Background: Nonimmediate (delayed) allergic reactions to penicillins are common and some of them can be life-threatening. The genetic factors influencing these reactions are unknown/poorly known/poorly understood. We assessed the genetic predictors of a delayed penicillin allergy that cover the HLA loci. Methods: Using next-generation sequencing (NGS), we genotyped the MHC region in 24 patients with delayed hypersensitivity compared with 20 patients with documented immediate hypersensitivity to penicillins recruited in Italy. Subsequently, we analyzed in silico Illumina Immunochip genotyping data that covered the HLA loci in 98 Spanish patients with delayed hypersensitivity and 315 with immediate hypersensitivity compared to 1,308 controls. Results: The two alleles DRB3*02:02:01:02 and DRB3*02:02:01:01 were reported in twenty cases with delayed reactions (83%) and ten cases with immediate reactions (50%), but not in the Allele Frequency Net Database. Bearing at least one of the two alleles increased the risk of delayed reactions compared to immediate reactions, with an OR of 8.88 (95% CI, 3.37–23.32; P <0.0001). The haplotype (ACAA) from rs9268835, rs6923504, rs6903608, and rs9268838 genetic variants of the HLA-DRB3 genomic region was significantly associated with an increased risk of delayed hypersensitivity to penicillins (OR, 1.7; 95% CI: 1.06–1.92; P=0.001), but not immediate hypersensitivity. Conclusion: We showed that the HLA-DRB3 locus is strongly associated with an increased risk of delayed penicillin hypersensitivity, at least in Southwestern Europe. The determination of HLA-DRB3*02:02 alleles in the risk management of severe delayed hypersensitivity to penicillins should be evaluated further in larger population samples of different origins.

Objective Ovarian mature teratoma (OMT) is a common ovarian tumor found in the pediatric population. In 10% to 20% of cases, OMT occurs as multiple synchronous or metachronous lesions on ipsi- or contralateral ovaries. Ovarian sparing surgery (OSS) is recommended to preserve fertility, but total oophorectomy (TO) is still performed. This study reviews the clinical data of patients with OMT, and analyzes risk factors for second events. Design A retrospective review of all girls under 18 years of age with OMTs was performed. Data on clinical features, imaging, laboratory studies, surgical reports, follow-up second events and their management were retrieved. Results Overall, 350 children were identified. Eighteen patients (5%) presented with a synchronous bilateral form at diagnosis. Surgery was performed by laparotomy (85%) and laparoscopy (15%). OSS and TO were performed in 59% and 41% of cases respectively. Perioperative tumor rupture occurred in 23 cases, independently of the surgical approach. Twenty-nine second events occurred (8.3%) in a median time of 30.5 months from diagnosis (ipsilateral: 8 cases including one malignant tumor, contralateral: 18 cases, both ovaries: 3 cases). A large palpable mass, bilateral forms at diagnosis and perioperative rupture had a statistical impact on the risk of second event, whereas type of surgery or approach did not. Conclusion This study is a plea in favor of OSS as the first choice of treatment of OMT when possible. Close follow-up during the first five years is mandatory considering the risk of 8.3% of second events especially in cases with risk factors.

Objective Although it may have been criticized and questioned by numerous authors, external fixation holds its place in modern orthopaedics and traumatology. The aim of this paper is to show the applicability of the unilateral 3D external fixation in everyday practice. Methods For external fixation of the bones, we used unilateral 3D external fixators according to Mitkovic. Results In the Republic of Serbia, the Mitkovic unilateral 3D external fixation system has been used in over 30,000 cases. The indication field of applicability of this method is wide. External fixation method was mostly used for the treatment of open and closed tibial fractures at all levels, in open femoral fractures as a part of the “staging” protocol and in fractures of the upper limbs. We used external fixation for the treatment of nonunions, malunions, in the treatment of osteitis, septic pseudoarthrosis, angular knee deformities, post-traumatic deformities, for limb lengthening and in replantation surgery. Conclusion The unilateral external fixator enables 3D biomechanical stability and is suitable for use in everyday traumatology and orthopaedics practice.

