A Guide to Developing Safety Protocols for International Craniofacial Outreach Programs During the COVID-19 Era.

ABSTRACT: The ongoing COVID-19 outbreak has created obstacles to health care delivery on a global scale. Low- and middle-income countries (LMICs), many of which already suffered from unmet surgical and medical needs, are at great risk of suffering poor health outcomes due to health care access troubles brought on by the pandemic. Craniofacial outreach programs (CFOP)-a staple for craniofacial surgeons-have historically provided essential care to LMICs. To date, there has not been literature discussing the process of resuming CFOP mission trips. Herein, we propose a roadmap to help guide future journeys, as well as summarize practical considerations.

Tophaceous gout of the nose in a male FMR1 premutation carrier.

Premutation alleles with 55-200 CGG repeats in FMR1 can lead to fragile X-associated tremor/ataxia syndrome (FXTAS). In this case study, we report uncontrolled gout in a 68-year-old male with FXTAS with multiple sites of involvement including a rare gouty tophus in the nasal region.

Serum Müllerian Inhibiting Substance/anti-Müllerian hormone levels in patients with adult granulosa cell tumors directly correlate with aggregate tumor mass as determined by pathology or radiology.

OBJECTIVES: Granulosa cell tumors (GCTs) comprise 2-5% of ovarian tumors. Serum Müllerian Inhibiting Substance (MIS, also known as anti-Müllerian hormone, or AMH) levels have been validated as a marker of GCT recurrence and progression. There has been little correlation between serum MIS/AMH levels and several clinical parameters in GCTs, including tumor burden. We have performed a retrospective review correlating aggregate tumor mass as reported by pathologic examination or by radiology with serum MIS/AMH levels drawn on the date of examination. METHODS: We retrospectively identified 32 GCT patients at our institution over the last 15 years who had serum MIS/AMH measurements. Patients who had serum MIS/AMH measurements within three days of surgery or on the same day as abdominal computerized tomography scan (CT) or magnetic resonance imaging (MRI) were further evaluated. RESULTS: We found a significant direct correlation between patient serum MIS/AMH levels and gross aggregate tumor mass determined by pathology (slope=15.4+/-6.06, r=0.65, p<0.04) or by radiographic aggregate tumor mass for all data points identified (slope=0.07+/-0.03, r=0.33, p<0.04) and after correcting for selection bias (slope=1.45+/-0.17, r=0.93, p<0.01). We also identified a significant difference between serum MIS/AMH levels between samples drawn the same day as negative and positive abdominal CT or MRI scans (8.16+/-1.54 vs. 158.7+/-32.2 ng/ml, p<0.0001). CONCLUSIONS: These data indicate a significant direct correlation between serum MIS/AMH levels and both gross and radiographic aggregate tumor mass in GCT patients. Together with the current literature, the present data argue for a more prominent role for serum MIS/AMH in the management of GCTs.

Frontal sinus fractures: a 28-year retrospective review.

OBJECTIVES: To analyze 202 consecutive frontal sinus fracture (FSF) patients treated between 1974 and 2002 at the University of California, Davis. METHODS: A retrospective chart review was performed, including all patients with frontal sinus fractures from 1987 to 2002. This and 72 previously reported patients (1974-1986) were analyzed, comparing age, gender, fracture type, associated fractures, procedure type, and complications. RESULTS: Frontal sinus fractures resulting from motor vehicle accidents (MVAs) decreased from 71% to 52% (P < 0.05). Fractures from assaults increased from 9% to 21% (P < 0.05). The incidence of "through and through" fractures decreased from 40% to 11% (P < 0.05). Whereas combined anterior/posterior table fractures increased from 36% to 57% (P < 0.05). CONCLUSION: The etiology and severity of FSF has changed from 1974 to 2002. This is reflected in a reduced number of fractures resulting from MVAs as well as a reduced severity of injury. The most likely explanation is the use of safety belts and airbags.

New approaches for high-yield purification of Müllerian inhibiting substance improve its bioactivity.

We have established a new method to purify Müllerian inhibiting substance (MIS) with higher purity and recovery over existing procedures. Recombinant human MIS was expressed in Chinese hamster ovary cells and secreted into chemically defined serum-free media. The secreted products were concentrated by either precipitation with ammonium sulfate or lectin-affinity chromatography, each of which was followed by anion-exchange chromatography. Further separation of the active carboxy-terminal domain of MIS was achieved after cleavage by plasmin followed by lectin-affinity chromatography. This method may be applicable to other members of the transforming growth factor beta family with which MIS shares sequence homology.

Mandibular reconstruction with an alloplastic bone tray in dogs.

OBJECTIVE: Mandibular alloplastic bone trays have an unacceptably high rate of extrusion. The introduction of resorbable mesh has renewed interest in such trays. This study evaluates the effect of resorbable trays on bone graft healing in a dog model. DESIGN: Unilateral, 20-mm mandibular body defects were created in 10 dogs, and repaired with cancellous bone grafts. A resorbable mesh bone tray was applied to 5 animals. All mandibles underwent gross examination, 4-point stress testing, and histologic and radiographic analysis. RESULTS: All animals had excellent bony unions. There was one intraoral mesh exposure. There was no difference between the control and treatment groups with regard to clinical findings, radiologic analysis, stress testing (P = 0.17), or histologic analysis (P = 0.66). CONCLUSION: The metabolic breakdown products of the resorbable mesh do not inhibit bone healing or strength. Resorbable mesh trays are a viable modality for reconstruction of segmental mandibular defects in a dog model.

Molecular cloning and characterization of spurt, a human novel gene that is retinoic acid-inducible and encodes a secretory protein specific in upper respiratory tracts.

Retinoids, such as all-trans-retinoic acid, play an essential role in the regulation of airway epithelial cell growth, differentiation, and gene expression. Using cDNA microarray, we identified a clone, DD4, that contains the cDNA of a novel gene, spurt (secretory protein in upper respiratory tracts) that was significantly induced by all-trans-retinoic acid in primary cultured human tracheobroncheal epithelia. Two alternatively spliced spurt transcripts of 1090 and 1035 base pairs exist that contain the same open reading frame expressing a 256-amino acid peptide. The full-length spurt cDNA sequence spans a genomic DNA fragment of 7,313 bp, and the gene is located on chromosome 20q11.21. spurt mRNA is notably expressed at high levels in human nasal, tracheal, and lung tissues. In situ hybridization demonstrated that spurt message is often present in secretory cell types. The human spurt gene product is a secretory protein that contains a distinct signal peptide sequence in its first 19 amino acids. Mono-specific antibodies were generated to characterize spurt expression. Our data demonstrate that spurt is secreted onto the apical side of primary human airway epithelial cultures and is present in clinical sputum samples. spurt gene expression is higher in sputum and tissue samples obtained from patients with chronic obstructive lung disease. Our results provide the cloning and characterization of this tissue-specific novel gene and its possible relationship with airway diseases.