bluuebunny/crossref_metadata_2025 huggingface dataset:
Significant transaortic gradient after direct flow aortic valve implantation
Authors: Hernandez‐Antolín Rosa‐Ana , Salido Luisa , Zamorano José Luis
Published: December 2014

A patient with severe aortic valve disease and high surgical risk underwent Direct Flow (DF) valve implantation. Anatomical assessment (Trans‐esophageal echocardiography (TEE) and CT scan) revealed a 3‐leaflet aortic valve (annulus diameter 23.4 mm) that was functionally bicuspid because of complete and linearly calcified fusion of noncoronary and right cusps. The valve had severe stenosis (peak/mean gradients of 70/45 mm Hg) and moderate to severe regurgitation. A balloon valvuloplasty (semicompliant 23 mm × 45 mm balloon, 2 inflations) was performed with persistence of balloon waist. A 25 DF valve was positioned in the aortic annulus, with both rings well expanded. A mild deformity in the vertical supporting tubes was observed but considered nonrelevant because valve function (peak/mean gradients of 25/12 mm Hg respectively and no aortic regurgitation) was acceptable. Then the polymer was injected and the valve released from its attachments. Postoperative course was uneventful without clinical complications; nevertheless 3 days later Doppler peak/mean transaortic gradients were 80/45 mm Hg. These high gradients were confirmed by direct invasive measurements while CT scan documented a severe geometrical deformation of the valve cuff. Since patient was in good clinical condition, a conservative strategy was adopted. Eight months later, patient functional status had improved (NYHA class II), left ventricular dimensions decreased, left ventricular ejection fraction (LVEF) increased, and valve gradients remained unchanged; therefore surgical aortic valve replacement has been deferred until clinical indication. Such a favorable course can be explained by disappearance of aortic regurgitation. Patient anatomical and procedural features that conditioned this very rare phenomenon are discussed as well as clues to prevent it. © 2015 Wiley Periodicals, Inc.
Transcatheter aortic‐valve implantation with one single minimal contrast media injection
Authors: Arrigo Mattia , Maisano Francesco , Haueis Sabine , Binder Ronald K. , Taramasso Maurizio , Nietlispach Fabian
Published: December 2014

Objectives

Performing transcatheter aortic valve implantation (TAVI) with the use of minimal contrast in patients at high‐risk for acute kidney injury (AKI). Background: Contrast‐induced nephropathy (CIN) is a major cause of AKI following TAVI and is associated with increased morbidity and mortality. The amount of contrast media used increases the risk for CIN.

Methods

Computed tomography was omitted during the screening process. For the procedure transfemoral access was default. The self‐expanding CoreValve prosthesis was chosen in all patients to minimize the risk of annular rupture in case of oversizing. Valve sizing was based on echocardiography, aortography, calcification on fluoroscopy, as well as weight and height of the patient. A single contrast injection was performed to confirm correct position of the pigtail catheter at the level of the annulus. The pigtail then served as the marker for the device landing zone. Intraprocedural assessment of the implantation result relied on echocardiography and hemodynamics.

Results

Five patients with severe aortic stenosis and at high risk for developing CIN were included. Device success was achieved in all patients and no major complications occurred. The median dose of injected contrast media was 8 ml (4–9). All but one patient had improved renal function after the intervention compared to baseline.

Conclusions

Our study shows feasibility of performing TAVI with a single minimal contrast media injection, using a self‐expandable valve. This technique has the potential to reduce the incidence of CIN. © 2015 Wiley Periodicals, Inc.
Rainfall during parental care reduces reproductive and survival components of fitness in a passerine bird
Authors: Öberg Meit , Arlt Debora , Pärt Tomas , Laugen Ane T. , Eggers Sönke , Low Matthew
Published: December 2014

Adverse weather conditions during parental care may have direct consequences for offspring production, but longer‐term effects on juvenile and parental survival are less well known. We used long‐term data on reproductive output, recruitment, and parental survival in northern wheatears (Oenanthe oenanthe) to investigate the effects of rainfall during parental care on fledging success, recruitment success (juvenile survival), and parental survival, and how these effects related to nestling age, breeding time, habitat quality, and parental nest visitation rates. While accounting for effects of temperature, fledging success was negatively related to rainfall (days > 10 mm) in the second half of the nestling period, with the magnitude of this effect being greater for breeding attempts early in the season. Recruitment success was, however, more sensitive to the number of rain days in the first half of the nestling period. Rainfall effects on parental survival differed between the sexes; males were more sensitive to rain during the nestling period than females. We demonstrate a probable mechanism driving the rainfall effects on reproductive output: Parental nest visitation rates decline with increasing amounts of daily rainfall, with this effect becoming stronger after consecutive rain days. Our study shows that rain during the nestling stage not only relates to fledging success but also has longer‐term effects on recruitment and subsequent parental survival. Thus, if we want to understand or predict population responses to future climate change, we need to consider the potential impacts of changing rainfall patterns in addition to temperature, and how these will affect target species' vital rates.
Are the numbers adding up? Exploiting discrepancies among complementary population models
Authors: Stenglein Jennifer L. , Zhu Jun , Clayton Murray K. , Van Deelen Timothy R.
Published: December 2014