Background and aims : Colorectal cancers are one of the most common types of cancer. Gastric intestinal metaplasia is considered a precancerous lesion that can progress into gastric cancer. Even though there are previous publications stating that Helicobacter pylori and intestinal metaplasia are related to colorectal adenomas, there are also studies stating the opposite. This study aims to determine the relationship between gastric intestinal metaplasia and colorectal neoplasia. Methods: A total of 214 patients between the ages of 19 and 92 who underwent combined gastroscopy and colonoscopy between August 2016 and April 2020 were included in this retrospective study. Medical records including demographic data, gastroscopy and colonoscopy findings and histopathology results of the patients were reviewed and analyzed. The association of intestinal metaplasia and Helicobacter pylori infection with colorectal neoplasia was evaluated in these patients. Results: The mean age of the patients included in the study was 49.07±15.80, and 125 (58.4%) of the patients were male. A statistically significant correlation was found between intestinal metaplasia and colon neoplasm prevalence (p= 0.03). However, such a correlation was not seen between Helicobacter pylori and colon neoplasia. Conclusion: A positive correlation was found between gastric intestinal metaplasia, which is a precancerous lesion, and colon neoplasia. Even though this correlation indicates higher prevalence rates of colon neoplasia in patients with gastric intestinal metaplasia, how to evaluate these patients in terms of colon neoplasia remains a controversial issue.

Objective: To determine if children born preterm were at increased risk of influenza hospitalization up to age five. Methods: National registry data on all children born in Norway between 2008 and 2011 was used in Cox regression models to estimate adjusted hazard ratios (aHR) for influenza hospitalizations up to age five in children born preterm (<37 pregnancy weeks). HRs were also estimated separately for very preterm (<32 weeks), early term (37-38 weeks), and post-term (≥42 weeks) children. Results: Among 238 628 children born in Norway from January 2008 to December 2011, 15 086 (6.3%) were born preterm. There were 754 (0.3%) children hospitalized with influenza before age five. The rate of hospitalizations in children born preterm was 1.4 per 10 000 person-years (95% confidence interval [CI]: 1.1-1.7), and 0.6 per 10 000 person-years (95% CI: 0.5-0.6) in children born at term (≥37 weeks). Children born preterm had a higher risk of influenza hospitalization before age 5: aHR 2.33 (95% CI: 1.85-2.93). The risk increased with decreasing gestational age and was highest among those born very preterm; aHR 4.07 (95% CI: 2.63-6.31). Compared to children born at 40-41 weeks, children born early term also had an elevated risk of influenza hospitalization; aHR (37 weeks) 1.89 (95% CI: 1.43-2.40), aHR (38 weeks) 1.43 (95% CI: 1.15-1.78). Conclusion: Children born preterm had a higher risk of influenza hospitalizations before age five. An elevated risk was also present among children born at an early term. Children born preterm would benefit from influenza vaccinations.

The realization of fractional quantum chemistry is presented. Adopting the integro-differential operators of the calculus of arbitrary-order, we develop a general framework for the description of quantum nonlocal effects in the complex electronic environments. After a brief overview of the historical and fundamental aspects of the calculus of arbitrary-order, various classes of fractional Schrödinger equations are discussed and pertinent controversies and open problems around their applications to model systems are detailed. We provide a unified approach toward fractional generalization of the quantum chemical models such as Hartree-Fock and Kohn-Sham density functional theory and develop fractional variants of the fundamental molecular integrals and correlation energy. Furthermore, we offer various strategies for modeling static and dynamic quantum nonlocal effects through constant- and variable-order fractional operators, respectively. Possible directions for future developments of fractional quantum chemistry are also outlined.

