Influence of preoperative radiotherapy on head and neck free-flap reconstruction: Systematic review and meta-analysis.

The effect of preoperative external radiotherapy (XRT) on head and neck free-flap reconstruction is still controversial. In this study, we aimed to determine the impact of preoperative XRT on the outcomes of head and neck microvascular free-flap reconstruction. A systematic review and meta-analysis was conducted in concordance with the Systematic reviews and Meta-Analyses protocol. We searched several databases (PubMed, EMBASE, Web of Science, and Cochrane Library) to find published papers on the topic. The R program was used for data synthesis and statistical heterogeneity evaluation; then, fixed effect or random effect models were used. A total of 37 studies, involving 12 408 patients with 12 668 flaps, were included in this meta-analysis. The overall flap success rate for all studies was 94.4%. Pooled analysis showed that patients with preoperative XRT were significantly associated with an increased risk of total flap failure (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.45-2.23, P < .001), partial flap failure (OR = 1.90, 95% CI = 1.07-3.38, P = .029), and postoperative complication rates (OR = 2.22, 95% CI = 1.64-2.72, P < .001). Our study suggests that preoperative XRT is associated with an increased risk of developing free-flap failure and an increased postoperative complication rate.

Sulforaphane induces adipocyte browning and promotes glucose and lipid utilization.

SCOPE: Obesity is closely related to the imbalance of white adipose tissue storing excess calories, and brown adipose tissue dissipating energy to produce heat in mammals. Recent studies revealed that acquisition of brown characteristics by white adipocytes, termed "browning," may positively contribute to cellular bioenergetics and metabolism homeostasis. The goal was to investigate the putative effects of natural antioxidant sulforaphane (1-isothiocyanate-4-methyl-sulfonyl butane; SFN) on browning of white adipocytes. METHODS AND RESULTS: 3T3-L1 mature white adipocytes were treated with SFN for 48 h, and then the mitochondrial content, function, and energy utilization were assessed. SFN was found to induce 3T3-L1 adipocytes browning based on the increased mitochondrial content and activity of respiratory chain enzymes, whereas the mechanism involved the upregulation of nuclear factor E2-related factor 2/sirtuin1/peroxisome proliferator activated receptor gamma coactivator 1 alpha signaling. SFN enhanced uncoupling protein 1 expression, a marker for brown adipocyte, leading to the decrease in cellular ATP. SFN also enhanced glucose uptake and oxidative utilization, lipolysis, and fatty acid oxidation in 3T3-L1 adipocytes. CONCLUSION: SFN-induced browning of white adipocytes enhanced the utilization of cellular fuel, and application of SFN is a promising strategy to combat obesity and obesity-related metabolic disorder.

Simultaneous costochondral graft and distraction osteogenesis in unilateral TMJ ankylosis associated with mandibular retrognathia and asymmetry.

The purpose of this study was to review the long-term effect of simultaneous costochondral graft (CCG) and distraction osteogenesis (DO) in the management of unilateral temporomandibular joint ankylosis associated with severe dentofacial deformities in our clinic. In addition, we sought to analyze the advantages and disadvantages of CCG and DO. Four patients were included in this clinical study during 2005 to 2007. The mean length of ankylosis history was 14.5 years. All patients had significant mandibular retrognathia and asymmetry histories and have been diagnosed with obstructive sleep apnea syndrome by a polysomnogram before surgery. A 1-stage surgery, with gap arthroplasty, CCG, and mandibular DO, was performed. The surgical plan and technique were reviewed. No severe complications were observed after surgery. Distraction was started on day 7 after surgery. The distance of distraction ranged from 20 to 25 mm (mean, 22.5 mm). Mouth opening was increased from 25 to 37 mm (mean, 33.5 mm) during the follow-up period (range of 3.5-5 y). No recurrence of joint ankylosis occurred based on the clinical and radiographic evaluations. All of the patients had significant improvement in obstructive sleep apnea syndrome after surgery. Mandibular asymmetry and retrognathia were well corrected in all of the patietns. In conclusion, a 1-stage surgical treatment with DO and CCG demonstrated its feasibility and effectiveness in management of temporomandibular joint ankylosis combined with severe dentofacial deformity. It is a safe and reliable method of treatment.