Faculty Bibliography

Objectives: To report changes in survival probabilities as patients survive one or more years with head and neck melanoma, and to characterize prognostic factors for this conditional survival statistic. Study Design: Retrospective population-based cohort study. Methods: All subjects from the Surveillance, Epidemiology and End Results (SEER 17) database of the National Cancer Institute with head and neck cutaneous melanoma were analyzed. Using the life table actuarial method, conditional 5 year disease specific survival (DSS) and relative survival were determined for patients surviving one to ten years after diagnosis. Grouped comparisons were performed for anatomic subsites within the head and neck and the rest of the body. Probabilities were also stratified by histologic subtype, thickness of invasion and lymph node status. Results: Five year DSS for scalp and neck melanomas increases from 83.1% to 93.9% for patients surviving five years, compared to an increase from 89.2% to 96.2% for other anatomic sites. Nodular melanoma displayed the worst initial survival among histologic subtypes (73.4%) but improves to 91% at five years. Conditional DSS for node positive patients improves from 47.9% to 83.1%. Survival at diagnosis is stratified by tumor thickness from 96.7% (T1) to 62.3% (T4), but tends to converge between five to ten years of survivorship. Conclusions: For patients with head and neck melanoma who have survived several years, conditional survival provides accurate and useful prognostic information. In general, expected survival increases with time survived since diagnosis, and for low and high T-stage patients, conditional survival statistics converge over time

BACKGROUND: Bone engineering requires thicker three-dimensional constructs than the maximum thickness supported by standard cell-culture techniques (2 mm). A flow-perfusion bioreactor was developed to provide chemotransportation to thick (6 mm) scaffolds. METHODS: Polyurethane scaffolds, seeded with murine preosteoblasts, were loaded into a novel bioreactor. Control scaffolds remained in static culture. Samples were harvested at days 2, 4, 6, and 8 and analyzed for cellular distribution, viability, metabolic activity, and density at the periphery and core. RESULTS: By day 8, static scaffolds had a periphery cell density of 67% +/- 5.0%, while in the core it was 0.3% +/- 0.3%. Flow-perfused scaffolds demonstrated peripheral cell density of 94% +/- 8.3% and core density of 76% +/- 3.1% at day 8. CONCLUSIONS: Flow perfusion provides chemotransportation to thick scaffolds. This system may permit high throughput study of 3D tissues in vitro and enable prefabrication of biological constructs large enough to solve clinical problems

PURPOSE: End-to-side (ETS) nerve repair allows for target-muscle reinnervation, with simultaneous preservation of donor-nerve function. Acetyl-L-carnitine (ALCAR) was shown to enhance axonal sprouting in early regeneration following transection and repair of the sciatic nerve in rodents. The purpose of this article was to determine the ability of ALCAR to enhance axonal regeneration in an ETS rodent model. METHOD: The right musculocutaneous nerve in 16 adult male Sprague-Dawley rats was transected to induce biceps muscle paralysis. The distal stump was then coapted by ETS neurorrhaphy through a perineurial window to the ipsilateral median nerve. Experimental groups received ALCAR for 1, 2, 3, and 4 weeks whereas controls received placebo. RESULTS: Weekly postoperative behavioral evaluations revealed increased functional return over control but the difference was not significant. Potentials from biceps were recorded from the third postoperative week in the experimental group and from the fourth week in the control group. Histomorphometric evaluations revealed higher musculocutaneous nerve axon counts, higher myelin thickness in the fourth postoperative week, and differences in the appearance and the number of motor-end-plates in the biceps in experimental versus control group. CONCLUSION: Intraperitoneal administration of ALCAR can expedite biceps muscle recovery in an ETS model by increasing the rate of axonal regeneration. Despite the morphological changes, no behavioral changes were noted and further studies are needed to confirm clinical efficacy of ALCAR for potential use in the development of therapeutic protocols

Neurofibromatosis type 1 (NF1) is a dominant autosomal disturbance that presents multiple cutaneous lesions frequently in the range of 500 to 1000. In addiction of the psychological implications, the lesions constitute a difficult dilemma because there are only limited surgical options. The authors presents a sehe of 175 patients with numerous cutaneous lesions treated with a new approach using electrocautery excision. The technics turns out to be an effective way to ressect large number of lesions with less discomfort and more satisfaction to the patient

We propose that high-fidelity animations enhanced with real-time 3d interactivity, that demonstrate various breast reconstruction procedures will assist in a patient's decision-making process. These computer based modules will in no way replace a consultation with the physician; instead they will be added to the armamentarium of patient education

Marine reserves have been advocated worldwide as conservation and fishery management tools. It is argued that they can protect ecosystems and also benefit fisheries via density-dependent spillover of adults and enhanced larval dispersal into fishing areas. However, while evidence has shown that marine reserves can meet conservation targets, their effects on fisheries are less understood. In particular, the basic question of if and over what temporal and spatial scales reserves can benefit fished populations via larval dispersal remains unanswered. We tested predictions of a larval transport model for a marine reserve network in the Gulf of California, Mexico, via field oceanography and repeated density counts of recently settled juvenile commercial mollusks before and after reserve establishment. We show that local retention of larvae within a reserve network can take place with enhanced, but spatially-explicit, recruitment to local fisheries. Enhancement occurred rapidly (2 yrs), with up to a three-fold increase in density of juveniles found in fished areas at the downstream edge of the reserve network, but other fishing areas within the network were unaffected. These findings were consistent with our model predictions. Our findings underscore the potential benefits of protecting larval sources and show that enhancement in recruitment can be manifested rapidly. However, benefits can be markedly variable within a local seascape. Hence, effects of marine reserve networks, positive or negative, may be overlooked when only focusing on overall responses and not considering finer spatially-explicit responses within a reserve network and its adjacent fishing grounds. Our results therefore call for future research on marine reserves that addresses this variability in order to help frame appropriate scenarios for the spatial management scales of interest.