Medical Bulletin 16/ December/ 2024

Here are the top medical news for the day:

Enhanced Flap Technique Achieves 100% Success Rates in Head and Neck Reconstruction: Study Finds

Osaka Metropolitan University researchers have developed a technique for head and neck reconstruction that shifts the placement of transferred tissue with blood vessels attached, offering a safer, faster option for patients with complex tissue defects, especially those at high risk. The findings are published in plastic and reconstructive surgery – global open.

Head and neck reconstruction plays a crucial role in the treatment of patients with head and neck cancer. The goal is to preserve functions vital for breathing, eating, and speaking, while maintaining the patient’s appearance and quality of life.

“Traditional reconstruction typically uses free flaps, which may not be feasible for some patients, such as those who have had prior radiation treatment or multiple surgeries,” said Tsubasa Kojima, a medical doctor and lecturer at Osaka Metropolitan University’s Graduate School of Medicine and lead author of the study.

The research team cut a new path and worked instead with pedicled flaps taken from the back, called pedicled latissimus dorsi (LD) myocutaneous flaps. Unlike free flaps, pedicled flaps remain partially attached to the donor site, retaining their natural blood supply as they are transferred to the recipient site for reconstruction.

While the latissimus dorsi flap has been used in various reconstructive surgeries, the team developed a unique approach that placed the skin portion of the latissimus dorsi flap more distally, or lower on the back, than in conventional techniques. This design includes the lateral cutaneous branch of the 10th posterior intercostal artery, ensuring reliable blood flow to the flap.

The study, conducted between 2003 and 2024, demonstrated that the pedicled latissimus dorsi flap was successfully integrated in all 22 patients with complex head and neck defects.

Reference: Kojima, Tsubasa MD; Motomura, Hisashi MD, PhD; Nochi Deguchi, Ayaka MD; Maeda, Shusaku MD; Kang, Songsu MD. Salvage Operation of Head and Neck Reconstruction Using a Pedicled Latissimus Dorsi Myocutaneous Flap with Distally Positioned Skin Paddle. Plastic & Reconstructive Surgery-Global Open 12(10):p e6199, October 2024. | DOI: 10.1097/GOX.0000000000006199

Exposure to Long Term Air Pollution May Increase Risk for Venous Blood Clots

A large study found that greater exposure to long-term air pollution was linked with increased risks for blood clots that can occur in deep veins, which, if untreated, can block blood flow and cause serious complications, even death. The findings were published in the journal Blood.

These findings came from a longitudinal study that included 6,651 U.S. adults who were followed for an average of 17 years between 2000 and 2018. Participants lived in or near one of six major metropolitan areas:

New York, Baltimore, Chicago, Los Angeles, Minneapolis, and Winston-Salem, North Carolina.

Throughout the study, 248 adults, 3.7% of the study sample, developed blood clots in deep veins that required hospital care. The likelihood of this outcome was linked to anywhere from a 39% to a more than two-fold increased risk based on long-term exposure to three different types of air pollutants. Exposure to air pollution, which can set the stage for inflammation and contribute to blood clotting, has long been associated with cardiovascular and respiratory diseases.

This included exposure to tiny air pollution particles equal to or less than 2.5 micrometers, which can be inhaled from a variety of sources. Participants with greater overall exposure to this type of air pollution had a 39% increased associated risk for venous thromboembolism compared to people exposed to lower levels. People with increased exposure to oxides of nitrogen and nitrogen dioxide, pollutants most often found from vehicle exhaust, had a respective 121% to 174% increased risk.

To reach these findings, the researchers analyzed the relationship between patients hospitalized for venous thromboembolism and levels of air pollution collected through extensive biweekly community-level monitoring — including samples taken from the homes of participants. They then compared those with the highest exposure levels — the top 75% — to those with the lowest exposure — the bottom 25%. They also conducted multiple analyses to control for variables associated with venous thromboembolism, such as age, exposure to tobacco, and underlying respiratory and other health conditions.

