Video-Assisted Thoracic Surgery Resection without Intraoperative Fluoroscopy after CT-Guided Microcoil Localization of Peripheral Pulmonary Nodules.

The aim of this brief report is to determine the safety and reliability of minimally invasive video-assisted thoracic surgery (VATS) resection without the aid of intraoperative fluoroscopy after computed tomography (CT)-guided microcoil localization of small peripheral pulmonary nodules. Twenty patients with peripheral lung nodules underwent percutaneous needle localization with a microcoil that was tagged back to the visceral pleural surface. Same-day VATS resection was performed without the use of intraoperative fluoroscopy. All 20 nodules were successfully localized in the CT procedure room, and all 20 nodules were resected with negative margins and no major complications.

Cranberry and grape seed extracts inhibit the proliferative phenotype of oral squamous cell carcinomas.

Proanthocyanidins, compounds highly concentrated in dietary fruits, such as cranberries and grapes, demonstrate significant cancer prevention potential against many types of cancer. The objective of this study was to evaluate cranberry and grape seed extracts to quantitate and compare their anti-proliferative effects on the most common type of oral cancer, oral squamous cell carcinoma. Using two well-characterized oral squamous cell carcinoma cell lines, CAL27 and SCC25, assays were performed to evaluate the effects of cranberry and grape seed extract on phenotypic behaviors of these oral cancers. The proliferation of both oral cancer cell lines was significantly inhibited by the administration of cranberry and grape seed extracts, in a dose-dependent manner. In addition, key regulators of apoptosis, caspase-2 and caspase-8, were concomitantly up-regulated by these treatments. However, cranberry and grape seed extracts elicited differential effects on cell adhesion, cell morphology, and cell cycle regulatory pathways. This study represents one of the first comparative investigations of cranberry and grape seed extracts and their anti-proliferative effects on oral cancers. Previous findings using purified proanthocyanidin from grape seed extract demonstrated more prominent growth inhibition, as well as apoptosis-inducing, properties on CAL27 cells. These observations provide evidence that cranberry and grape seed extracts not only inhibit oral cancer proliferation but also that the mechanism of this inhibition may function by triggering key apoptotic regulators in these cell lines. This information will be of benefit to researchers interested in elucidating which dietary components are central to mechanisms involved in the mediation of oral carcinogenesis and progression.

Analysis of oral cancer epidemiology in the US reveals state-specific trends: implications for oral cancer prevention.

BACKGROUND: Downward trends have been observed in oral cancer incidence and mortality in the US over the past 30 years; however, these declines are not uniform within this population. Several studies have now demonstrated an increase in the incidence and mortality from oral cancers among certain demographic groups, which may have resulted from increased risks or risk behaviors. This study examines the underlying data that comprise these trends, to identify specific populations that may be at greater risk for morbidity and mortality from oral cancers. METHODS: Oral cancer incidence and mortality data analyzed for this study were generated using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. RESULTS: While oral cancer incidence and mortality rates have been declining over the past thirty years, these declines have reversed in the past five years among some demographic groups, including black females and white males. Sorting of these data by state revealed that eight states exhibited increasing rates of oral cancer deaths, Nevada, North Carolina, Iowa, Ohio, Maine, Idaho, North Dakota, and Wyoming, in stark contrast to the national downward trend. Furthermore, a detailed analysis of data from these states revealed increasing rates of oral cancer among older white males, also contrary to the overall trends observed at the national level. CONCLUSION: These results signify that, despite the declining long-term trends in oral cancer incidence and mortality nationally, localized geographic areas exist where the incidence and mortality from oral cancers have been increasing. These areas represent sites where public health education and prevention efforts may be focused to target these specific populations in an effort to improve health outcomes and reduce disparities within these populations.

Research enrichment: evaluation of structured research in the curriculum for dental medicine students as part of the vertical and horizontal integration of biomedical training and discovery.

