Mucosal melanoma of the head and neck: recurrence characteristics and survival outcomes
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Faruk Kadri Bakkal, Adil Başman, Yusuf Kızıl, Özgür Ekinci, Mustafa Gümüşok, Mehmet Ekrem Zorlu, Utku Aydil ObjectiveThe aim of this study was to review oncologic outcomes and recurrence characteristics of head and neck mucosal melanomas (HNMMs) managed at a tertiary referral center.Study DesignClinical records of 10 patients who were managed for HNMMs between 2001 and 2013 were retrospectively analyzed.ResultsThe median age was 66 years (range 28-76 years) and male/female (M/F) ratio was 1:5. The 3-year disease-free survival (DFS) rates and overall survival (OS) rates were 11.7% and 35%, respectively; and the 5-year DFS rates and OS rates 11.7% and 23.3%, respectively. The median DFS and OS periods were 12 months (range 2-36 months) and 17 months (range 7-96 months), respectively. The rates of development of local, regional, and systemic recurrences were 20%, 50%, and 80%, respectively. Lungs were involved in all patients who had distant metastasis.ConclusionsThis study shows that HNMMs has a very aggressive course and that distant metastases are common. For this reason, systemic control of the disease is an important aim of treatment. Read More » 
Denosumab-related osteonecrosis of the jaw: a case report and management based on pharmacokinetics
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Tae min You, Kang-Hee Lee, Soo-Hyeon Lee, Wonse Park Denosumab, a monoclonal antibody against the receptor activator for nuclear factor–kappa B ligand (RANKL), is a recently approved antiresorptive drug that suppresses osteoclast formation by targeting preosteclasts, in contrast to the traditional antiresorptive bisphosphonates that target mature osteoclasts. Osteonecrosis of the jaw (ONJ) is a well-known, if rare, side effect of bisphosphonate therapy; however, cases of ONJ have also been reported since 2010 in patients taking denosumab. We describe here a patient who developed ONJ while receiving denosumab; the pharmacokinetics of denosumab and bisphosphonates are discussed in the context of ONJ management. Read More »
Editorial Board
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Read More »
Epidemiology, prognostic factors, and management of malignant odontogenic tumors: an analysis of 295 cases
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Robert J. Lee, Elizabeth L. Tong, Riki Patel, Leslie A. Go, Russell E. Christensen ObjectiveTo determine the demographic characteristics, prognostic factors, and management for patients diagnosed with a malignant odontogenic tumor (MOT).Study DesignThe Surveillance, Epidemiology, and End Results (SEER) registry was reviewed for patients diagnosed with MOT from 1973 to 2011. Kaplan-Meier and multivariate Cox regression analyses were performed on patient demographic characteristics and pathologic variables.ResultsThe SEER database identified 295 MOT patients. The mean age at diagnosis was 50.5 years (range 5-89 years). Of these patients, 61.7% were male and 38.3% were female. The racial composition was 66.4% White, 22% Black, 6.1% Asian, 3.1% Pacific Islander, 0.3% Native American, and 2.1% Other/Unknown. Kaplan-Meier analysis found an overall survival (OS) and disease-specific survival (DSS) at 5 years of 54% and 67%, respectively. Multivariate analysis of the entire cohort found that age and stage were predictors of OS and that age was a predictor for DSS. For stage I/II MOTs, age and surgical therapy were predictors of OS and DSS, respectively.ConclusionsHere we report the largest study to date investigating demographic characteristics, prognostic factors, and management of MOT patients. Determinants of survival for OS and DSS include age, stage, and surgical therapy. Read More »
Fractal analysis of mucosal microvascular patterns in oral lichen planus: a preliminary study
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Alberta Lucchese, Enrica Gentile, Giovanni Capone, Gionata De Vico, Rosario Serpico, Gabriel Landini ObjectivesThe objective of this study was to assess local vascular architecture in atrophic-erosive oral lichen planus (OLP).Materials and MethodsWe investigated the capillary structure of the oral mucosa in 31 patients with OLP and 32 healthy controls. Capillaries images were captured in vivo through a capillaroscope. We applied fractal analysis to quantify the microvasculature morphometric changes in the oral mucosa of atrophic-erosive OLP patients in terms of their fractal dimension (D).ResultsThe oral vascular networks of atrophic-erosive OLP lesions had a significantly higher D, both in buccal mucosae (D = 1.167, P = .019) and in tongue (D = 1.196, P = .038), compared with the control population (1.123 for both locations, respectively).ConclusionsThe present study confirms previous literature data on a close relationship between abnormal vascular architecture and atrophic-erosive OLP. Fractal analysis provided a quantitative descriptor of the complexity of the vascular patterns, which increases in the OLP samples. These data may provide new information on the OLP pathogenesis, as well as serve as morphologic quantifiers for monitoring treatment strategies. Read More »
The effectiveness of antibiotic prophylaxis to prevent infectious endocarditis is not easily dismissed
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Arthur H. Friedlander, Tina I. Chang, Renna C. Hazboun, Nona Aghazadehsanai Read More »
Information for Readers
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Read More »
Aggressive giant cell lesion of the jaws: a review of management options and report of a mandibular lesion treated with denosumab
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): John Edward O'Connell, Conor Bowe, Colm Murphy, Mary Toner, Gerard J. Kearns Giant cell lesions (GCLs), previously referred to as giant cell granulomas, are benign tumors of the jaws of unknown etiology. Surgical management of aggressive GCLs is challenging, as these lesions demonstrate a tendency to recur following surgical removal. In addition, surgical treatment can be associated with significant morbidity. In an attempt to reduce both the extent of morbidity and the recurrence rate following surgery, a number of pharmacologic therapies have been advocated on the basis of assumptions about the predominant cell types and receptors, for the management of these lesions.This report describes the use of denosumab, an agent originally used for its anti-resorptive effects, in the management of an aggressive GCL of the mandible in an older patient, who was unsuitable for extensive surgery and in whom treatment with intralesional triamcinolone had proved unsuccessful. Denosumab may be a viable alternative or adjunct to surgery in the management of GCLs of the jaws. Read More »
An innovative approach in osteoporosis opportunistic screening by the dental practitioner: the use of cervical vertebrae and cone beam computed tomography with its viewer program
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Imad Barngkgei, Easter Joury, Ali Jawad ObjectivesTo investigate the use of cone beam computed tomography (CBCT) for predicting osteoporosis based on the cervical vertebrae CBCT-derived radiographic density (RD) using the CBCT-viewer program.Study DesignCBCT scans (WhiteFox, de Gotzen S.r.l device, distributed by Satelec-Acteon Group, Italy) and dual-energy X-ray absorptiometry examinations of 38 women who participated in an earlier investigation were examined. A coronal slice, subjectively determined from the cervical vertebrae, was selected and the RD as gray values for the first and second vertebrae, and the dens was calculated by using CBCT-viewer software (WhiteFox imaging).ResultsThe CBCT-derived RD values of the dens and the left part of the first cervical vertebra showed the strongest correlation coefficients (r = 0.7, 0.6; P < .001) and the highest sensitivity (76.9%, 70%), specificity (92%, 92.9%), and accuracy (90.8%, 86.4%) in predicting osteoporosis in the lumbar vertebrae and the femoral neck, respectively.ConclusionsCBCT-derived RD of cervical vertebrae can predict osteoporosis status using a CBCT-viewer program. This finding should be confirmed on other CBCT devices. Read More »
Contents
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Read More »
The benefit and risk of screening for oral potentially malignant epithelial lesions and squamous cell carcinoma
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Joel B. Epstein, Michaell A. Huber Read More »
The cadmium telluride photon counting sensor in panoramic radiology: gray value separation and its potential application for bone density evaluation
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Robert Langlais, Akitoshi Katsumata, Sudeshni Naidoo, Koichi Ogawa, Tatsumasa Fukui, Shinji Shimoda, Kaoru Kobayashi ObjectiveTo investigate whether bone mineral density can be evaluated more accurately using a panoramic device with a new cadmium telluride photon-counting sensor and software than 2 panoramic devices with a conventional semiconductor sensor.Study DesignA fiduciary test object with several known levels of hydroxy apatite mineral concentration was placed in a phantom on the mandibular occlusal plane. Panoramic images were acquired by changing the position of the test object within the dental arch. The gray value, the spectrum deformation index (SDI), and the relative attenuation index (RAI) of the test object were evaluated. The SDI and RAI represent unique energy information as acquired by the QR-Master panoramic machine and the corresponding special QR-MC analysis software. In order to compare the values expressed in the different units (gray, SDI, and RAI values), the percentage discrepancy was calculated.ResultsThe cadmium telluride photon-counting fitted machine more consistently separated each of the hydroxy apatite concentrations in all of the different positioning configurations and locations. The SDI function of the QR Master machine produced more stable values than the RAI value and the gray values of the 2 conventional panoramic machines.ConclusionsThe methodologies as developed for this study can be used to test more sophisticated analyses for the determination of bone density. Read More »
Marketing versus science: a call for evidence-based advertising in dentistry
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Michaell A. Huber, Joel B. Epstein Read More »
Platelet-rich plasma for periodontal regeneration in the treatment of intrabony defects: a meta-analysis on prospective clinical trials
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Àlvar Roselló-Camps, Alberto Monje, Guo-Hao Lin, Vahid Khoshkam, Mitchel Chávez-Gatty, Hom-Lay Wang, Jordi Gargallo-Albiol, Federico Hernandez-Alfaro ObjectiveThe aim of this systematic review and meta-analysis was to assess the influence of platelet-rich plasma (PRP) on the regeneration of periodontal intrabony defects by means of evaluating clinical and radiographic outcomes in prospective human clinical trials.BackgroundPRP is a high concentration of platelets suspended in a small volume of plasma and has been used for periodontal tissue regeneration. However, although it has been broadly studied, there is much controversy on its efficacy when used to treat infrabony periodontal defects.MethodsAn electronic literature search was conducted by two reviewers (AR and AM) in several databases up to February 2014. The PICO question was: Does PRP have a higher or similar efficacy of regenerating periodontal intrabony defects compared with other conventional periodontal regeneration treatments (e.g., bone grafts, barrier membranes)? Articles were included in this systematic review if they were prospective clinical trials with 10 or more human patients, reporting the radiographic and/or clinical outcomes PRP for regeneration intrabony periodontal defects. Random effects meta-analyses of the selected studies were applied to avoid any bias being caused by methodologic differences among studies.ResultsTwenty-two papers were obtained and reviewed. Of these, 21 articles fulfilled the inclusion criteria and subsequently were qualitatively analyzed. Eighteen of these could be meta-analyzed. Fourteen articles were included for evaluating of probing pocket depth (PPD). The weighted mean difference (WMD) was 0.55 mm, with a 95% CI = −0.09 to 1.20 mm (P = .09). For bone level (BL), 2 articles measured BL in millimeters, and the other two articles measured BL in percentage. The WMD was 0.76 mm (95% CI = 0.21-1.31 mm; P = .007) and 47.41% (95% CI = 32.48%-62.33%; P < .0001), respectively. For attachment level (AL) changes, 12 articles were included. The WMD was 0.58 mm, with a 95% CI = 0.24 to 0.91 mm (P = .0008). Sixteen articles were included for evaluation of marginal gingival level (MGL). The WMD −0.10 mm, with a 95% CI = −0.19 to −0.01 (P = .03).ConclusionsHigh heterogeneity among studies made it difficult to draw clear conclusions. Nonetheless, within the limitations of this review, PRP might offer some beneficial effects on clinical and radiographic outcomes for regeneration of periodontal intrabony defects. Read More »
Society Page
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Read More »
Influence of hyperbaric oxygen on the initial stages of bone healing
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Flaviana Soares Rocha, Camilla Christian Gomes Moura, Denise Betulucci Rocha Rodrigues, Darceny Zanetta-Barbosa, Karen Renata Nakamura Hiraki, Paula Dechichi ObjectiveThe objective of this study was to evaluate, in a rat model, the effect of hyperbaric oxygen (HBO) on the healing of normal bone on day 7.Study DesignForty male rats were used, equally divided into two groups based on treatment and time of sacrifice: the control group had bone defects created; and the HBO group had bone defects and received HBO. HBO sessions were conducted daily, at 2.5 atmosphere absolute for 90 minutes, and the animals were euthanized after 1, 3, 5, or 7 days. Bone density, bone neoformation, and expression of Runt-related transcription factor 2 (Runx2) and tartrate-resistant acid phosphatase were evaluated.ResultsComputed tomography analysis revealed significant differences only at 3 days (P = .01) between the control and HBO groups. HBO treatment accelerated the initial events of bone repair, resulting in improved bone neoformation. Increased expression of Runx2 was observed, especially on days 5 and 7 in the HBO group, although not significantly. There was no significant difference (P = .74) in the number of tartrate-resistant acid phosphatase–positive osteoclasts between the control and HBO groups on day 7.ConclusionsThese results suggest that exposure to HBO enhances bone anabolism, reduces inflammation, and accelerates bone healing, with positive results in bone neoformation. Therefore, the aim of this study was to evaluate the effect of HBO on the healing of experimental defects created in normal bone, on the first 7 days, in a rat model. Read More »
Clinicopathologic conference: bluish gingival nodule
