Shrinkage in oral squamous cell carcinoma: An analysis of tumor and margin measurements in vivo,post-resection,and post-formalin fixation

Purpose

To quantify changes in tumor size and tumor-free margins following surgical resection and formalin fixation of oral cavity squamous cell carcinoma.

Mohs micrographic surgery technique

This article provides a protocol for the systematic approach to the technique of Mohs micrographic surgery. Each step, from tumor excision and tissue mapping, to specimen processing and histologic interpretation, through wound closure and postoperative management, is covered. The advantages of Mohs surgery over other treatment modalities are observed histologic margin control, superior cure rates, and maximal tissue-sparing potential. The increased preservation of normal tissue leads to smaller surgical defects, optimal reconstructive results, and diminished risk of poor surgical outcomes. Overall, the risks of the procedure are few, the benefits numerous, and the outcomes worth the time and effort spent in learning the technique.     

Dynamic stability during walking in children with and without cerebral palsy

BackgroundCerebral palsy (CP) is associated with a high risk of falling during walking. Many gait abnormalities associated with CP likely alter foot placement and center of mass (CoM) movement in a way that affects anterior or lateral dynamic stability, in turn influencing fall risk.Research questionDo children with CP demonstrate altered anterior or lateral dynamic stability compared to typically-developing (TD) children?MethodsIn this case-control, observational study, we measured gait kinematics of two groups of children (15 CP, 11 GMFCS level I, 4 GMFCS level II; 14 TD; age 5–12) in walking conditions of a preferred speed, a fast speed, and a preferred speed while completing a cognitive task. For dominant and non-dominant limbs, the margin of stability (MoS), a spatial measure of dynamic stability, was calculated as the distance between the edge of the base of support and the CoM position after accounting for scaled velocity. Statistical comparisons of were made using mixed factorial ANOVAs. Post hoc comparisons were Sidak adjusted.ResultsThe anterior MoS before foot strike and at mid-swing differed between each condition but not between groups. Based on the minimum lateral MoS, children with CP had more stability when bearing weight on their non-dominant limb compared to TD children. These differences were not apparent when on the dominant limb.SignificanceThis high-functioning group of children with CP exhibited a more conservative lateral stability strategy during walking when bearing weight with the non-dominant limb. This strategy may be protective against lateral falls. We observed no between-group differences in anterior stability. Because CP has been previously associated with impaired anterior balance reactions, and there was no observed compensation in anterior gait stability, this lack of group differences could contribute to a higher risk of falling in that direction.     

Dynamic stability in cerebral palsy during walking and running: Predictors and regulation strategies

BackgroundThe postural control in cerebral palsy (CP) is often deficient and manifests in a variety of impairments. Consequently, maintaining balance and controlling posture is impeded and results in an increased cost of locomotion and higher risk of falls.The margin of stability is an established measure to quantify dynamic stability during gait. It can be facilitated to analyze impaired control mechanisms, but it is unknown if and how people with CP manage to control the margin of stability during a more demanding motor task, such as running.Research questionHow do people with cerebral palsy regulate dynamic stability during walking and running?MethodsChildren and adolescents with bilateral cerebral palsy (N = 117; 50 female, 67 male; age 11.0 ± 3.2) were retrospectively included. All underwent instrumented 3D gait analysis, walking and running barefoot at a self-selected gait speed. People with CP were compared to a control group of N = 25 typically developed (TD). Repeated measures ANOVAs were computed to analyze group differences and multiple linear regressions to identify predictors for the medio-lateral margin of stability.ResultsThe medio-lateral margin of stability was significantly higher in the CP group and was statistically unchanged during running. Different adaptions when running were particularly observed in the lateral trunk lean and step width, which remained high in CP, whereas the TD increased the trunk lean and reduced their step width. Step width was the main predictor for the medio-lateral margin of stability in both gait conditions.SignificanceYoung people with cerebral palsy manage to maintain their medio-lateral margin of stability during walking and running, however, with significantly higher safety margins compared to typically developed. This conservative strategy may reflect an adaption to motor and postural control impairments.     

Rapid noninvasive optical imaging of tissue composition in breast tumor margins

Background

In women undergoing breast conserving surgery (BCS), up to 60% can require re-excision. Our objective is to develop an optically based technology which can differentiate benign from malignant breast tissues intraoperatively through differences in tissue composition factors.

Methods

A prospective study of optical imaging of BCS margins is being performed. Optical images are transformed into tissue composition maps with parameters of total hemoglobin concentration, b-carotene concentration and scattering. The predicted outcome is then compared to the margin-level pathology.

Results

Fifty-five margins from 48 patients have undergone assessment. Within 34 specimens with pathologically confirmed positive margins, the ratio map of b-carotene/scattering showed the most significant difference reflecting a decrease in adipose and an increase in cell density within malignant margins (p=.002). These differences were notable in both in-situ and invasive disease.

Conclusions

We present a novel optical spectral imaging device that provides a rapid, non-destructive assay of the tissue composition of breast tumor margins.     

卫生资源配置的经济学思考

鉴于卫生保健领域资源的有限性,人们提出了各种配置卫生资源的方法。但是,对这些方法进行比较的文献却很少见,而且多数决策者对这些方法并不很了解。该文从经济理论方面对现有的一些资源配置方法,如需要评价法、疾病负担法、基本医疗服务法进行了剖析,指出这些方法都存在一个共同的缺憾,即忽视了机会成本和边际理论。文章建议:更多地关注基本经济学原理将有助于优先领域的资源配置。     

四肢创伤手术切口感染8例临床分析

目的：如何减少四肢创伤手术切口感染的发生率。方法：主要根据我院骨科2007—2009年度进行四肢创伤手术的200例患者进行回顾性系统分析。结果及结论：调查的患者中发生院内手术切口感染的患者有8名,占全部手术病人的4％,对其原因分析高龄,手术清创不够彻底,术前未使用有效的抗生素进行预防,有基础疾病,四肢主干血管损伤缺血严重未及时再通,手术季节和情绪与伤口感染有确切关系。