Faculty Bibliography

PURPOSE: Peer evaluation is underused in medical education. The goals of this study were to validate in a multiinstitutional study a peer nomination form that identifies outstanding students in clinical competency and interpersonal skills, to test the hypothesis that with additional survey items humanism could be identified as a separate factor, and to find the simplest method of analysis. METHOD: In 2003, a 12-item peer nomination form was administered to junior or senior medical students at three institutions. Factor analysis was used to identify major latent variables and the items related to those characteristics. On the basis of those results, in 2004 a simpler, six-item form was developed and administered. Student rankings based on factor analysis and nomination counts were compared. RESULTS: Factor analysis of peer nomination data from both surveys identified three factors: clinical competence, caring, and community service. New survey items designed to address humanism are all weighted with interpersonal skills items; thus, the second major factor is characterized as caring. Rankings based on peer nomination results analyzed by either factor analysis or simply counting nominations distinguish at least the top 15% of students for each characteristic. CONCLUSIONS: Counting peer nominations using a simple, six-item form identifies medical student exemplars for three characteristics: clinical competence, caring, and community service. Factor analysis of peer nomination data did not identify humanism as a separate factor. Peer nomination rankings provide medical schools with a reliable tool to identify exemplars for recognition in medical student performance evaluations and selection for honors (e.g., Gold Humanism Honor Society).

We examined benign and malignant mesothelial tissue samples for the presence of X-linked inhibitor of apoptosis protein (XIAP), a potent constituent of the inhibitor of apoptosis family of caspase inhibitors. We subjected 55 sections (31 malignant mesotheliomas, 2 well-differentiated peritoneal mesotheliomas, 13 pleural mesothelial hyperplasias, and 9 benign mesothelial tissues) from archival formalin-fixed, paraffin-embedded surgical tissue blocks to citrate-based antigen retrieval and then incubated them with monoclonal anti-XIAP (clone 48, dilution 1:250; BD Biosciences, San Jose, CA) at 4 degrees C for 72 hours and developed them using EnVision-Plus reagents (DAKO, Carpinteria, CA) and diaminobenzidine as the chromogen. Particulate or nonhomogeneous cytoplasmic staining was considered positive. All 9 normal mesothelial samples were negative for XIAP. Of 13 mesothelial hyperplasias, 1 (8%) was weakly positive in fewer than 10% of cells, as was 1 of 2 well-differentiated peritoneal mesotheliomas. Of 31 malignant mesotheliomas, 25 (81%) displayed XIAP positivity. XIAP immunostaining, when strong, allows for distinction of malignant from benign and hyperplastic mesothelial cell populations and is a potentially useful immunodiagnostic marker in small samples and morphologically controversial cases. Elevated expression of XIAP could contribute to tumorigenesis in mesothelioma.

Despite the fact that vocal folds are subjected to extensive mechanical forces, the role of mechanical strain in vocal fold wound healing has been overlooked. Recent studies on other tissues have demonstrated that low physiological levels of mechanical forces are beneficial to injured tissues, reduce inflammation, and induce synthesis of matrix-associated proteins essential for enhanced wound healing. In this study, we speculated that mechanical strain of low magnitudes also attenuates the production of inflammatory mediators and alters the extracellular matrix synthesis to augment wound healing in cultured vocal fold fibroblasts. To test this hypothesis, fibroblasts from rabbit vocal folds were isolated and exposed to various magnitudes of cyclic tensile strain (CTS) in the presence or absence of interleukin-1beta (IL-1beta). Results suggest that IL-1beta activates proinflammatory gene transcription in vocal fold fibroblasts. Furthermore, CTS abrogates the IL-1beta-induced proinflammatory gene induction in a magnitude-dependent manner. In addition, CTS blocks IL-1beta-mediated inhibition of collagen type I synthesis, and thereby upregulates collagen synthesis in the presence of IL-1beta. These findings are the first to reveal the potential utility of low levels of mechanical signals in vocal fold wound healing, and support the emerging on vivo data suggesting beneficial effects of vocal exercise on acute phonotrauma

Botulinum toxin A is an effective and safe treatment for perioral rejuvenation. This article explores the application of this toxin for cosmetic use in the perioral region, facial asymmetry, and improved facial wound healing. This article also describes how the use of botulinum toxin A, which has traditionally been used on the upper one third of the face, has expanded to the lower two thirds with the advent of a new formulation that consists of botulinum toxin combined with an anesthetic agent and a vasoconstrictor. The new formula provides the injecting physician with immediate feedback on the eventual treatment effect and reduces local diffusion of the simultaneously injected agents, potentially limiting systemic absorption and diffusion to neighboring muscle groups and adding to an already remarkable safety profile.

