Expression of Toll-like receptor and cytokine mRNAs in feline odontoclastic resorptive lesion (FORL) and feline oral health.

Feline odontoclastic resorptive lesion (FORL) is a common chronic inflammatory condition whose aetiopathogenesis remains unclear. FORL affects 20-75% of cats and causes excruciating pain and tooth loss. The purpose of this study was to evaluate chronic inflammation in FORL by assessing differences in Toll-like receptor (TLR) and cytokine transcripts in gingival tissues between diseased and healthy cats. Gingival tissue samples were collected from 14 healthy cats with no known clinical signs of oral disease and 41 cats with FORL. Levels of mRNA encoding TLR2, TLR3, TLR4, TLR7, TLR9 and the cytokines interleukin-1ß (IL-1ß), IL-4, IL-6, IL-10, IL-12, interferon-γ (IFN-γ) and tumour necrosis factor-α (TNF-α) was evaluated using quantitative real-time PCR. Statistical significance of the results was assessed using non-parametric tests. Levels of TLR and cytokine transcripts were upregulated in gingival tissue from cats with FORL as compared with healthy gingival tissue: TLR2, TLR3 and TLR9, p ≤ 0.001; TLR4 and TLR7, p ≤ 0.01; IFN-γ, IL-4, IL-6, IL-10, IL-12, IL-1ß and TNF-α, p ≤ 0.001). In conclusion, expression of TLR and both pro- and anti-inflammatory cytokines were significantly increased, confirming an ongoing chronic inflammatory response to the microbiome in FORL. It is likely that dysbiosis of the oral microbiota in cats with FORL activates the innate immune response, leading to active inflammation that results in tooth resorption.

Outcomes of Cancer Survivorship Care Provided by Advanced Practice RNs Compared to Other Models of Care: A Systematic Review

Problem Identification: Advanced practice RNs (APRNs) have become leaders in providing survivorship care. However, outcomes of survivorship care provided by APRNs compared to other providers remain unclear. Literature Search: A systematic literature search included articles published after 2005 that described a survivorship model of care and use of a survivorship care plan (SCP), as well as reported outcomes. Data Evaluation: Sixteen studies were appraised and ranked by strength. Literature was evaluated based on the model of care, which included physicians, nurses, and APRNs who provided or reviewed SCPs. Outcomes evaluated were satisfaction, quality of life (QOL), and process/cost efficiency. Synthesis: Survivorship care is reimbursable when provided by APRNs secondary to the ability to bill for services. Improved patient satisfaction and QOL are demonstrated when survivorship care is provided by APRNs. Incorporation of SCPs into health records improves process/cost efficiency. Conclusions: Patient satisfaction was reported in all models of care. When compared to groups who received no survivorship care, no differences were reported in QOL, but survivorship care required extensive use of resources. Survivorship care provided by APRNs demonstrated improvement in satisfaction, QOL, and process/cost efficiency. Implications for Nursing: Incorporating descriptions of care models and associated outcomes into randomized, controlled trials of survivorship care would provide stronger evidence to guide practice. Studies evaluating outcomes of process/cost efficiency should be considered for future research. Outcome research is needed regarding the incorporation of SCPs into electronic health records.

Expanding the scope of the turnover flap.

BACKGROUND: Turnover flaps are often utilized as alternatives to more traditional flaps, especially in situations where traditional flap viability is limited. Most turnover flaps are currently used in the lower extremities. METHODS: This study examined the senior author's use of the turnover flap in 103 cases between 1987 and 2004. Postoperative follow-up ranged from 3 months to 10 years, with an average follow-up of 9 months. RESULTS: The majority (n = 90) of the cases involved the lower extremities and carried high success rates; there were 72 successful operations (complete graft take), 10 partial flap losses (partial graft take that could be treated postoperatively without surgery), and eight complete flap losses (no graft take and the necessity of additional surgery). Three of the partial flap losses and two of the complete flap losses involved patients with end-stage vascular disease. End-stage vascular disease cases represented 20.0 percent of the lower extremity cases and carried a significantly higher percentage of partial or complete flap loss (27.8 percent). These circumstances were examined in detail; the authors found that the turnover flap provided improved outcome to such end-stage patients who otherwise would have undergone amputation. In 13 cases, turnover flaps were utilized in nontraditional regions, such as the chest wall, abdominal wall, head and neck region, and upper extremities, with a high degree of success (zero partial or complete flap losses). These approaches are discussed in detail. The surgical approach is examined with recommendations regarding preferred wound size and type and overall flap design. CONCLUSIONS: This study indicates that turnover flaps are effective and useful as an alternative and, in some cases, primary procedure. In addition, the results serve to expand the present scope of the turnover flap by examining nontraditional regions in which the flap was highly successful. The authors believe the turnover flap should be given higher priority as a reconstructive option, but more research is needed to explain the sources of blood supply in these flaps.

Salvage of infected prosthetic grafts of the great vessels via muscle flap reconstruction.

OBJECTIVE: The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conservative treatments such as debridement and antibiotic irrigation routinely fail, and patient survival rates are low. Literature has indicated that flap procedures often provide better treatment. In the present article, we report our experience utilizing pectoralis major muscle flaps, occasionally coupled with latissimus dorsi, rectus abdominis, and/or serratus anterior flaps, to wrap infected grafts and fill dead space. PATIENTS: Between 1990 and 2004, 10 patients were brought to our attention with infections of prosthetic grafts of the great vessels (7 men and 3 women; mean age, 53 years). Infections in nine patients involved an ascending aortic graft, while one patient had an infected pulmonary artery graft. DESIGN: Following diagnosis and exploration, an initial debridement is performed, followed by 48 h of antibiotic irrigation. A definitive muscle flap procedure is then utilized to fill dead space and clear the infection, followed by an appropriate antibiotic regimen. RESULTS: The infections in all 10 patients were cleared using the muscle flap procedure. Two patients required a tapered-dose regimen of oral steroids, one of whom also required a secondary flap procedure due to the advanced stage of infection. Two other patients later died due to unrelated complications; however, autopsies revealed that operative sites had healed successfully. Patients were followed up for a period of 2 months to 2 years, and recurrence was not found. CONCLUSIONS: Our outcomes suggest that muscle flap procedures, specifically utilizing the pectoralis major and regional muscles, should be kept in mind in the management of life-threatening infections of aortic grafts. Due to the limited number of patients in this study, we feel more research with a larger volume of cases is warranted.