Large carnivores are difficult to monitor because they tend to be sparsely distributed, sensitive to human activity, and associated with complex life histories. Consequently, understanding population trend and viability requires conservationists to cope with uncertainty and bias in population data. Joint analysis of combined data sets using multiple models (i.e., integrated population model) can improve inference about mechanisms (e.g., habitat heterogeneity and food distribution) affecting population dynamics. However, unobserved or unobservable processes can also introduce bias and can be difficult to quantify. We developed a Bayesian hierarchical modeling approach for inference on an integrated population model that reconciles annual population counts with recruitment and survival data (i.e., demographic processes). Our modeling framework is flexible and enables a realistic form of population dynamics by fitting separate density‐dependent responses for each demographic process. Discrepancies estimated from shared parameters among different model components represent unobserved additions (i.e., recruitment or immigration) or removals (i.e., death or emigration) when annual population counts are reliable. In a case study of gray wolves in Wisconsin (1980–2011), concordant with policy changes, we estimated that a discrepancy of 0% (1980–1995), −2% (1996–2002), and 4% (2003–2011) in the annual mortality rate was needed to explain annual growth rate. Additional mortality in 2003–2011 may reflect density‐dependent mechanisms, changes in illegal killing with shifts in wolf management, and nonindependent censoring in survival data. Integrated population models provide insights into unobserved or unobservable processes by quantifying discrepancies among data sets. Our modeling approach is generalizable to many population analysis needs and allows for identifying dynamic differences due to external drivers, such as management or policy changes.
HMGB1 induces angiogenesis in rheumatoid arthritis via HIF‐1α activation
Authors: Park So Youn , Lee Sung Won , Kim Hye Young , Lee Won Suk , Hong Ki Whan , Kim Chi Dae
Published: December 2014

High‐mobility group box protein 1 (HMGB1), a nonhistone nuclear protein and a cytokine mediator, is implicated in the pathogenesis of rheumatoid arthritis (RA). Extracellular HMGB1 binds to its receptors and triggers downstream signal cascade leading to the perpetuation of synovitis and local tissue invasion. Here, we investigated a novel role of HMGB1 in regulating hypoxia‐inducible factor (HIF)‐1α to mediate angiogenesis in RA synovium. HIF‐1α mRNA levels and activities in synovial fibroblasts from RA patients were enhanced by HMGB1. Pharmacological inhibition of TLR4 and NF‐kappaB activation blocked the HMGB1‐dependent upregulation of HIF‐1α mRNA expression and its activity, suggesting the involvement of transcriptional regulation. HMGB1 stimulated expression of vascular endothelial growth factor (VEGF), and inhibition of HIF‐1α attenuated HMGB1‐induced VEGF. Conditioned media derived from HMGB1‐stimulated synovial fibroblasts enhanced tube formation in human microvascular endothelial cells by upregulating HIF‐1α. In the joint tissues of mice with collagen‐induced arthritis, treatment with anti‐HMGB1 neutralizing antibody prevented blood vessel formation in association with decreased expression of HIF‐1α. These observations support the idea that increased HMGB1 induces an extension of inflamed synovium by accelerating angiogenesis in RA through enhancement of HIF‐1α activation. Therefore, inhibition of HMGB1 could prove beneficial for the treatment of angiogenesis in RA.
Structural and functional assessment of skin nerve fibres in small‐fibre pathology
Authors: Karlsson P. , Nyengaard J.R. , Polydefkis M. , Jensen T.S.
Published: December 2014

Damage to nociceptor nerve fibres may give rise to peripheral neuropathies, some of which are pain free and some are painful. A hallmark of many peripheral neuropathies is the loss of small nerve fibres in the epidermis, a condition called small‐fibre neuropathy (SFN) when it is predominantly the small nerve fibres that are damaged. Historically,SFNhas been very difficult to diagnose as clinical examination and nerve conduction studies mainly detect large nerve fibres, and quantitative sensory testing is not sensitive enough to detect small changes in small nerve fibres. However, taking a 3‐mm punch skin biopsy from the distal leg and quantification of the nerve fibre density has proven to be a useful method to diagnoseSFN. However, the correlation between the nerve fibre loss and other test results varies greatly. Recent studies have shown that it is possible not only to extract information about the nerve fibre density from the biopsies but also to get an estimation of the nerve fibre length density using stereology, quantify sweat gland innervation and detect morphological changes such as axonal swelling, all of which may be additional parameters indicating diseased small fibres relating to symptoms reported by the patients. In this review, we focus on available tests to assess structure and function of the small nerve fibres, and summarize recent advances that have provided new possibilities to more specifically relate structural findings with symptoms and function in patients withSFN.
Reconstruction of expanding tracheoesophageal fistulae in post‐radiation therapy patients who undergo total laryngectomy with a bipaddled radial forearm free flap: Report of 8 cases
Authors: Dewey Eliza H. , Castro Jerry R. , Mojica Jacqueline , Lazarus Cathy L. , Su Henry K. , Alpert Erin H. , Dos Reis Laura L. , Urken Mark L.
Published: December 2014

Background

Our surgical approach describes a bipaddled radial forearm free flap (RFFF) for closure of chronic tracheoesophageal fistulae (TEF) in patients who underwent total laryngectomy. The desired functional results were achieved.

Methods

Eight patients underwent the procedure. The surgical approach includes exposure and resection of the fistula tract, and a bipaddled RFFF transfer. Key surgical maneuvers include: circumferential dissection and mobilization of the trachea; partial sternal resection in select cases; inset of flap's distal paddle into the anterior esophageal wall; and inset of the proximal skin paddle to the posterior tracheal wall and cervical skin.

Results

Successful reconstruction of all 8 cases was done to restore a normal diet and a widely patent tracheal opening. One patient developed a delayed esophageal stricture, which was successfully managed with home dilation.

