Thermal capsuloplasty of the glenohumeral joint: Technique and results OF treatment

Mobility of the upper extremity is essential in everyday life. Yet a large shoulder range of motion is also partlythe reason that the glenohumeral joint is the most commonly dislocated joint of the body. After such instability, successful surgical treatment requires precise repair of joint pathoanatomy. Traditional open repair techniques involve capsulolabral plication and repair of the Bankart lesion, if present, to the glenoid bone. Because artlu-oscopy allows intra-capsular visualization of the glenohumeral joint, new techniques were developed in hopes of improving results. Instead, arthroscopic techniques have had success rates that often were inferior to the success rates with traditional, open techniques. One reason may be technical differences that influence the adequacy of repair, but failure to restore normal capsulolabral length using the arthroscopic technique may also contribute to poor outcomes. Thermal capsuloplasty enables the surgeon to diminish capsulolabral length using an arthroscopic technique. Not only must the technique of joint pathoanatomy repair be understood, but also the parameters of the instrument used to apply the heat. Clinical outcome may be equal to that of traditional open repair techniques in treatment of some instability types. Yet concerns remain, as rates of nerve injury and difficult-to-repair soft tissue injuries after thermal capsuloplasty remain uncertain.     

Evaluation of the inferior and superior laryngeal nerve stumps for perineural spread in laryngeal cancer

OBJECTIVE: Perineural spread (PNS) is an important risk factor for locoregional failure and is correlated with reduced survival rates in squamous cell carcinoma of the larynx. PNS may extend proximally and/or distally in the nerve sheath by leaving uninvolved nerve segments. This method of extension may preclude obtaining tumor-free surgical margins, which may be responsible for recurrent disease. The purpose of this study is to investigate the presence or absence of PNS in extralaryngeal superior and inferior laryngeal nerves in patients who underwent total laryngectomy for squamous cell carcinoma of the larynx. METHODS: Extralaryngeal segments of superior and inferior laryngeal nerves were resected bilaterally during 15 consecutive laryngectomies. Laryngectomy specimens and the harvested proximal nerve segments were histopathologically examined for the presence or absence of PNS. RESULTS: Ten of 15 laryngectomy specimens showed PNS; however, none of the extralaryngeal superior or inferior laryngeal nerve segments revealed perineural involvement. CONCLUSION: Extralaryngeal extension of PNS is highly unlikely in squamous cell carcinoma of the larynx.     

Promoter hypermethylation: an important epigenetic mechanism for hMLH1 gene inactivation in head and neck squamous cell carcinoma.

OBJECTIVE: The hMLH1 gene is one of the mismatch DNA repair genes. Inactivation of the hMLH1 gene has been implicated in the tumorigenesis of many types of human cancers. In most sporadic forms of human cancers, promoter hypermethylation is responsible for hMLH1 gene inactivation. Lack of hMLH1 protein expression has been found in a subset of head and neck squamous cell carcinomas (HNSCCs). The purpose of this study was to investigate whether promoter hypermethylation causes hMLH1 gene inactivation in HNSCCs. STUDY DESIGN: hMLH1 protein expression was determined by immunohistochemical staining in 62 cases, whereas hMLH1 gene promoter methylation was analyzed by methylation-sensitive restriction enzyme digestion, followed by polymerase chain reaction, in 35 cases of HNSCCs. RESULTS: Sixteen (26%) of 62 cases of HNSCCs showed near-complete loss of hMLH1 protein expression on immunohistochemical staining. Twelve (92%) of 13 cases that were negative for the hMLH1 protein displayed promoter hypermethylation, whereas 17 (77%) of 22 cases positive for the protein were free of promoter methylation. CONCLUSIONS: Promoter hypermethylation may be an important mechanism for hMLH1 gene inactivation in a subset of HNSCCs.     

Is sentinel lymph node biopsy after neoadjuvant chemotherapy feasible in Chinese patients with invasive breast cancers?

Background: A wide variation in the accuracy of performance of sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy in breast cancer has been reported despite its increased use. This study aimed to be the first to evaluate the feasibility and accuracy of SLNB after neoadjuvant chemotherapy in Chinese patients with breast cancer. Methods: A review of prospectively collected data from breast cancer patients who had SLNB after prior neoadjuvant chemotherapy was performed. A combination of radiopharmaceutical 99mTc‐albumin colloid (Pharmalucence, MA, USA) and Patent Blue V dye (Guerbet, France) was used to identify the SLN. SLNB was followed by standard axillary dissection in all patients. Results: A total of 365 patients received SLNB from May 1999 to April 2006. A total of 78 patients with neoadjuvant chemotherapy followed by SLNB were recruited. The SLN identification rate, false‐negative rate and accuracy rate were 83.3, 10.3 and 73.1%, respectively. Analysis was stratified into clinical and pathological response group. Location of the tumour was also found to be an important factor in affecting the false‐negative rate (P= 0.019). For upper, outer quadrant tumour, five (32.3%, out of 16) patients presented with false‐negative. Patients with more sentinel lymph node harvest had higher accuracy. A total of 22 patients had three or more lymph nodes harvested, and the false‐negative rate was 21.7% (5 out of 23 patients) (P= 0.00). Conclusions: The results of our study show that SLNB is feasible and applicable in Chinese patients with breast cancer with operable disease who have received neoadjuvant chemotherapy.     

