The use of the platysma myocutaneous flap for reconstruction in the head-neck area -- a retrospective study

OBJECTIVE: Following extended tumor resections in the head-neck area options immediate defect reconstruction is needed to reduce healing time and improve rehabilitation. Reconstruction of significant areas of mucosal defects is best accomplished by introduction of a pliable regional transplant. The platysma myocutaneous flap has been used for defect reconstruction in head and neck area since more than 20 years. Its popularity is limited. Since 2001 in our department the platysma mucocutaneous flap is used for such reconstructions. We present a retrospective study evaluating our experience with the platysma myocutaneous flap. METHOD: From 2001-2003 25 patients have been subjected to surgical reconstruction applying the platysma mucocutaneous flap. The primary tumor was located in 16 patients (64 %) in the oropharynx, in 5 patients (20 %) in the hypopharynx and in 4 patients (16 %) in the oral cavity. Evaluation was based on medical records including the operative reports. All patients get a follow up in our outpatient clinic. RESULTS: The platysma flap is easy to harvest and has a low general risk level. Complications are minor and may be avoided by exact preoperative planning. Necrosis of the skin-muscle-flap was observed only after resection of the A. carotis externa (two cases). In these 2 cases an operative revision was necessary (stenting of the pharynx or secondary reconstruction by pectoralis major-flap). The resection of the A. facialis (three cases) did not lead to a serious complication. CONCLUSIONS: Considering the exact indication the platysma flap is suitable for reconstruction of surface defects in the pharynx and oral cavity. A special attention is given to the ipsilateral vascular supply and the length of the muscular pedicel. It proved to be a cost effective method due to the less time and personal expenditure.     

Contributions of lower limb and abdominal compression to ventilation inhomogeneity in hypergravity

Gravito-inertial load in the head-to-foot direction (Gz) and compression of the lower body half by an anti-G suit (AGS) are both known to influence ventilation distribution in the lungs. To study the interaction of Gz and AGS and to asses the separate contributions from lower limbs and abdominal compressions to large and small-scale ventilation inhomogeneities nine males performed SF6/He vital capacity (VC) single-breath washouts at 1, 2, and 3 Gz in a centrifuge, with abdominal and/or lower limbs compressions. SF6/He and (SF6-He) phase III slopes were used for determination of overall and small-scale ventilation inhomogeneity. Closing volume and phase IV height were used as measures of large-scale inhomogeneity. VC decreased marginally with G-load but markedly with lower limbs compression. Small-scale ventilation inhomogeneity increased slightly with G-load, but substantially with AGS pressurization. Small-scale ventilation inhomogeneity increased with AGS pressurization. Large-scale inhomogeneity increased markedly with G-load. Translocation of blood to the lungs might be the key determinant for changes in small-scale ventilation inhomogeneity when pressurizing an AGS.     

Cough determinants in patients with neuromuscular disease

Neuromuscular disease leads to cough impairment. Cough augmentation can be achieved by mechanical insufflation (MI) or manually assisted coughing (MAC). Many studies have compared these two methods, but few have evaluated them in combination. In 155 neuromuscular patients, we assessed determinants of peak cough flow (PCF) using stepwise correlation. Maximal inspiratory capacity contributed 44% of the variance (p<0.001), expiratory reserve volume 13%, and maximal expiratory pressure 2%. Thus, augmenting inspiration seems crucial. However, parameters dependent on expiratory muscles independently influence PCF. We measured vital capacity and PCF in 10 neuromuscular patients during cough augmentation by MI, MAC, or both. MI or MAC significantly improved VC and PCF (p<0.01) as compared to the basal condition and VC and PCF were higher during MI plus MAC than during MAC or MI alone (p<0.01). In conclusion, combining MAC and MI is useful for improving cough in neuromuscular patients.     

