,9-phenanthren-10-one]-based interfacial layer materials (MSs; designated MS-PC, MS-PA, MS-OC, and MS-OA). Carbazoles and dimethylacridine substituents with an extended π-conjugation achieved through ortho- or para-orientations were used as donors at the spiro[fluorene-9,9'-phenanthren-10'-one] moiety. Highly efficient and stable inverted perovskite solar cells (PSCs) with the device architecture of ITO/NiOx/MSs/perovskite/PC61BM/BCP/Ag can be achieved to improve the surface morphology of NiOx when MSs are adopted as the interfacial layer. During a morphological study, the ortho-orientated donor of MS-OC and MS-OA has spherical structures indicated that the films were smooth and that the films of perovskite deposited on them had large grain size and uniformity. The photoluminescence properties of the perovskite layers on the NiOx/MSs were showed better hole-transporting capabilities than the bare NiOx. The dual-functional interfacial layer has shown defect passivation effect, it not only improved the surface morphology of NiOx but also enlarged the perovskite layer grain size. The best PSC device performance of the NiOx/MS-OC was characterized by 22.34 mA cm-2 short-circuit current density (Jsc), 1.128 V open-circuit voltage (Voc), and 80.8% fill factor (FF), resulting in 20.34% power conversion efficiency (PCE). The NiOx/MS-OC PSCs showed good long-term device stability, even retained the original PCE of 93.16% after 370 days under argon (25 °C). Owing to the superior perovskite morphologies of the NiOx/MSs, the resulting devices outperformed the bare NiOx-based PSCs.

Peroneal flap: How to harvest and clinical appraisal for head and neck reconstruction.

BACKGROUND: A peroneal flap, the boneless version of fibula flap, is considered as the equivalent of radial forearm flap of the lower leg. Because it is thinner than an anterolateral thigh (ALT) flap, the use of a peroneal flap is a viable option for the repair of soft tissue defects when a thin flap could bring about better functional and cosmetic outcomes. In this article, we describe the details of peroneal flap harvest and present our experience with the use of peroneal flaps for head and neck reconstruction. MATERIALS AND METHODS: Between 1996 and 2017, a total of 265 peroneal flaps were used to reconstruct a variety of head and neck defects. With the same vascular anatomy and slight modifications to the harvesting technique of a fibula flap, a peroneal flap can be harvested within 1-2 h. All medical records were retrospectively reviewed. RESULTS: A peroneal flap can be harvested as different types of chimeric flaps to fit a variety of head and neck defects. The peroneal flap failure rate was 3.4% and the postoperative complication rate was 12.8%. CONCLUSION: A peroneal flap might be an alternative option for the reconstruction of head and neck defects.

Lymphovenous Anastomosis for Treating Lymphedema in IgG4-Related Disease.

Immunoglobin G4-related disease (IgG4RD) is a multi-organ immune-mediated condition, and lymphoplasmacytic infiltration is one of the main pathologic features.1,2 Lower extremity lymphedema is likely to occur if the infiltration involves multiple inguinal lymph nodes and thus disrupting lymphatic transport. Lymphovenous anastomosis (LVA) is a surgical procedure used to treat obstructive lymphedema in extremities3,4 or in the head and neck area.5 It basically reroutes the obstructed lymph flow into patent venous system by making microsurgical anastomosis between lymphatic duct and vein over the swollen area. Herein, we reported a patient with recalcitrant lower extremity lymphedema caused by IgG4RD, whose lymphedema subsided after being treated with LVA.

Effects of Artificial Texture Insoles and Foot Arches on Improving Arch Collapse in Flat Feet.