BACKGROUND: Research programs within medical and dental schools are important vehicles for biomedical and clinical discovery, serving as effective teaching and learning tools by providing situations in which predoctoral students develop problem-solving and critical-thinking skills. Although research programs at many medical and dental schools are well-established, they may not be well integrated into the predoctoral curriculum to effectively support the learning objectives for their students. METHODS: A series of structured seminars, incorporating faculty research, was designed for first-year dental students at the University of Nevada, Las Vegas, School of Dental Medicine to reinforce and support the concepts and skills taught in concurrent courses. A structured research enrichment period was also created to facilitate student engagement in active research using faculty and student curricular release time. Course evaluations and surveys were administered to gauge student perceptions of the curricular integration of research, the impact of these seminars on recruitment to the research program, and overall levels of student satisfaction with research enrichment. RESULTS: The analysis of course surveys revealed that students perceived the research-containing seminars effectively illustrated concepts, were logically sequenced, and were well-integrated into their curriculum. In addition, analysis of surveys revealed that the Integration Seminar courses motivated students to engage in research enrichment. Finally, this analysis provided evidence that students were very satisfied with their overall learning experience during research enrichment. CONCLUSION: Curricular integration is one method of improving the teaching and learning of complicated and inter-related concepts, providing an opportunity to incorporate research training and objectives into traditionally separate didactic courses. Despite the benefits of curricular integration, finding the most appropriate points of integration, obtaining release time for curricular development and for research engagement, and funding predoctoral student research remain issues to be addressed in ways that reflect the character of the faculty and the goals of each institution.

Recent admissions trends at UNLV-SDM: perspectives on recruitment of female and minority students at a new dental school.

As the U.S. population continues to become more diverse, there has been a movement toward the recruitment of more diverse students into the dental profession. The purpose of this study was to assess the current and historical trends in diversity among dental school applicants and enrollees at a new dental institution, the University of Nevada, Las Vegas, School of Dental Medicine (UNLV-SDM). Applicant and enrollment data for the first four cohorts, sorted by gender and ethnicity, were retrieved and summarized by the Office of Admissions and Student Affairs at UNLV-SDM. The principal findings of this analysis revealed enrollment of females at UNLV-SDM was relatively consistent during this time interval, although significantly lower than the U.S. average of all dental schools. The enrollment of minorities at UNLV-SDM, however, was consistent and comparable to the U.S. average, although these percentages were disproportionately smaller than the percentage of minorities in the general population. Based upon these findings, a new model for outreach and recruitment of females and minorities was recently created, based in part upon evidence of successful strategies by dental educators at other institutions, in order to increase the enrollment of female and underrepresented minority students.

Oral squamous cell carcinoma proliferative phenotype is modulated by proanthocyanidins: a potential prevention and treatment alternative for oral cancer.

BACKGROUND: Despite the recently reported drop in the overall death rate from cancer, the estimated survival rate and number of deaths from oral cancer remain virtually unchanged. Early detection efforts, in combination with strategies for prevention and risk-reduction, have the potential to dramatically improve clinical outcomes. The identification of non-toxic, effective treatments, including complementary and alternative therapies, is critical if the survival rate is to be improved. Epidemiologic studies have suggested a protective effect from certain plant-derived foods and extracts; however, it has been difficult to isolate and identify the compounds most responsible for these observations. The primary purpose of this study was to investigate the response of human oral squamous cell carcinoma (OSCC) to proanthocyanidin (PAC), a plant-derived compound that may inhibit the progression of several other cancers. METHODS: Using a series of in vitro assays, we sought to quantify the effects of PAC on OSCC, cervical carcinoma, and non-cancerous cell lines, specifically the effects of PAC on cell proliferation. Recent data suggest that infection with the human papillomavirus (HPV) may also modulate the proliferative potential of OSCC; therefore, we also measured the effects of PAC administration on HPV-transfected OSCC proliferation. RESULTS: Our results demonstrated that PAC administration was sufficient to significantly suppress cellular proliferation of OSCC in a dose-dependent manner. In addition, the increased proliferation of OSCC after transfection with HPV 16 was reduced by the administration of PAC, as was the proliferation of the cervical cancer and non-cancerous cell lines tested. Our results also provide preliminary evidence that PAC administration may induce apoptosis in cervical and oral cancer cell lines, while acting merely to suppress proliferation of the normal cell line control. CONCLUSION: These results signify that PAC may be a compelling candidate for testing in both animal and human models. Furthermore, these data provide adequate justification for elucidating the divergent mechanisms of PAC-induced proliferation, inhibition, and apoptosis among these and other cell lines.