Naming of newly learned objects: a PET activation study

The present study tracked the naming-related brain activity by positron emission tomography (PET) when successfully learned unfamiliar objects were named. Ten Finnish-speaking subjects participated in the study. Prior to the PET scan, each subject underwent a 4-day long training period in which 40 names of rare unfamiliar objects were taught. The stimulus categories were as follows: unfamiliar but real objects for which both the name and the definition were given during training, only the name was given, no information was given. In addition, familiar objects and visual noise patterns were used. The unfamiliar items mainly represented ancient domestic tools unknown to modern-day people. As semantic support did not affect the PET results, all trained items were pooled together. The trained objects vs. familiar objects contrast revealed rCBF increases in the left inferior frontal cortex (Broca's area), the left anterior temporal area, and the cerebellum. Likewise, the trained objects vs. unfamiliar objects (for which no information was given) contrast revealed more extensive left frontal (roughly Broca's area) and cerebellar rCBF increases, while anterior temporal activation was bilateral. Familiar objects, contrasted with both visual noise patterns and a rest condition, elicited activation increases in expected areas, i.e., bilateral occipital regions and the fusiform gyrus. Our results indicate that the naming of newly learned objects recruits more extensive brain areas than the naming of familiar items, namely a network that includes left-dominant frontotemporal areas and cerebellum. Its activity is tentatively related to enhanced lexical-semantic and lexical-phonological retrieval, as well as associative memory processes.     

Regulation of miRNA expression during neural cell specification

MicroRNA (miRNA) are a newly recognized class of small, noncoding RNA molecules that participate in the developmental control of gene expression. We have studied the regulation of a set of highly expressed neural miRNA during mouse brain development. Temporal control is a characteristic of miRNA regulation in C. elegans and Drosophila, and is also prominent in the embryonic brain. We observed significant differences in the onset and magnitude of induction for individual miRNAs. Comparing expression in cultures of embryonic neurons and astrocytes we found marked lineage specificity for each of the miRNA in our study. Two of the most highly expressed miRNA in adult brain were preferentially expressed in neurons (mir-124, mir-128). In contrast, mir-23, a miRNA previously implicated in neural specification, was restricted to astrocytes. mir-26 and mir-29 were more strongly expressed in astrocytes than neurons, others were more evenly distributed (mir-9, mir-125). Lineage specificity was further explored using reporter constructs for two miRNA of particular interest (mir-125 and mir-128). miRNA-mediated suppression of both reporters was observed after transfection of the reporters into neurons but not astrocytes. miRNA were strongly induced during neural differentiation of embryonic stem cells, suggesting the validity of the stem cell model for studying miRNA regulation in neural development.     

Mild neonatal hypoxia exacerbates the effects of vitamin-deficient diet on homocysteine metabolism in rats

Elevated plasma homocysteine has been linked to pregnancy complications and developmental diseases. Whereas hyperhomocysteinemia is frequently observed in populations at risk of malnutrition, hypoxia may alter the remethylation of homocysteine in hepatocytes. We aimed to investigate the combined influences of early deficiency in nutritional determinants of hyperhomocysteinemia and of neonatal hypoxia on homocysteine metabolic pathways in developing rats. Dams were fed a standard diet or a diet deficient in vitamins B12, B2, folate, month, and choline from 1 mo before pregnancy until weaning of the offspring. The pups were divided into four treatment groups corresponding to "no hypoxia/standard diet," "hypoxia (100% N2 for 5 min at postnatal d 1)/standard diet," "no hypoxia/deficiency," and "hypoxia/deficiency," and homocysteine metabolism was analyzed in their liver at postnatal d 21. Hypoxia increased plasma homocysteine in deficient pups (21.2 +/- 1.6 versus 13.3 +/- 1.2 microM, p < 0.05). Whereas mRNA levels of cystathionine beta-synthase remained unaltered, deficiency reduced the enzyme activity (48.7 +/- 2.9 versus 83.6 +/- 6.3 nmol/h/mg, p < 0.01), an effect potentiated by hypoxia (29.4 +/- 4.7 nmol/h/mg, p < 0.05). The decrease in methylene-tetrahydrofolate reductase activity measured in deficient pups was attenuated by hypoxia (p < 0.05), and methionine-adenosyltransferase activity was slightly reduced only in the "hypoxia/deficiency" group (p < 0.05). Finally, hypoxia enhanced the deficiency-induced drop of the S-adenosylmethionine/S-adenosylhomocysteine ratio, which is known to influence DNA methylation and gene expression. In conclusion, neonatal hypoxia may increase homocysteinemia mainly by decreasing homocysteine transsulfuration in developing rats under methyl-deficient regimen. It could therefore potentiate the well-known adverse effects of hyperhomocysteinemia.     