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Michelle Agostini, Aline Corrêa Abrahão, Márcia Grillo Cabral, Bruno Augusto Benevenuto de Andrade, Mário José Romañach Read More »
Non-Osteotomy Treatment of Class III Skeletal Malocclusion Using Bone Anchored Maxillary Protraction
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): NATHAN EBERLE, ERIC STELNICKI, JOHN MARCHETTO, Nathan Eberle Read More »
The diagnostic challenges of separating chronic ulcerative stomatitis from oral lichen planus
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): Hiba Qari, Carmen Villasante, Jordan Richert, Terry Rees, Harvey Kessler ObjectiveTo attempt to establish criteria to differentiate between chronic ulcerative stomatitis (CUS) and oral lichen planus (OLP) with hematoxylin and eosin (H&E) staining alone.Study DesignTen confirmed cases of CUS were reviewed from the Stomatology Clinic at the Texas A&M University Baylor College of Dentistry.ResultsThe original diagnosis on H&E evaluation was OLP, chronic mucositis, or mucositis with lichenoid features, but subsequent direct immunofluorescence (DIF) revealed a positive speckled intranuclear deposition of immunoglobulin G (IgG) in the basal and parabasal layers of the epithelium, confirming a diagnosis of CUS.ConclusionsNo consistent histopathologic features were present that would allow recognition of CUS from H&E analysis alone. DIF remains the gold standard for diagnosis. Read More »
Airway Management and Control of Severe Hemorrhage by Transarterial Embolization Through Interventional Radiology and 3-Staged Repair of Multiple Facial Fractures in a Maxillofacial Trauma Patient
Publication date: November 2015Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 120, Issue 5 Author(s): RYAN RICHARDS, POOJA GANGWANI, MICHAEL ERLICHMAN, HILLEL EPHROS, RICHARD P. SZUMITA, Ryan Richards Read More »
Remote infarct of the temporal lobe with coexistent hippocampal sclerosis in mesial temporal lobe epilepsy
Publication date: Available online 8 October 2015Source:Human Pathology Author(s): Jordan M. Gales, Richard A. Prayson In patients undergoing surgery for temporal lobe epilepsy, hippocampal sclerosis remains the most commonly observed pathology. In addition to hippocampal sclerosis, 5-30% of these resections on magnetic resonance imaging contain a second independently epileptogenic lesion, commonly referred to as dual pathology. A second etiology of seizure activity, as seen in dual pathology, may serve as an important cause of treatment failure in striving for post-operative seizure control. Dual pathology, consisting of hippocampal sclerosis and a remote infarct of the adjacent cortex, has been rarely reported. Cases of pathologically confirmed hippocampal sclerosis diagnosed between January 2000 and December 2012 (n=349) were reviewed and seven cases of coexistent infarct (2%) formed the study group. Seven individuals (mean age 29 years, range 5–47 years) with a mean epilepsy duration of 12.5 years (3.3-25 years) and a mean pre-surgery frequency of 15 seizures per week (range 0.5-56 seizures/week) were followed postoperatively for a mean duration of 64 months (range 3–137 months). Pathologically, the most common form of hippocampal sclerosis observed was International League against Epilepsy type Ib or severe variant (n=4). Four of the six individuals with post-surgery follow-up were seizure free at last encounter. The reported incidence of dual pathology, including hippocampal sclerosis and remote infarct, is low (2% in the present study), but may indicate a slight increased risk of developing hippocampal sclerosis in the setting of a remote infarct. Surgical intervention for such cases anecdotally appears effective in achieving seizure control. Read More »
Mutational spectrum of intraepithelial neoplasia in pancreatic heterotopia
Publication date: Available online 9 October 2015Source:Human Pathology Author(s): Changqing Ma, Christopher D. Gocke, Ralph H. Hruban, Deborah A. Belchis Heterotopic pancreatic parenchyma recapitulates the normal pancreas in extra-pancreatic locations and on rare occasions can even give rise to pancreatic adenocarcinoma. The genetic signatures of pancreatic adenocarcinoma and its precursor lesions are well characterized. We explored the genetic alterations in precursor lesions (intraductal papillary mucinous neoplasms [IPMN], pancreatic intraepithelial neoplasia [PanIN]) in patients with pancreatic heterotopias but without concomitant pancreatic ductal adenocarcinomas. This allowed us to determine whether the stereotypical dysplasia—infiltrating carcinoma sequence also occurs in these extra-pancreatic foci. Seven cases of heterotopic pancreas with ductal precursor lesions were identified. These included two IPMNs with focal high grade dysplasia and five PanINs with low to moderate grade dysplasia (PanIN grades 1–2). Neoplastic epithelium was micro-dissected and genomic DNA was extracted. Sequencing of commonly mutated hotspots (KRAS, TP53, CDKN2A, SMAD4, BRAF, and GNAS) in pancreatic ductal adenocarcinoma and its precursor lesions was performed. Both IPMNs were found to have KRAS codon 12 mutations. The identification of KRAS mutations suggests a genetic pathway shared with IPMN of the pancreas. No mutations were identified in our heterotopic PanINs. One of the possible mechanisms for the development of dysplasia in these lesions is field effect. At the time of these resections there was no clinical or pathologic evidence of a prior or concomitant pancreatic lesion. However, a clinically undetectable lesion is theoretically possible. Therefore, while a field effect cannot be excluded, there was no evidence for it in this study. Read More »
Primary digestive melanoma in association with tubular adenoma: A case report illustrating the distinction from metastatic colonic melanoma
Publication date: Available online 9 October 2015Source:Human Pathology Author(s): Adeline Furudoï, Charline Caumont, Caroline Dutriaux, David Cappellen, Jean-François Goussot, Béatrice Vergier, Christine Merlio, Christophe Barberis, Jean-Philippe Merlio, Audrey Gros Read More »
Effect modification by race–ethnicity of environmental tobacco smoke exposure on airway inflammation in US children
Publication date: Available online 9 October 2015Source:Annals of Allergy, Asthma & Immunology Author(s): Alem Mehari, Ngozi Enwerem, Yewande Odeyemi, Richard. F. Gillum BackgroundAsthma mortality and morbidity are higher in black than in white children. Fractional exhaled nitric oxide (FeNO) is a noninvasive biomarker of eosinophilic airway inflammation. Identification of differences in the effect of environmental tobacco smoke (ETS) on airway inflammation by race and ethnicity from a large sample is needed.ObjectiveTo estimate a racial difference in association with ETS and FeNO.MethodsData from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed to compare associations of ETS and FeNO levels in US black and other children. No ETS exposure was defined as a serum cotinine level lower than 0.05 ng/mL and ETS exposure was defined as a serum cotinine level of at least 0.05 ng/mL. FeNO was measured using a device that relies on an electrochemical sensor. Analyses took the complex survey design into account.ResultsThe analytic sample was formed by 5,473 participants (6–11 years old, n = 2,385; 12–19 years old, n = 3,088) with complete data on demographics, serum cotinine levels, and 2 reproducible FeNO measurements. In weighted linear regression analyses at 6 to 11 years, the interaction term for ETS and black race was not significant (P = .15). At 12 to 19 years, the interaction term was significant (P = .03) in an analysis of all racial groups. In race-specific models, the coefficient for ETS exposure in blacks was −0.033 and that in others was −0.175, ie, ETS exposure was associated with a greater decrease in FeNO in non-blacks than in blacks.ConclusionThere was no evidence at 6 to 11 years of age for an effect modification by race of the association between ETS and FeNO. At 12 to 19 years, the data suggested an effect modification. Read More »
Identification of cross-reactivity between buckwheat and coconut
Publication date: Available online 9 October 2015Source:Annals of Allergy, Asthma & Immunology Author(s): Liliana Cifuentes, Gianni Mistrello, Stefano Amato, Antonia Kolbinger, Mahzad Ziai, Markus Ollert, Davide Pennino, Johannes Ring, Ulf Darsow, Enrico Heffler Read More »
Letter-to-the-editor: "A Core Neuroanatomy Syllabus for Diverse Student Populations"
Read More »
Scope Of Practice: "The Most Misunderstood Concept In Dentistry"
It is unusual for a week to go by where I do not read an article or position paper from some organization or association that purports to outline the "Scope of Practice" for some discipline or field of dentistry. As I review these position papers, it is not difficult to identify the agenda of the organization that is proffering the alleged scope of practice proclamation. We ALL have certain agendas! I am not saying that it is illegal or even wrong to have an agenda. I do however, feel that it is wrong for any organization to imply that it is illegal for a dentist to provide treatment contrary to their self-serving "Scope of Practice – Position Paper". A dentist's scope of practice is divided into three separate and identifiable parts: A. Dental Practice Act/Board of Dental Examiners "The Black Letter LAW" Any rulings of the Board of Dental Examiners
Limitations placed by the Dentist's place of employment or insurance coverage. We will take a look at each of these areas as they relate to your "Scope of Practice". 1. Dental Practice Act/Board of Dental Examiners: Within the definition of the "practice of dentistry" in your state's dental practice act, is the description of your scope of practice. This is the terminology used by your State Board of Dental Examiners to define the procedures, actions, and processes that are permitted by licensed dentists in your state. Most states have adopted the ADA model definition or some variation thereof. It reads as follows: ADA's Definition of Dentistry: The evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law. Adopted: ADA Resolution 1997 Obviously, this model definition is only a model for state boards to reference. However, it has received favorable review and acceptance by many state boards. As you can see, the definition of the practice of dentistry is very broad in scope. Each state's dental practice act and the included definition of the practice of dentistry, is much like our U.S. Constitution in that it is an evolving document which changes and grows as the practice of dentistry progresses. The definition of the practice of dentistry (Scope of Practice) is written so that it purposefully overlaps other professions. If one reviews the "scope of practice" for Dentists and ENTs, one will find that there is a great amount of overlap. Additionally, all dental practice acts are searchable online making access easy for all practitioners. I personally practice in Northwest Arkansas and the Arkansas Legislature has adopted the ADA Model with some modifications. This is my Scope of Practice: 17-82-102. DEFINITIONS. (1)(A) "Practicing dentistry" means: (i) The evaluation, diagnosis, prevention and treatment by nonsurgical, surgical or related procedures of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body, but not for the purpose of treating diseases, disorders and conditions unrelated to the oral cavity, maxillofacial area and the adjacent and associated structures…….. Notice that my scope of practice is for any type of treatment, of any type of condition, of the "oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body…". So, any condition that has any oral-facial component is well within the definition of the practice of Dentistry for the State of Arkansas. The State Board of Dental Examiners can then limit these broad privileges if the occasion arises. For example, in my 30 plus years of practicing dentistry, the Arkansas regulations and requirements for providing sedation have changed several times. While sedation broadly falls within the scope of practice for a dentist in Arkansas, the Arkansas Board of Dental Examiners have promulgated regulations defining the educational requirements and office/emergency equipment necessary to provide this service. 2. Education and training As a general statement, one's education and training is far more important in determining a dentist's "SCOPE OF PRACTICE" than your state's dental practice act. All dental practice acts are so broad they encompass all the areas of dentistry as well as many areas of medicine. In most states, oral surgeons and general dentist both operate under the same definition of the practice of dentistry even though, the scope of their practices are vastly different. So what is the difference? Levels of education!!! One's training is the primary determinate in establishing one's SCOPE OF PRACTICE!!!!!! Using that premise it is easy to see that two general dentists practicing next door to each other can have different scopes. Personally, I love implant dentistry. In our office we routinely perform sinus lifts, ridge augmentations, PRP for grafting and wound healing, and placement of implants. I placed my first blade implant in 1984. So the question remains, what is my scope of practice compared to the dentist next door? The difference is the 5000 hours of continuing education which qualifies me to practice at the level that I have chosen. Therefore, general dentists in the same state can have different Scopes of Practice. Additionally, each dentist can choose to change his or her scope of practice by becoming competent in a new area of study. From a medical/legal stand-point the issue is whether adequate levels of training have been achieved to insure competence. Each practitioner should be prepared to document his training and experience to the Board of Dental Examiners or a jury if the need arises. In each new area of study, practitioners should document courses taken and the conventions attended keeping a list of the dates of each course and the names of lecturers. Additionally, one should become a member of the prominent professional associations in that area and routinely read the appropriate journals. Employer/Insurance As we all know, not all dentists work for themselves. Many of us are employed in various capacities where our employer determines the services and procedures that we perform. In that situation, our employer may limit our scope of practice and establish guidelines for that organization. For example, it is likely within the scope of practice for all dentists to remove impacted wisdom teeth. However, not every office is prepared to offer this service. Limitations placed by the dentist's place of employment or available insurance coverage, are a real restriction to one's scope. I would not recommend that any dentist add a new procedure to his practice without consulting his liability/malpractice carrier to insure coverage. How do you determine whether a new procedure or service is within your scope of practice?