Creating an evidence-based admissions formula for a new dental school: University of Nevada, Las Vegas, School of Dental Medicine.

This article reports development of an evidence-based admissions formula that effectively incorporates the admissions criteria most likely to influence dental school performance. This study utilized peer-reviewed literature and analysis of admissions and performance data from the first three classes of students at the University of Nevada, Las Vegas, School of Dental Medicine (UNLV-SDM). We used Pearson's correlation, linear regression, and ANOVA to determine the strength and direction of association between admissions variables, both singly and in combination, and performance measures. Our initial results revealed no significant relationship between our previous admissions formula, which was adapted from other dental admissions offices, and student performance for our first class and National Board Dental Examination Part I (NBDE-I) (R=.288) or dental school grade point average (DS-GPA) (R=0.193). After using the combined data from the first three classes of students at UNLV-SDM, we confirmed no significant relationship between our previous admissions formula and DS-GPA (R=0.207) and a slight increase in correlation to NBDE-I (R=0.303). More detailed analysis of the admissions variables within the formula revealed that some Dental Admission Test scores, such as Reading Comprehension, Quantitative Analysis, and Biology, were significantly correlated with dental school performance at UNLV-SDM, allowing for revision of the admissions formula to a formula score that is now significantly correlated with student performance for the first class to NBDE-I (R=0.458) and DS-GPA (R=0.368), as well as the combined data from the first three cohorts at UNLV-SDM (R=0.361, 0.218, respectively). In addition, this reformulation did not significantly impact the overall ranking of females or minorities. Although formulaic data can never perfectly predict student performance, this study demonstrated that constant review and revision of relevant admissions criteria are needed for each school to maintain an evidence-based admissions program that provides for fair and effective comparison of student admissions data.

The integration seminar: a first-year dental course integrating concepts from the biomedical, professional, and clinical sciences.

This study describes the planning, implementation, and evaluation of a seminar course designed to facilitate discussion and understanding of cross-disciplinary concepts by first-year dental students. Dental and medical schools are implementing integrated curricula in which clinical courses are taught early in the curriculum and the clinical and basic sciences are taught not only concurrently, but in an integrated manner. This first-year course, Integration Seminar, was developed to cross traditional subject and departmental boundaries with the intent of fostering dental care providers who understand the interdependence of the major concepts within these areas. This report describes the development and structure of the Integration Seminar. Furthermore, student perception of this course was determined by evaluating year-end course surveys, and student performance outcomes were measured by comparing student scores on the National Board Dental Examination Part I (NBDE-I) prior to and after the inception of this course. We determined that a substantial majority of students recognized the integrated nature of the course. In addition, NBDE-I scores were significantly higher for the cohorts of students who had participated in the course, although this observation is likely dependent upon many other factors. This report may thus provide a course model for other schools with a similar goal of achieving an integrated curriculum.

Transfection of oral squamous cell carcinoma with human papillomavirus-16 induces proliferative and morphological changes in vitro.

BACKGROUND: Human papillomavirus has been implicated in virtually all cervical cancers and is believed to be the primary etiological factor that transforms cervical epithelia. The presence of HPV in oral cancers suggests that HPV may play a similar role in transforming the oral epithelia. The prevalence of HPV in oral cancers is highly variable, however, presenting problematic issues regarding the etiology of oral cancers, which must be investigated more thoroughly. Past analyses of HPV in cancers of the oral cavity have largely been confined to retrospective studies of cancer patients. The purpose of this study was to examine the potential for HPV16 infection to alter the proliferative phenotype of oral squamous cell carcinoma in vitro. RESULTS: This study found that the oral squamous cell carcinoma cell line, CAL27, transfected with HPV16, exhibited significantly increased proliferation, compared with non-transfected CAL27. The increased proliferation was observed under low density conditions, even in the absence of serum. Moreover, these effects were specific to proliferation, adhesion, and morphology, while cell viability was not affected. CONCLUSION: This study represents one of the first investigations of the effects of HPV16 infection on the proliferation, adhesion, and morphology of an oral squamous cell carcinoma cell line in vitro. The finding that HPV16 has the ability to measurably alter adhesion and proliferative potential is significant, indicating that HPV may have multiple influences on precancerous and cancerous lesions and should be explored as a risk factor and mediator of cancer phenotypes. These measurements and observations will be of benefit to researchers interested in elucidating the mechanisms of oral cancer transformation and the factors governing carcinogenesis and progression.

