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

Arrhythmia-related Hospitalization and Comorbid Cannabis Use Disorder: Trend Analysis in US Hospitals (2010-2014)

Objective To study the trends of arrhythmia hospitalizations with cannabis use disorders (CUDs) in terms of demographic characteristics and inpatient outcomes. Methods We used the nationwide inpatient sample (NIS) data during the post-legalization period (2010-2014) and included 570,556 arrhythmia inpatients (age, 15-54 years), and 14,426 inpatients had comorbid CUD (2.53%). We used the linear-by-linear association test and independent-sample T-test for assessing the change in hospital outcomes in inpatients with CUD. Results Arrhythmia hospitalizations with CUD increased by 31% (2010-2014). This increasing trend was seen in adults (45-54 years, P < 0.001) and was predominant in males (77.6%). Hypertension (40.6%), hyperlipidemia (17.6%), and obesity (15%) were prevalent medical comorbidities with variable trends over the five years. Among substance use disorders, tobacco (50.9%), and alcohol (31.4%) were major comorbidities with a variable trend (P = 0.003 for each). There was a 71.4% increase in the inpatient mortality rate between 2010 (0.7%) and 2014 (1.2%). The mean length of stay was three days, and the total hospitalization charges have been increasing (P < 0.001), averaging $35,812 per hospital admission. Conclusion Chronic cannabis use or abuse worsens hospitalization outcomes in arrhythmic patients, and more clinical studies are needed to study the causal association between these conditions due to the rising mortality risk

Staggered fermion matrix elements using smeared operators

We investigate the use of two kinds of staggered fermion operators, smeared and unsmeared. The smeared operators extend over a $4^4$ hypercube, and tend to have smaller perturbative corrections than the corresponding unsmeared operators. We use these operators to calculate kaon weak matrix elements on quenched ensembles at $\beta=6.0$, 6.2 and 6.4. Extrapolating to the continuum limit, we find $B_K(NDR, 2 GeV)= 0.62\pm 0.02(stat)\pm 0.02(syst)$. The systematic error is dominated by the uncertainty in the matching between lattice and continuum operators due to the truncation of perturbation theory at one-loop. We do not include any estimate of the errors due to quenching or to the use of degenerate $s$ and $d$ quarks. For the $\Delta I = {3/2}$ electromagnetic penguin operators we find $B_7^{(3/2)} = 0.62\pm 0.03\pm 0.06$ and $B_8^{(3/2)} = 0.77\pm 0.04\pm 0.04$. We also use the ratio of unsmeared to smeared operators to make a partially non-perturbative estimate of the renormalization of the quark mass for staggered fermions. We find that tadpole improved perturbation theory works well if the coupling is chosen to be \alpha_\MSbar(q^*=1/a).Comment: 22 pages, 1 figure, uses eps

Problematic Cannabis Use and Risk of Complications in Patients with Chronic Hepatitis C

Objectives To evaluate the risk of complication in hospitalized chronic hepatitis C (CHC), patients with cannabis use disorder (CUD). Methods We conducted a retrospective study using the nationwide inpatient sample (NIS), and included 31,623 patients (age 15-54) with a primary international classification of diseases, ninth revision (ICD-9) diagnosis for CHC and grouped by co-diagnosis of CUD (1101, 3.5%). Logistic regression model adjusted for confounders was used to evaluate the odds ratio (OR) of CUD and complications during CHC hospitalization. Results Comorbid CUD was prevalent in males (73.2%), Caucasians (59.9%), and from low-income families (65.7%). The most prevalent complications in patients with CUD were ascites (44.9%), alcoholic cirrhosis (42.8%) and non-alcoholic cirrhosis (41.1%). The odds of association for hepatic encephalopathy was 2.2 times higher (95% CI 1.477-3.350) in 2.8% CHC inpatients with CUD compared to 1.2% non-CUD inpatients. Hepatic encephalopathy had higher odds of association with a male by 1.4 times (95% CI 1.094-1.760), and African American by 1.7 times (95% CI 1.293-2.259). Conclusion CUD is significantly associated with 122% increased likelihood for hepatic encephalopathy that may worsen overall hospitalization outcomes in CHC patients. Hence, we need to consider the complex relationship between CUD and CHC and manage them optimally to improve the health-related quality of life