Ex vivo expansion of highly purified NK cells for immunotherapy after haploidentical stem cell transplantation in children

BACKGROUND: Allogeneic natural killer (NK) cells are known to show medium to high cytotoxic activity against HLA-nonidentical leukemia or tumor cells. For a possible benefit of post transplant treatment with NK cells after haploidentical stem cell transplantation (haplo-SCT) we developed a clinical scale procedure for NK cell processing observing Good Manufacturing Practice (GMP). METHODS: Allogeneic donor NK cells were selected from 15 unstimulated leukaphereses using two rounds of immunomagnetic T cell depletion, followed by an NK cell enrichment step. CD56 (+)CD3 (-) NK cells were stimulated and expanded in vitro according to GMP. Quality control of NK cell purity, residual T cells and cytotoxic activity was done by multi-coloured flow cytometric analyses. RESULTS: Purification led to an absolute number of 234-1 237 x 10 (6) CD56 (+)CD3 (-) NK cells from leukapheresis harvests with a median purity of 95 % and a 4 to 6(1/2) log depletion of T cells. After two weeks stimulation with IL-2 a five-fold expansion of NK cells with a T cell contamination below 0.1 % was reached. Median cell viability was 95 % after purification and 99 % after expansion. The IL-2 stimulated NK cells showed a highly increased lytic activity against the MHC-I deficient K562 cells compared to freshly isolated NK cells and a medium cytotoxicity against patients' leukemic cells. CONCLUSIONS: Clinical scale enrichment and activation of allogeneic donor NK cells is feasible. High dose NK cell application may be a new treatment option for pediatric patients with leukemia or solid tumors in case of minimal residual disease or unbalanced chimerism post haplo-SCT as we could show for the first three patients .     

Efficient growth inhibition of Bacillus anthracis by knocking out the ribonucleotide reductase tyrosyl radical

Bacillus anthracis, the causative agent of anthrax, is a worldwide problem because of the need for effective treatment of respiratory infections shortly after exposure. One potential key enzyme of B. anthracis to be targeted by antiproliferative drugs is ribonucleotide reductase. It provides deoxyribonucleotides for DNA synthesis needed for spore germination and growth of the pathogen. We have cloned, purified, and characterized the tyrosyl radical-carrying NrdF component of B. anthracis class Ib ribonucleotide reductase. Its EPR spectrum points to a hitherto unknown three-dimensional geometry of the radical side chain with a 60 degrees rotational angle of C(alpha)-(C(beta)-C(1))-plane of the aromatic ring. The unusual relaxation behavior of the radical signal and its apparent lack of line broadening at room temperature suggest a weak interaction with the nearby diiron site and the presence of a water molecule plausibly bridging the phenolic oxygen of the radical to a ligand of the diiron site. We show that B. anthracis cells are surprisingly resistant to the radical scavenger hydroxyurea in current use as an antiproliferative drug, even though its NrdF radical is efficiently scavenged in vitro. Importantly, the antioxidants hydroxylamine and N-methyl hydroxylamine scavenge the radical several orders of magnitude faster and prevent B. anthracis growth at several hundred-fold lower concentrations compared with hydroxyurea. Phylogenetically, the B. anthracis NrdF protein clusters together with NrdFs from the pathogens Bacillus cereus, Bacillus thuringiensis, Staphylococcus aureus, and Staphylococcus epidermidis. We suggest the potential use of N-hydroxylamines in combination therapies against infections by B. anthracis and closely related pathogens.