Conclusion

Several TEF treatment approaches have been reported. Our 87.5% esophageal lumen preservation success rate, reestablishment of adequate airway, and uncomplicated postoperative courses demonstrates the reliability of this surgical approach. © 2015 Wiley Periodicals, Inc.Head Neck38: E172–E178, 2016
Targeting CD133 in the enhancement of chemosensitivity in oral squamous cell carcinoma–derived side population cancer stem cells
Authors: Yu Cheng‐Chia , Hu Fang‐Wei , Yu Chuan‐Hang , Chou Ming‐Yung
Published: December 2014

Background

Oral squamous cell carcinoma (OSCC) is one of the most common cancers in the world. Previously, we enriched a subpopulation of OSCC‐derived cancer stem cells (OSCC‐CSCs), and identified CD133 as an OSCC‐CSC marker.

Method

We determined the function of CD133 on chemosensitivity of oral cancer CSCs by silencing CD133.

Results

Initially, we observed that the expression profile of CD133 in OSCC‐side population (OSCC‐SPs) cells, which exerted properties of CSCs, was significantly upregulated than that of major population (MPs) cells of OSCCs. The cell viability experiments showed that SPs were more chemoresistant compared with major populations. Importantly, targeting CD133 ameliorated the drug resistance of OSCC‐SPs to cisplatin treatment. Targeting CD133 and cisplatin co‐treatment led to the maximal inhibition on tumor initiating properties in OSCC‐SPs.

Conclusion

Side population cells with CSCs properties existed in OSCCs, and silencing CD133 exhibited a prominent therapeutic effect in enhancing the sensitivity of chemotherapy in OSCC through elimination of CSCs. © 2015 Wiley Periodicals, Inc. Head Neck 38: E231–E238, 2016
Revisiting the argument for 1‐ versus 2‐vein outflow in head and neck free tissue transfers: A review of 317 microvascular reconstructions
Authors: Silverman Dustin A. , Przylecki Wojciech H. , Arganbright Jill M. , Shnayder Yelizaveta , Kakarala Kiran , Nazir Niaman , Tsue Terance T. , Girod Douglas A. , Andrews Brian T.
Published: December 2014

Background

The purpose of this study was to determine the benefit of 1‐vein versus 2‐vein outflow in microvascular free tissue transfers.

Methods

A retrospective review reflects the experience of 6 surgeons. Analysis included all patients who underwent reconstruction at a single institution between January 2004 and December 2012.

Results

Three hundred nine patients underwent a total of 317 microvascular free flap reconstructions for head and neck defects. Two hundred thirteen of 317 flaps (67.2%) used 1 venous anastomosis and 104 (32.8%) used 2 venous anastomoses. Venous congestion necessitated urgent take back in 37 of 57 patients (64.9%) requiring exploration for perioperative complications. Thirty of 37 flaps (81.1%) with venous congestion had 1 vein anastomosis, whereas 7 (18.9%) had dual vein outflow (p = .03). Overall flap success was 303 of 317 (95.6%), despite an 18.0% (57 of 317) perioperative take back rate.

Conclusion

Coapting 2 veins was shown to minimize venous congestion. © 2015 Wiley Periodicals, Inc. Head Neck 38: 820–823, 2016
Evidence on effectiveness of intensity‐modulated radiotherapy versus 2‐dimensional radiotherapy in the treatment of nasopharyngeal carcinoma: Meta‐analysis and a systematic review of the literature
Authors: Co Jayson , Mejia Michael Benedict , Dizon Janine Margarita
Published: December 2014

Background

Current management of nasopharyngeal carcinoma (NPC) uses radiotherapy (RT) as the curative treatment modality. Radiation delivery techniques for NPC can be achieved using 2D conventional RT or intensity‐modulated radiotherapy (IMRT).

Methods

A systematic review and meta‐analysis of the literature was undertaken to assess the effectiveness of IMRT versus 2D conventional RT in primary treatment of NPC.

Results

IMRT showed better results than 2D conventional RT in terms of local control, regional control, and overall survival, but when stratified, only in T4, N2, and stage III were the differences that were seen. Objective saliva measurements and physician‐graded xerostomia were better in IMRT. However, patient‐reported xerostomia showed minimal improvement only in IMRT. The evidence of superiority of IMRT over 2D conventional RT is not clear.

Conclusion

In the absence of more clinical data demonstrating the superiority of IMRT in the treatment of nasopharyngeal carcinoma, 2D conventional RT seems to be a reasonable treatment option, especially in limited resource settings. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2130–E2142, 2016
Near‐infrared fluorescence imaging‐guided surgery improves recurrence‐free survival rate in novel orthotopic animal model of head and neck squamous cell carcinoma
Authors: Atallah Ihab , Milet Clément , Henry Maxime , Josserand Véronique , Reyt Emile , Coll Jean‐Luc , Hurbin Amandine , Righini Christian Adrien
Published: December 2014

Background

Appropriate animal models are required to test novel therapeutics for head and neck squamous cell carcinoma (HNSCC) such as near‐infrared (NIR) imaging‐guided surgery.

Methods

We developed an optimized animal model of orthotopic HNSCC (in female athymic NMRI (Naval Medical Research Institute) nude mice) with a prolonged survival time. Resection of the orthotopic tumors was performed 30 days after implantation with or without the aid of a miniaturized clinical grade NIR optical imaging device, after systemic administration of a fluorescent RGD‐based probe that targets αvβ3 integrin.

Results

NIR optical imaging‐guided surgery increased the recurrence‐free survival rate by 50% through the detection of fluorescent cancer residues as small as 185 µm; these fragments could remain unidentified if resection was performed exclusively under unaided visual guidance.

