The time of presentation of flap compromise is a significant predictor of flap salvage outcome. Intensive flap monitoring at a special microsurgical intensive care unit by well-trained nurses and surgeons allows for early detection of vascular compromise, which leads to better outcomes.

Extensive composite defects of the oromandibular area are usually created after the surgical treatment of T3 and T4 cancers, requiring complex reconstructive plastic surgical procedures. The preferred treatment method for this type of defect is reconstruction with two free flaps. The use of the vascularized fibula osteoseptocutaneous flap for the bone and inner lining defect is well known and accepted. Among the flaps that can be used for the outer lining and soft-tissue reconstruction, the two most commonly used have been the forearm flap and the rectus abdominis myocutaneous flap. However, these flaps have some disadvantages that restrict their use for this purpose. The forearm flap is usually too thin to cover the fibular bone and reconstruction plate, and the rectus abdominis myocutaneous flap can cause a subclinical reduction in abdominal strength. Both radial forearm and rectus abdominis myocutaneous flaps are difficult to harvest during tumor excision. Because of these drawbacks, over the past several years the authors have preferred to use the anterolateral thigh flap for outer face, neck, and submandibular region reconstructions. From October of 1998 to June of 2000, 22 extensive composite mandibular defect reconstructions using the free anterolateral thigh flap, combined with the vascularized free fibula osteoseptocutaneous flap, were performed at the Chang Gung Memorial Hospital. Complete flap survival was 90.9 percent (40 of 44 flaps). Complete loss was seen in an anterolateral thigh flap, which was then reconstructed with a pectoralis major myocutaneous pedicled flap (2.3 percent). There were five venous problems: three in osteoseptocutaneous free fibula flaps, the other two in anterolateral thigh flaps; all were revised immediately. However, the skin islands of two osteoseptocutaneous free fibula flaps and one anterolateral thigh flap developed partial necrosis (6.8 percent). The other complications were compartment syndrome in the leg in one patient, external carotid artery rupture in one patient, three donor-site infections in two patients, three neck wound infections, and one myocardial insufficiency; all were treated properly. Thirteen patients underwent revision procedures 6 months after the first operation. These procedures included debulking of the flap or revision of the mouth angle or both. Trismus or intraoral contraction was noted in none of these patients. In conclusion, the free anterolateral thigh flap combined with the vascularized fibula osteoseptocutaneous flap seems to be a good choice in the reconstruction of the extensive composite defects of the oromandibular region aesthetically and functionally.

The aim of this study was to identify the changes of hematologic and immunological parameters in COVID-19 patients. We collected and analyzed the data of 117 patients who were laboratory confirmed as SARS-CoV-2 infection. The cases were divided into regular group, severe group and critically ill group according to the sixth edition scheme for COVID-19 diagnosis and treatment of China. The laboratory tests included blood routine, cellular and humoral immunity indices, biochemical detections and inflammatory biomarker. Compared with regular patients, severe and critically ill patients had significantly lower lymphocyte count (p < 0.01), decreased red blood cell and hemoglobin (p < 0.01), low levels of immunoglobulin G (p < 0.05) and significantly higher in D-dimer (p < 0.0001), fibrinogen (p < 0.01), white blood cell count (p < 0.01), neutrophil count (p < 0.0001), interleukin-6 (p < 0.05), C-reactive protein (p < 0.01), procalcitonin (p < 0.01), erythrocyte sedimentation rate (p < 0.05), ferritin (p < 0.01) and lactate dehydrogenase (p < 0.0001). The specific immunoglobulin G antibodies to the SARS-CoV-2 in severe and critically ill patients were significantly lower than that in regular patients (p < 0.05). Our findings suggest that the lymphocyte counts, red blood cell counts and the immunoglobulin G antibodies of COVID-19 patients were impaired to varying degrees and the blood was in a state of hypercoagulation, which were more obvious in critically ill patients.

The growth process of gold nanoplates formed by a thermal aqueous solution approach was investigated by withdrawing drops of a heated solution containing HAuCl4, cetyltrimethylammonium bromide (CTAB), and trisodium citrate and examined the intermediate products formed by a transmission electron microscopy analysis. The formation process proceeds extremely rapidly within seconds of reaction to form large aggregated structures, which are composed of wormlike structures just several nanometers in diameter. These tiny nanostructures are fused extensively toward the central region to form a thicker mass. The central core grows in size via incorporating the exterior wormlike nanostructures and eventually evolves into the plate morphology. Appropriate amounts of CTAB and trisodium citrate were also found to be critical to the formation of nanoplates. This synthesis approach has been extended to prepare ultrasmall triangular gold nanoplates with average widths of 40 ± 7 and 58 ± 10 nm. Because of their relatively uniform sizes, these tiny nanoplates can spontaneously self-assemble into some ordered 2-dimensional structures such as the hexagonally arranged pattern. UV−vis absorption spectroscopy showed that these nanoplates exhibit a strong absorption band at 590−602 nm and a weak and broadband centered at ∼775−900 nm.

Recipient vessel selection and preparation in primary head and neck cancer reconstruction requiring two simultaneous flaps should take into consideration (1) avoidance of unnecessary destruction during tumor ablations and preservation of as many neck vessels as possible, (2) length and diameter match between flap pedicles and recipient vessels to avoid vein grafts, and (3) possible need of another free-flap reconstruction for flap failure, complication, recurrence, or secondary primary cancers. The previously radiated or operated neck does not preclude the use of recipient vessels from that side. Distal run-off of the inner flap for external flap revascularization should be avoided if possible. Once those principles are observed, two-flap reconstruction for primary cancer presents no more difficulties than single-flap reconstruction.

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We report a new development for the direct high-yield synthesis of high aspect ratio gold nanorods. By using a modified seed-mediated synthesis approach for the preparation of high aspect ratio gold nanorods with the addition of an appropriate amount of nitric acid during nanorod growth, uniform and monodispersed gold nanorods were synthesized in large quantity. The formation of triangular nanoplate byproducts was substantially reduced by replacing trisodium citrate with cetyltrimethylammonium bromide (CTAB) surfactant as the capping agent in the preparation of gold seeds. The percent yield of nanorods produced can be as high as over 90% after a simple purification step. The nanorods have an average length of 355.3 ( 31.3 nm and an average diameter of 18.7 nm, giving them an average aspect ratio of 19. These nanorods can spontaneously self-assemble into highly ordered side-by-side packing structures over a large area. The X-ray diffraction pattern revealed a very strong (111) diffraction peak. The ultra-small gold seeds used for nanorod growth were ∼1-2 nm in diameter and showed a weak surface plasmon resonance (SPR) absorption band centered at ∼480 nm. The nanorods showed a transverse SPR absorption band at 497 nm and a longitudinal SPR band at ∼2135 nm. Because of the large reduction in the amount of triangular and truncated triangular nanoplates formed, the absorbance of the nanoplates at 830 nm has been lowered substantially.

The research outcomes support the value of community-based health promotion programmes in rural areas, incorporating a multidisciplinary health team and culturally competent materials to help the elder rural inhabitants with diabetes enjoy better health and quality of life.