This is a common misconception among dentists. It is amazing to me that dentists think they are prohibited from treating any condition that may also be treated by an MD. This could not be farther from the truth. There is broad overlap in the definitions of the practice of medicine and the practice of dentistry. However, the practice of dentistry and the practice of medicine are governed by separate boards and are regulated separately. It is the intention of state legislatures that the disciplines work together to provide care for our patients. Additionally, the medical practice act of each state specifically exempts the practice of dentistry from any prohibitions expounded within the Medical Practice Acts. For example the Arkansas Medical Practice Act defines the practice of medicine as: (2) "Practice of medicine" means: (A) Holding out one's self to the public within this state as being able to diagnose, treat, prescribe for, palliate, or prevent any human disease, ailment, injury, deformity, or physical or mental condition, whether by the use of drugs, surgery, manipulation, electricity, or any physical, mechanical, or other means whatsoever; (B) Suggesting, recommending, prescribing, or administering any form of treatment, operation, or healing for the intended palliation, relief, or cure of any physical or mental disease, ailment, injury, condition, or defect of any person with the intention of receiving, either directly or indirectly, any fee, gift, or compensation whatsoever; (C) The maintenance of an office or other place to meet persons for the purpose of examining or treating persons afflicted with disease, injury, or defect of body or mind; (D) Using the title "M.D.," "M.B.," "D.O.," "Physician," "Surgeon," or any word or abbreviation to indicate or induce others to believe that one is engaged in the diagnosis or treatment of persons afflicted with disease, injury, or defect of body or mind, except as otherwise expressly permitted by the laws of this state relating to the practice of any limited field of the healing arts; or (E) Performing any kind of surgical operation upon a human being. 17-95-203. Exemptions. Nothing herein shall be construed to prohibit or to require a license with respect to any of the following acts: (3) The practice of the following professions as defined by the laws of this state, which Sub-Chapters 2-4 of this chapter are not intended to limit, restrict, enlarge, or alter the privileges and practice of, as provided by the laws of this state: (A) Dentistry; (B) Podiatry; (C) Optometry; (D) Chiropractic; (E) Cosmetology. Therefore, as long as the new treatment or procedure falls broadly within your state's definition of the practice of dentistry, you are exempted from any regulations, restrictions or requirements enacted by your state's Medical Practice Act. However, it is critically important for each dentist to know when to refer! Know your limitations and levels of competence. If in doubt, send it out!!!! In Conclusion: Every dentist is ultimately in control of his or her Scope of Practice. Very few limitations have been placed in our way. In my opinion this has been purposefully done to encourage each practitioner to expand his or her knowledge and abilities to the fullest. We should not become stagnant! With that in mind, never allow any individual or organization other than your state's Board of Dental Examiners, to dictate your "Scope of Practice". In my career, I have repeatedly been told that I cannot perform certain procedures because I am just a "Dentist". These many encounters have provided an incentive to expand my level of knowledge! So where do we go in the future? The sky is the LIMIT!!! Respectfully Submitted: Ken Berley DDS, JD Disclaimer: NOT GIVING LEGAL ADVICE Contact attorney in your state Seek an opinion from an attorney with experience practicing before your state dental board THIS IS JUST MY OPINION Read More »
Clearing the field: a novel device to assist microsurgeons
We describe an innovative technique which uses a synergistic approach to maintain a static, clear and dry field and allow the optimal microsurgical repair of neurovascular structures. Read More »
You Smell Dangerous: Communicating Fight Responses Through Human Chemosignals of Aggression
The ability to detect conspecifics that represent a potential harm for an individual represents a high survival benefit. Humans communicate socially relevant information using all sensory modalities, including the chemosensory systems. In study 1, we investigated whether the body odor of a stranger with the intention to harm serves as a chemosignal of aggression. Sixteen healthy male participants donated their body odor while engaging in a boxing session characterized by aggression-induction methods (chemosignal of aggression) and while performing an ergometer session (exercise chemosignal). Self-reports on aggression-related physical activity, motivation to harm and angry emotions selectively increased after aggression induction. In study 2, we examined whether receivers smelling such chemosignals experience emotional contagion (e.g., anger) or emotional reciprocity (e.g., anxiety). The aggression and exercise chemosignals were therefore presented to 22 healthy normosmic participants in a double-blind, randomized exposure during which affective/cognitive processing was examined (i.e., emotion recognition task, emotional stroop task). Behavioral results indicate that chemosignals of aggression induce an affective/cognitive modulation compatible with an anxiety reaction in the recipients. These findings are discussed in light of mechanisms of emotional reciprocity as a way to convey not only affective but also motivational information via chemosensory signals in humans. Read More »
Arecoline Alters Taste Bud Cell Morphology, Reduces Body Weight, and Induces Behavioral Preference Changes in Gustatory Discrimination in C57BL/6 Mice
Arecoline, a major alkaloid in areca nuts, is involved in the pathogenesis of oral diseases. Mammalian taste buds are the structural unit for detecting taste stimuli in the oral cavity. The effects of arecoline on taste bud morphology are poorly understood. Arecoline was injected intraperitoneally (IP) into C57BL/6 mice twice daily for 1–4 weeks. After arecoline treatment, the vallate papillae were processed for electron microscopy and immunohistochemistry analysis of taste receptor proteins (T1R2, T1R3, T1R1, and T2R) and taste associated proteins (α-gustducin, PLCβ2, and SNAP25). Body weight, food intake and water consumption were recorded. A 2-bottle preference test was also performed. The results demonstrated that 1) arecoline treatment didn't change the number and size of the taste buds or taste bud cells, 2) electron microscopy revealed the change of organelles and the accumulation of autophagosomes in type II cells, 3) immunohistochemistry demonstrated a decrease of taste receptor T1R2- and T1R3-expressing cells, 4) the body weight and food intake were markedly reduced, and 5) the sweet preference behavior was reduced. We concluded that the long-term injection of arecoline alters the morphology of type II taste bud cells, retards the growth of mice, and affects discrimination competencies for sweet tastants. Read More »
Audiometric correlations with pathologies of ossicular chain in 159 ears with chronic otitis media
Abstract
Hearing loss in chronic suppurative otitis media may result from tympanic membrane perforation and/or a pathology of the ossicular chain including discontinuity or immobility.
We analysed preoperative audiogram and intraoperative findings in ears with chronic suppurative otitis media to investigate predictive value of audiogram in diagnosis of ossicular chain pathologies.
The air-bone gaps at 500, 1000 and 2000 Hz were significantly higher in ears with immobile vs. mobile ossicular chain and the air-bone gap at 4000 Hz was not different.
The air-bone gaps at 500, 1000, 2000 or 4000 Hz were significantly greater in ears with ossicular chain discontinuity than in ears with intact ossicular chain.
Ears with intact ossicular chain, independent from being mobile or immobile, shows best hearing (least air-bone gap) at 2000 Hz compared to other frequencies while the ears with ossicular chain discontinuity causes greater air-bone gap at all frequencies including 2000 Hz.
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Measurement of head and neck paragangliomas: is volumetric analysis worth the effort?
AbstractObjectives
The aim of the current study was to assess the reproducibility of different measurement methods and define the most workable technique for measuring head and neck paragangliomas, in order to determine the best method for evaluating tumor growth. The evaluation of tumor growth is vital for a 'wait and scan' policy, a management strategy that became increasingly important.
Study design
Method comparison study.
Setting and participants
Thirty tumors, including carotid body, vagal body, jugulotympanic tumors, and conglomerates of multiple tumors were measured in duplicate, using linear dimensions, manual area tracing and an automated segmentation method.
Main outcome measures
Reproducibility was assessed using the Bland-Altman method.
Results
The smallest detectable difference using the linear dimension method was 11% for carotid body and 27% for vagal body tumors, compared with 17% and 20% for the manual area tracing method. Due to the irregular shape of paragangliomas in the temporal bone and conglomerates, the manual area tracing method showed better results in these tumors (26% and 8 % vs 54% and 47%). The linear dimension method was significantly faster (median 2.19 vs 18.46 minutes, p < 0.001). The automatic segmentation method yielded smallest detectable differences between 39% and 75%, and although fast (2.19 ± 1.49 minutes), it failed technically.
Conclusions
Due to a relatively good reproducibility, fast and easy application, we found the linear dimension method to be the most pragmatic approach for evaluation of growth of carotid and vagal body paragangliomas. For jugulotympanic tumors, the preferred method is manual area tracing. However, volumetric changes of these tumors may be of less clinical importance than changes in relation to surrounding anatomical structures.
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Quantitative analysis of gains and catch-up saccades of video-head impulse testing by age in normal subjects
AbstractObjectives
To evaluate video-head impulse test (vHIT) results in normal subjects, to determine the normative values of vHIT for the vestibulo-ocular reflex (VOR), and to characterize the catch-up saccades (CSs).
Design
Prospective cohort study.
Setting
Tertiary care academic referral center.
Participants
Fifty healthy subjects with no history of vestibular impairment, ten each in their 20's, 30's, 40's, 50's, and 60's, underwent vHITs in the lateral semicircular canal plane.
Main outcome measures
vHIT gains and the incidence and amplitudes of covert and overt CSs.
Results
The mean vHIT gain was 1.02 ± 0.07, and the mean gain asymmetry was 2.39 ± 1.96%, with no significant differences among age groups. CSs were observed during 22.6% of the trials and in 49% of the ears. The incidence of CSs was not associated with age. The mean velocity of CSs was 55.5 ± 16.9°/s, and its mean interaural difference was 11.8 ± 10.7°/s.
Conclusions
vHIT gains were consistently equal to 1.0 in all age groups (20's to 60's), suggesting that abnormal criteria for vHIT gain (e.g., 0.8) and gain asymmetry (e.g., 8%) can be used, regardless of age. CSs were observed in about half of normal ears, suggesting that VOR is a hypometric system. The amplitudes and interaural difference of CSs were also similar in all age groups, suggesting that abnormal criteria for CS amplitude (e.g., 100°/s) and interaural difference (e.g., 40°/s) can be used, regardless of age.
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Honey and Beehive Products in Otorhinolaryngology: a narrative review
AbstractBackground
Honey and beehive products were rediscovered as an alternative treatment in wounds. The medicinal properties also raised interest of their use in Otorhinolaryngology.
Objective of review
To give an overview of the effectiveness of beehive products in otorhinolaryngology.
Type of review
Narrative.
Search strategy and evaluation
A literature search of the databases PubMed, EMBASE and Cochrane was performed from the last 2 decades till December 2014. The search terms 'honey', 'propolis' or 'royal jelly (RJ)' were used. Articles, which evaluated the effectiveness of beehive products in Otorhinolaryngology were included. The quality assessment of included studies was performed using the Cochrane Collaboration risk of bias tool.
