Free anterolateral thigh flap versus free forearm flap: Functional results in oral reconstruction.

Nowadays, microsurgery performed for oral reconstruction of cancer patients, has become the standard treatment in restoring oral functions. The free radial forearm flap (FRFF) is still apparently the first reconstructive choice in oral cavity cancers. Recently the anterolateral thigh flap (ALTF) seemed to challenge the superiority of FRFF. The lack of functional data on which to base this recent supposition is the reason for this new research. Twenty reconstructed patients were enrolled for this study. Speech, swallowing, and donor site complications were studied to assess differences between the two techniques. Results show that difference in function between ALTF and FRFF groups is statistically insignificant. Donor site risks and complications seem to be the only variables among groups. These variables may be used as indicators when making a surgical choice.     

A Case of Hypopigmented Mycosis Fungoides in a Young Caucasian Boy

Abstract: Hypopigmented mycosis fungoides is a variant of mycosis fungoides characterized by the presence of hypopigmented patches as the sole manifestation of the disease. It has been described aimost always in young black or dark-skinned patients. The only white patient described was a 64-year-oid woman who not oniy had hypopigmented lesions, but also nodular lesions with lymphadenopathy. We describe hypopigmented lesions arising in a white boy 12 years of age, born in northern Italy, without any foreign ancestors. The microscopic alterations, with epidermotropism, the immunoiogic markers, the negativity of T-cell receptor gene rearrangement, and the good response to PUVA therapy correspond to the main findings in black patients with this disease. Long-term follow-up of these patients is important to obtain better knowledge of the natural history of the disorder, Hypopigmented mycosis fungoides must now be included in the differential diagnosis of hypopigmented macular lesions not only in black or dark-skinned patients but also in white patients.     

Effect of pharmacist counseling on ambulatory patients' use of aerosolized bronchodilators

Patients' use of a newly prescribed inhaler was evaluated on the basis of pulmonary function test (PFT) results and the number of steps of an 11-step inhaler sequence that were completed correctly. Adult male outpatients with mild to moderate chronic obstructive pulmonary disease were assigned to a counseled (n = 10) or noncounseled (n = 9) group. Patient characteristics were similar in both groups. The counseled group was instructed by a pharmacist on the correct use of the inhaler; the noncounseled group was not. Counseled patients had a significantly higher mean percentage change in forced expiratory volume in one second (FEV1) after inhaler use than did the noncounseled group. The mean number of steps missed was significantly greater for the noncounseled group, and there was a significant negative correlation between the number of steps missed and the percentage change in FEV1. Evaluation of the 11-step inhaler sequence identified three steps ("shake the inhaler," "use one puff at a time," and "shake between puffs") that correlated with PFT results and appeared to contribute to improved bronchodilation. Of the five patients who achieved adequate response, only four (all in the counseled group) performed these steps correctly. Instruction with demonstration and practice resulted in better patient understanding and performance of the correct steps for inhaler use, with improved bronchodilation as measured by PFTs.     

SMC1 involvement in fragile site expression

Common fragile sites have been involved in neoplastic transformation, although their molecular basis is still poorly understood. Here, we demonstrate that inhibition of the SMC1 by RNAi is sufficient to induce fragile site expression. By investigating normal, ATM- and ATR-deficient cell lines, we provide evidence that the contribution of SMC1 in preventing the collapse of stalled replication fork is an Atr-dependent pathway. Using a fluorescent antibody specific for gamma-H2AX, we show that very rare discrete nuclear foci appear 1 and 2 h after exposure to aphidicolin and/or RNAi-SMC1, but became more numerous and distinct after longer treatment times. In this context, fragile sites might be viewed as an in vitro phenomenon originating from double-strand breaks formed because of a stalled DNA replication that lasted too long to be managed by physiological rescue acting through the Atr/Smc1 axis. We propose that in vivo, following an extreme replication block, rare cells could escape checkpoint mechanisms and enter mitosis with a defect in genome assembly, eventually leading to neoplastic transformation.     