Confirmation of Rb gene defects in B-CLL clones and evidence for variable predominance of the Rb defective cells within the CLL clone

Summary. In 70 B-CLL patients, deletion or translocation, at or near the retinoblastoma (Rb) site, was detected in 20 by cytogenetic analysis. Purified B cell clones from 13 of these B-CLL patients were isolated and studied for Rb gene status, Rb mRNA and the Rb protein product. Southern blot analysis of the Rb site detected internal deletions ( N = 1) or a single allele loss ( N = 2) in five patients. Northern blots detected reduced Rb mRNA in four patients. Immunoblot of whole cell lysate revealed reduced levels of unphosphorylated Rb protein in six CLL patients. No CLL B cell clone contained phosphorylated Rb species. These molecular studies have confirmed the cytogenetic alteration of 13q12–14 sites in B-CLL cells. In addition, cytogenetic and molecular biologic analysis suggest heterogeneity in the B cell clone for Rb gene abnormality. B-CLL patients with abnormalities in both cytogenetic and Rb DNA/RNA analysis will have a dominance of B cells with an Rb abnormality ( N = 5). In patients whose Rb defective CLL cells constitute only a minor subpopulation of the total B cell clone, only cytogenetic defects would likely be detected ( N = 7).     

Low-Molecular-Weight Heparin and the Relative Risk of Surgical Site Bleeding Complications: Results of a Systematic Review and Meta-Analysis of Randomized Controlled Trials of Venous Thromboprophylaxis in Patients After Total Joint Arthroplasty

Background

Venous thromboembolism causes significant morbidity and mortality in patients after total joint arthroplasty. Although network meta-analyses have demonstrated a benefit of various thromboprophylactic agents, there remains a concern in the surgical community regarding the resulting wound complications. There is currently no systematic review of the surgical site bleeding complications of thromboprophylactic agents. The aim of this study was to systematically review the surgical site bleeding outcomes of venous thromboembolism prophylaxis in this population.

Memory functions of Taiwanese American older adults

Memory complaints are common among older adults, of which ethnic minorities are the fastest growing group. Little is known about the memory function of Taiwanese American older adults.This article utilizes a cross-sectional, correlational design to examine the relationship between sleep, physical activity, depression, and memory self-efficacy and memory function and to determine the variance in memory function explained by the four independent variables and six control variables in Taiwanese American older adults. Memory self-efficacy correlated significantly with memory performance. Among the independent variables and control variables, age was the strongest predictor of memory function. A simultaneous multiple regression analysis showed that the four independent and six control variables together accounted for 41.8% of the variance in memory function. Results of this study are consistent with that of many other studies conducted in the United States: Memory declined with age.     

Self‐administered acupressure for insomnia disorder: a pilot randomized controlled trial

Self‐administered acupressure has potential as a low‐cost alternative treatment for insomnia. To evaluate the short‐term effects of self‐administered acupressure for alleviating insomnia, a pilot randomized controlled trial was conducted. Thirty‐one subjects (mean age: 53.2 years; 77.4% female) with insomnia disorder were recruited from a community. The participants were randomized to receive two lessons on either self‐administered acupressure or sleep hygiene education. The subjects in the self‐administered acupressure group (n = 15) were taught to practise self‐administered acupressure daily for 4 weeks. The subjects in the comparison group (n = 16) were advised to follow sleep hygiene education. The primary outcome was the Insomnia Severity Index (ISI). Other measures included a sleep diary, Hospital Anxiety and Depression Scale and Short‐form Six‐Dimension. The subjects in the self‐administered acupressure group had a significantly lower ISI score than the subjects in the sleep hygiene education group at week 8 (effect size = 0.56, P = 0.03). However, this observed group difference did not reach a statistically significant level after Bonferroni correction. With regard to the secondary outcomes, moderate between‐group effect sizes were observed in sleep onset latency and wake after sleep onset based on the sleep diary, although the differences were not significant. The adherence to self‐administered acupressure practice was satisfactory, with 92.3% of the subjects who completed the lessons still practising acupressure at week 8. In conclusion, self‐administered acupressure taught in a short training course may be a feasible approach to improve insomnia. Further fully powered confirmatory trials are warranted.     

Evaluating Photographs as a Replacement for the In-Person Physical Examination of the Scored Patient-Generated Subjective Global Assessment in Elderly Hospital Patients

Background

Undernourished patients discharged from the hospital require follow-up; however, attendance at return visits is low. Teleconsultations may allow remote follow-up of undernourished patients; however, no valid method to remotely perform physical examination, a critical component of assessing nutritional status, exists.