Discussion and Conclusion
A total of 36 studies were identified and evaluated. Eighteen studies investigated their effect in oral infections, 7 in infection of the respiratory tract, 6 in rhino-sinusal diseases, 4 investigated the use in tonsillectomy and head and neck surgery and one study explored the preventive effect in otitis media. Honey can be considered as effective (additional) treatment in mucositis, childhood cough, persistent post-infectious cough and after tonsillectomy. Propolis may have a role in the treatment of (aphtous) stomatitis, mouth ulcer and prevention of acute otitis media. RJ showed to reduce mucositis. In the presented studies beehive products proved to be safe, with only minor adverse reactions. Studies showed to be diverse and had some methodological limitations.
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Assessing the safety and efficacy of drugs used in preparing the nose for diagnostic and therapeutic procedures: a systematic review
AbstractBackground
Local anaesthetics and vasoconstrictors are essential for pain control and to aid intraoperative haemostasis in nasal procedures. They also improve access, and reduce discomfort when performing nasal endoscopy. There are no clear guidelines on preparing the nose despite evermore diagnostic and therapeutic procedures utilising the nose as a point of access.
Objective of review
This review aims to identify nasal preparations used in diagnostic and therapeutic nasal procedures and to examine their safety and efficacy.
Type of review
Systematic review.
Search strategy
A search was carried out using Pubmed MEDLINE, Ovid EMBASE, the Cochrane library and references from the included articles.
Evaluation method
The inclusion criteria included: Full text, English language articles with regard to nasal preparation for surgery. Case reports, systematic reviews, meta-analysis, double-blind placebo controlled randomised trials (RCTs), and case series were included.
Results
A total of 53 articles were retrieved: 13 articles on nasal preparation for operative procedures, 6 on functional endoscopic sinus surgery, and 22 on nasendoscopy as well as 6 case reports. Cocaine was the most widely used topical preparation for operative procedures but was associated with more side effects, thus topical tetracaine or levobupivacaine infiltration are alternatives with equivalent efficacy but reduced adverse effects. All articles reviewed for functional endoscopic sinus surgery used a mixture containing lidocaine, adrenaline or both. Flexible nasendoscopy causes minimal patient discomfort and preparation is only recommended to select patients, in contrast to rigid nasendscopy which requires preparation.
Conclusion
For operative procedures, such as septorhinoplasty, a single agent tetracaine or levobupivicaine provide an improved surgical field. In functional endoscopic sinus surgery, lidocaine-adrenaline preparations have resulted in significantly better surgical and patient outcomes. There is little evidence to support the routine use of pre-procedural nasal preparation for flexible nasendoscopy. Those undergoing rigid endoscopy, conversely always require use of a vasoconstrictor and local anaesthetic. Pre-procedure assessment of patients is recommended, with agents being reserved for those with low pain thresholds, high anxiety and small nasal apertures presenting resistance to the insertion of the endoscope.
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A Single Primary Site Obstruction May Lead to Sleep-Disordered Breathing in Multiple Sites: An Animal Model
Objectives:This study aimed to investigate the dynamic upper airway changes occurring in an obstructive sleep apnea (OSA) rabbit model using dynamic computerized tomography (CT). Methods:In this study, 2.5 U of botulinum toxin type A was injected into the genioglossus to paralyze the tongue in the OSA group (n = 7). The control group was injected with normal saline (n = 7). Apnea-hypopnea index was measured using ApneaLink at baseline and at 1, 2, 3, 4, 6, and 8 weeks post-injection. Anterior to posterior (AP) and transverse diameters at the levels of the palate and tongue base were measured using a dynamic CT at baseline and at 1 and 2 weeks post-injection. Results:The success rate of OSA induction was higher in the OSA group (P = .02). In the OSA group, transverse and AP diameters at the palate level and AP diameter at the tongue base level significantly decreased 2 weeks post-injection (P = .01). Conclusions:A single obstruction site may constitute the primary pathogenesis in some OSA patients, even when the involvement of multiple sites is indicated. These findings may contribute to the identification of OSA pathogenesis and improve the planning of treatment based on the primary cause of OSA. Read More »
A Novel In Vivo Protocol for Molecular Study of Radiation-Induced Fibrosis in Head and Neck Cancer Patients
Objectives:Radiation-induced fibrosis is a common complication for patients following head and neck cancer treatment. This study presents a novel minimally invasive protocol for molecular study of fibrosis in the stromal tissues. Methods:Subjects with radiation-induced fibrosis in the head and neck who were at least 6 months post treatment received submental core needle biopsies, followed by molecular processing and quantification of gene expression for 14 select pro-inflammatory and pro-fibrotic genes. Control biopsies from the upper arm were obtained from the same subjects. Patients were followed up at 1 and 2 weeks to monitor for safety and adverse outcomes. Results:Six subjects were enrolled and completed the study. No subjects experienced adverse outcomes or complication. An 18 gauge core biopsy needle with a 10 mm notch inserted for up to 60 seconds was needed. Subcutaneous tissue yielded 3 ng of RNA, amplified to 6 µg of cDNA, allowing for adequately sensitive quantitative polymerase chain reaction (qPCR) analysis of approximately 28 genes. Conclusions:This study demonstrates the safety and utility of a novel technique for the molecular study of fibrosis in head and neck cancer patients. Longitudinal studies of patients undergoing radiation therapy will allow for identification of molecular targets that contribute to the process of fibrosis in the head and neck. Read More »
Risk Factors for Dysplasia in Recurrent Respiratory Papillomatosis in an Adult and Pediatric Population
Aim:Recurrent respiratory papillomatosis (RRP) is classically described as a benign neoplasm of the larynx caused by the low-risk human papillomavirus (HPV) viral subtypes. Nevertheless, transformation to dysplasia and invasive carcinoma can occur. We aimed to assess the prevalence of dysplasia and carcinoma-ex-papilloma in both adult-onset and juvenile-onset RRP and identify patient risk factors for this dysplastic transformation. Material and Methods:Ten-year retrospective chart review of a tertiary otolaryngology referral center. Patients with papilloma were identified from a review of a pathology database and clinical records. Patient demographics, pathologic data, and treatment history, including use of cidofovir as an adjunctive therapy for papilloma, were extracted from electronic medical records. Results:One hundred fifty-nine RRP patients were identified, 96 adult-onset (AORRP) and 63 juvenile-onset (JORRP) cases. Of this cohort, 139 (87%) had only benign papilloma as a pathologic diagnosis. In the AORRP cohort, 10 patients (10%) were diagnosed with dysplasia or carcinoma in situ in addition to papilloma, and 5 patients (5%) had malignant transformation to invasive carcinoma-ex-papilloma. There was a significantly higher age of disease onset for those with dysplasia or carcinoma versus those without dysplasia or carcinoma (56 vs 45 years old; P = .0005). Of the 63 JORRP patients, there were no cases of dysplasia but 3 (5%) cases of invasive carcinoma-ex-papilloma, all involving pulmonary disease. The JORRP patients with carcinoma-ex-papilloma had a younger average disease onset (2 vs 6 years old; P = .009) and a higher rate of tracheal involvement than those without carcinoma. Gender, smoking history, number of operations, or use of cidofovir showed no association with the development of dysplasia or carcinoma-ex-papillomatosis in either the AORRP or JORRP population. Conclusion:In a large series of RRP, age of disease onset is the strongest predictor of dysplastic transformation in the adult and pediatric population. Carcinoma-ex-papillomatosis was uniformly associated with pulmonary disease in the JORRP population in this series. No other demographic or behavioral factors, including adjunctive therapy with cidofovir, were statistically associated with dysplasia or carcinoma-ex-papilloma. Read More »
Efficacy and safety of budesonide administered by pressurized metered-dose inhaler in children with asthma
Budesonide is approved for delivery using a nebulized solution and dry-powder inhaler, but its use through a pressurized metered-dose inhaler (pMDI) in pediatric patients with asthma has not been determined. Read More »
Safety of rush subcutaneous immunotherapy administered in real life using an infusion pump
Rush subcutaneous immunotherapy (SCIT) schedules offer rapid clinical response, improved adherence, and increased cost-effectiveness because of a lower number of visits and doses. However, this therapy is associated with an increased incidence of adverse reactions (ARs).1–6 A few years ago, our group described the use of an infusion pump (IP) to administer SCIT according to a rush schedule.7 The purpose of this study is to update our data on the safety of this therapy approach and to assess risk factors for ARs in real life using a similar rush schedule with an IP. Read More »
Long-term adherence to self-injectable epinephrine in the veteran population
According to practice parameters, first-line treatment for anaphylaxis, a life-threatening medical emergency that requires prompt recognition and intervention, is intramuscular epinephrine administered in the anterolateral aspect of the thigh.1 Despite the availability of a lifesaving self-administrable treatment, studies indicate poor prescribing rates by health care professionals and poor adherence rates by patients. Limited data exist for adherence rates of self-injectable epinephrine (SIE) in a clinic setting, particularly during a long-term period. Read More »
IL-6/NOS2 inflammatory signals regulate MMP-9 and MMP-2 activity and disease outcome in nasopharyngeal carcinoma patients
AbstractThe role of nitric oxide (NO)· in the development of the metastatic properties of nasopharyngeal carcinoma (NPC) is not fully understood. Previous studies proposed that interleukin-6 (IL-6) would act as regulator of matrix metalloprotease activation in NPC. Recently, we showed that (NO)· was a critical mediator of tumor growth in patients. The aim of this study was to determine the implication of IL-6 in the progression of NPC pathology via metalloprotease (MMP) activation and their possible correlation with (NO)· production. We observed a significant increase in IL-6 and nitrite (NO2−) synthesis in patients (n = 17) as well as a strong expression of IL-6 and nitric oxide synthase 2 (NOS2) in the analyzed tumors (n = 8). In patients' plasma, a negative correlation associated IL-6 with circulating nitrites (r = −0.33). A negative correlation associated the H-scores of these signals in the tumors (r = −0.47). In patients' plasma, nitrite synthesis was positively associated with MMP-9 activation (r = 0.45), pro-MMP-2 expression (r = 0.37), and negatively correlated with MMP-2 activation (r = −0.51). High nitrite levels was associated with better recurrence-free survival (RFS) (p = 0.02). Overall, our results suggest that the IL-6/NOS2 inflammatory signals are involved in the regulation of MMP-9- and MMP-2-dependent metastatic activity and that high circulating nitrite levels in NPC patients may constitute a prognostic predictor for survival.Read More »
The plasma lncRNA acting as fingerprint in non-small-cell lung cancer
AbstractRecent studies have indicated that long non-coding RNAs (lncRNAs) could act as non-invasive tumor markers in both diagnosis and predicting the prognosis. In this study, we focused to determine the expression of circulating lncRNAs in patients suffering from non-small-cell lung cancer (NSCLC), aiming to found the potential lncRNA as predictor. Twenty-one lncRNAs which previously identified were selected as candidate targets for subsequent circulating lncRNA assay. The candidate lncRNAs were validated by qRT-PCR arranged in the training and validation sets. Circulating SPRY4-IT1, ANRIL, and NEAT1 were significantly increased in plasma samples of NSCLC patients during training set and validation set. Receiver operating characteristic curve (ROC) analysis revealed that plasma ANRIL provided the highest diagnostic performance with an area under ROC curve value (AUC) of 0.798. Further combination with the three factors indicated a higher power (AUC, 0.876; sensitivity, 82.8 %; specificity, 92.3 %). The stableness detection of the three factors indicated that circulating SPRY4-IT1, ANRIL, and NEAT might serve as a predictor for the early warning of non-small-cell lung cancer.Read More »
Hyperfibrinogenemia predicts poor prognosis in patients with advanced biliary tract cancer
