112 research outputs found
Current thinking about the management of recurrent pleomorphic adenoma of the parotid: a structured review
No full textPleomorphic adenoma is the most common tumour of the parotid gland, and can recur after excision. Recurrent pleomorphic adenoma can be a challenge to treat, and has variable outcomes. The aim of this review was to summarise current thinking in its management, which may be helpful to clinical teams and could improve patients’ health-related quality of life. We searched several online databases using the key terms pleomorphic adenoma, recurrent pleomorphic adenoma, parotid gland tumours, parotid surgery, radiotherapy and parotid pleomorphic adenoma, and parotid surgery outcomes. Information collected included sample size, recurrence rate, condition of the facial nerve, type of operation, adjuvant treatments associated with recurrence, and clinical outcome. We screened 2301 papers, of which 49 were eligible. There was no consensus among authors about management. There are few if any randomised studies, and so conclusions in most papers were based on coherent arguments. Pleomorphic adenomas of the parotid tend to recur after long intervals, with a propensity towards multifocal disease, and the risk of recurrence (which depends on the initial surgical technique) is higher when the initial operation was done at a young age, after enucleation, and if the initial margins were invaded. Published conclusions suggest that the accepted management varies from observation in selected cases to total parotidectomy with or without postoperative radiotherapy
Clinical and Molecular Determinants of Malignant Transformation in Oral Epithelial Dysplasia (MD Thesis)
No full textKnown risk factors for malignant transformation in oral lesions with malignant potential include the size and appearance, however the importance of site, grade of dysplasia and exposure to environmental carcinogens remains controversial. Patients with a diagnosis of oral epithelial dysplasia (OED) were recruited to a longitudinal observational cohort study in a tertiary oral dysplasia clinic. Clinical, histopathological and risk factor data were assessed to identify clinical determinants of malignant transformation; in patients where the oral dysplasia underwent malignant transformation the treatment outcomes were evaluated.
Ninety-eight eligible patients were recruited and followed up for the median duration of 48 months. Twenty-six (26.5%) patients underwent malignant transformation, with significant predictors as follows: non-smoking status, lateral tongue subsite, non-homogeneous appearance, high histological grade and size of lesion >200mm2. Whilst these clinical features have previously been associated with malignant transformation in OED, the highly statistically significant finding of malignant transformation in non-smokers, consistent with several cohorts reported in the recent years. This suggests that these patients, apparently with endogenous OED, perhaps with inherited or acquired predisposition, are considered to be at higher risk (compared to smokers) and should form the focus for further investigation.
All 26 patients in whom dysplasia transformed to oral squamous cell carcinoma were presented to the multidisciplinary team (MDT) with stage 1 disease. Ninety-one percent (21/23) were initially treated by wide local excision and 9% (2/23) required tumour resection followed by reconstruction. Twenty-two percent (5/23) of patients developed second primary OSCC, and further diagnoses of oral dysplasia with an estimate that 76% of patients will undergo one or more event in 5 years. Specialist monitoring of OED by a multidisciplinary team allows detection of OSCC at an early stage, facilitating largely curative treatment with simple and usually minor surgical intervention. The high incidence of second primary OSCC formation in high risk patients with OED supports an intensive targeted surveillance regimen in this group of patients.
The observed higher rate of malignant transformation in non (or light)-smokers supports the hypothesis of an endogenous aetiology. It is hypothesised that loss of FANCD2 and associated proteins lead to genomic instability and oncogenesis.
Longitudinal archival samples were obtained from 40 individuals with OED from time of diagnosis to the most recent clinical review in 23 non-transforming/stable OED or until excision of the SCC in 17 unstable OED undergoing malignant transformation. Histopathological reassessment, immunohistochemistry for FANCD2 and Western blotting for phosphorylation/mono-ubiquitination status of ATR, CHK1, FANCD2 and FANCG were undertaken on each tissue sample.
Immunohistochemistry studies found under-expression of FANCD2 was observed in the diagnostic biopsy of OED lesions which later underwent malignant transformation when compared with stable OED. Combining the FANCD2 immunohistochemistry scores with histological grading more accurately predicted malignant transformation (p=0.005) than histology alone and correctly predicted malignant transformation in 10/17 initial biopsies. A significantly reduced expression of total FANCD2, pFANCD2, pATR, pCHK-1 and pFANCG were observed in OED which underwent malignant transformation.