The success of replicating adenoviruses for cancer therapy is limited by inefficient virus delivery and poor distribution within the tumor mass. Stromal matrix within the tumor may hinder the free cell-to-cell spread of the virus. In this study, in vitro cell culture experiments showed that collagen I blocked the passage of an adenoviral vector through a membrane. On the basis of reports of the effective collagen I-degrading activity of matrix metalloproteinase-8 (MMP-8), we constructed an adenovirus to express the MMP-8 transgene (AdMMP8). A549 cells infected in vitro with AdMMP8 did not show altered growth but were able to modify a fibrillar collagen substrate to allow viral diffusion. Further, AdMMP8 did not affect replication of the wild-type virus (Adwt300). Established human A549 lung cancer and BxPC-3 pancreatic cancer xenograft tumors that were injected with Adwt300 together with the non-replicating AdMMP8 virus showed significantly reduced growth compared with control tumors. Histochemical analysis showed reduced amounts of collagen within necrotic areas of MMP-8-injected tumors compared with controls. These results demonstrate that intra-tumoral expression of MMP-8 is a possible strategy for improving viral spread and improving the oncolytic activity of replicating adenovirus

OBJECTIVE: To determine the position of the lower eyelid and lateral canthus after release of the lower eyelid retractors with the 'inside-out technique' by measuring the marginal reflex distance 2 (MRD2) and using the lateral canthal rounding scale. DESIGN: Retrospective analysis. RESULTS: Of the 171 patients who underwent inside-out blepharoplasty, 78 were followed up for 3 months. Preoperative MRD2 was 0.942 pixels. Postoperatively, the modified MRD2 was 0.903. Although the score of the modified MRD2 was found to decrease postoperatively, the decrease was not statistically significant (P < .07). The lateral rounding scale reviewed an average preoperative score of 2.04 and a postoperative score of 1.99. There was no statistical difference between pre- and postoperative observations based on a 1-tailed t test. No complications were reported. CONCLUSION: Using photographic analysis, the study found no difference in lateral canthal shape or MRD2 before and after surgery in patients who underwent inside-out blepharoplasty

Polypharmacy is a common cause of salivary hypofunction, producing symptoms of dry mouth or xerostomia, especially among older populations. As the number of older people continues to increase, polypharmacy-induced salivary hypofunction is becoming an increasing problem. Many over-the-counter products are available for relieving symptoms of dry mouth, but few have been tested in controlled clinical investigations. The purpose of this investigation was to evaluate the safety and efficacy of a group of topical dry mouth products (toothpaste, mouth rinse, mouth spray and gel) containing olive oil, betaine and xylitol. Forty adults were entered into this single-blinded, open-label, cross-over clinical study and 39 completed all the visits. Subjects were randomly assigned at baseline to using the novel topical dry mouth products daily for 1 week, or to maintain their normal dry mouth routine care. After 1 week, they were crossed over to the other dry mouth regimen. The results demonstrated that the use of the novel topical dry mouth products increased significantly unstimulated whole salivary flow rates, reduced complaints of xerostomia and improved xerostomia-associated quality of life. No clinically significant adverse events were observed. These data suggest that the daily use of topical dry mouth products containing olive oil, betaine and xylitol is safe and effective in relieving symptoms of dry mouth in a population with polypharmacy-induced xerostomia.

BACKGROUND: Posterior pharyngeal augmentation is a recognized treatment for velopharyngeal insufficiency in selected candidates. To date, however, the procedure has failed to gain widespread acceptance because of the absence of an implant material with sufficient safety, durability, and biocompatibility. In this study, the use of micronized acellular dermal matrix injection for augmentation of the posterior pharynx was investigated. Using a porcine animal model, the safety and durability of posterior pharyngeal augmentation by micronized decellularized dermis was evaluated. METHODS: Twelve Yorkshire piglets were used in this study. Under general anesthesia, porcine-derived micronized acellular dermal matrix was injected into the submucosa of the right side of the pharynx. At 30 days, the animals were euthanized, and the implants and surrounding tissues were assessed grossly for degree of augmentation and histologically to determine the extent of host cell infiltration, vascularization, and matrix deposition and remodeling. RESULTS: No animal perioperative or postoperative morbidity resulted from the operations. When the animals were euthanized and the tissue was harvested at 30 days, there existed no evidence of gross augmentation on the experimental side of the pharynx in any of the specimens. Histologic analysis demonstrated trace amounts of residual implant, with extensive host lymphocytic infiltration of the material. CONCLUSIONS: Although micronized acellular dermal matrix is a safe material when injected into the pharyngeal wall, this study demonstrated that it is not a durable implant at this site. The authors do not recommend its use for long-term soft-tissue augmentation of the posterior pharyngeal wall in patients with velopharyngeal insufficiency