AbstractHyperfibrinogenemia reportedly predicts poor prognosis in several cancers but has not been reviewed for biliary tract cancer (BTC). The aim of the present study was to evaluate associations between baseline plasma fibrinogen concentrations, clinicopathological characteristics, and survival parameters in patients with BTC. Data for 127 patients with BTC diagnosed at the Zhongshan Affiliated Hospital of Dalian University (Liaoning, China) from January 2011 to December 2014 were retrospectively evaluated. Associations between baseline fibrinogen concentrations, selected clinicopathological characteristics, and the prognostic value were examined using SPSS software. Data for 37 patients (29.1 % of study cohort) who had undergone curative intent surgery and 90 (70.9 %) with advanced biliary tract cancer (ABTC) were analyzed. The mean plasma fibrinogen concentration 4.0 ± 0.9 g/L for the entire cohort. The percentages with hyperfibrinogenemia (>4 g/L) were 45.7, 37.8, and 48.9 % overall and in the surgical and ABTC groups, respectively. Hyperfibrinogenemia was associated with performance status (PS) and neutrophil/lymphocyte ratio in the entire cohort but not with other relevant clinicopathological factors. Log-rank test indicated that baseline hyperfibrinogenemia was associated with decreased progression-free survival (PFS) and overall survival (OS) for patients with unresectable ABTC (P > 0.05). Multivariate analysis showed that poor PS and baseline hyperfibrinogenemia were independently associated with worse survival (HR: 1.39, 95 % CI: 1.02–1.90, P = 0.04; HR: 1.75.95 %, 95 % CI: 1.01–3.01, P = 0.04, respectively). Baseline hyperfibrinogenemia is an independent predictor of poor prognosis in patients with ABTC. Baseline plasma fibrinogen concentrations may be a readily available and inexpensive prognostic biomarker in patients with ABTC; this needs further validation in large prospective clinical trials.Read More »
MiR-30a regulates the proliferation, migration, and invasion of human osteosarcoma by targeting Runx2
AbstractOsteosarcoma (OS) is the most common primary malignant bone tumor in young patients. However, treatment paradigms and survival rates have not improved in decades. MicroRNAs have been shown to be critical regulators of physiological homeostasis and pathological process, including bone disease. Nearly half of the microRNA (miRNA) genes are located at genomic regions and fragile sites known to be frequently deleted or amplified in various kinds of cancers. In this study, we investigated the role miR-30a in OS. A negative correlation between miR-30a expression and malignant grade was observed in OS cell lines. The overexpression of miR-30a reduced proliferation, migration, and invasion in 143B cells and the inhibitor of miR-30a increased proliferation, migration, and invasion in Saos2 cells. Further studies revealed that runt-related transcription factors 2 (Runx2) was a regulative target gene of miR-30a. Rescue assay significantly reversed the effects of overexpressing or inhibiting miR-30a. miR-30a also suppressed tumor formation and pulmonary metastasis in vivo. All the results suggest a critical role of miR-30a in suppressing proliferation, migration, and invasion of OS by targeting Runx2.Read More »
3-Bromopyruvate inhibits cell proliferation and induces apoptosis in CD133+ population in human glioma
AbstractThe study was aimed to investigate the role of 3-bromopyruvate in inhibition of CD133+ U87 human glioma cell population growth. The results demonstrated that 3-bromopyruvate inhibited the viability of both CD133+ and parental cells derived from U87 human glioma cell line. However, the 3-bromopyruvate-induced inhibition in viability was more prominent in CD133+ cells at 10 μM concentration after 48 h. Treatment of CD133+ cells with 3-bromopyruvate caused reduction in cell population and cell size, membrane bubbling, and degradation of cell membranes. Hoechst 33258 staining showed condensation of chromatin material and fragmentation of DNA in treated CD133+ cells after 48 h. 3-Bromopyruvate inhibited the migration rate of CD133+ cells significantly compared to the parental cells. Flow cytometry revealed that exposure of CD133+ cells to 3-bromopyruvate increased the cell population in S phase from 24.5 to 37.9 % with increase in time from 12 to 48 h. In addition, 3-bromopyruvate significantly enhanced the expression of Bax and cleaved caspase 3 in CD133+ cells compared to the parental cells. Therefore, 3-bromopyruvate is a potent chemotherapeutic agent for the treatment of glioma by targeting stem cells selectively.Read More »
Analysis of serum levels and tissue expression of galectin-1 and galectin-3 as noninvasive biomarkers in osteosarcoma patients
AbstractGalectin-1 and galectin-3 are differentially expressed in different normal and pathologic tissues and are involved in biological process such as tumor growth, invasion, angiogenesis, and metastasis. The present study aimed to determine the clinical value of galectin-1 and galectin-3 expression levels in serum and tissue of patients with osteosarcoma. We evaluated the serum levels of galectin-1 and galectin-3 using enzyme-linked immunosorbent assay (ELISA) in patient suffering from osteosarcoma and healthy controls. Furthermore, immunohistochemistry method was used to evaluate the expression levels of these markers in the osteosarcoma and the surrounding non-malignant tissues of the same osteosarcoma patients. The mean galectin-1 serum level in the patients with osteosarcoma was remarkably higher as compared to the healthy control samples (mean SD; 2.04 ± 0.83 ng/ml; 0.75 ± 0.19 ng/ml; p < 0.001). Furthermore, the mean galectin-3 serum levels in the osteosarcoma patients were strongly higher when compared with the healthy control samples (mean SD; 3.11 ± 0.71 ng/ml; 1.07 ± 0.41 ng/ml; p < 0.001). Our findings showed that higher mean serum levels of galectin-1 and galectin-3 were remarkably correlated with different Enneking stages. Furthermore, our result indicated that the expression levels of the galectin-1 and galectin-3 were strongly higher in osteosarcoma tissues as compared to the surrounding non-malignant tissues. We found that high galectin-1 and galectin-3 expressions were significantly correlated with Enneking stage in osteosarcoma tissues (p < 0.001). Taken together, our findings indicated the clinical importance of galectin-1/3 serum level and tissue expression in osteosarcoma. These markers may be potential biomarkers for the evaluation of progression of osteosarcoma.Read More »
HNRNPC as a candidate biomarker for chemoresistance in gastric cancer
AbstractChemoresistance is a major cause of treatment failure and high mortality in advanced gastric cancer (AGC). Currently, the mechanism of chemoresistance remains unclear, and there is no biomarker to accurately predict the efficacy of chemotherapy. In the present study, we established human gastric cancer (GC) cell lines resistant to 5-fluorouracil (5FU), paclitaxel (TA), or cisplatin (DDP) by gradient drug treatment and generated a novel monoclonal antibody 5B2 targeting heterogeneous nuclear ribonucleoproteins C1/C2 (HNRNPC) overexpressed in chemoresistant GC cells. Overexpressing HNRNPC in GC cells promoted chemoresistance, and knockdown of HNRNPC by small interfering RNA (siRNA) reversed chemoresistance. By utilizing available datasets, we demonstrated that high level of HNRNPC transcript indicated poor overall survival (OS) and free of progression (FP). HNRNPC expression was negatively correlated with OS of GC patients treated with 5FU-based drugs and with time to progression (TTP) of GC patients treated with CF regimen. These data suggest the potential usefulness of HNRNPC as a prognostic and therapeutic marker of GC.Read More »
Facial lymph node involvement as a prognostic factor for patient survival in oral cavity squamous cell carcinoma
AbstractTo investigate the incidence of metastasis to facial lymph nodes (FLNs) and to determine its impact on the prognosis and survival of patients at onset of oral cavity squamous cell carcinoma (OSCC). A retrospective review of 641 patients with OSCC treated with curative surgery (CS) alone or CS + postoperative radiotherapy (PORT) was performed. Based on FLN status, an analysis of clinicopathologic parameters, prognosis, and survival was conducted. By classifying patients according to FLN status, a reasonable treatment modality was identified in the low-risk group, which was defined as those who had N0–1 disease, negative margin, and no extracapsular nodal spread (ENS). FLN involvement was identified in 103 patients (16 %), which showed statistically significant associations with several established risk factors and negatively affected local controls (P < 0.001), neck controls (P < 0.001), and disease-specific survival (P < 0.001). Compared to CS alone, CS + PORT increased the 5-year neck control rate (76.8 vs. 30.7 %, P = 0.006) and disease-specific survival rate (67.8 vs. 30.7 %, P = 0.037) of the OSCC patients with FLN metastasis in the low-risk group. Metastasis to FLNs is strongly associated with poor disease control and lower survival rate of OSCC patients. PORT minimized the residual risk of involved FLN in the low-risk group.Read More »
Ribonucleotide reductase large subunit M1 plays a different role in the invasion and metastasis of papillary thyroid carcinoma and undifferentiated thyroid carcinoma
AbstractRibonucleotide reductase (RR) has been reported to be associated with several types of cancer while the expression and role of RR in thyroid carcinoma (TC) has not been investigated. Here, we first examined the expression level of three RR subunit proteins (RRM1, RRM2, and RRM2B) in papillary thyroid carcinoma (PTC) and undifferentiated thyroid carcinoma (UTC) patient samples by immunohistochemistry. The results showed that RRM1 was higher expressed in 95.2 % cancer tissues compared with their adjacent normal tissues in 146 PTC samples. The expression level of RRM1 was positively correlated with T stage, lymph node metastasis (LNM), extrathyroidal invasion (ETI), and TNM stage in PTC patients. However, in 12 UTC samples, RRM1 expression was negatively expressed in six cases. To further determine the biological role of RRM1 in TC, ectopic expression or siRNA-mediated knockdown of RRM1 were carried out in the high-differentiated thyroid carcinoma cell line TPC-1 and the poor-differentiated thyroid carcinoma cell line SW579, respectively. In TPC-1 and SW579 cells, overexpression and siRNA knockdown of RRM1 demonstrated that RRM1 promoted DNA synthesis and proliferation in both cell lines as shown by EdU incorporation and cell viability assays. However, RRM1 enhanced cell migration and invasion in TPC-1 cells but inhibited that in SW579 cells as shown by wound healing and transwell assays. Moreover, we also found that RRM1 promoted PTEN expression and reduced Akt phosphorylation in a RR-activity-independent manner in the low-differentiated TC cells but not in the high-differentiated TC cells. In contrast, RRM2 expression was higher expressed in both PTC and UTC patient samples, consisting with its oncogenic role in other cancers. Therefore, we suggest that RRM1 promotes thyroid carcinoma proliferation as a component of RR but may play a different role in the invasion and metastasis of differently differentiated thyroid carcinomas through a non-RR pathway, which could be meaningful to precision treatment of thyroid carcinoma with RR inhibitors.Read More »
Stellenwert der suprakrikoidalen Teilresektion beim moderat fortgeschrittenen Glottiskarzinom (T3–T4a)
ZusammenfassungHintergrundDie transorale Lasermikrochirurgie (TLM) ist die Methode der Wahl für Larynxteilresektionen in Deutschland. In fortgeschrittenen Stadien wird zunehmend häufig die Radiochemotherapie zum Organerhalt indiziert.FragestellungDie Indikation und Ergebnisse der suprakrikoidalen Larynxteilresektion (SPL), auch als Krikohyoido(epiglotto)pexie bekannt, soll als Option des chirurgischen Organerhalts beim moderat fortgeschrittenen Glottiskarzinom (T3–T4a) im Spannungsfeld zwischen TLM und Radiochemotherapieprotokollen in Deutschland dargestellt werden.MethodeRetrospektive Evaluation der funktionellen und onkologischen Ergebnisse aller SPL von 2008 bis 2014. Im genannten Zeitraum wurden 17 SPL mit Resektion eines Arytänoidknorpels im Stadium rpT2 (n = 2), (r)pT3 (n = 11) und (r)pT4a (n = 4) durchgeführt. Das mittlere Alter betrug 58, die Spanne 47–75 Jahre. Bei 5 Patienten bestand ein erstes oder zweites Rezidiv nach TLM oder offener Teilresektion. Sieben Patienten mit rpT4a oder pN+ wurden adjuvant bestrahlt.ErgebnisseZwei Patienten mussten sich einer Salvage-Laryngektomie mit adjuvanter Strahlentherapie unterziehen. Alle anderen Patienten (n = 15) zeigten eine im Mittel 4 Jahre lange tumorfreie Nachsorge mit funktionell intaktem Larynx: Sie ernähren sich peroral, haben ein verschlossenes Tracheostoma und eine gute Sprache. Zwei Patienten starben mit 76 Jahren nach 3 Jahren tumorfreier Nachsorge mit funktionell intaktem Larynx.DiskussionDie SPL ist beim Larynxkarzinom pT3–4a eine seltene, aber wertvolle Option des chirurgischen Larynxerhalts.Read More »
Immuntherapie bei Kopf-Hals-Karzinomen
ZusammenfassungDie physiologische Immunantwort auf maligne Zellen beruht auf der Interaktion antigenpräsentierender Zellen, wie dendritischen Zellen und Makrophagen, mit T- und B-Lymphozyten. Die Tumorzelllyse erfolgt vorrangig über CD8+-T-Effektorzellen und natürliche Killerzellen. Bei der Entstehung und beim Progress solider Malignome im Kopf-Hals-Bereich nutzen Tumorzellen verschiedene Mechanismen, um das körpereigene Immunsystem zu beeinflussen. Über regulatorische T-Zellen, Suppressorzellen myeloiden Ursprungs, tumorassoziierte Makrophagen und krebsassoziierte Bindegewebszellen fördern die Tumorzellen die Entwicklung suppressiver Signalwege, welche den Tumorprogress ermöglichen. Hier ergeben sich Ansatzpunkte für den Einsatz von Immuntherapeutika. Im Fokus aktueller Studien stehen u. a. die medikamentöse Beeinflussung immunstimulierender oder -supprimierender Signalwege, die Aktivierung von Toll-like-Rezeptoren sowie Vakzinierungen bei Kopf-Hals-Tumoren. Die Entwicklung monoklonaler Antikörper ermöglicht zudem eine direkte, hochspezifische Bindung an Zellrezeptoren; hier eröffnet die Entdeckung der Immuncheckpointrezeptoren neue Perspektiven. Aktuelle Studien zu monoklonalen Antikörpern, welche agonistisch an T-Zell-stimulierenden Rezeptoren wie CD28 und CD134 oder antagonistisch an immunsuppressiven Rezeptoren wie CTLA-4 oder PD-1 wirken, haben vielversprechende Ergebnisse geliefert.Read More »