In 2010, vulnerable golden bandicoots (Isoodon auratus) were translocated from Barrow Island, Western Australia, to a predator-free enclosure on the Matuwa Indigenous Protected Area. Golden bandicoots were once widespread throughout a variety of arid and semi-arid habitats of central and northern Australia. Like many small to medium-sized marsupials, the species has severely declined since colonisation and has been reduced to only four remnant natural populations. Between 2010 and 2020 the reintroduced population of golden bandicoots on Matuwa was monitored via capture-mark-recapture data collection which was used in spatially explicit capture-recapture analysis to monitor their abundance over time. In 2014, we used VHF transmitters to examine the home range and habitat selection of 20 golden bandicoots in the enclosure over a six-week period. We used compositional analysis to compare the use of four habitat types. Golden bandicoot abundance in the enclosure slowly increased between 2010 and 2014 and has since plateaued at approximately one quarter of the density observed in the founding population on Barrow Island. The population may have plateaued because some bandicoots escape through the fence. Golden bandicoots used habitats dominated by scattered shrubland over spinifex grass more than expected given the habitat’s availability. Nocturnal foraging range was influenced by sex and trapping location, whereas diurnal refuge habitat was consistent across sex and trapping location. Our work suggests that diurnal refuge habitat may be an important factor for the success of proposed translocations of golden bandicoots.

A knowledge of the exchanges of energy and water over the terrestrial surface is the first step to understand the ecohydrological mechanisms, particularly in water-limited ecosystems in the dryland environments. However, patterns of energy exchange and evapotranspiration (ET) are not well understood in the oasis-desert ecotone, which plays an important role in protecting oasis against the threat of desertification in northwestern China’s arid regions. Here the continuous measurements of surface energy fluxes were made using eddy covariance in conjunction with auxiliary measurements for two years (2014-2015) at a shrubland within an oasis-desert ecotone in the arid regions, northwestern China. Statistical analysis on 30-min time scale indicates that about 50% of daytime net radiation (Rn) over the shrubland is dissipated as H on average, which peaks in spring; one third Rn is consumed by soil heat flux (G). Only 9% of Rn was consumed for latent heat flux (λE), which peaks in summer (21% in 2014 and 16% in 2015), corresponding to the season with highest rainfall among all seasons. Daily mean ET is about 1 mm·d−1 during growing season of the shrub species. The rapid and transient increase in ET occurs following a rainfall event. A switch in surface soil moisture from 0.04 to 0.11 m3·m−3 causes an increase in Rn by about 11% and λE by 151% at the shrubland, respectively. Accumulated annual ET were 195 and 181 mm in 2014 and 2015, respectively, exceeding the corresponding P by about 87 and 77 mm, indicating that groundwater may be another important source of water for ET over the shrubland aside from P. These results provide valuable insight into the mechanisms of sustaining energy and water balance at the ecotone, and then produce some management guidelines for allocating water resources and protecting vegetation.

Complex civil structures require the cooperation of many building materials. However, it is difficult to accurately monitor and evaluate the inner damage states of various material systems. Based on a convolutional neural network (CNN) and the acoustic emission (AE) time-frequency diagram, we used the transfer learning method for classifying the AE signals of different materials under external loads. The results show the CNN model can accurately classify cracks that come from different materials based on AE signals. The recognition accuracy can reach 90% just by re-training the full connection layer of the pre-trained model, and its accuracy can reach 97% after re-training the top 2 convolutional layers of this model. A realization of cracking source identification mainly depends on the differences in mineral particles in materials. This work highlights the great potential for real-time and quantitative monitoring of the health status of composite civil structures.

Seaweed Gracilaria verrucosa is one of the potential marine natural resource commodities in Karawang Regency, Indonesia. The G. verrucosa-enriched bar soap is one of the added value products that can be developed from seaweed since it has a potential antiseptic function for human skin. Also, the seaweed-enriched bar soap sale can give more incomes for the seaweed farmers and coastal community in Karawang Regency. This study aims to produce bar soap with the addition of different seaweed G. verrucosa formulation and to examine the sensory, physicochemical, and bioactivity characteristics of G. verrucosa-enriched bar soap. This study applied five variants: the bar soap with extract of water + 250 ppm of seaweed (W250), extract of water + 500 ppm of seaweed (W500), extract of water + 750 ppm of seaweed (W750), extract of ethanol + 750 ppm of seaweed (E750), and seaweed pulp (SWP). The bar soap of variant W500 has the highest attributes according to the sensory and physicochemical analysis, while the variant SWP has the highest bioactivity parameter. From the results, the bar soap of variant W500 and SWP can be the candidates for further product development.