Conclusion

NIR optical imaging‐guided surgery showed an improved HNSCC tumor resection quality in our optimized orthotopic animal model. © 2015 Wiley Periodicals, Inc. Head Neck 38: E246–E255, 2016
Tumor deposits in head and neck carcinomas
Authors: Sarioglu Sulen , Akbulut Nilhan , Iplikci Selen , Aydin Barbaros , Dogan Ersoy , Unlu Mehtat , Ellidokuz Hulya , Ada Emel , Akman Fadime , Ikiz Ahmet Omer
Published: December 2014

Background

Tumor deposits, nodules in the peritumoral adipose tissue with no architectural residue of lymph node, have previously been described in colorectal adenocarcinomas. To date, however, there has been no examination of tumor deposits in head and neck squamous cell carcinoma (HNSCC).

Methods

Neck dissection specimens of 140 patients with HNSCC were reevaluated for tumor deposits.

Results

Tumor deposits were detected in 24 cases (17%). Cases with tumor deposits had more lymphatic invasion (p = .007), higher pathological N classification (p = .00), and more frequently showed distant metastasis (p = .003). Disease‐free and overall survival were significantly shorter for tumor deposit positive cases (p = .016 and p = .005, respectively). Only tumor deposits were significant for overall survival. Tumor deposits increased the risk of recurrent disease 2294 times. Tumor deposits and pericapsular invasion were identified as independent prognostic markers; tumor deposits increased the risk of death from disease 3.4 times, whereas pericapsular invasion was associated with a 2.2‐fold increase in the risk of death.

Conclusion

These results highlight the existence of tumor deposits in neck dissection specimens of HNSCC and their association with poor prognosis. © 2015 Wiley Periodicals, Inc. Head Neck 38: E256–E260, 2016
Outcomes after surgery and postoperative radiotherapy for perineural spread of head and neck cutaneous squamous cell carcinoma
Authors: Warren Timothy A. , Panizza Benedict , Porceddu Sandro V. , Gandhi Mitesh , Patel Parag , Wood Martin , Nagle Christina M. , Redmond Michael
Published: December 2014

Background

Queensland, Australia, has the highest rates of cutaneous squamous cell carcinoma (SCC). Perineural invasion (PNI) is associated with reduced local control and survival.

Methods

A retrospective review of a prospective database of patients with clinical PNI from cutaneous SCC of the head and neck (SCCHN) treated with surgery and postoperative radiotherapy (PORT) between 2000 and 2011 and a minimum of 24 months follow‐up. Patients were excluded if immunosuppressed, had non‐SCC histology, or were treated palliatively.

Results

Fifty patients (mean age, 60 years) with median follow‐up of 50 months were included in this study. A total of 54.8% of known primary tumors had incidental PNI. Ten percent had nodal disease at presentation. MRI neurogram was positive in 95.8%. Recurrence‐free survival (RFS) at 5‐years was 62%. Five‐year disease‐specific survival (DSS) and overall survival (OS) were 75% and 64%, respectively. There were no perioperative deaths.

Conclusion

This report demonstrates that long‐term survival is achievable in patients with clinical PNI from cutaneous SCCHN after surgery and PORT. © 2015 Wiley Periodicals, Inc. Head Neck 38: 824–831, 2016
Influence of body composition on survival in patients with head and neck cancer
Authors: Karnell Lucy Hynds , Sperry Steven M. , Anderson Carryn M. , Pagedar Nitin A.
Published: December 2014

Background

Recent evidence has suggested links between obesity and outcomes for various types of cancer. This study investigates the impact that body composition has on survival in patients with head and neck cancer.

Methods

Data prospectively collected from 578 patients were analyzed using Cox regression models to determine independent associations that pretreatment body mass index (BMI) and 3‐month weight change have on observed survival.

Results

Higher BMIs were associated with better survival (p < .001). Five‐year rates ranged from 33.8% for underweight to 75.3% for overweight/obese patients. Patients with stable weight had the highest 5‐year rate (72.6%; p = .019), whereas patients who gained ≥5% had worse survival (45.8%) than those who lost ≥5% (65.8%). BMI independently predicted survival, whereas weight change was not an independent predictor.

Conclusion

This demonstrated association between BMI and survival provides useful information when offering prognoses and investigating optimal treatments © 2015 Wiley Periodicals, Inc. Head Neck 38: E261–E267, 2016
Clinical outcome analysis of 47 patients with advanced head and neck cancer with preoperative suspicion of carotid artery invasion
Authors: Chung Eun‐Jae , Kwon Kee‐Hwan , Yoon Dae‐Young , Cho Sung‐Woo , Kim Eung‐Joong , Rho Young‐Soo
Published: December 2014

Background

The purpose of this study was to retrospectively analyze the feasibility of the surgical management of the carotid artery in advanced head and neck cancer with preoperative suspicion of carotid artery invasion.

Methods

A total of 47 patients were retrospectively analyzed. Twenty‐one patients (44.7%) received surgery as initial treatment, and 26 patients (55.3%) had salvage surgical treatment for recurrences. Intraoperative dissection and preservation of the carotid artery was achieved in 39 patients (83%). Eight patients underwent carotid resection with/without reconstruction (17%).

Results

The cumulative 2‐year and 5‐year overall survival rates were 40.4% and 34%, and the disease‐specific survival rates were 59.5% and 55.3%, respectively. The overall perioperative mortality rate was 6.4%. Carotid blowout developed in 6 patients.

