Salvage of failed free flaps used in head and neck reconstruction

Free flap success rates are in excess of 95%. Vascular occlusion (thrombosis) remains the primary reason for flap loss, with venous thrombosis being more common than arterial occlusion. The majority of flap failures occur within the first 48 hours. With early recognition and intervention of flap compromise salvage is possible. Successful salvage rates range from 28% to over 90%. Rapid re-exploration in this clinical setting is crucial to maximise the chances of flap salvage. If salvage is not feasible or unsuccessful then non-surgical methods of salvage may be employed with some possibility of success. The purpose of this article is to review the causes of free flap failure and to highlight the available options for salvage

Acoustic voice characteristics with and without wearing a facemask

Facemasks are essential for healthcare workers but characteristics of the voice whilst wearing this personal protective equipment are not well understood. In the present study, we compared acoustic voice measures in recordings of sixteen adults producing standardised vocal tasks with and without wearing either a surgical mask or a KN95 mask. Data were analysed for mean spectral levels at 0–1 kHz and 1–8 kHz regions, an energy ratio between 0–1 and 1–8 kHz (LH1000), harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPS), and vocal intensity. In connected speech there was significant attenuation of mean spectral level at 1–8 kHz region and there was no significant change in this measure at 0–1 kHz. Mean spectral levels of vowel did not change significantly in mask-wearing conditions. LH1000 for connected speech significantly increased whilst wearing either a surgical mask or KN95 mask but no significant change in this measure was found for vowel. HNR was higher in the mask-wearing conditions than the no-mask condition. CPPS and vocal intensity did not change in mask-wearing conditions. These findings implied an attenuation effects of wearing these types of masks on the voice spectra with surgical mask showing less impact than the KN95

The Use of Pork from Entire Male and Immunocastrated Pigs for Meat Products—An Overview with Recommendations

Due to the strong public initiative in Europe and increased regulator focus to mitigate pain, surgical castration of pigs is being gradually abandoned, while the importance of other sex categories like entire males (EM) and immunocastrates (IC) increases. Although beneficial for animal welfare and economics, their use also brings forward several quality problems. Besides the occurrence of boar taint in EM, these include excessive carcass leanness, softer fat, meat color and pH deviations, inferior water holding capacity and increased meat toughness. In this paper, the raw material differences between the male sex categories and their influence on product quality are reviewed, and possible solutions are presented. Using EM for dried or thermally processed products may result in lower processing yields and inferior sensory quality, which may partially be prevented by applying specific processing adaptations. Immunocastration is a viable solution, especially when prolonging the vaccination to slaughter interval. Low to medium levels of boar taint can be effectively managed in most of the meat products, applying procedures like cooking, microbial inoculation or masking (by spices and especially smoking), while highly tainted material can be valorized only by combining various methods and/or with dilution of the tainted meat.info:eu-repo/semantics/publishedVersio

Using Motor Tempi to Understand Rhythm and Grammatical Skills in Developmental Language Disorder and Typical Language Development

Children with developmental language disorder (DLD) show relative weaknesses on rhythm tasks beyond their characteristic linguistic impairments. The current study compares preferred tempo and the width of an entrainment region for 5- to 7-year-old typically developing (TD) children and children with DLD and considers the associations with rhythm aptitude and expressive grammar skills in the two populations. Preferred tempo was measured with a spontaneous motor tempo task (tapping tempo at a comfortable speed), and the width (range) of an entrainment region was measured by the difference between the upper (slow) and lower (fast) limits of tapping a rhythm normalized by an individual’s spontaneous motor tempo. Data from N = 16 children with DLD and N = 114 TD children showed that whereas entrainment-region width did not differ across the two groups, slowest motor tempo, the determinant of the upper (slow) limit of the entrainment region, was at a faster tempo in children with DLD vs. TD. In other words, the DLD group could not pace their slow tapping as slowly as the TD group. Entrainment-region width was positively associated with rhythm aptitude and receptive grammar even after taking into account potential confounding factors, whereas expressive grammar did not show an association with any of the tapping measures. Preferred tempo was not associated with any study variables after including covariates in the analyses. These results motivate future neuroscientific studies of low-frequency neural oscillatory mechanisms as the potential neural correlates of entrainment-region width and their associations with musical rhythm and spoken language processing in children with typical and atypical language development

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction

Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

<p>Abstract</p> <p>Background</p> <p>Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows.</p> <p>Methods</p> <p>Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex.</p> <p>Results</p> <p>Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1^st(7.4 μg/m³) to the 25^th(17.2 μg/m³), 50^th(33.8 μg/m³), 75^th(108.3 μg/m³), and 90^th(180.8 μg/m³) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage.</p> <p>Conclusions</p> <p>The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.</p

Supraglottic Botulinum Toxin Improves Symptoms in Patients with Laryngeal Sensory Dysfunction Manifesting as Abnormal Throat Sensation and/or Chronic Refractory Cough

Laryngeal sensory dysfunction (LSD) encompasses disorders of the vagal sensory pathways. Common manifestations include chronic refractory cough (CRC) and abnormal throat sensation (ATS). This study examined clinical characteristics and treatment outcomes of LSD using a novel approach of laryngeal supraglottic Onabotulinum toxin Type A injection (BTX). This was a retrospective review of clinical data and treatment outcomes of supraglottic BTX in patients with LSD. Between November 2019 and May 2021, 14 patients underwent 25 injection cycles of supraglottic BTX for treatment of symptoms related to LSD, including ATS and CRC. Primary outcome measures included the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ), Cough Severity Index (CSI), Reflux Symptom Index (RSI), and Voice Handicap Index-10 (VHI-10) at baseline and within three months of treatment. Pre- and post-treatment data were compared using a linear mixed model. After supraglottic BTX, LHQ scores improved by 2.6. RSI and CSI improved by 8.0 and 5.0, respectively. VHI-10 did not change as a result of treatment. Short-term response to SLN block was significantly associated with longer term response to BTX treatment. These findings suggest that LSD presents clinically as ATS and CRC along with other upper airway symptoms. Supraglottic BTX injection is a safe and effective technique in the treatment of symptoms of LSD

Adult obstructive sleep apnoea and the larynx

Purpose of review: The review examines current evidence and thinking regarding the relationship between the larynx and obstructive sleep apnoea (OSA) in adults. Recent findings: Drug-induced sleep endoscopy has an emerging role in the identification of laryngeal obstruction associated with sleep apnoea and may be adjunctive to awake dynamic assessment in specific cases. Nocturnal stridor and OSA is a common and treatable finding in patients with multiple system atrophy. Acromegaly can cause OSA by obstruction at the laryngeal level via supraglottic soft tissue hypertrophy or decreased vocal fold mobility. Emerging evidence suggests a relationship between OSA, laryngopharyngeal reflux, and laryngeal sensory dysfunction including chronic cough. The mechanisms remain unclear and warrant further investigation. Summary: The larynx plays an important role in assessment and treatment of adult sleep apnoea. Laryngeal afferent sensory pathways play a critical role in reflexes controlling airway patency during sleep. Airway obstruction at the laryngeal level should be considered and assessed especially in OSA patients nonresponsive to standard therapies. Isolated laryngeal airway obstruction is rare but identification of specific conditions is important as they are amenable to appropriate treatments. OSA can also affect normal laryngeal function. People with OSA exhibit higher levels of laryngeal inflammation, laryngopharyngeal reflux, and chronic cough. Treatment with continuous positive airway pressure has a potential role in improving laryngeal symptomatology in these cases