Multiple-Flap Reconstruction of Head and Neck Defects

The goals of head and neck reconstruction of cancer-related defects are to restore speech, swallowing, and cosmesis and maximize patient quality of life. During the past 2 decades, our ability to achieve these goals with free, pedicled, and local tissue transfer alone or in combination has steadily improved. The reconstructive surgeon now has a robust armamentarium with an array of tissue choices, including bone, muscle, viscera, skin (thick, thin, hair bearing, and color match to facial skin). In addition, there has been an expansion of recipient vessels, which allows an increased range of options for patients in whom prior therapy has failed and who present for head and neck reconstruction. These advances have changed the way that we think about the various components of the head and neck and increased the number of creative choices to restore form and function and minimize morbidity.

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Antibiotic Prescription Patterns for Management of Acute Otitis Media in Lebanon

Publication date: Available online 16 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ali Nasrallah, Ali Bacharouch, Fadia Jaafar, Mariam Ayyash, R. Alexander Blackwood

Abstract

Objectives

The high incidence of Acute Otitis Media (AOM) along with low antibiotic efficacy in the treatment of AOM is particularly favorable for the emergence of antimicrobial resistance. The promotion of more conservative antibiotic prescription habits has become an important focus of governments and academic societies. Little is known about the awareness and use of AOM practice guidelines by physicians in the Middle East. Our aim is to characterize AOM management in Lebanon by using an anonymous survey instrument to uncover potential disparities in treatment trends and evaluate differences in clinical guideline adherence patterns.

Methods

A total of 75 practicing physicians were anonymously surveyed in Beirut, Saida, Nabatieh, Bekaa and Tripoli, Lebanon. The survey tool used was previously used in Amman, Jordan by our colleagues at the University of Michigan. The survey we used assessed awareness of and adherence to practice guidelines by prompting responses to hypothetical AOM cases. Differences in performance between various physician groups were noted.

Results

Overall, physician participants answered 67% of the survey questions correctly. Trainees did better overall in terms of AOM management (62% correct responses as compared to 48% in attending physicians, p=0.0175). Trainees also performed better in terms of their ability to manage cases of potential AOM in two-year old children and their ability to choose the appropriate medications (79% correct response rate compared to 71% in attending physicians, p=0.0278). Participants who reported guideline adherence most or all of the time had a 67% correct response rate in regards to their ability to diagnosis AOM, compared to a 57% correct response rate in those who reported adhering sometimes or rarely to the guidelines (p=0.0489). In the cases requiring antibiotic treatment for body temp of over 39C with/without otalgia, only 47-57% of participants identified the appropriate antibiotic regimen.

Conclusion

There are areas of potential improvement in adherence to clinical guidelines in the management, diagnosis, and treatment of AOM by Lebanese physicians. Conducting interventions among physicians to improve awareness of clinical guidelines and current treatment recommendations in Lebanon will likely improve adherence to guidelines, enhance clinical outcomes, and may help advance the fight against antimicrobial resistance.

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3-Dimensional Printed Haptic Simulation Model To Teach Incomplete Cleft Palate Surgery In An International Setting

Publication date: Available online 16 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Valerie Cote, Marissa Schwartz, Jose F. Arbouin Vargas, Michael Canfarotta, Katherine Kavanagh, Usama Hamdan, Tulio Valdez

Abstract

Introduction

Cleft palate is one of the most common congenital anomalies, yet surgical repair remains challenging and can lead to significant complications in the hands of inexperienced surgeons. There is a great need for the development of a simulation model that will allow surgeons worldwide to learn and practice the intricate skills needed for cleft palate surgery.

Objectives

1. To develop a low-cost incomplete cleft palate simulation model using additive manufacturing technology (3D printing). 2. To evaluate its validity and utility to teach palatoplasty in a global health care setting.

Methods

Three-dimensional models of a soft palate cleft and an incomplete hard and soft palate cleft were developed using 3D printing and silicone casting. The cost and time of assembly of the 3D printed models were calculated. The models were then assessed for validity by cleft surgeons and trainees during a cleft mission in Ecuador. 3D models were assessed for resemblance to anatomy and tissue characteristics, the ability to incise the soft tissue, dissect and reposition the palatal flaps, and the ease of suture placement. Models were rated using the Likeness to Human Tissue Scale.

Results

Cleft palate simulators were successfully developed using 3D printing and silicone casting. Participants reported that models provided a realistic representation of human anatomy and were adequate for novice surgeons to practice the procedure. The models were portable, low cost, and easily assembled.

Conclusion

The use of 3D printed haptic simulation models for teaching and learning cleft palate repair techniques could enhance skill acquisition and possibly improve surgical outcomes. In outreach settings, it could help achieve local, sustainable comprehensive care for cleft palate patients.

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Facial vein thrombophlebitis: A Case Report and literature review

Publication date: Available online 16 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Miki Paker, Jacob T. Cohen, Nedal Moed, Lev Shleizerman, Muhamed Masalha, Dror Ashkenazi, Salim Mazzawi

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Cloning, expression analysis and functional characterization of an interleukin-1 receptor-associated kinase 4 from Apostichopus japonicus

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Yi Cui, Liting Jiang, Ronglian Xing, Zhengdong Wang, Zhenhui Wang, Yina Shao, Weiwei Zhang, Xuelin Zhao, Chenghua Li

Abstract

Interleukin 1 receptor-associated kinase 4 (IRAK4) is a key factor in TLR-mediated host immune function. In this study, an IRAK4 homologue molecule was identified from Apostichopus japonicus (designated as AjIRAK4) by RACE approach. The full-length cDNA of AjIRAK4 was of 2024 bp containing an open reading frame of 1311 bp encoding a 436-amino-acid (aa) residue polyprotein with the typical death domain (10-113aa) and the kinase domain (160-426aa). The mRNA transcripts of AjIRAK4 displayed constitutively expressed in all examined tissues with highest expression in the muscles (7.20-fold increase compared to the coelomocytes). The pathogen Vibrio splendidus challenge and LPS exposure could both significantly up-regulate the mRNA expression of AjIRAK4. Silencing AjIRAK4 in vitro and in vivo could inhibit the expression of TLR members at mRNA and protein levels, suggesting AjIRAK4 was an important component of TLR cascade in sea cucumber. More importantly, knockdown of AjIRAK4 by specific siRNA resulted in the significant promotion of coelomocyte apoptosis by 1.82-fold increase in vitro and 1.95-fold in vivo. Taken together, all our results suggested that AjIRAK4 might be served as coelomocyte apoptosis regulator via TLR cascade.

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Genomic Sequencing Assays Characterize the Mutational Landscape of Advanced Thyroid Cancers

Clinical Thyroidology, Volume 30, Issue 8, Page 371-373, August 2018.


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Serum TSH Remains Normal in Those without Significant Risk Factors for Thyroid Dysfunction

Clinical Thyroidology, Volume 30, Issue 8, Page 385-387, August 2018.


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