There is strong evidence that defects in the DNA damage sensing-signalling-repair cascade are associated with malignant transformation in OED. Loss of post-translational modification in FANCD2 and related proteins, was more predictive of malignant transformation when compared to clinical parameters
Physicochemical characterizations of amphiphilic block copolymers with different MWs and micelles for development of anticancer drug nanocarriers
No full textBiocompatible polymers have been of considerable interest in developing drug delivery systems (DDSs). However, physicochemical characterizations of the polymers and DDSs had been limited because of the difficulty in obtaining the same synthesized copolymers and achieving a similar drug loading ability with the differing properties of the drugs. Therefore, a correlational study of the relationships between copolymers and DDSs was required to estimate the properties of the DDSs and to develop optimal systems of delivery depending on the drug. In this study, we presented several relationship correlation equations of physicochemical properties and copolymers according to their molecular weights (MWs) using amphiphilic block copolymers composed of poly(L-lactide)-block-methoxy-poly(ethylene glycol) (PLA-b-mPEG). The PLA-b-mPEG was characterized by nuclear magnetic resonance and gel permeation chromatography, and the critical micelle concentration (CMC), sizes, and drug loading capacity (DLC) of the self-assembling micelles from the copolymers with different MWs were all measured. The increase in MW of the PLA led to a decrease in CMC and DLC with an increase of the particle sizes. The relationship between the MW of the PLA and the physicochemical properties of the micelles demonstrated a good correlation, which provides excellent information for the use in the development of tailor-made DDSs based on copolymers pursuing optimal particle size, DLC, CMC, and so on.ope
Mechanical wall stress and wall shear stress are associated with atherosclerosis development in non-calcified coronary segments
No full textBackground and aims: Atherosclerotic plaque onset and progression are known to be affected by local biomechanical factors. While the role of wall shear stress (WSS) has been studied, the impact of another biomechanical factor, namely mechanical wall stress (MWS), remains poorly understood. In this study, we investigated the association of MWS, independently and combined with WSS, towards atherosclerosis in coronary arteries. Methods: Thirty-four human coronary arteries were analyzed using near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) and optical coherence tomography (OCT) at baseline and after 12 months. Baseline WSS and MWS were calculated using computational models, and wall thickness (ΔWT) and lipid-rich necrotic core size (ΔLRNC) change were measured in non-calcified coronary segments. The arteries were further divided into 1.5 mm/45° sectors and categorized as plaque-free or plaque sectors. For each category, associations between biomechanical factors (WSS & MWS) and changes in coronary wall (ΔWT & ΔLRNC) were studied using linear mixed models. Results: In plaque-free sectors, higher MWS (p < 0.001) was associated with greater vessel wall growth. Plaque sectors demonstrated wall thickness reduction over time, likely due to medical therapy, where higher levels of WSS and WMS, individually and combined, (p < 0.05) were associated with a greater reduction. Sectors with low MWS combined with high WSS demonstrated the highest LRNC increase (p < 0.01). Conclusions: In this study, we investigated the association of the (largely-overlooked) biomechanical factor MWS with coronary atherosclerosis, individually and combined with WSS. Our results demonstrated that both MWS and WSS significantly correlate with atherosclerotic plaque initiation and development.Medical Instruments & Bio-Inspired Technolog
Mowat–Wilson syndrome in a Chinese population: A case series
No full textMowat–Wilson syndrome (MWS) is characterized clinically by a distinctive facial gestalt, intellectual disability, microcephaly, epilepsy, and nonobligatory congenital malformations such as Hirschsprung disease, urogenital anomalies, congenital heart disease, eye malformations. This article summarized the clinical features and molecular findings of 15 Chinese MWS patients. The results revealed a higher incidence of congenital heart disease in Chinese MWS patients compared to that previously reported in Caucasian cohorts, while the incidence of Hirschsprung disease and genitourinary malformation appeared to be lower. This suggests possible ethnicity‐related modifying effects in the MWS phenotype.link_to_subscribed_fulltex
MATTHEW-WOOD SYNDROME: A CASE WITH DEXTROCARDIA AND STREAK GONADS
No full textMatthew-Wood syndrome: a case with dextrocardia and streak gonads: Matthew-Wood syndrome (MWS), also termed Microphthalmia, syndrome 9 (MCOPS9, MIM 601186), Spear syndrome, or pulmonary hypoplasia, diaphragmatic hernia, anophthalmia and cardiac defects syndrome (PDAC syndrome), is an autosomal recessive disorder characterised by ocular, respiratory and cardiac abnormalities. Mutations in retinoic acid 6 gene (STRA6) have been reported in clinically diagnosed patients with MWS. Here we presented a case with MWS, who has characteristic findings of the syndrome as well as dextrocardia as an undescribed feature, and bilateral streak gonads which was described only in one patient previously. Molecular analysis showed a homozygous exonic missense mutation in the STRA6 gene
Pengaruh Persepsi Harga, Kualitas Produk dan Kualitas Pelayanan terhadap Kepuasan Pelanggan di Jw Marriott Hotel Jakarta
No full textThe purpose of this research is to determine the influence of price perceptions, product quality and service quality of JW Marriott Hotel Jakarta on customer satisfaction, by applying quantitative methods and Accidental Sampling at JW Marriott Hotel Jakarta. The research results show a value of 0.874 with a significance of 0.384. With a significance of more than 0.05, HO is accepted, indicating that price perception has no partial effect on customer satisfaction at JW Marriott Hotel Jakarta. Product quality with a calculated t value of 3.108 and a significance of 0.002. This states that product quality also partially influences customer satisfaction at JW Marriott Hotel Jakarta. The t-count service quality results produce a value of 6.704 with a significance of 0.000. With a significance of less than 0.05, HO is rejected, which means that service quality has a partial effect on customer satisfaction
Coexisting Intraarticular Disorders Are Unrelated To Outcomes After Arthroscopic Resection of Dorsal Wrist Ganglions
No full textBACKGROUND:
Dorsal wrist ganglions are one of the most frequently encountered problems of the wrist and often are associated with intraarticular disorders. However, it is unclear whether coexisting intraarticular disorders influence persistent pain or recurrence after arthroscopic resection of dorsal wrist ganglions.