Conclusion

Surgical treatment of the carotid artery in selected patients can provide locoregional control and the possibility of prolonged disease‐free survival with acceptable morbidity. © 2015 Wiley Periodicals, Inc. Head Neck 38: E287–E292, 2016
Improved surgical margin definition by narrow band imaging for resection of oral squamous cell carcinoma: A prospective gene expression profiling study
Authors: Farah Camile S. , Dalley Andrew J. , Nguyen Phan , Batstone Martin , Kordbacheh Farzaneh , Perry–Keene Joanna , Fielding David
Published: December 2014

Background

Incomplete primary tumor excision contributes to localized postsurgical recurrence of oral squamous cell carcinoma (OSCC). The purpose of this study was to provide molecular evidence that surgical margin definition using narrow band imaging (NBI) resulted in more complete OSCC excision than conventional white light (WL) panendoscopy.

Methods

Molecular divergence among tumor, WL, and NBI‐defined surgical margins was compared in 18 patients through microarray analysis (GeneChip U133‐plus‐2.0).

Results

The numbers of differentially expressed genes (NBI = 4387; WL = 3266; vs tumor) signified that NBI placed margins into less involved tissue than WL examination. Principal component analysis segregated tumor, WL, and NBI tissues appropriately based solely on mRNA profiles, and unsupervised hierarchical clustering identified 4 patients (22%) who benefited directly from NBI surgical margin definition. Gene ontology enrichment indicated increasing cell phenotypic diversity: tumor<WL<NBI.

Conclusion

Resection to NBI‐defined margins will leave less dysplastic and malignant residual tissue and thereby increase ablative surgery success rates. © 2015 Wiley Periodicals, Inc. Head Neck 38: 832–839, 2016
Glottic cancer in patients without complaints of hoarseness
Authors: Tachibana Tomoyasu , Orita Yorihisa , Marunaka Hidenori , Makihara Seiichiro , Hirai Misato , Miki Kentaro , Ogawara Yuya , Ishihara Hisashi , Matsuyama Yuko , Abe–Fujisawa Iku , Shimizu Aiko , Sato Yasuharu , Nishizaki Kazunori
Published: December 2014

Background

Few studies have investigated the clinical characteristics of patients with glottic cancer without hoarseness.

Methods

This retrospective clinical study investigated 371 patients with glottic cancer.

Results

Thirty‐two of the 371 patients (8.6%) with glottic cancer first presented to hospitals with complaints other than hoarseness. Although proportions of stage I and T1 disease were significantly higher among patients without hoarseness than among those with hoarseness (p = .0036 and p = .0004, respectively), survival curves showed no significant differences between groups (p = .1334).

Conclusion

Patients with glottic cancer without complaints of hoarseness were diagnosed at an earlier stage than those with hoarseness. Accumulation of more cases may lead to better survival of patients with glottic cancer without hoarseness compared to those with hoarseness. Checking the larynx of patients without hoarseness or encouraging internists to check the larynx when performing gastroscopic or respiratory examinations may lead to improvement of glottic cancer prognosis. © 2015 Wiley Periodicals, Inc. Head Neck 38: E316–E320, 2016
Osseointegrated implant‐based dental rehabilitation in head and neck reconstruction patients
Authors: Ch'ng Sydney , Skoracki Roman J. , Selber Jesse C. , Yu Peirong , Martin Jack W. , Hofstede Theresa M. , Chambers Mark S. , Liu Jun , Hanasono Matthew M.
Published: December 2014

Background

Dental restoration is an integral part of head and neck cancer reconstruction.

Methods

We evaluated the success rate of osseointegrated implants in patients with head and neck cancer, comparing outcomes between implants placed in fibula free flaps to those placed in native mandibular and maxillary bone.

Results

A total of 1132 implants were placed in 246 patients. The overall implant loss rate was 3.7% and was higher in fibula flaps (8.2%) compared to the native mandible (2.6%) and maxilla (2.2%), although these differences did not reach statistical significance (p = .059 and p = .053, respectively). The failure rate was 8.0% for implants placed after radiation and 3.6% in patients who did not undergo radiation (p = .097). Osteoradionecrosis (ORN) occurred in 19 patients (7.7%) after implant placement, and tobacco use was found to be a risk factor (p = .027).

Conclusion

Osseointegrated implants are reliable in patients with head and neck cancer, including those undergoing bony free flap reconstruction. © 2015 Wiley Periodicals, Inc. Head Neck 38: E321–E327, 2016
Meta‐analysis on survival of patients treated with transoral surgery versus radiotherapy for early‐stage squamous cell carcinoma of the oropharynx
Authors: Morisod Benoît , Simon Christian
Published: December 2014

Background

Transoral surgery (TOS) for patients with early stage oropharyngeal squamous cell carcinoma (SCC) is increasingly used, however, criticized, because of less optimal access to the tumor than open techniques and thus potentially jeopardizing tumor control in comparison with radiotherapy (RT). Therefore, we compared the currently available data on survival provided by TOS versus RT.

Methods

Survival data were extracted after a MEDLINE, Web of Science, and Google Scholar search followed by a meta‐analysis.

Results

The analysis was based on 729 patients in the RT group versus 276 in the TOS group with similar quality of studies in both groups. The 5‐year disease‐specific survival (DSS)/overall survival (OS) was 90.4% (95% confidence interval [CI], 85.6% to 95.2%/58.8%; 95% CI, 52.8% to 64.7%) in the RT group versus 89.6% (95% CI, 81.8% to 97.3%/78.1%; 95% CI, 71.2% to 85.1%) in the TOS group.