Association between large aortic arch atheromas and high-intensity transient signals in elderly stroke patients

BACKGROUND AND PURPOSE: Aortic arch atheromas (AAs) have been shown to be a risk factor for ischemic stroke (IS) in the elderly because of their potential for cerebral embolization. However, the association between AAs and the presence of cerebral microemboli has not been clearly established. The aim of this study was to determine whether large AAs are associated with an increased frequency of high-intensity transient signals (HITS) in elderly patients with IS. METHODS: We performed bitemporal simultaneous HITS monitoring of both middle cerebral arteries in 62 consecutive elderly patients with acute IS (mean age 72.5+/-8.8 years, 65% men). In 16 patients, one or both temporal windows were inadequate; therefore, the analysis of HITS was performed in the remaining 46 patients. All patients underwent omniplane transesophageal echocardiography (TEE), and they had no significant extracranial or intracranial artery disease and no cardiac prosthetic valves. Large AA was defined as > or = 4 mm in thickness. Complex AA was defined as ulcerated or mobile, regardless of plaque thickness. HITS monitoring was performed within 24 hours of TEE and analyzed by an experienced neurologist-sonographer blinded to TEE findings. A 9-dB threshold was chosen to discriminate HITS from background Doppler signal. The HITS counts in the left and in the right middle cerebral arteries were added and reported as a total number of HITS in 30 minutes. RESULTS: HITS were detected in 14 (78%) of 18 patients with large AAs versus 8 (29%) of 28 patients with no or small AAs (odds ratio [OR] 8.8, 95% CI 2.2 to 34.8; P=0. 001). The association was also present in 27 patients with no other cardiac embolic sources, such as atrial fibrillation, patent foramen ovale, spontaneous echo contrast, and thrombus (7 of 10 patients with large AAs versus 3 of 17 patients with small or no AA; OR 10.9, 95% CI 1.7 to 68.5; P=0.013). Complex AAs were associated with a higher frequency of HITS than were noncomplex AAs (6 of 6 patients with complex AAs versus 15 of 39 patients with noncomplex AAs; OR 2. 6, 95% CI 1.7 to 3.9; P=0.005). CONCLUSIONS: HITS are significantly associated with large AAs in elderly stroke patients. This observation may support the causal role of large AAs in IS.     

Phase II double-blind randomized study of lonidamine and radiotherapy in epidermoid carcinoma of the lung

Patients with non metastatic squamous cell lung cancer were treated with radiotherapy (RT) plus lonidamine (LND) or placebo (PLAC), according to a randomized double-blind study design.

Treatment with lonidamine 150 mg t.i.d (27 patients) or placebo (23 patients) started 3 days before RT,lasted up to 7 months. Partial responses were observed in 14 and 6 patients respectively in the LND+RT and PLAC+RT groups. Statistical analysis of the survival curves showed no significant difference between the LND+RT (median 311 days) and PLAC+RT (median 193 days) groups.

Stage III patients survived significantly longer (p<0.05) when treated with LND+RT (median 318 days) than with PLAC+RT (median 163 days). No synergistic toxic effects between radiation and LND were noted.

To confirm these data a new and larger multicentric study is now in progress.     

Synthesis of symmetric bis-α-ketoamides from renewable starting materials and comparative study of their nucleating efficiency in PLLA

An efficient and smart synthesis of bis-α-ketoamides has been disclosed. The desired products have been obtained through a Passerini multicomponent reaction using biobased aldehydes, acetic acid and bis-isocyanides (prepared from the corresponding biobased diamides), followed by a deprotection/oxidation step. The effect of the synthesized compounds on the crystallization behavior of poly(l-lactide) (PLLA) has been investigated by differential scanning calorimetry (DSC) in non-isothermal conditions. Among all the synthesized compounds, only a few are able to meaningfully enhance the nucleation of PLLA, as confirmed by a shift of the polymer crystallization peak temperature towards higher values. With the research of active polymer nucleating agents being mostly empirical, the combinatorial synthetic approach proposed herein, coupled with the possibility of a small scale mixing procedure, can potentially represent a useful strategy for the discovery of new efficient biobased polymer additives.

A new class of organic nucleating agents for PLLA has been obtained through a Passerini multicomponent reaction using biobased building blocks.