QUESTIONS/PURPOSES:
We investigated (1) which intraarticular disorders coexist with dorsal wrist ganglions and (2) whether they influenced pain, function, and recurrence after arthroscopic ganglion resection.
METHODS:
We retrospectively reviewed 41 patients with primary dorsal wrist ganglions who underwent arthroscopic resection. We also obtained VAS pain scores and the Mayo Wrist Scores (MWS) preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter postoperatively. Minimum followup was 24 months (mean, 38.9 months; range, 24-60 months).
RESULTS:
Twenty-one patients had other coexisting intraarticular disorders: 18 triangular fibrocartilage complex tears and nine intrinsic ligament tears. All coexisting disorders were treated simultaneously. Two years after surgery, the mean VAS pain score decreased from 2.4 to 0.6, and mean grip strength increased from 28 to 36 kg of force. The mean active flexion-extension showed no change. The mean MWS improved from 74 to 91. Three ganglions recurred. There was no difference in mean VAS pain score and MWS preoperatively and at 2 years after surgery or recurrence of ganglions between patients with or without coexisting lesions.
CONCLUSIONS:
Intraarticular disorders commonly coexist with ganglions but we found they were unrelated to pain, function, and recurrence after arthroscopic resection of the ganglion when the intraarticular disorders were treated simultaneously.
LEVEL OF EVIDENCE:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.ope
A waferscale Si wire solar cell using radial and bulk p-n junctions
No full textSilicon nanowires (NWs) and microwires (MWs) are cost-effectively integrated on a 4-inch wafer using metal-assisted electroless etching for solar cell applications. MWs are periodically positioned using low-level optical patterning in between a dense array of NWs. A spin-on-doping technique is found to be effective for the formation of heavily doped, thin n-type shells of MWs in which the radial doping profile is easily delineated by low voltage scanning electron microscopy. Controlled tapering of the NWs results in additional optical enhancement via optimization of the tradeoff between increased light trapping (by a graded-refractive-index) and increased reflectance (by decreasing areal density of NWs). Compared to single NW (or MW) arrayed cells, the co-integrated solar cells demonstrate improved photovoltaic characteristics, i.e. a short circuit current of 20.59 mA cm(-2) and a cell conversion efficiency of similar to 7.19% at AM 1.5G illumination.This work was supported by the New & Renewable Energy R&D Program (no. 2009T100100614) of the Ministry of Knowledge Economy, Korea, and the Pioneer Research Center Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (grant no. 2009-0082820). H-DU, S-WJ and K-TP acknowledge financial support from the sixth-stage Brain Korea 21 Project in 2010
Precise Synthesis of Bottlebrush Block Copolymers from ω-End-Norbornyl Polystyrene and Poly(4-tert-butoxystyrene) via Living Anionic Polymerization and Ring-Opening Metathesis Polymerization
No full textA facile and efficient synthetic grafting-through strategy for preparing well-defined bottlebrush block copolymers (BBCPs) was developed through a combination of living anionic polymerization (LAP) and ring-opening metathesis polymerization (ROMP). ω-End-norbornyl polystyrene (NPSt) and poly(4-tert-butoxystyrene) (NPtBOS) were synthesized by LAP using terminator of chlorine moiety containing silane-protecting amine and coupled with a subsequent amidation using norbornyl activated ester. Bottlebrush homopolymers of NPSt were obtained by ROMP with ultrahigh molecular weights (MWs, M_w = 2928 kDa) and narrow molecular weight distributions (MWDs, Đ = 1.07) at high degree of polymerizations (DP_w = 1084). Well-defined BBCPs with ultrahigh MWs (M_w ∼ 3055 kDa) and narrow MWDs (Đ ∼ 1.13) were synthesized through sequential ROMP of NPSt with NPtBOS. The effect of ultrahigh MWs was investigated by self-assembly of the BBCPs in which the phase-separated BBCPs presented periodic lamellar structures and exhibited structural colors from blue to pink
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