The arches of the foot play a vital role in cushioning the impact and pressure generated from ground reaction forces due to body weight. Owing to a lack of normal human arch structure, people diagnosed as having flat feet often have discomfort in the soles of their feet. The results may not only cause inappropriate foot pressure distribution on the sole but also further cause foot injuries. This study heavily relies on a homemade foot pressure sensing device equipped with textured insoles of different heights and artificial arches. This was to explore the extent to which the pressure distribution of the foot in people with flat feet could be improved. A further comparison was made of the effects of using the textured insoles with different heights on two different groups of people diagnosed with flat and normal feet respectively. Sixty-five undergraduate and postgraduate volunteers were invited to receive the ink footprint test for measuring their degrees of arch index. Nine of these 65 had 2 flat feet, 3 had a left flat foot, 5 had a right flat foot, and 48 had 2 normal feet. To ensure the same number of subjects in both the control and the experimental groups, 9 of the 48 subjects who had normal feet were randomly selected. In total, 26 subjects (Male: 25, Female: 1; Age: 22 ± 1 years; height: 173.6 ± 2.5 cm; body mass: 68.3 ± 5.4 kg; BMI: 22.6 ± 1.2) were invited to participate in this foot pressure sensing insoles study. The experimental results showed that the use of textured insoles designed with different heights could not effectively improve the plantar pressure distribution and body stability in subjects with flat feet. Conversely, the use of an artificial arch effectively improved the excessive peak in pressure and poor body stability, and alleviated the problem of plantar collapse for patients with flat feet, especially in the inner part of their hallux and forefoot.

Comparison of Silicone Sheets and Paper Tape for the Management of Postoperative Scars: A Randomized Comparative Study.

OBJECTIVE: To compare the effectiveness of silicone sheets and paper tape in the prevention of postoperative cesarean section scars. METHODS: Patients undergoing horizontal cesarean section were included in this randomized controlled trial. Surgical wounds were divided into two halves. Patients randomly applied silicone sheets or paper tape to each side of their wound as assigned for 3 months. Wounds were assessed at 1, 3, 6, and 12 months after surgery. Researchers used the objective Vancouver Scar Scale (VSS) to evaluate the scars and the subjective visual analog scale (VAS) to evaluate itch, pain, and scar appearance. RESULTS: No significant differences between the silicone sheet and paper tape groups were noted at postoperative follow-ups with respect to VSS scores. The silicone sheet group had significantly better VAS scores for scar appearance than the paper tape group at 6 (6.81 ± 1.47 vs 6.19 ± 1.62, P = .03) and 12 (6.88 ± 2.01 vs 6.2 ± 2.08, P = .04) months' follow-up, respectively. CONCLUSIONS: The silicone sheet group showed statistically significant differences in comparison with the paper tape group in terms of scar appearance as determined by the VAS. However, the differences were too small to be clinically meaningful.

Risk of Free Flap Failure in Head and Neck Reconstruction: Analysis of 21,548 Cases From A Nationwide Database.

BACKGROUND: Head and neck reconstruction is complicated and is made even more challenging by free flap failure. We identified risk factors associated with free flap failure in records extracted from a nationwide database of a 23 million populations. METHODS: We used International Classification of Diseases, Ninth Version, codes 140 to 149 and 161 to identify patients in Taiwan's National Health Insurance Research Database with head and neck cancer between 2000 and 2013. Patient's age, sex, neoadjuvant treatment, comorbidities, and anticoagulation use were also retrieved. Free flap reconstruction twice, or free flap and pedicle flap reconstructions during the same hospitalization were recorded as free flap failure. Logistic regression was used to identify factors that increased risk of free flap failure. RESULTS: A total of 21,548 patients with head and neck cancer were identified; 883 (4.1%) experienced free flap failure. Use of aspirin, clopidogrel, urokinase, prostaglandin (PGE1), low-molecular-weight heparin, and operation time were associated with free flap failure. However, some potential confounders could not be identified from the database. CONCLUSIONS: Several statistically significant findings were prone to influence by potential confounders. The clinically applicable result was that longer operation time and preoperative chemotherapy could increase the likelihood of free flap failure. On the other hand, several factors were proved to be irrelevant to free flap failure.