Reference: Lutsey P, Misialek J, Young M, et al. Air pollution is associated with increased risk of venous thromboembolism: The Multi-Ethnic Study of Atherosclerosis. Blood. 2024; doi: https://doi.org/10.1182/blood.2024026399.

Repeated Doses of Paracetamol May Increase Risk of Gastrointestinal, Cardiovascular Complications in Older Adults

New research, led by experts at the University of Nottingham, has found that repeated doses of paracetamol in people aged 65 and over, can lead to an increased risk of gastrointestinal, cardiovascular and renal complications.

The new study, which is published in Arthritis Care and Research, shows that care must be taken when repeated doses are required for chronic painful conditions such as osteoarthritis in older people.

Professor Weiya Zhang, from the NIHR Biomedical Research Centre in the School of Medicine at the University of Nottingham who also led the study, said: “Due to its perceived safety, paracetamol has long been recommended as the first line drug treatment for osteoarthritis by many treatment guidelines, especially in older people who are at higher risk of drug-related complications.”

The study analysed data from the Clinical Practice Research Datalink-Gold. Participants were aged 65 and over with an average age of 75, and had been registered with a UK GP practice for at least a year between 1998 and 2018.

Researchers looked at the health records of 180,483 people who had been prescribed paracetamol repeatedly during the study. Their health outcomes were then compared to 402,478 people of the same age who had never been prescribed paracetamol repeatedly.

The findings showed that prolonged paracetamol use was associated with an increased risk of peptic ulcers, heart failure, hypertension and chronic kidney disease.

Professor Zhang adds: “Whilst further research is now needed to confirm our findings, given its minimal pain-relief effect, the use of paracetamol as a first line pain killer for long-term conditions such as osteoarthritis in older people needs to be carefully considered.”

Reference: Kaur, J., Nakafero, G., Abhishek, A., Mallen, C., Doherty, M. and Zhang, W. (2024), Incidence of side effects associated with acetaminophen in people aged 65 years or more: a prospective cohort study using data from the Clinical Practice Research Datalink. Arthritis Care Res. Accepted Author Manuscript. https://doi.org/10.1002/acr.25471

Study Highlights Potential for Circadian Clock Modulation in Inflammatory Bowel Disease Treatment

A review sheds light on the crucial link between the body’s circadian clock and inflammatory bowel disease, paving the way for innovative therapeutic approaches.

This study highlights the critical role of the body’s circadian clock in regulating immune activity and digestive functions, revealing its influence on the development and progression of inflammatory bowel diseases (IBDs) such as Crohn's disease and ulcerative colitis. Disruptions in circadian rhythms exacerbate inflammation, suggesting that aligning treatment strategies with these natural biological cycles could improve patient outcomes. By advocating for personalized medicine that incorporates individual chronotypes, lifestyle interventions like sleep hygiene and meal timing, and real-time biological monitoring, the study paves the way for innovative, rhythm-based therapies. This approach has the potential to significantly enhance inflammatory bowel disease management, addressing both the physical and emotional burden of these chronic conditions.

The study reveals that both immune system activity and digestive functions follow daily rhythms governed by the circadian clock. Disruption of this internal timing system has been linked to increased inflammation, suggesting it plays a key role in the development and progression of inflammatory bowel disease.

Highlights and Future Directions

Personalized Medicine: Incorporating chronotype data into treatment plans could tailor therapies to individual patients, improving outcomes.

Biological Sampling and Monitoring: Saliva, sweat, or blood samples collected at different times during the day, alongside wearable device data, could provide insights into how circadian rhythms influence inflammation.

Lifestyle Interventions: Programs focusing on sleep hygiene and timed meal interventions could reset the circadian clock, reducing inflammation and delaying disease flares.

Therapeutic Advances: Developing tools to evaluate circadian system performance may lead to therapies that enhance the effectiveness of current inflammatory bowel disease treatments.

Reference: Froy, O., & Weintraub, Y. (2024). The circadian clock in inflammatory bowel diseases. Trends in Molecular Medicine.