Conclusion

The data suggest equivalent efficacy of both treatments in terms of disease control for early stage oropharyngeal SCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: 2143–2150,
Extent of central neck dissection among thyroid cancer surgeons: Cross‐sectional analysis
Authors: Deutschmann Michael W. , Chin‐Lenn Laura , Au Jennifer , Brilz Alan , Nakoneshny Steve , Dort Joseph C. , Pasieka Janice L. , Chandarana Shamir P.
Published: December 2014

Background

It is unclear if surgeons are performing comprehensive central neck dissections for well‐differentiated thyroid cancer. The purpose of this study was to determine mean lymph node retrieval in central neck dissection as well as variability across surgeons and institutions.

Methods

A prospectively collected database identified 18 surgeons performing 425 central neck dissections, 313 unilateral and 112 bilateral. Demographics, perioperative, and pathologic factors were analyzed.

Results

Mean lymph node yield was 7.4 and 11.9 for unilateral and bilateral central neck dissection, respectively. Although 224 central neck dissections were prophylactic, both total and pathologic lymph node yields were significantly higher in therapeutic central neck dissection. There was a significant variation in lymph node yield across individual surgeons, institutions, and regions. High‐volume central neck dissection surgeons have significantly lower lymph node yield compared to low‐volume surgeons.

Conclusion

Central neck dissection seems to be performed adequately; however, there is a significant variation in lymph node yield. Future initiatives should try to standardize the central neck dissections performed, with emphasis on obtaining a sufficient yield. © 2015 Wiley Periodicals, Inc. Head Neck 38: E328–E332, 2016
Recombinant adeno‐associated virus–mediated inhibition of microRNA‐21 protects mice against the lethal schistosome infection by repressing both IL‐13 and transforming growth factor beta 1 pathways
Authors: He Xing , Xie Jun , Zhang Dongmei , Su Qin , Sai Xue , Bai Ruipu , Chen Chao , Luo Xufeng , Gao Guangping , Pan Weiqing
Published: December 2014

Schistosomiasis is a serious parasitic disease in humans, which can lead to liver fibrosis and death. Accumulating evidence indicated that targeting the deregulated microRNAs (miRNAs) could mitigate disease outcomes. Here, we showed that progressive hepatic schistosomiasis caused elevation of miR‐21 and efficient and sustained inhibition of miR‐21 by using highly hepatic tropic adeno‐associated virus serotype 8 (rAAV8), which protected mice against lethal schistosome infection through attenuation of hepatic fibrosis (HF). We demonstrated an additive role of interleukin (IL)−13 and transforming growth factor beta 1 (TGF‐β1) in up‐regulating miR‐21 expression in hepatic stellate cells (HSCs) by activation of mothers against decapentaplegic (SMAD) proteins. Furthermore, down‐regulation of miR‐21 in HSCs reversed HF by enhancing SMAD7 expression, thus repressing TGF‐β1/Smad and IL‐13/Smad pathways. Conclusion: This study suggests the mechanism of IL‐13‐mediated schistosomiasis HF by up‐regulation of miR‐21 and highlights the potential of rAAV8‐mediated miR‐21 inhibition as a therapeutic intervention for hepatic fibrotic diseases, such as schistosomiasis. (Hepatology 2015;61:2008–2017)
A seven‐gene signature can predict distant recurrence in patients with triple‐negative breast cancers who receive adjuvant chemotherapy following surgery
Authors: Park Yeon Hee , Jung Hae Hyun , Do In‐Gu , Cho Eun Yoon , Sohn Insuk , Jung Sin‐Ho , Kil Won Ho , Kim Seok Won , Lee Jeong Eon , Nam Seok Jin , Ahn Jin Seok , Im Young‐Hyuck
Published: December 2014

The aim of this study was to investigate candidate genes that might function as biomarkers to differentiate triple negative breast cancers (TNBCs) among patients, who received adjuvant chemotherapy after curative surgery. We tested whether the results of a NanoString expression assay that targeted 250 prospectively selected genes and used mRNA extracted from formalin‐fixed, paraffin‐embedded would predict distant recurrence in patients with TNBC. The levels of expression of seven genes were used in a prospectively defined algorithm to allocate each patient to a risk group (low or high). NanoString expression profiles were obtained for 203 tumor tissue blocks. Increased expressions of the five genes (SMAD2, HRAS, KRT6A, TP63 and ETV6) and decreased expression of the two genes (NFKB1 and MDM4) were associated favorable prognosis and were validated with cross‐validation. The Kaplan–Meier estimates of the rates of distant recurrence at 10 years in the low‐ and high‐risk groups according to gene expression signature were 62% [95% confidence interval (CI), 48.6–78.9%] and 85% (95% CI, 79.2–90.7%), respectively. When adjusting for TNM stage, the distant recurrence‐free survival (DRFS)s in the low‐risk group was significantly longer than that in the high‐risk group (p <0.001) for early stage (I and II) and advanced stage (III) tumors. In a multivariate Cox regression model, the gene expression signature provided significant predictive power jointly with the TNM staging system. A seven‐gene signature could be used as a prognostic model to predict DRFS in patients with TNBC who received curative surgery followed by adjuvant chemotherapy.
Oxicams, a class of nonsteroidal anti‐inflammatory drugs and beyond
Authors: Xu Shu , Rouzer Carol A. , Marnett Lawrence J.
Published: December 2014

