Faculty Bibliography

BACKGROUND:Long-term survival of heart transplants is hampered by chronic rejection (CR). Studies indicate the involvement of host macrophages in the development of CR; however, the precise role of these cells in CR is unclear. Thus, it is important to develop noninvasive techniques to serially monitor the movement and distribution of recipient macrophages in chronic cardiac allograft rejection in vivo. METHODS AND RESULTS/RESULTS:We have employed a rat heterotopic working-heart CR model for a magnetic resonance imaging experiment. Twenty-one allograft (PVG.1U-->PVG.R8) and 9 isograft (PVG.R8-->PVG.R8) transplantations were performed. Recipient macrophages are labeled via intravenous injection of micron-sized paramagnetic iron oxide particles (0.9 microm in diameter) at a dose of 4.5 mg Fe per rat 1 day before transplantation. Serial in vivo magnetic resonance images were acquired for up to 16 weeks. The migration of labeled recipient cells in our CR model, in which cardiac CR is evident at 3 weeks and most extensive by 16 weeks after transplantation, can be assessed with the use of in vivo magnetic resonance imaging for >100 days after a single micron-sized paramagnetic iron oxide injection. The location and distribution of labeled recipient cells were confirmed with magnetic resonance microscopy and histology. CONCLUSIONS:This approach may improve our understanding of the immune cells involved in CR and the management of heart transplantation. Moreover, this study demonstrates the feasibility of noninvasively observing individual targeted cells over long time periods by serial in vivo magnetic resonance imaging.

BACKGROUND: Adjunctive techniques that may facilitate the early detection of oral premalignant and malignant lesions (OPML) have emerged in the past decades. METHODS: The authors undertook a systematic review of the English-language literature to evaluate the effectiveness of toluidine blue (TB), ViziLite Plus with TBlue (Zila Pharmaceuticals, Phoenix), ViziLite (Zila Pharmaceuticals), Microlux DL (AdDent, Danbury, Conn.), Orascoptic DK (Orascoptic, a Kerr Company, Middleton, Wis.), VELscope (LED Dental, White Rock, British Columbia, Canada) and OralCDx (Oral CDx Laboratories, Suffern, N.Y.) brush biopsy. They abstracted data relating to study design, sampling and characteristics of the study group, interventions, reported outcomes and diagnostic accuracy of adjunctive aids from 23 articles meeting inclusion and exclusion criteria, including availability of histologic outcomes. RESULTS: The largest evidence base was for TB. A limited number of studies was available for ViziLite, ViziLite Plus with TBlue and OralCDx. Studies of VELscope have been conducted primarily to assess the margins of lesions in known OPML. The authors identified no studies of Microlux DL or Orascoptic DK. Study designs had various limitations in applicability to the general practice setting, including use of higher-risk populations and expert examiners. CONCLUSIONS: There is evidence that TB is effective as a diagnostic adjunct for use in high-risk populations and suspicious mucosal lesions. OralCDx is useful in assessment of dysplastic changes in clinically suspicious lesions; however, there are insufficient data meeting the inclusion criteria to assess usefulness in innocuous mucosal lesions. Overall, there is insufficient evidence to support or refute the use of visually based examination adjuncts. Practical Implications. Given the lack of data on the effectiveness of adjunctive cancer detection techniques in general dental practice settings, clinicians must rely on a thorough oral mucosal examination supported by specialty referral and/or tissue biopsy for OPML diagnosis.

This study evaluates school personnel perceptions, knowledge, and behaviors before and after a 36-hr training program designed to prepare early childhood school personnel for implementation of an after-school family preventive intervention for conduct problems. Participants were 40 female school personnel (22 professionals and 18 paraprofessionals). Research Findings: Participation and satisfaction with the training program were high. Before training, school personnel responded correctly to 53% to 66% of knowledge questions and indicated that they would be 'somewhat comfortable to comfortable' in facilitating the after-school groups with families. Before training, professionals had greater knowledge than paraprofessionals; there was no difference in initial comfort level by professional status. Trainees made substantial gains in knowledge related to cognitive-behavioral strategies for preschoolers, program philosophy, and group facilitation skills, responding correctly to 69% to 77% of questions. These large effects on knowledge were not moderated by professional status. There were no significant changes in comfort level. Gains in knowledge in cognitive-behavioral strategies generalized over time (5 months) but not across contexts (into the classroom). Practice or Policy: This study provides preliminary evidence for the feasibility and potential efficacy of a training program to prepare early childhood school personnel to implement an after-school family preventive intervention for conduct problems