Objective: Diffuse-large-B-cell-lymphoma (DLBCL) can complicate B-cell-primary-immunodeficiencies (PIDs) course or induce total gamma-globulin level (TGL) lowering, whose clinical status as an effective secondary immunodeficiency (SID) remains unspecified. This study aims to assess the frequency, clinical and prognostic relevance of the lowest TGLs discovered at DLBCL diagnosis. Results: In a two year monocentric retrospective cohort, 96 patients diagnosed with DLBCL who had a serum electrophoresis (SEP) were included. Patients were divided into the lowest (L)- and the highest (H)-TGLs (TGL ≤5.5 g/L and TGL >5.5 g/L) subgroups and compared for outcomes, including fatal infectious events. In our cohort, 12 (12.5%; 8 males; median age: 68 [55—82] years) exhibited L-TGL. There was no differences regarding demographics, Ann-Arbor-lymphoma-stages, inflammatory parameters or chemotherapy regimen between both groups. However, overall (10/12, 83.3% versus 22/96, 26.2%; p=0.03) and infection-related death rates (10/12, 83% versus 6/96, 6.2%; p<0.001) were significantly higher in the L-TGL group. Conclusion: We demonstrate for the first time the strong negative impact of L-TGL on overall and infection-related mortality in DLBCL. Prospective studies should distinguish DLBCL-related SIDs from preexisting humoral PIDs, using biomolecular testing and post-treatment TGLs monitoring to determine the best management strategy for infectious risk during DLBCL treatment in L-TGL context.

Objectives: The aim of this study was to assess differences in echocardiographic findings between a normal adult and a post Covid-19 population. Background: Coronavirus disease (Covid-19) is known to produce a systemic inflammatory syndrome, with pulmonary and cardiac involvement. However, the cardiovascular impact in patients with mild clinical forms of the disease is uncertain. There is small evidence supporting the finding of global ventricular longitudinal strain (GLS) alterations in these patients. Methods: One hundred and five consecutive patients admitted to an ambulatory care center, underwent a conventional transthoracic echocardiographic (TTE) study with acquisition of GLS. Patients were included if they underwent a positive diagnostic reverse transcriptase polymerase chain reaction (PCR) test, having no relevant preexisting conditions, with exception of obesity. Demographic and clinical data were prospectively obtained. For this purpose, we considered a normal cut off point of -17,09%, based on previous studies. Echocardiographic findings were compared with those of 67 healthy individuals. Results: Out of 172 patients, 105 correspond to Covid-19 group, and 67 to healthy individuals. There were no significant differences in GLS regarding age, left ventricular mass index (LVMI) and E/e’ ratio. The multivariate analysis showed that the percentage of patients with pathological GLS values was significantly higher within the Covid-19 and male groups (OR 6.02 IC 1.88-22.57; p 0.004 and OR 3.17 IC 1.03-10.50; p 0.05, respectively). Conclusion: These data support that Covid-19 infection could affect ventricular GLS and encourage the use of conventional TTE with GLS measurements in patients with non-significant forms of the disease.