Oxicams are a class of nonsteroidal anti‐inflammatory drugs (NSAIDs) structurally related to the enolic acid class of 4‐hydroxy‐1,2‐benzothiazine carboxamides. They are used clinically to treat both acute and chronic inflammation by inhibiting the activity of the two cyclooxygenase (COX) isoforms, COX‐1 and COX‐2. Oxicams are structurally distinct from all other NSAIDs, exhibiting a novel binding pose in the COX active site. The 4‐hydroxyl group on the thiazine ring partners with Ser‐530 via hydrogen bonding while two coordinated water molecules mediate a polar interaction between the oxicam and COX. The rotation of Leu‐531 in the complex opens a new pocket, which is not used for binding other NSAIDs to the enzyme. This structure provides the basis for understanding documented structure–activity relationships within the oxicam class. In addition, from the oxicam template, a series of potent microsomal prostaglandin E synthase‐1 (mPGES‐1) inhibitors represents a new direction for drug development. Here, we review the major route of oxicam synthesis and structure–activity for COX inhibition, as well as recent advances in oxicam‐mediated mPGES‐1 inhibition. © 2014 IUBMB Life, 66(12):803–811, 2014
Characterization of the in vivo host response to a bi‐labeled chitosan‐dextran based hydrogel for postsurgical adhesion prevention
Authors: Cabral Jaydee D. , McConnell Michelle A. , Fitzpatrick Clare , Mros Sonya , Williams Gail , Wormald Peter J. , Moratti Stephen C. , Hanton Lyall R
Published: December 2014

In developing a chitosan/dextran‐based (CD) hydrogel as an adhesion prevention postsurgical aid, the in vivo biodegradation rate, biodistribution, and inflammatory response are important parameters to the biomedical device design. Herein, for the first time, a CD hydrogel was prepared by mixing aqueous solutions of a near infrared (NIR) labeled succinylated chitosan (SC) and tritiated [3H] oxidized dextran (DA). The biodegradation and biodistribution of the NIR/[3H]‐CD hydrogel was tracked noninvasively using NIR fluorescence imaging, and by liquid scintillation counting (LSC) of organs/tissues after subcutaneous injection in BALB/c mice. The inflammatory response was assessed by measuring serum cytokine levels using a Bio‐plex assay and by histological examination of injection site tissue. Fluorescence imaging showed the hydrogel to degrade in under a week. LSC revealed the hydrogel to reside mainly at the injection site, and excreted primarily via the urine within the first 48 h. The CD hydrogel showed a mild inflammatory response as cytokine levels were comparable to saline injected controls. Histological examination of injection site tissue confirmed the cytokine results. In summary, the CD hydrogel's in vivo biodegradation rate, biodistribution, and inflammatory response was determined. Our results indicate that the CD hydrogel has an appropriate biocompatibility after s.c. administration. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 103A: 2611–2620, 2015.
Carbonyl Traps as Potential Protective Agents against Methimazole‑Induced Liver Injury
Authors: Heidari Reza , Niknahad Hossein , Jamshidzadeh Akram , Azarpira Negar , Bazyari Mandana , Najibi Asma
Published: December 2014

Liver injury is a deleterious adverse effect associated with methimazole administration, and reactive intermediates are suspected to be involved in this complication. Glyoxal is an expected reactive intermediate produced during methimazole metabolism. Current investigation was undertaken to evaluate the role of carnosine, metformin, andN‐acetyl cysteine as putative glyoxal (carbonyl) traps, against methimazole‐induced hepatotoxicity. Methimazole (100 mg/kg, intraperitoneally) was administered to intact and/or glutathione (GSH)‑depleted mice and the role of glyoxal trapping agents was investigated. Methimazole caused liver injury as revealed by an increase in serum alanine aminotransferase and aspartate aminotransferase. Moreover, lipid peroxidation and protein carbonylation occurred significantly in methimazole‑treated animals’ liver. Hepatic GSH reservoirs were decreased, and inflammatory cells infiltration was observed in liver histopathology. Methimazole‑induced hepatotoxicity was severe in GSH‐depleted mice and accompanied with interstitial hemorrhage and necrosis of the liver. Glyoxal trapping agents effectively diminished methimazole‐induced liver injury both in intact and/or GSH‑depleted animals.
Quantum‐chemistry based calibration of the alkali metal cation series (Li+Cs+) for large‐scale polarizable molecular mechanics/dynamics simulations
Authors: Dudev Todor , Devereux Mike , Meuwly Markus , Lim Carmay , Piquemal Jean‐Philip , Gresh Nohad
Published: December 2014

The alkali metal cations in the series Li+Cs+ act as major partners in a diversity of biological processes and in bioinorganic chemistry. In this article, we present the results of their calibration in the context of the SIBFA polarizable molecular mechanics/dynamics procedure. It relies on quantum‐chemistry (QC) energy‐decomposition analyses of their monoligated complexes with representative O, N, S, and Se ligands, performed with the aug‐cc‐pVTZ(‐f) basis set at the Hartree–Fock level. Close agreement with QC is obtained for each individual contribution, even though the calibration involves only a limited set of cation‐specific parameters. This agreement is preserved in tests on polyligated complexes with four and six O ligands, water and formamide, indicating the transferability of the procedure. Preliminary extensions to density functional theory calculations are reported.
Feedback on Professional Skills as Enculturation into Communities of Practice
Authors: Gilbuena Debra M. , Sherrett Benjamin U. , Gummer Edith S. , Champagne Audrey B. , Koretsky Milo D.
Published: December 2014

Background

Professional skills are critical in engineering practice. Differing definitions and lack of empirical evidence make it difficult to help students develop these skills.

Purpose

This research seeks to understand what it means to have professional skills in an industrially situated capstone project and, by extension, in engineering. We also aim to demonstrate the influence on those skills of the feedback provided to students.

Design/Method

Our ethnographic study employs discourse analysis to focus on professional skills. Using the construct of communities of practice, we describe and analyze conversations between a coach and four student teams as the coach provided feedback, and conversations among students as they worked in teams.