BACKGROUND:Nebulized budesonide (Pulmicort Respules, AstraZeneca, Wilmington, DE) provides control of respiratory tract inflammation in asthmatic patients. The Mucosal Atomization Device (MAD; Wolfe-Tory Medical, Salt Lake City, UT) is a novel sinonasal atomization device. METHODS:Uncontrolled case series of postoperative patients with chronic rhinosinusitis (CRS) who received budesonide via MAD was performed. RESULTS:A total of 44 patients with a mean age of 53.5 years met inclusion criteria. The average follow-up was 31.5 weeks (SD 17.55; range, 8 to 80 weeks). Overall, patient and physician global assessments demonstrated moderate to significant improvement. Average daily oral prednisone usage among patients who took systemic steroids (n = 27) was reduced from 7.96 to 1.94 mg/day without relapse of polyps, mucosal edema, and nasal discharge. Prednisone use was reduced to zero in 16 patients and reduced or stabilized in 10 other patients. CONCLUSION/CONCLUSIONS:Topical budesonide via MAD may reduce the need for systemic prednisone and improve both physician and patient global assessment scores in postoperative CRS patients. Additional investigation is warranted to exclude placebo effect, spontaneous resolution, and regression to the mean as responsible factors for the reported findings.

The vertical rectus abdominus myocutaneous (VRAM) flap is a valuable option for tongue reconstruction. However, the traditional inset (skin to remaining oral mucosa) obviates a more anatomic reconstruction. Eight patients underwent total or subtotal glossectomy with VRAM reconstruction. The muscle inset was supported at the inferior mandibular border attached to the remaining lingual mucosa or gingiva. The neotongue, consisting of skin and subcutaneous fat, was sutured posteriorly to the remaining tongue base, and the other surfaces were trimmed and left unsutured. Reconstruction was successful in all patients. The neotongue assumed palatal configuration, and within 2 weeks uniform granulation tissue followed by mucosalization occurred. One year postoperatively, all patients tolerated ad lib diets, spoke intelligibly, were gastrostomy tube and tracheotomy free and had no evidence of aspiration. This neotongue sits on the mandible under voluntary control, permitting effective obturation against the hard palate and providing successful speech and swallowing

Neck dissection is one the most commonly performed operations in head and neck surgery. Better understanding of the structure and patterns of lymphatic flow in the neck has transformed this operation into a more selective and less morbid treatment. Rationale for this operation and modifications of it in different clinical scenarios such as node negative, node positive and radiated neck are detailed in this article. Recommendations are made based on the available evidence.

The anterolateral approach is a popular and safe method of exposing the lower cervical spine (levels C3 to T1) for management of cervical spine disease. We present a description of the technique we use in conducting the procedure, a review of the literature, and a retrospective chart review of 30 consecutive patients who underwent cervical spine exposure via a left anterolateral approach. All patients had an uneventful perioperative course, and the two patients who experienced postprocedure symptoms recovered completely within 1 month without treatment

OBJECTIVES: Intraoperative testing of cochlear implant devices, establishment of electrical threshold for acoustic reflex, and recording neural responses to electrical stimulation have traditionally required the presence of a cochlear implant audiologist in the operating room. The goal of this study was to determine the feasibility of remote testing to improve time efficiency and reduce cost. STUDY DESIGN: Prospective. METHODS: A standard PC with Tridia VNC software and either Cochlear Corporation or Advanced Bionics Corporation mapping software was configured to perform remote testing. The time required to perform on-site or remote testing was measured. RESULTS: With the availability of the laptop and internet access, there were no geographic restrictions regarding the site of remote testing. Remote testing was time efficient, requiring 9 minutes of audiologist's time compared with 93 minutes when the audiologist had to travel to the operating room. CONCLUSION: Remote testing of the cochlear implant device and patient's response to electrical stimulation is technically feasible. It is timesaving, practical, and cost efficient

HYPOTHESIS: The current hybrid electrode can be inserted without trauma to the temporal bone and, after insertion, assumes a position within the scala tympani near the outer cochlear wall just beneath the basilar membrane. BACKGROUND: Conservation of residual hearing after cochlear implant electrode insertion requires a special insertion technique and an atraumatic short electrode. This allows electroacoustic stimulation in ears with significant residual hearing. METHODS: Human cadaveric temporal bones were implanted with soft surgical technique under fluoroscopic observation. Dehydrated and resin-impregnated bones are dissected. Real-time electrode insertion behavior and electrode position were evaluated. The bones are examined for evidence of insertion-related trauma. RESULTS: No gross trauma was observed in the implanted bones, and the electrode dynamics evaluation revealed smooth scala tympani insertions. CONCLUSION: Atraumatic insertion of the 10-mm hybrid electrode can be accomplished using an appropriate cochleostomy and insertion technique