The enigma of the interconnection of trigeminal pain and cranial autonomic symptoms
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Trigeminal neuralgia (part II): Factors affecting early pharmacotherapeutic outcome
AimsWe conducted a cohort study to examine demographic and clinical features associated with the pharmacotherapeutic outcome in classical trigeminal neuralgia (CTN) patients. MethodsPatients with a clinical profile indicating a diagnosis of CTN, as per the International Headache Society's published classification, were enrolled prospectively. Demographic and pain-related characteristics were carefully collected. For the purposes of the study, patients with features such as autonomic signs and longer attack duration were included. All patients were then initiated on a standardised and accepted stepped pharmacotherapeutic protocol for the management of CTN. Initial pain scores and prospectively collected pain scores from pain diaries were used to assess the treatment outcome, with a ≥50% reduction considered significant. ResultsA total of 86 patients were seen, of whom five had an underlying disorder that could account for the pain. The study cohort therefore consisted of 81 patients, and based on attack duration these were divided into short (≤2 minutes, n = 61) and long (>2 minutes, n = 20) groups, for further analysis. The features of these patients and a discussion on the differential diagnosis have been presented in part 1 of this report. Employing an accepted stepped pharmacotherapeutic protocol for the management of CTN, significant improvement was more frequent in the short (74%) than in the long attack group (50%, p = 0.05). In the short attack group there were statistically significant associations between a poor treatment response and longer disease duration, the presence of autonomic signs and atypical pain descriptors for pain quality (p < 0.05). ConclusionThis report supports previous findings that prolonged disease duration and autonomic signs are negative prognostic indicators. The present study now adds long attack duration as a further negative prognostic sign. Read More »
Anxiety and depressive disorders in elderly with chronic dizziness of vestibular origin
Publication date: Available online 9 October 2015Source:Brazilian Journal of Otorhinolaryngology Author(s): Érica Toledo Piza Peluso, Maria Inês Quintana, Fernando Freitas Ganança IntroductionDizziness is one of the most prevalent symptoms in the elderly. Anxiety and depression are common in dizzy adult patients, but there is scarce information about comorbidity between vestibular disturbances and psychiatric disorders in the aged.ObjectiveTo assess the prevalence of anxiety and depression disorders in elderly with chronic dizziness of vestibular origin.MethodsTransversal study that used the Brazilian version of the Composite International Diagnostic Interview 2.1 to assess anxiety and depressive disorders in elderly patients (≥60 years old) with chronic dizziness.ResultsMost of the 44 patients included in the study were female (88.6%) with a mean age of 71 years (±7.5), 68.1% had experienced dizziness for 1 year or more. The most prevalent diagnosis was benign paroxysmal positional vertigo (52.3%). The prevalence of generalized anxiety disorder and specific phobias during life were 29.5% and 22.7%, respectively, and, in the last 12 months, 18.2% and 15.9%. There was no patient with panic disorder, agoraphobia or social phobia. The prevalence of depressive disorder during life was 45.4%, and, in the last 12 months, were 11.3%.ConclusionAged patients with chronic dizziness had high prevalence of some mental disorders. Read More »
Atypical Kawasaki disease presenting as a retropharyngeal abscess
Publication date: Available online 9 October 2015Source:Brazilian Journal of Otorhinolaryngology Author(s): Jong Seung Kim, Sam Hyun Kwon Read More »
The Invisible Hand: Toddlers Connect Probabilistic Events With Agentive Causes
Abstract
Children posit unobserved causes when events appear to occur spontaneously (e.g., Gelman & Gottfried, 1996). What about when events appear to occur probabilistically? Here toddlers (M = 20.1 months) saw arbitrary causal relationships (Cause A generated Effect A; Cause B generated Effect B) in a fixed, alternating order. The relationships were then changed in one of two ways. In the Deterministic condition, the event order changed (Event B preceded Event A); in the Probabilistic condition, the causal relationships changed (Cause A generated Effect B; Cause B generated Effect A). As intended, toddlers looked equally long at both changes (Experiment 1). We then introduced a previously unseen candidate cause. Toddlers looked longer at the appearance of a hand (Experiment 2) and novel agent (Experiment 3) in the Deterministic than the Probabilistic conditions, but looked equally long at novel non-agents (Experiment 4), suggesting that by 2 years of age, toddlers connect probabilistic events with unobserved agents.
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Lost in the Rhythm: Effects of Rhythm on Subsequent Interpersonal Coordination
Abstract
Music is a natural human expression present in all cultures, but the functions it serves are still debated. Previous research indicates that rhythm, an essential feature of music, can enhance coordination of movement and increase social bonding. However, the prolonged effects of rhythm have not yet been investigated. In this study, pairs of participants were exposed to one of three kinds of auditory stimuli (rhythmic, arrhythmic, or white-noise) and subsequently engaged in five trials of a joint-action task demanding interpersonal coordination. We show that when compared with the other two stimuli, exposure to the rhythmic beat reduced the practice effect in task performance. Analysis of the behavioral data suggests that this reduction results from more temporally coupled motor movements over successive trials and that shared exposure to rhythm facilitates interpersonal motor coupling, which in this context serves to impede the attainment of necessary dynamic coordination. We propose that rhythm has the potential to enhance interpersonal motor coupling, which might serve as a mechanism behind its facilitation of positive social attitudes.
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The Selective Laziness of Reasoning
Abstract
Reasoning research suggests that people use more stringent criteria when they evaluate others' arguments than when they produce arguments themselves. To demonstrate this "selective laziness," we used a choice blindness manipulation. In two experiments, participants had to produce a series of arguments in response to reasoning problems, and they were then asked to evaluate other people's arguments about the same problems. Unknown to the participants, in one of the trials, they were presented with their own argument as if it was someone else's. Among those participants who accepted the manipulation and thus thought they were evaluating someone else's argument, more than half (56% and 58%) rejected the arguments that were in fact their own. Moreover, participants were more likely to reject their own arguments for invalid than for valid answers. This demonstrates that people are more critical of other people's arguments than of their own, without being overly critical: They are better able to tell valid from invalid arguments when the arguments are someone else's rather than their own.
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Graph-Theoretic Properties of Networks Based on Word Association Norms: Implications for Models of Lexical Semantic Memory
Abstract
We compared the ability of three different contextual models of lexical semantic memory (BEAGLE, Latent Semantic Analysis, and the Topic model) and of a simple associative model (POC) to predict the properties of semantic networks derived from word association norms. None of the semantic models were able to accurately predict all of the network properties. All three contextual models over-predicted clustering in the norms, whereas the associative model under-predicted clustering. Only a hybrid model that assumed that some of the responses were based on a contextual model and others on an associative network (POC) successfully predicted all of the network properties and predicted a word's top five associates as well as or better than the better of the two constituent models. The results suggest that participants switch between a contextual representation and an associative network when generating free associations. We discuss the role that each of these representations may play in lexical semantic memory. Concordant with recent multicomponent theories of semantic memory, the associative network may encode coordinate relations between concepts (e.g., the relation between pea and bean, or between sparrow and robin), and contextual representations may be used to process information about more abstract concepts.
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Neuroscientific Prediction and the Intrusion of Intuitive Metaphysics
Abstract
How might advanced neuroscience—in which perfect neuro-predictions are possible—interact with ordinary judgments of free will? We propose that peoples' intuitive ideas about indeterminist free will are both imported into and intrude into their representation of neuroscientific scenarios and present six experiments demonstrating intrusion and importing effects in the context of scenarios depicting perfect neuro-prediction. In light of our findings, we suggest that the intuitive commitment to indeterminist free will may be resilient in the face of scientific evidence against such free will.
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Attentional capture during attentional awakening
AbstractWe investigated whether attentional set is available at the beginning of a trial or whether it develops gradually within a trial. Thus, we manipulated the time from the onset of a trial to a target and observers' search strategy. We also observed the effect of the presence or absence of distractors as an index of the temporal development of attentional set. Participants identified a target letter embedded in a stream of rapidly presented nontargets while ignoring peripheral distractors. Baseline accuracy when no peripheral distractor was presented increased as the target appeared later in the stream, suggesting attentional awakening. Identification accuracy was impaired by the presence of peripheral distractors (i.e., attentional capture) early in the stream only when observers adopted the feature search mode. The magnitude of attentional capture increased over the course of the first 1,000 ms of a trial under the singleton detection and feature search modes. These results suggest that singleton detection mode requires time for a bottom-up signal to be effective in capturing attention, whereas the feature search mode does not require such a warm-up period to be effective and is available from the beginning of viewing the stream.Read More »
Neutrophil Gelatinase-Associated Lipocalin, but Not Kidney Injury Marker 1, Correlates with Duration of Delayed Graft Function
Background: No specific early biomarker is available to measure kidney injury after kidney transplantation (KT). Both neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury marker 1 (KIM-1) increase after oxidative injury. Their potential as early biomarkers was evaluated in this one-arm pilot study. Materials and Methods: Twenty consecutive KT patients receiving a kidney from a donation after circulatory death donor were included. Graft perfusate was collected, as well as serum samples before transplantation, at the end of surgery, and 1, 4, and 7 days after transplantation. NGAL and KIM-1 were measured using ELISA. Kidney function and delayed graft function (DGF) were monitored. Results: In this cohort, 85% of the KT patients developed DGF. Perfusate NGAL correlated with donor age (r2 = 0.094, p = 0.01) and serum creatinine (r2 = 0.243, p = 0.05). A cardiac cause of death was associated with higher NGAL in the perfusate (p = 0.03). Serum NGAL at day 1 was significantly higher in patients with DGF (730 ng/ml, range 490-1,655, vs. 417 ng/ml, range 232-481; p = 0.01). Serum NGAL levels at day 1, 4, and 7 correlated with the duration of DGF. KIM-1 was not detectable in the perfusate or in the serum until postoperative day 4 in 80% of patients. Conclusions: NGAL in the perfusate correlates with known donor risk factors for DGF. For the first time, we describe that serum NGAL at day 1 can discriminate between DGF and immediate graft function. Also, serum NGAL levels at day 1, 4, and 7 correlate with the duration of DGF. No association with KIM-1 was found. These data suggest that NGAL may be used as an early biomarker to detect DGF and warrants further study.Eur Surg Res 2015;55:319-327 Read More »
A review of simulation platforms in surgery of the temporal bone
AbstractBackground
Surgery of the temporal bone is a high-risk activity in an anatomically complex area. Simulation enables rehearsal of such surgery. The traditional simulation platform is the cadaveric temporal bone, but in recent years other simulation platforms have been created, including plastic and virtual reality platforms.
Objective of review
To undertake a review of simulation platforms for temporal bone surgery, specifically assessing their educational value in terms of validity and in enabling transition to surgery.