Results

Approximately half the discussion addressed the following professional skills: communication, documentation, teamwork, the economic impact of engineering solutions, and project management. Development of professional skills promotes students' enculturation into both a disciplinary community (chemical engineering) and an industrial community (semiconductor industry). Feedback on professional skills generally was given in the context of technical aspects, and we found an interplay between the teams' participation in professional skills activities and participation in more technical activities.

Conclusions

Participation in engineering design projects provides students opportunities to practice both professional and technical skills. Feedback on professional skills helps students recognize how to simultaneously represent themselves as legitimate members of multiple communities of practice.
Collagen arrangement in space of Disse correlates with fluid flow in normal and cirrhotic rat livers
Authors: Poonkhum Raksawan , Showpittapornchai Udomsri , Pradidarcheep Wisuit
Published: December 2014

Little is known about collagen arrangement in the space of Disse was related to the fluid flow both in normal and cirrhotic liver. We examined the changes in the arrangement of type‐I collagen in thioacetamide‐induced cirrhotic rat livers with immunohistochemistry and SEM after maceration of the noncollagenous tissues with NaOH. The sparse bundles of collagen fibers in the spaces of Disse were mostly elongated fibers with a disorganized arrangement in each nodule. They connected with the broad fibrous septa. Based on a comparison of the architecture of the collagen fibers and the established flow of fluid in the space of Disse, we hypothesize that the fluid in the space of Disse streams along collagen fibers in all directions to broad fibrous septa. The appearance of perinodular plexus in cirrhotic rat livers probably helps to reduce portal hypertension. Microsc. Res. Tech. 78:187–193, 2015. © 2014 Wiley Periodicals, Inc.
Similar outcomes among general medicine patients discharged on weekends
Authors: McAlister Finlay A. , Youngson Erik , Padwal Raj S. , Majumdar Sumit R.
Published: December 2014

BACKGROUND

Hospitals reduce staffing levels and services on weekends. This raises the question of whether weekend discharges may be inadequately prepared and thus at higher risk for adverse events postdischarge.

OBJECTIVE

To compare death or nonelective readmission rates 30 days after weekend versus weekday discharge.

DESIGN

Retrospective cohort.

SETTING

All teaching hospitals in Alberta, Canada.

PATIENTS

General internal medicine (GIM) discharges (only 1 per patient).

MEASUREMENTS

Analyses were adjusted for demographics, comorbidity, and length of stay based on a previously validated index.

RESULTS

Of 7991 patients (mean age, 62.1 years; 51.9% male; mean Charlson 2.56; 57.5% LACE ≥10) discharged from 7 teaching hospitals, 1146 (14.3%) were discharged on a weekend. Although they had substantially shorter lengths of stay (5.64 days, 95% confidence interval [CI]: 5.35–5.93 vs 7.86 days, 95% CI: 7.71–8.00, adjusted P value < 0.0001) and were less likely to be discharged with homecare support (10.9% vs 19.3%) or to long‐term care facilities (3.1% vs 7.8%), patients discharged on weekends exhibited similar rates of death or readmission at 30 days compared to those discharged on weekdays (10.6% vs 13.2%, adjusted odds ratio [aOR]: 0.94, 95% CI: 0.77–1.16), even among the 4591 patients deemed to be at high risk for postdischarge events based on LACE (length of hospital stay, acuity of admission, comorbidity burden quantified using the Charlson Comorbidity Index, and emergency department visits in the 6 months prior to admission) score ≥10 (16.8% vs 16.5% for weekday discharges, aOR: 1.09 [95% CI: 0.85–1.41]).

CONCLUSIONS

GIM patients discharged from teaching hospitals on weekends have shorter lengths of stay and exhibit similar postdischarge outcomes as patients discharged on weekdays. Journal of Hospital Medicine 2015;10:69–74. © 2014 Society of Hospital Medicine
RACK1 (receptor for activated C‐kinase 1) interactions with spectrin repeat elements
Authors: Myklebust Line M. , Horvli Ole , Raae Arnt J.
Published: December 2014

Receptor for activated C‐kinase 1 (RACK1) is an intracellular scaffolding protein involved in a multitude of signalling pathways. The cytoskeleton is fundamental for intracellular cell signalling as it forms an interconnected network of regulatory proteins. Here, spectrin is a central component as it forms the actin–spectrin network that serves as docking surfaces for cellular components. The interaction between RACK1 and components of spectrin, the single spectrin repeats R16, R17 and the double spectrin repeat R1617 from the α‐spectrin chain were investigated by biosensor technology and docking analysis. RACK1 associated only weakly to R16 (KD = 1.0 ± 0.5 × 10−6 M), about 20 times stronger to R1617 (KD = 5.3 ± 0.7 × 10−8 M) and 100 times stronger to R17 (KD = 0.9 ± 0.3 × 10−8 M). Docking analysis showed that while R16 alone preferentially docked with its B‐helix, R17 docked through its A‐helix and BC loop. The double repeat and RACK1 mainly formed two different complex conformations. R1617 docked tangentially to the N/C‐terminal of RACK1 or radially along a groove on the outer surface of RACK1. These configurations could account for the slight increase in entropic and the decrease in enthalpic interactions for the R1617–RACK1 interaction, compared with the interactions of RACK1 to the two single repeats. Our results suggest a mode of interaction that allows spectrin to attach to the N/C part of RACK through the inter‐helical AB and BC loops and adopt a multitude of configurations in between the two limiting configurations. Copyright © 2014 John Wiley & Sons, Ltd.