I=2I=2 pion scattering amplitude with Wilson fermions

We present an exploratory calculation of the $I=2$ $\pi-\pi$ scattering amplitude at threshold using Wilson fermions in the quenched approximation, including all the required contractions. We find good agreement with the predictions of chiral perturbation theory even for pions of mass 560-700 MeV. Within the 10\% errors, we do not see the onset of the bad chiral behavior expected for Wilson fermions. We also derive rigorous inequalities that apply to 2-particle correlators and as a consequence show that the interaction in the antisymmetric state of two pions has to be attractive.Comment: This PS file includes 4 tables and figures 1-8 on 25 pages. Los Alamos Preprint Number LAUR-92-364

Gene Expression Profiling of Bronchoalveolar Lavage Cells Preceding a Clinical Diagnosis of Chronic Lung Allograft Dysfunction.

BackgroundChronic Lung Allograft Dysfunction (CLAD) is the main limitation to long-term survival after lung transplantation. Although CLAD is usually not responsive to treatment, earlier identification may improve treatment prospects.MethodsIn a nested case control study, 1-year post transplant surveillance bronchoalveolar lavage (BAL) fluid samples were obtained from incipient CLAD (n = 9) and CLAD free (n = 8) lung transplant recipients. Incipient CLAD cases were diagnosed with CLAD within 2 years, while controls were free from CLAD for at least 4 years following bronchoscopy. Transcription profiles in the BAL cell pellets were assayed with the HG-U133 Plus 2.0 microarray (Affymetrix). Differential gene expression analysis, based on an absolute fold change (incipient CLAD vs no CLAD) &gt;2.0 and an unadjusted p-value ≤0.05, generated a candidate list containing 55 differentially expressed probe sets (51 up-regulated, 4 down-regulated).ResultsThe cell pellets in incipient CLAD cases were skewed toward immune response pathways, dominated by genes related to recruitment, retention, activation and proliferation of cytotoxic lymphocytes (CD8+ T-cells and natural killer cells). Both hierarchical clustering and a supervised machine learning tool were able to correctly categorize most samples (82.3% and 94.1% respectively) into incipient CLAD and CLAD-free categories.ConclusionsThese findings suggest that a pathobiology, similar to AR, precedes a clinical diagnosis of CLAD. A larger prospective investigation of the BAL cell pellet transcriptome as a biomarker for CLAD risk stratification is warranted

The Kaon BB-parameter with Wilson Fermions

We calculate the kaon $B$-parameter in quenched lattice QCD at $\beta=6.0$ using Wilson fermions at $\kappa=0.154$ and $0.155$. We use two kinds of non-local (``smeared'') sources for quark propagators to calculate the matrix elements between states of definite momentum. The use of smeared sources yields results with much smaller errors than obtained in previous calculations with Wilson fermions. By combining results for $\vec p =(0,0,0)$ and $\vec p =(0,0,1)$, we show that one can carry out the non-perturbative subtraction necessary to remove the dominant lattice artifacts induced by the chiral symmetry breaking term in the Wilson action. Our final results are in good agreement with those obtained using staggered fermions. We also present results for $B$-parameters of the $\Delta I = 3/2$ part of the electromagnetic penguin operators, and preliminary results for \bk\ in the presence of two flavors of dynamical quarks.Comment: 39 pages, including 9 PS figures (LA UR-91-3522

‘Post-race’ racism in the narratives of ‘Brexit’ voters

Although a growing body of scholarship seeks to understand the motivations behind the ‘Brexit’ vote – including that which centralises explorations of racism, nationalism and post-colonialism – little consideration has been given to the ways in which ‘post-race’ racisms underpin the narratives of Leave voters. This article draws on data generated through 13 semi-structured interviews to examine the subtle and subterranean ways in which xeno-racism is articulated in the accounts of some Leave voters in the Greater Manchester city of Salford: a city that saw a higher percentage of the electorate (56.8%) vote to leave the EU than the national average (51.9%). Whilst restricting immigration was a key motivator of Leave voters in our research, interviewees vehemently rejected accusations of racism. Instead, couching their views in seemingly non-racial ways, they framed their concerns about immigration as a ‘legitimate’ response to a victimised whiteness. Thus, in discussing our data, we argue that far from living in a ‘post-racial’ epoch, racisms continue to thrive through new modes of articulation. These new racisms emerge from the shadows at key times, such as the EU Referendum, and refashion themselves in ways that are considered more palatable than the older (explicit) racisms of past