Free Flaps for Advanced Oral Cancer in the Older Old and Oldest Old : A Retrospective Multi-Institutional Study

Introduction: Surgery followed by adjuvant therapy represents the most adequate treatment for advanced oral squamous cell carcinoma (OSCC). Free flaps are considered the best reconstructive option after major oral surgery. In the last decades, OSCC has increased in the elderly due to an augmented life span. The aim of this work is to evaluate the feasibility of microvascular surgery in patients older than 75 years, focusing on clinical and surgical prognosticators. Methods: "Older old" (aged >= 75) and "oldest old" (>85) patients who underwent microvascular reconstruction for OSCC from 2002 to 2018 were retrospectively evaluated in three referral Head and Neck Departments. Demographic, clinical, and surgical data were collected and analyzed. Pre-operative assessment was performed by ASA and ACE-27 scores. Complications were grouped as medical or surgical, an d major or minor according to the Clavien-Dindo scale. Results: Eighty-four patients (72 "older old" and 12 "oldest old") were treated with a free flap success rate of 94.1%. Thirty-seven (44.7%) and nine (10.7%) patients had minor and major medical complications, respectively; 18 (21.4%) and 17 (20.2%) had minor and major surgical complications, respectively. Twenty-one (25%) patients had both medical and surgical complications (with a statistically significant association, p = 0.018). Overall, 52 (61.9%) patients had at least one complication: ASA score, diabetes mellitus, and duration of general anesthesia (DGA) significantly impacted the complication rate at multivariate analysis. Conclusion: Our data confirm the feasibility of free flaps for OSCC reconstruction in appropriately selected elderly patients. Pre-operative assessment and aggressive management of glycemia in patients with diabetes is mandatory. DGA should be reduced as much as possible to prevent post-surgical complications. Comprehensive geriatric assessment is of paramount importance in this subset of patients

Determination of Primary Surface Water Pollution Indicators by Multivariate Statistical Techniques in an Industrialized Basin

This study aimed to investigate the point and diffuse pollution sources of high total phosphorus (TP) pollution detected in the dry and wet seasons of the industrialized and urbanized Saz-Cayirova Basin through field observation and multivariate statistical techniques. In this context, nineteen water quality parameters were analyzed in surface water samples collected monthly between June 2020 and July 2021 from nineteen different sites along the Saz-Cayirova stream. Firstly, two reference sites representing a better surface water status were determined and assessed the water quality on the stream tributaries affecting the wastewater treatment plant in the two Organized Industrial Zones (OIZ). Secondly, hierarchical cluster analysis (HCA) and principal component analysis (PCA) were performed to evaluate the complex water quality dataset and reveal the latent sources of TP pollution. The results showed that the tributaries in the pressure of OIZ discharges were highly enriched in COD, TOC, NO3-N, NH3-N, and TP concentrations compared to the reference level. Compared with reference sites, the concentrations of the four heavy metals examined were at a plausible level. Besides, the pollution sources of TP were industrial processes wastewater such as dyeing, washing, phosphating, domestic wastewater from OIZ, urban diffuse waters with organic character, and continuous discharges of undefined sources. The seasonal variation of TP values is observed relatively low, indicating that the stream network is greatly affected by point source pollution. Our observation and analysis imply that the treatment technologies adopted by the OIZ wastewaters plant is sufficient to treat heavy metals. However, measures need to be formulated to remove TP and organic pollution from the secondary production process. © 2022, Avestia Publishing. All rights reserved

The Importance of Continuing Breastfeeding during Coronavirus Disease-2019: In Support of the World Health Organization Statement on Breastfeeding during the Pandemic.

There are many questions and concerns about the coronavirus disease 2019 (COVID-19), including its implications for breastfeeding. This commentary draws on a statement and recommendations recently issued by the Regional Office for Europe of the World Health Organization with the contribution of the European Pediatric Association-Union of National European Pediatric Societies and Associations and other main European pediatric organizations.1 Our aim is to provide pediatricians with further guidance on breastfeeding and related safety measures during COVID-19, particularly in instances where a mother has or may have COVID-19