Type of review
Systematic qualitative review.
Search strategy
Search of the Pubmed, CINAHL, BEI and ERIC databases.
Evaluation method
Assessment of reported outcomes in terms of educational value.
Results
49 articles were included, covering cadaveric, animal, plastic, and virtual simulation platforms. Cadaveric simulation is highly rated as an educational tool, but there may be a ceiling effect on educational outcomes after drilling 8-10 temporal bones. Animal models show significant anatomical variation from man. Plastic temporal bone models offer much potential, but at present lack sufficient anatomical or haptic validity. Similarly, virtual reality platforms lack sufficient anatomical or haptic validity, but with technological improvements they are advancing rapidly.
Conclusions
At present cadaveric simulation remains the best platform for training in temporal bone surgery. Technological advances enabling improved materials or modelling mean that in the future plastic or virtual platforms may become comparable to cadaveric platforms, and also offer additional functionality including patient-specific simulation from CT data.
This article is protected by copyright. All rights reserved.
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Analiza finansowania publicznego świadczeń zdrowotnych w chorobach alergicznych w Polsce. Część pierwsza – leczenie szpitalne
Publication date: Available online 9 October 2015Source:Alergologia Polska - Polish Journal of Allergology Author(s): Jakub Gierczyński, Jerzy Gryglewicz, Małgorzata Sobotka-Gałązka, Jerzy Kruszewski, Bolesław Samoliński, Rafał Pawliczak, Piotr Kuna The article presents the public funding of health care in allergic diseases in terms of hospital treatment in 2014. On the basis of the National Health Fund (NHF) data available in the public domain, the authors analysed the financial outlay on the contracts by province and compared them with the waiting time for benefits. As a result, the analysis found inadequate public funding for hospital care to meet the growing health needs of the population in the field of allergic diseases. There have also been inter-province differences in the levels of financing hospital care and waiting lists. Read More »
The Efficacy of Mitomycin C in the Treatment of Laryngotracheal Stenosis: Results and Experiences with a Difficult Disease Entity
Background/Aims: Laryngotracheal stenosis (LTS) is a difficult entity to treat, with many patients requiring multiple procedures. Our study assessed the efficacy of mitomycin C (MMC) application as complimentary treatment of LTS. Methods: We reviewed clinical charts of patients with operative procedures for LTS between January 2005 and May 2013. Patients were grouped according to mitomycin use. Several outcome measures were assessed, including the number of procedures and time between procedures. Results: Seventy-one patients were included in the study (30 MMC, 41 non-MMC). They underwent similar numbers of procedures (2.3 MMC, 2.0 non-MMC, p > 0.05). The average time between procedures was 360 (MMC) and 178 (non-MMC) days (p = 0.015). Multiple treatments with mitomycin increased the duration between procedures (366 vs. 340 days, multiple vs. single application, p > 0.05). Fewer mitomycin patients underwent procedures for respiratory distress than non-MMC patients (6.6 vs. 19.5%, p > 0.05). Mitomycin use increased the duration between procedures in patients treated specifically for subglottic stenosis (375 vs. 186 days, p > 0.05). Conclusion: Our results and experiences with mitomycin demonstrate it is an effective agent for adjuvant treatment of LTS. Its use lengthens the symptom-free period, with further improvement demonstrated when patients expected to undergo multiple surgeries receive multiple mitomycin treatments.ORL 2015;77:351-358 Read More »
Multidimensional staging system for pediatric acquired cholesteatoma: A 30-year verification data
Publication date: Available online 9 October 2015Source:Auris Nasus Larynx Author(s): Chin-Lung Kuo, An-Suey Shiao, Chien-Hao Chen, Chiang-Feng Lien ObjectiveThis article presents a points-based prognostic prediction model for pediatric acquired cholesteatoma, incorporating the multidimensional factors that contribute to surgical failure.MethodsThis study included 132 ears with acquired cholesteatoma from 128 children (≤18 years) identified between 1982 and 2012. Each case was scored for the extent of the cholesteatoma, history of grommet insertion, age of the patient, ossicular destruction, and otorrhea. The patients were classified as stage I, II, or III. We compared differences between stages regarding the cumulative rates of recidivism and linear trends in these rates.ResultsAmong stage I cases, the rate of cumulative recidivism was 0%; however, among stage 2 cases, this increased with time, eventually leveling off at 15.7% after 18 years of follow-up. The same was observed among stage III cases, which leveled off at 34.1% after 17 years of follow-up. In the second half of the cohort and the entire cohort, differences in the cumulative recidivism curves reached statistical significance, as did the linear trends (all p<0.05).ConclusionsOur findings demonstrate the efficacy of the proposed multidimensional staging system in linking the severity of cholesteatoma to outcomes, thereby enabling the stratification of patients according to prognosis in order to identify children at risk of recidivism. Read More »
Angiotensin-converting enzyme genotype is a risk factor for wheat-dependent exercise-induced anaphylaxis sensitized with hydrolyzed wheat protein
Publication date: Available online 9 October 2015Source:Allergology International Author(s): Akiko Sugiyama, Reiko Kishikawa, Satoshi Honjo, Terufumi Shimoda, Haruko Nishie, Chikako Motomura, Naohiko Taba, Yoko Murakami, Mihoko Iwata, Hiroshi Odajima, Tomoaki Iwanaga, Masutaka Furue Read More »
Up-Regulation of miR-21 Expression Predicate Advanced Clinicopathological Features and Poor Prognosis in Patients with Non-Small Cell Lung Cancer
AbstractMicroRNAs (miRNAs) are endogenous small (19–24 nt long) noncoding RNAs that regulate gene expression in a sequence specific manner. An increasing association between miRNA and cancer has been recently reported. Lung cancer is globally responsible for 1.4 million deaths annually and is the leading cause of cancer-related deaths in both women and men. In this study, we investigated the miR-21 expression in non-small cell lung cancer (NSCLC) to evaluate their value in prognosis of this tumor. Here, we assess miR-21 expression in NSCLC and its clinical significance including survival analysis. The expression of miR-21 in matched normal and tumor tissues of NSCLC was evaluated using a quantitative real-time RT-PCR. A Kaplan–Meier survival curve was generated following a logrank test. It was observed that miR-21 expression was up-regulated in NSCLC tissues compared with noncancerous lung tissues (mean ± SD: 6.7 ± 2.3 vs. 3.7 ± 1.5, P < 0.001). The up-regulation of miR-21 in NSCLC cancer tissues was also significantly correlated with aggressive clinicopathological features. We found that the patients with high miR-21 expression have a higher tumor grade (P = 0.027) and are in higher risk of lymph node metastasis (P = 0.021). Moreover, the results of Kaplan–Meier analyses showed that NSCLC patients with the high miR-21 expression tend to have shorter overall survival and progression free survival (P < 0.001). The multivariate analysis clearly indicated that the high miR-21 expression in biopsy samples may be considered as an independent prognostic factor in NSCLC for decreased survival (RR 3.88; 95%CI, 2.47–6.11). Our data indicate the potential of miR-21 as a novel prognostic biomarker for NSCLC. Large well-designed studies with diverse populations and functional evaluations are warranted to confirm and extend our findings.Read More »
Aesthetic and Functional Reconstruction After Parotidectomyn Pediatric Patients–A Case Series
Publication date: Available online 9 October 2015Source:International Journal of Pediatric Otorhinolaryngology Author(s): Lucas M. Bryant, David Cognetti, Adam Baker, Sudeep Roy, Douglas R. Johnston, Joseph Curry, Howard Krein Parotidectomys a mainstayf treatment for benign and malignant parotid lesionsn children and adults. Dependingn surgical methods used and tumor size, parotidectomy may resultn significant facialisfigurement as well as functional challenges. Weescribe a seriesf four pediatric patients, ages 13-16 who presented tour clinic with a parotid mass. All patients underwent parotidectomy withmmediate reconstruction by local tissue rearrangementr free fat graft. Aesthetic and functional reconstruction after parotidectomys not wellescribedn pediatrictolaryngology literature. A reviewf current literature andescriptionf reconstructive methodssncluded. Read More »
COSMO ("Communicating about Objects using Sensory–Motor Operations"): A Bayesian modeling framework for studying speech communication and the emergence of phonological systems
Publication date: Available online 9 October 2015Source:Journal of Phonetics Author(s): Clément Moulin-Frier, Julien Diard, Jean-Luc Schwartz, Pierre Bessière While the origin of language remains a somewhat mysterious process, understanding how human language takes specific forms appears to be accessible by the experimental method. Languages, despite their wide variety, display obvious regularities. In this paper, we attempt to derive some properties of phonological systems (the sound systems for human languages) from speech communication principles. We introduce a model of the cognitive architecture of a communicating agent, called COSMO (for "Communicating about Objects using Sensory–Motor Operations') that allows a probabilistic expression of the main theoretical trends found in the speech production and perception literature. This enables a computational comparison of these theoretical trends, which helps us to identify the conditions that favor the emergence of linguistic codes. We present realistic simulations of phonological system emergence showing that COSMO is able to predict the main regularities in vowel, stop consonant and syllable systems in human languages. Read More »
Surgical Treatment of the Twisted Nose
Publication date: Available online 9 October 2015Source:Clinics in Plastic Surgery Author(s): Dirk Jan Menger TeaserThe twisted nose is a challenging procedure in rhinoplasty. The goal of surgery is to realign the nasal skeleton to create symmetry in the face and restore nasal patency. Key in the surgical procedure is that all structures of the nasal skeleton be dissected free, mobilized, repositioned, and stabilized. Important surgical steps are intermediate osteotomies on the contralateral side of the deviation for the upper nasal third; for the mid nasal third, a unilateral spreader graft or splint on the nondeviated side, and for the lower nasal third, fixation of the caudal septum to the anterior nasal spine.Read More »
Recomendaciones CODEPEH 2014: detección precoz de la hipoacusia diferida, diagnóstico audiológico y adaptación audioprotésica y atención temprana
Publication date: Available online 9 October 2015Source:Acta Otorrinolaringológica Española Author(s): Faustino Núñez-Batalla, Carmen Jáudenes-Casaubón, Jose Miguel Sequí-Canet, Ana Vivanco-Allende, Jose Zubicaray-Ugarteche La literatura científica más reciente señala el diagnóstico precoz de la sordera como elemento fundamental para definir el pronóstico educativo y de inclusión del niño sordo, pues permite aprovechar el periodo crítico de su desarrollo (0-4 años).Existen diferencias altamente significativas entre las personas sordas estimuladas tempranamente y las que han recibido esta atención específica de forma más tardía y/o inadecuada.La identificación temprana de los trastornos diferidos requiere de una especial atención y conocimientos entre todos los profesionales que atienden a los niños durante su infancia. Se trata de diseñar programas y de planificar acciones adicionales más allá del cribado neonatal para asegurar que todos los niños con una hipoacusia significativa sean detectados pronto.Con este propósito, la CODEPEH quiere poner de relieve la necesidad de un seguimiento continuado de la salud auditiva de los niños, estableciendo para ello las recomendaciones contenidas en el presente documento.The latest scientific literature considers early diagnosis of deafness as the key element to define the educational and inclusive prognosis of the deaf child, because it allows taking advantage of the critical period of development (0-4 years).Highly significant differences exist between deaf people who have been stimulated early and those who have received late or improper intervention.Early identification of late-onset disorders requires special attention and knowledge on the part of every childcare professional. Programs and additional actions beyond neonatal screening should be designed and planed to ensure that every child with a significant hearing loss is detected early.For this purpose, the CODEPEH would like to highlight the need for continuous monitoring of children's auditory health. Consequently, CODEPEH has drafted the recommendations included in the present document. Read More »
Sleep-based memory processing facilitates grammatical generalization: Evidence from targeted memory reactivation
