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Neoplasms of the maxilla have multiple different origins and histology, and often extend towards the infratemporal fossa, orbit, or skull base. Extensive resection may be required, often leading to poor esthetic and functional results. Usually, these lesions are removed via a transfacial approach. The aim of this study was to compare the outcomes of the transoral versus transfacial approach for maxillary tumors. A single-institution retrospective study was conducted on patients with maxillary-midface tumors, treated between January 2009 and December 2019. The patients were divided into two groups according to the surgical approach, transfacial or transoral, and the following outcomes were assessed: extent of the resection based on Brown's classification; postoperative pathology margin assessment; reconstruction technique; esthetic/functional results. A total of 178 patients were included. A satisfactory resection was obtained in both groups, with the transoral cohort achieving a higher rate of clear oncological margins (positive margins: transoral group 3.7% versus transfacial group 6.8%, P = 0.389) and a significantly higher University of Washington Quality of Life score (mean 72.2 versus 67.8, P < 0.001). Even large and invasive tumors can be treated successfully with the transoral approach, avoiding unesthetic facial scars while still providing complete resection of the tumor. [ABSTRACT FROM AUTHOR]

Suicide by firearm remains one of the leading causes of violence-related injury death in the United States each year. The mortality rate from these injuries is high, resulting in a paucity of outcome data in the literature regarding injuries to the maxillofacial region. This has largely been attributed to a lack of funding for research in this area compared to other leading causes of mortality in the United States. The aim of this study was to detail the authors' experience and approach to complex maxillofacial reconstruction using both local reconstructive methods and microvascular free tissue transfer. A retrospective cohort study was designed, including patients who sustained self-inflicted gunshot wounds to the maxillofacial region between January 1, 2012 and May 1, 2020. Forty-one patients met the inclusion criteria. The majority of the patients were male (87.8%). Mean patient age was 44.2 ± 16.6 years. Alcohol or drugs, and a psychiatric history were present in a majority of the cases. The most involved anatomical region was the midface (75.6% of cases). Seven patients required free tissue transfer for reconstruction, with many needing multiple flaps. Self-inflicted gunshot wounds represent challenging reconstruction scenarios, often in the setting of severe psychological trauma, and require a multidisciplinary team to ensure the optimal outcome. [ABSTRACT FROM AUTHOR]

Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries. [ABSTRACT FROM AUTHOR]

• Bandgap formation in a fluid conveying pipe using local resonators. • Pipe modelled as a Euler-Bernoulli beam. • Bandgaps predicted using unit cell method based on infinitely long beam. • Bandgaps also predicted using unit modal analysis approach based in finite length beam. • Effect of flow velocity, ratio of resonator's mass to that of pipe in addition to other parameters on bandgap formation. The objective of this paper is to investigate the effects of fluid flow velocity on the edge frequencies of the bandgap in an acoustic metamaterial pipe in a non-dimensional framework. Two methodologies are presented to predict the formation of the bandgap. In the first methodology, the pipe is considered to be infinitely long and the dispersion of an elastic wave in a single representative periodic unit cell of the structure is used to estimate the bandgap edge frequencies. In the second method, the pipe is modeled as a finite structure with defined boundary conditions and a modal analysis-based method is used to estimate the edge frequencies. A parametric study is performed wherein parameters identified from the non-dimensional analysis are varied, namely, the dimensionless flow velocity, the ratio of the resonator's mass to that of the pipe and the fluid and the ratio of the fluid's mass to that of the pipe and the fluid. It is shown that a close agreement in the bandgap edge frequencies is achieved using both methodologies. Furthermore, it is observed that an increase in the fluid velocity induces a decrease in the bandgap width, an increase of the mass ratio of the fluid to that of the pipe and the fluid results in a small decrease in the bandgap width and finally an increase in the mass of the resonators relative to that of the pipe leads to an increase in the bandgap width. [ABSTRACT FROM AUTHOR]

The 30-day readmission rate is a highly scrutinized metric of quality surgical care, because readmission is costly and perceived to be avoidable with planning and patient education. Head and neck surgery patients generally have multiple risk factors for readmission, as readmitted patients are generally older, with more co-morbidities, lower socio-economic status, and a history of multiple emergency department visits and readmissions. A retrospective cohort study was implemented to determine the incidence and etiology of 30-day readmission after microvascular head and neck reconstructive surgery, focusing on social risk factors. Data were analyzed by χ2 test, analysis of variance, t -test, and logistic regression, with statistical significance set at P < 0.05. Of 209 patients included in this study, 35 (16.7%) had a 30-day readmission. Increased needs at discharge were associated with increased readmission, while other social risk factors were less significant for a readmission in this study. [ABSTRACT FROM AUTHOR]