Mini Commentary – BJOG

Anaemia in pregnancy remains a global health problem In this issue of BJOG Hull et al …… et al report on an important study from South Africa regarding anaemia in pregnancy and the response to iron therapy. They report that in HIV-positive women the response was slower than in HIV-negative women. The underlying causes of anaemia varied and included iron deficiency (as assessed by ferritin levels) as well as concurrent infections (urinary tract infections and tuberculosis)Anaemia in pregnancy (blood haemoglobin Hb<11.0g/dl) occurs in > 40% of women living in low- and middle-income countries (LMIC) and in some settings in Asia prevalence is >60%. (McCauley et al, BMJ Global Health, 2018; 3(3):e000625) The latest WHO recommendations on antenatal care consider anaemia as the world’s second leading cause of disability and one of the most serious global public health problems (WHO Geneva 2016 ) .Although globally the focus has largely been on anaemia in pregnancy resulting from either iron deficiency or malaria, this is an incomplete approach at best. Iron deficiency is hard to measure and confirm as; i) this requires a functioning laboratory to be in place, ii) indicators for iron deficiency are influenced by the presence of concurrent infection, or, iii) repeated measures of Hb are needed to check whether the anaemia is responsive to treatment with iron. By contrast, malaria is relatively easy to diagnose via rapid diagnostic tests or microscopic examination of a stained blood smear slide. The handful of studies which have comprehensively assessed aetiology of anaemia in pregnant women demonstrate that anaemia is most commonly the result of complex multiple underlying factors including nutritional deficiencies as well as infectious diseases. Both nutritional deficiency and other infections (malaria, tuberculosis) are more likely with HIV-infection which itself can lead to anaemia probably through direct suppression of erythropoiesis.Hull et al show what was possible in a real-life clinical practice setting. This example of integration of research into clinical practice is laudable and is illustrative of how such integration could result in better services being made available for women in LMIC where burden of disease is high, but diagnostic tests are largely unavailable. It is sobering to realise that the majority of women world-wide will still only be screened for anaemia during pregnancy using ‘conjunctival inspection’ which is highly inaccurate. (van den Broek et al. Bull WHO 1999; 77(1):15-21) Rapid diagnostic tests are available for Hb, malaria, syphilis, HIV and, more recently, for tuberculosis. We are doing women a dis-service if we cannot offer at least these basic diagnostic tests as part of antenatal care.To prevent anaemia during pregnancy, the ‘fall-back’ position is to offer all women daily iron prophylaxis (30-60mg elemental iron) - with luck tablets are available that include folic acid (0.4mg) - along with presumptive treatment of malaria (various regimes) in endemic areas. Multi-micronutrients (including the required amount of iron and folic acid) might actually be better but cannot be recommended because of lack of evidence and they are still three times as expensive as iron and folic acid supplementation alone (3$ vs 1$ approximately).WHO recently recommended a better understanding of the aetiology of anaemia. A search on PubMed shows a clear lack of papers on the topic and more good research is needed. Investment in the antenatal care package offered to women is also much needed if we are aiming for a global ‘Health for All’.

Those patients with hypopharyngoesophageal cancer often sacrificed larynx before reconstruction using jejunum to restore the continuity of the digestive tract and allow oral alimentation. We retrospectively collected and analyzed three patients who underwent hypopharyngoesophageal reconstruction by free partial patch and partial tube jejunal graft transfer with reservation of laryngeal function caused by hypopharyngeal cancer invading the cervical esophagus. The partial patch and partial tube jejunal graft transfer survival rate was 100%(3/3). The larynx was reserved in the three patients. The partial patch and partial tube jejunal graft transfer is a safe and reliable choice for reconstruction of large and complex defects after pharyngectomy and cervical esophagectomy with larynx preserved.

Key Points: 1. We have identified ambiguity in the current guidance on thyroid MDT’s, and have also found nationwide variation in compliance with this. 2. We recommend: a. All surgeons undertaking thyroid surgery should complete a minimum of 20 thyroid procedures per year, and this should also form part of surgeons’ annual appraisal. b. All surgeons should contribute data to UKRETS (unless prevented by local legal frameworks) and this should form part of surgeons’ annual appraisal and be audited by individual MDT’s and regional cancer networks. c. Thyroid MDT’s should be held weekly where possible, with a minimum frequency of fortnightly. d. The core membership of a thyroid MDT (stand alone and joint) should include thyroid surgeons, specialist radiology, endocrinology, nuclear medicine, nurse specialists, histopathology +/- cytology and clinical oncology.

A document by Mark Wilkie. Click on the document to view its contents.

A 46- year old male, during intense physical activity, sustained malperfusion of the lower extremities from Type A thoracic aortic dissection. We took him to the operating room. emergently and perfusing both lower extremities using a modified straight graft with side to side anastomosis to one limb and end to side anastomoses to the inflow perfusion and contralateral limb. The patient was successfully discharged and remained to be doing well. for four years.