Publication date: Available online 9 October 2015Source:Brain and Language Author(s): Laura J. Batterink, Ken A. Paller Generalization—the ability to abstract regularities from specific examples and apply them to novel instances—is an essential component of language acquisition. Generalization not only depends on exposure to input during wake, but may also improve offline during sleep. Here we examined whether targeted memory reactivation during sleep can influence grammatical generalization. Participants gradually acquired the grammatical rules of an artificial language through an interactive learning procedure. Then, phrases from the language (experimental group) or stimuli from an unrelated task (control group) were covertly presented during an afternoon nap. Compared to control participants, participants re-exposed to the language during sleep showed larger gains in grammatical generalization. Sleep cues produced a bias, not necessarily a pure gain, suggesting that the capacity for memory replay during sleep is limited. We conclude that grammatical generalization was biased by auditory cueing during sleep, and by extension, that sleep likely influences grammatical generalization in general. Read More »
Reply
Publication date: Available online 10 October 2015Source:Journal of Allergy and Clinical Immunology Author(s): Tali Czarnowicki, James G. Krueger, Emma Guttman-Yassky Read More »
Leprosy is teaching us the immunopathogenesis of inflammatory skin disease
Publication date: Available online 10 October 2015Source:Journal of Allergy and Clinical Immunology Author(s): Tina Rendini, William Levis Read More »
Autoimmune lymphoproliferative syndrome caused by a homozygous FasL mutation that disrupts FasL assembly
Publication date: Available online 10 October 2015Source:Journal of Allergy and Clinical Immunology Author(s): Ali Sobh, Elena Crestani, Brittney Cangemi, Jennifer Kane, Janet Chou, Sung-Yun Pai, Luigi D. Notarangelo, Waleed El-Herz, Raif S. Geha, Michel J. Massaad Read More »
Endoskopie und Operationsqualität
ZusammenfassungHintergrundEndoskopieren setzt voraus, dass ein „Endoskopieturm" mit Kameraeinheit, Bildschirm, Lichtquelle und Dokumentationstechnik, meist in einer fahrbaren Einheit zusammengefasst, zur Verfügung steht. Mit dieser Basisausrüstung lassen sich verschiedene Endoskope verbinden, sodass je nach Zielorgan verschiedene Arten von Endoskopien durchgeführt werden können.MethodenEndoskopisches Operieren dient dazu, eine Operation sichtbar zu kontrollieren und genauer oder weniger invasiv durchzuführen. Die Endoskopie ist in vielfältiger Weise fester Bestandteil der Mund-, Kiefer- und Gesichtschirurgie. Diese ist ohne die Möglichkeit, bei Bedarf auf die Endoskopie zurückgreifen zu können, in der gewohnten Qualität heute nicht mehr vorstellbar. Die endoskopische Chirurgie ist somit auch ein wichtiger Teil der Facharztausbildung des MKG-Chirurgen. Die Navigation hat erst in den letzten 10 Jahren in Form eigenständiger chirurgischer Navigationssysteme zur Echtzeitnavigation („real time navigation") Einzug in MKG-chirurgische Operationssäle gehalten. Werden chirurgische Navigationssysteme benutzt, um z. B. ein Endoskop zu steuern, die erhaltenen endoskopischen Bilder noch genauer dem Situs zuzuordnen oder in andere Bilddatensätze wie Computer- oder Magnetresonanztomographie einzuordnen, ergeben sich weiterführende Möglichkeiten. Im vorliegenden Artikel werden beispielgebend die Pharyngoskopie, die Rhinoskopie, die Sialendoskopie, die Kiefergelenkarthroskopie sowie die meist weniger bekannte endoskopisch gestützte supraforaminale Unterkieferosteotomie zur Unterkieferumstellung besprochen.SchlussfolgerungDie perspektivische Verbindung zwischen Endoskopie und chirurgischer Navigation findet zunehmend Beachtung und könnte in Zukunft einen weiteren Qualitätssprung in der Behandlung mund-, kiefer- und gesichtschirurgischer Krankheitsbilder ermöglichen.Read More »
Letter to the editor
Publication date: Available online 9 October 2015Source:American Journal of Otolaryngology Author(s): Satvinder Singh Bakshi Read More »
Bony ankylosis of hydroxyapatite prostheses in the middle ear
Publication date: Available online 9 October 2015Source:American Journal of Otolaryngology Author(s): Opeoluwa Fawole, Sarah Mowry BackgroundOssiculoplasty is a commonly performed middle ear procedure. Ossicular chain reconstruction (OCR) prostheses should be made of a biocompatible material; one such common material is hydroxyapatite (HA).Methods2 patients were identified who had HA OCR prostheses which had fused to the middle ear bony structures. One HA OCR had fused to the fallopian canal in the tympanic segment and represented a management dilemma. The other fused to the scutum.ConclusionBony ankylosis of a HA containing OCR prosthesis should be considered in the differential diagnosis of a failed ossiculplasty. Depending on the location of the fusion, special measures may be needed to free the prosthesis from the underlying middle ear structures. Read More »
Introduction
Publication date: September 2015Source:Gait & Posture, Volume 42, Issue 3 Author(s): Thomas Dreher Read More »
Bad science and how to avoid it, a movement analysis perspective: Study design, statistics and publication ethics
Publication date: September 2015Source:Gait & Posture, Volume 42, Issue 3 Author(s): Andy Kerr, Robin Prescott, Tim Theologis Read More »
Dynamics of postural control in Parkinson patients with and without symptoms of freezing of gait
Publication date: September 2015Source:Gait & Posture, Volume 42, Issue 3 Author(s): Olena Pelykh, Anke-Maria Klein, Kai Bötzel, Zuzana Kosutzka, Josef Ilmberger BackgroundIt has been suggested that dynamical measures such as sample entropy may be more appropriate than conventional measures when analyzing time series data such as postural sway. We evaluated conventional and dynamical measures of postural sway in Parkinson disease (PD) patients with and without freezing episodes.MethodsCOP (center of pressure) data were recorded during quiet standing with eyes open, eyes closed and while performing a dual task. Data for 16 patients with freezing of gait, 17 patients with no history of freezing and 24 healthy subjects were analyzed. The amount of postural sway was quantified using conventional measures, whereas for the characterization of the temporal structure of the COP data the normalized sway path and sample entropy was calculated.ResultsMean radius was higher and sample entropy was lower in patients with freezing symptoms as compared to healthy subjects in all three conditions. Dual-tasking significantly increased sway path length in patients with freezing, while normalized sway path did not change over conditions in this group.ConclusionsOur findings show that postural sway is characterized by a combination of large radius, short normalized sway path and high regularity of the COP only in patients with freezing. This pattern becomes most prominent in a dual-task paradigm. This may explain higher occurrence of gait freezing in dual task situations with subsequent higher risk of falls. Results suggested that dynamic measures may add valuable information for characterizing postural stability in PD patients. Read More »
Whole body mechanics differ among running and cutting maneuvers in skilled athletes
Publication date: September 2015Source:Gait & Posture, Volume 42, Issue 3 Author(s): Kathryn L. Havens, Susan M. Sigward Quick changes of direction during running (cutting) represent a whole body mechanical challenge, as they require deceleration and translation of the body during ongoing movement. While much is known with respect to whole body demands during walking turns, whole body mechanics and anticipatory adjustments necessary for cutting are unclear. As the ability to rapidly change direction is critical to athletes' success in many sports, a better understanding of whole body adjustments made during cuts is needed. Whole body center of mass velocity and position during the approach and execution steps of three tasks (straight running, 45° sidestep cut, and 90° sidestep cut) performed as fast as possible were compared in 25 healthy soccer athletes. Repeated measure ANOVA revealed that overall, braking and translation were greater during the cuts compared to the straight run. Interestingly, with systematically increased cut angle, disproportionately greater braking but proportionately greater translation was observed. Anticipatory adjustments made prior to the execution of the cuts suggested that individuals evenly distributed the deceleration and redirection demands across steps of the 45° cut but prioritized deceleration over translation during the approach step of the 90° cut. Read More »
Hip joint biomechanics during gait in people with and without symptomatic femoroacetabular impingement
Publication date: Available online 9 October 2015Source:Gait & Posture Author(s): Laura E. Diamond, Tim V. Wrigley, Kim L. Bennell, Rana S. Hinman, John O'Donnell, Paul W. Hodges Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip/groin pain and impaired function in younger active adults, and may lead to stiffness, muscle weakness, structural damage, and hip osteoarthritis. Understanding the impairments associated with FAI is crucial to guide treatment and rehabilitation strategies. Evidence is limited and conflicting about whether hip biomechanics are impaired during walking in people with symptomatic FAI. The objective of this study was to determine whether kinematics and kinetics during gait differ between people with symptomatic FAI and control participants. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery and 14 age-, and sex-matched disease-free controls underwent three-dimensional gait analysis. Tri-planar hip kinematics and kinetics were compared between the two groups. There were limited significant between-group differences with respect to spatiotemporal variables. Participants with FAI walked with less range of motion in the sagittal plane during a gait cycle, but did not exhibit any significant kinematic differences in the frontal or transverse planes. There were no systematic differences in kinetics between the groups in any plane. Findings suggest that individuals with symptomatic FAI have minimal impairments in gait biomechanics. Although these individuals demonstrate reduced hip joint motion in the sagittal plane, the size of the difference is small and its significance for symptoms and function is unclear. More pronounced deficits in hip kinetics and kinematics may be evident during functional tasks that challenge the hip towards the position of impingement. Read More »
Peeling mit Phenol
ZusammenfassungDas Phenolpeeling ist zu einer modernen Technik geworden, die allerdings unterschiedliche Ergebnisse liefert. Aufgrund eigener langjähriger Erfahrungen sollen in diesem Beitrag einige Irrtümer und Unwahrheiten richtiggestellt werden, die über diese Methode im Umlauf sind. Im Wesentlichen soll aber gezeigt werden, in welchen Bereichen das Phenolpeeling gut wirksam ist und wo seine Grenzen liegen. Außerdem sollen neue Entwicklungen des Phenolpeelings dargestellt werden.Read More »
Intérêt de la symétrisation immédiate au cours de la reconstruction mammaire unilatérale différée par DIEP. À propos de 33 cas
Publication date: Available online 9 October 2015Source:Annales de Chirurgie Plastique Esthétique Author(s): J. Pauchot, D. Feuvrier, M. Panouillères, I. Pluvy, Y. Tropet IntroductionAu décours d'une reconstruction mammaire unilatérale, un geste de symétrisation est souvent proposé au niveau du sein controlatéral. Nous présentons l'intérêt de la réalisation de la symétrisation immédiate au décours d'une reconstruction unilatérale par DIEP.MéthodeTrente-trois patientes consécutives, d'âge moyen 52,1ans, ont bénéficié d'une reconstruction mammaire différée unilatérale par DIEP avec symétrisation immédiate et 2 patientes d'une symétrisation différée. Une reconstruction mammaire en un temps correspond à une reconstruction mammaire avec une seule anesthésie générale sans exclure les possibilités de retouche sous anesthésie locale.RésultatsVingt-quatre patients (73 %) ont eu une reconstruction mammaire en un temps et 7 patients (24 %) ont dû avoir recours à une anesthésie générale supplémentaire et 1 patient à deux anesthésies générales supplémentaires. Dans 4 cas, une anesthésie générale était liée à une complication. La durée opératoire moyenne était de 485minutes.ConclusionLorsque la symétrisation est envisagée au décours d'une reconstruction mammaire unilatérale par DIEP, la symétrisation immédiate permet d'éviter une seconde anesthésie générale dans plus de 70 % des cas.BackgroundAfter unilateral breast reconstruction, a procedure on the contralateral breast is often needed to achieve symmetry. Here, we present a single surgeon's experience with performing contralateral symmetry procedures simultaneously with DIEP flap.MethodsWe evaluated 33 consecutive patients (mean age, 52.1 years) who underwent DIEP flap unilateral breast reconstruction and a simultaneous contralateral breast procedure performed and 2 patientes with delayed controlateral symmetry procedures. A single-stage breast cancer reconstruction is successful if after the original reconstruction no correction for revision of breast mound, or contralateral breast procedures are performed, under general anesthetic, to complete the reconstruction.ResultsIn 24 patients (73%), breast reconstruction was completed after a single stage with one general anesthetic, and in 8 patients (24%), revisions were performed with two general anesthetic (7 patients) and three general anesthetic in one case. Reconstructions requiring more than one general anesthetic were due to 4 of 39 (10%) postoperative complications. Mean operating time was 485minutes.ConclusionsFor patients who need contralateral reduction mammoplasty or mastopexy for symmetry, performing these procedures and breast reconstruction simultaneously facilitates single-stage breast reconstruction in most patients. Read More » |
Πέμπτη 15 Οκτωβρίου 2015
OtoLaryngology New Articles
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