Virtual surgical planning (VSP) promises higher accuracy, efficiency, and superior patient outcomes, helping normalize outcomes from surgeons of different experience levels. A systematic review was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The objective was to evaluate the accuracy and secondarily efficiency of VSP compared with free-hand surgery, for mandibular reconstruction with free flaps. Six studies met inclusion criteria and had quantitative data suitable for meta-analysis. Intercondylar distance and gonion angle were used to assess accuracy, evaluated by mean change from preoperative VSP and postoperative imaging. The mean weighted difference in VSP intercondylar distance was 2.0 mm, compared with 3.9 mm for free hand (P = 0.101) and mean change in gonion angle for VSP was 3.6°, compared with 7.7° for free hand (P < 0.05). Efficiency assessed by mean ischemia time, was 73.8 min and 109.9 min, for VSP and free hand, respectively (P = 0.203), and by total operative time, which was 391.8 min and 457.6 min in the VSP and free hand, respectively (P = 0.340). VSP is consistently proven to be more accurate and efficient than traditional free-hand surgery; however, a standardized method for accuracy and efficiency measurements is still missing, causing heterogeneity among the scientific reports. [ABSTRACT FROM AUTHOR]

Abstract The aim of this study was to evaluate the dynamic perfusion of the maxilla during various stages of a Le Fort I osteotomy using indocyanine green (ICG) dye angiography. This was a retrospective evaluation of patients who underwent a Le Fort I osteotomy. ICG was used to assess perfusion at specific time points during the procedure. Twenty-four patients underwent a Le Fort I osteotomy with dynamic perfusion ICG angiography. Statistically significant differences in perfusion were noted at all three locations assessed between preoperative (T0), post down-fracture (T1), and postoperative (T2) time points. When controlling for mean arterial pressure, statistically significant differences were noted at all three locations assessed between T0 and T1, and between T0 and T2. There were no statistically significant differences in patient age, heart rate, preservation or sacrifice of the descending palatine arteries, or conventional vs. segmental Le Fort I osteotomies across T0, T1, and T2. In conclusion, there was a statistically significant decrease in perfusion, as assessed by intraoperative dynamic angiography, to the anterior maxilla following maxillary down-fracture. Patient age, conventional vs. segmental Le Fort I osteotomy, changes in mean arterial pressure and/or heart rate, and preservation of the descending palatine vessels had no statistically significant effect on perfusion. [ABSTRACT FROM AUTHOR]

Importance: Clinical equipoise exists around the optimal time to start adjuvant endocrine therapy in patients who will receive post-operative radiotherapy for breast cancer. Concerns continue to exist regarding potential reduced efficacy, or increased toxicity, when radiation, and endocrine therapy are administered concurrently.Objective: To perform a systematic review of studies comparing outcomes between sequential and concurrent adjuvant radiation and endocrine therapy in early-stage breast cancer. All modalities of radiation therapy were considered, and endocrine therapy could be either tamoxifen or an aromatase inhibitor. Outcomes of interest included; local, regional or distant recurrence, overall survival and treatment-related toxicities.Evidence Reviewed: PubMed, Ovid Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from 1946 to December 2017. Two reviewers independently assessed each citation using the criteria outlined above. Study quality was assessed using the Cochrane Collaboration's tool for prospective studies, and the Newcastle-Ottawa scale for retrospective studies.Findings: Of 2137 unique citations identified, 13 met eligibility criteria. Eleven were unique studies (7569 patients), while 2 of the studies were updated analyses of previous studies. Studies evaluated the timing of adjuvant radiation, and tamoxifen (5 studies, 1550 patients), or aromatase inhibitors (6 studies, 6019 patients). We identified 1 complete randomized clinical trial (150 patients), and 5 retrospective studies (1580 patients), in addition to conference abstracts (5 studies, 5839 patients). Overall, none of the studies showed a significant difference in efficacy, or toxicity, with concurrent versus sequential treatment. However, given the significant heterogeneity of the study populations, it was not possible to conduct a meta-analysis.Conclusions and Relevance: In the absence of high quality data, adequately powered randomized trials are required to answer this important clinical question. [ABSTRACT FROM AUTHOR]