Background: There is limited information available on the use of PIP medication in older adults having psychiatric illness. Objective: To determine the prevalence of PIP medications, and assess its predictors in older adults with psychiatric illness. Methods: A cross-sectional study was carried out at a tertiary care hospital on 456 patients of either sex, with a median age of 65 years attending the psychiatry outpatient department. Evaluation of PIP medication was done using Beers criteria 2019 and STOPP criteria 2015. Bivariate logistic regression was used to find out the predictors of PIP prescribing. Results: Results of the study reflect that a staggering number of older adults, (more than 91% and 73%) out of total of 456 patients were prescribed with at least one PIP medication identified by Beers criteria and STOPP criteria, respectively. Long-acting benzodiazepine (LABZD) like clonazepam was identified as one of the most commonly prescribed PIP medications by both set of criteria. Further analysis revealed that older adults from rural background (Odds Ratio (OR) 2.60, 95% Confidence Interval (CI) 1.20-5.65; P=0.015), TCA (OR 0.30, 95% CI 0.12- 0.75; P= 0.010), LABZD (OR 33.72, 95% CI 11.27-100.85; P=<0.001), atypical antipsychotics (OR 22.35, 95% CI 5.31- 93.99; P= <0.001) use were most common predictors for PIP medication prescribing. Conclusion: The use of PIP medication is highly prevalent among older adults according to Beers criteria and STOPP criteria. The study reflects a more comprehensive and sturdy nature of Beer criteria as it significantly detects more PIP medication than STOPP criteria.

Introduction: The anatomy of the paranasal sinuses is important for many surgeon groups. The precise knowledge of such structures with variable anatomy will be important for the preservation of these structures and the management of complications in surgeries such as endoscopic sinus surgery and osteotomies involving the maxilla. Objective: The purpose of the present study is to investigate volumetric differences between ethmoid, sphenoid and maxillary sinus volumes in patients with maxillary deficiency requiring Le Fort osteotomy and healthy patients, by employing computed tomography imaging. Methods: Computed tomography scans of 120 patients (59 maxillary deficiency patients and 61 control patients) were included in the study. Images were processed, the paranasal sinuses were sculpted out from 3D images and measured. All measurements were taken twice by the same observers. The observers performed the study twice with an interval of 2 weeks to detect intra-observer variability. Results: Ethmoid and left and right maxillary sinus volumes were smaller in the Le Fort group, although no differences were observed for sphenoid sinus volumes. Conclusion: Paranasal sinus volumes varied between maxillary deficiency patients and control patients. This condition may be crucial for the surgeon operating in these areas and should be taken into consideration during surgeries.

Understanding the spatiotemporal changes in soil organic carbon (SOC) and their driving factors is an important prerequisite for decision-making in maintaining sustainable agricultural development and addressing climate change. A total of 1219 cropland topsoil SOC data (0-20 cm) collected from southern Jiangsu Province of China in 1980, 2000, and 2015, and geostatistical sequential Gaussian simulation were used to identify the changes in the spatiotemporal patterns of SOC during the period of 1980-2015. Results showed that the changes in SOC within the different time periods were significantly different, with a net increment of 3.65 g kg-1 during the period of 1980-2000 and a net decrement of 2.32 g kg-1 during the period of 2000-2015. Significant SOC accumulation occurred throughout the study area during 1980-2000, while SOC decline became predominant in the southeast during 2000-2015. Overall, the SOC contents for 60% of the study area increased significantly over the entire 35-year period. The SOC increase during the first two decades (1980-2000) was largely attributed to the increasing soil C input that resulted from the enhanced crop productivity by chemical fertilizers, while the stagnant soil carbon inputs associated with the rapid urban expansion were the primary reason for constraining cropland SOC accumulation in the subsequent 15 years (2000-2015). These findings highlight the importance of balancing agricultural development and urbanization processes to maintain SOC levels, and may also provide some guidance for planning cropland soil C management strategies in many areas that are undergoing similar urbanization processes.

The drum is the core part of a supercharged boiler that is prone to fatigue damage due to the dual action of thermal and mechanical stress. However, owing to its complex structure, complete modeling calculation of the drum requires considerable computational resources. Therefore, based on the basic theory of beam elements, we propose a simplified method using beam elements in place of solid tubes and evaluate the feasibility of this method. The results demonstrate that the simplified method reduced the overall mesh number of the model by 67.19% and the calculation time by 68.08%. Moreover, compared to the solid model, the maximum relative errors of stress and displacement were only 3.44% and 5.16%. Considering the dispersion of low-cycle fatigue life, we applied a statistical approach to the fatigue life assessment of the drum, and obtained the probability of failure corresponding to the fatigue life of the drum under the given operating conditions. This method provides an important basis for the systematic evaluation of fatigue life under various operating conditions and the prediction of failure occurrence.

Importance: Tumor encasement of the common carotid artery (CCA) and/or the internal carotid artery (ICA) in patients with advanced head and neck tumors represents a significant surgical challenge. At present, there are few reports on the treatment approach that can achieve the maximal oncological resection and reduce the difficulty of operation without affecting the carotid artery blood flow. Objective: To examine whether the combination of oncologic complete tumor resection and intravascular covered stent placement is more advantageous in the management of advanced head and neck cancer. Design, Setting, and Participants: Five patients with advanced head and neck squamous cell carcinoma (AHNSCC) invading one side of the carotid artery were retrospectively enrolled. The contrast-enhanced computed Tomography (CT) and angiography were performed to assess the severity of extrinsic tumor compression to the carotid artery. Covered stent was placed intra-arterially at least 1 cm proximal and distal beyond the area of tumor involvement. The tumor and the involved carotid artery were resected, and pectoralis major flap transfer was utilized for coverage of the great vessels supported with intra-arterial covered stent. Main Outcomes and Measures: Efficacy of oncologic complete tumor resection combined with endovascular stent placement. Results: The post-stenting demonstrated an improvement in the appearance and caliber of the affected carotid artery. Four patients experienced transient bradycardia and hypotension. All five patients underwent R0 resection. Postoperatively, the flap all had rich vascularity and healing. Three patients underwent adjuvant radiotherapy or chemoradiation. With median follow-up 6.5 months, one patient died of multiple organ failures at 6.5 months after surgery; one patient developed tracheal stoma recurrence and treated with salvaged surgery; the three other patients had no disease recurrence in their last follow-ups. Conclusions and Relevance: Surgical resection with intravascular covered stent placement could potentially achieve the maximal oncological resection without compromise carotid artery blood flow in patients with carotid artery encased head and neck cancer.

Introduction: The population is aging and older adults comprise the majority of patients in intensive care units. Colistin (COL) has been reintroduced to treat increasingly common resistant Gram-negative bacterial infections. Our study aims to investigate the factors affecting colistin nephrotoxicity in the general population and geriatric age group. Materials and Method: This retrospective study included 170 patients, 116 (68.2%) of which were in the geriatric group (age ≥65). Acute renal failure was evaluated using the RIFLE score. Firstly, factors associated with COL nephrotoxicity in the general population were investigated. Then, risk factors for COL nephrotoxicity were evaluated in the geriatric patient group. Results: Advanced age (odds ratio [OR]=1.043; 95% confidence interval [CI]: 1.018-1.068; p=0.001) and initial serum creatinine level (OR=23.122; 95% CI: 3.123-171.217; p=0.002) were found to be independent risk factors associated with nephrotoxicity. In the evaluation of the geriatric population-based on nephrotoxicity, the initial serum urea and creatinine levels, immunosuppression, and overall mortality rates were found to be statistically significant in the group with nephrotoxicity (p<0.05). Initial serum creatinine level (OR=22.48; 95% CI: 2.835-178.426; p=0.003) and concomitant nephrotoxic agent use (OR=2.516; 95% CI: 1.275-4.963; p=0.008) were independent risk factors associated with nephrotoxicity in geriatric patients. Conclusion: Advanced age was found to be a risk factor for COL nephrotoxicity. Caution should be exercised especially in geriatric patients who have initial serum creatinine levels close to the upper limit, concomitant use of nephrotoxic drugs should be avoided and if possible, evaluation should be made in terms of non-COL treatment options in these patients.