Lustre is a decoration consisting of a surface layer of silver and copper metal nanoparticles, a few hundreds of nanometres thick and incorporated into the glaze. It shows a colourful metallic and iridescent appearance which makes use of the quantum confined optical response of the metallic nanoparticles. Three apparently unrelated lustre decorations, yellow-orange golden ( Tell Minis ), a dark brown-reddish with iridescences ( Raqqa ) and yellow-brown golden ( Damascus ) were produced in the same area in successive periods over tin and lead-free glazes which is known to require specific strategies to obtain a metallic shiny lustre. The composition and nanostructure of the lustre layers are analysed and the materials and specific firing conditions followed in their production determined. The optical properties of the lustre layers have been analysed in terms of the nanostructure obtained and correlated to the specific processing conditions. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effect of dietary lysine on performance, protein deposition and respiratory chain gene expression in male broilers. A total of 252 Cobb 500 broilers were distributed, in a completely randomized design, into four treatments with seven replicates of nine birds per experimental unit. Experimental treatments consisted of diets based on corn and soybean meal, with four levels of digestible lysine: 1.016%, 1.099%, 1.182% and 1.265%. The increase in the level of digestible lysine in the diet provided higher weight gains, feed efficiency and body protein deposition. Birds fed the lowest level of dietary lysine (1.016%) showed a lower expression of genes such as NADH dehydrogenase subunit I (ND1), cytochrome b (CYTB) and cytochrome c oxidase subunits I (COX I), II (COX II) and III (COX III), displaying the worst performance and body protein deposition. This demonstrates the relationship existing between the expression of the evaluated genes and the performance responses. In conclusion, results indicate that broilers fed diets with higher levels of digestible lysine have increased messenger RNA expression of some genes coded in the mitochondrial electron transport chain (ND1, CYTB, COX I, COX II and COX III). It may be stated that diets with proper levels of digestible lysine, within the ‘ideal protein’ concept, promote the expression of genes, which increases the mitochondrial energy, thereby fostering body protein deposition and the performance of broilers in the starter phase. [ABSTRACT FROM PUBLISHER]

Background Bone-targeting agents (BTAs), such as bisphosphonates and denosumab, have demonstrated no discernable effects on tumour response or disease free/overall survival in patients with bone metastases from breast cancer. Doxycycline is both osteotropic and has anti-cancer effects. When combined with zoledronate in animal models, doxycycline showed significantly increased inhibition of tumour burden and increased bone formation. We evaluated the effects of adding doxycycline to ongoing anti-cancer therapy in patients with metastatic breast cancer. Methods Breast cancer patients with bone metastases and ≥3 months of BTA use, entered this single-arm study. Patients received doxycycline 100 mg orally, twice a day for 12 weeks. The co-primary endpoints were; effect on validated pain scores (FACT-Bone pain and Brief Pain Inventory) and bone resorption markers (serum C-telopeptide, [sCTx]). All endpoints (pain scores, sCTx, bone-specific alkaline phosphatase, skeletal-related events, toxicity) were evaluated at baseline, 4, 8 and 12 weeks. Bone marrow was sampled at baseline and week 12 for exploratory biomarker analysis. Results Out of 37 enroled patients, 27 (73%) completed 12 weeks of therapy. No significant changes were seen in pain scores or bone turnover markers. Failure to complete treatment: drug toxicity (70%) and disease progression (30%). Sixteen (43%) patients had GI adverse events. Conclusions Doxycycline 100 mg twice daily for 12 weeks had no significant effects on either bone pain or bone turnover markers. Its toxicity profile in this patient population would make further evaluation challenging. [ABSTRACT FROM AUTHOR]

Fracture characterization under mode II loading of a hybrid laminate composed by a unidirectional carbon fiber-epoxy composite and cork was performed using the End Notched Flexure test. A data reduction scheme based on equivalent crack length concept, specimen compliance and Timoshenko beam theory was applied to evaluate fracture toughness under mode II loading of a composed beam (cork and carbon-epoxy composite). The adopted procedure depends exclusively on the data issuing from load–displacement ( P–δ ) curve and does not require crack length monitoring during the test which is a difficult task to be accomplished with the necessary accuracy in the ENF test. A numerical analysis using cohesive zone modeling and an inverse procedure was performed to assess the mode II cohesive law that simulates the material fracture under shear loading. It was concluded that hybridization is advantageous relative to monolithic carbon-epoxy laminate in which concerns the observed failure mode, which altered from typically brittle to very ductile thus contributing to avoid sudden shear failures in real applications. [ABSTRACT FROM AUTHOR]

Abstract: In this work fracture characterization under mode I loading of a hybrid laminate composed by a unidirectional carbon–epoxy composite and cork was performed using the Double Cantilever Beam test. An equivalent crack length procedure based on specimen compliance and Timoshenko beam theory applied to the composed beam was adopted to evaluate the fracture energy. The procedure revealed to be quite effective and it was validated numerically by means of finite element analysis including cohesive zone modelling. The analysis of the experimental results has shown that an increase of 32% of mode I toughness relative to monolithic carbon–epoxy laminate was obtained, which proves that hybridization using cork results in a quite effective procedure to increase interlaminar toughness of composite laminates. [Copyright &y& Elsevier]