Inhibition of oral cancer growth in vitro is modulated through differential signaling pathways by over-the-counter proanthocyanidin supplements.

BACKGROUND: Approximately 30,000 people are diagnosed with oral cancer annually in the United States. Recent evidence suggests that nutrition may play a more complex role in the prevention of oral cancers than previously believed. Proanthocyanidins (PACs) are a class of compounds found in normal dietary foods that exhibit chemopreventive properties and chemotherapeutic potential. Recently preliminary evidence suggests that PACs inhibit the proliferation of oral cancer cell lines. The primary goal of this study was to elucidate the mechanisms responsible for previous observations that grape seed-derived PACs significantly inhibited oral cancer proliferation. METHODS: Using the well-characterized oral squamous cell carcinoma cell lines, CAL27 and SCC25, as well as nontumorigenic cell lines, a series of in vitro assays was performed to quantify the temporal and dose-specific growth inhibitory properties of PAC on oral cancers. In addition, quantitative analysis of mRNA from key intracellular signaling pathway molecules, involved in both cell-cycle control and apoptosis, were analyzed using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). RESULTS: This study found that oral cancer proliferation was inhibited by 24 hours in the PAC concentration range of 50-70 µg/mL with concomitant decreases in mRNA expression of specific cell-cycle regulators, and increases in the expression of apoptosis-specific molecules, such as caspase-2 and caspase-8. CONCLUSION: These results may represent the first demonstration of simultaneous, temporal inhibition of cell-cycle signaling pathways with the activation of specific apoptosis-related signaling pathways within oral cancers in response to PAC, lending further support to the concept that PACs may be promising candidates for adjuvant or complementary therapies for oral cancer patients.

Analysis of primary risk factors for oral cancer from select US states with increasing rates.

OBJECTIVES: To examine the primary risk factor for oral cancer in the US, smoking and tobacco use, among the specific US states that experienced short-term increases in oral cancer incidence and mortality. METHODS: Population-based data on oral cancer morbidity and mortality in the US were obtained from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) database for analysis of recent trends. Data were also obtained from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) to measure current and former trends of tobacco usage. To comprehensive measures of previous state tobacco use and tobacco-related policies, the Initial Outcomes Index (IOI, 1992-1993) and the Strength of Tobacco Control index (SoTC, 1999-2000) were also used for evaluation and comparison. RESULTS: Analysis of the NCI-SEER data confirmed a previous report of geographic increases in oral cancer and demonstrated these were state-specific, were not regional, and were unrelated to previously observed increases among females and minorities. Analysis of the CDC-BRFSS data revealed these states had relatively higher percentages of smokers currently, as well as historically. In addition, analysis of the IOI and SoTC indexes suggest that many factors, including cigarette pricing, taxes and home or workplace bans, may have had significant influence on smoking prevalence in these areas. Trend analysis of these data uncovered a recent and significant reversal in smoking rates that suggest oral cancer incidence and mortality may also begin to decline in the near future. CONCLUSION: Due to the rising costs of health care in the US and the limited resources available for health prevention efforts, it is essential to organize and direct more effective efforts by public health officials and epidemiologists, as well as funding from local, state and federal governments, to reduce and eliminate identified health disparities. This study provides evidence how these efforts may be directed to specific geographic areas, and towards the white males, previously thought to be unaffected by the increases in oral cancer among females and minorities.

High risk HPV types 18 and 16 are potent modulators of oral squamous cell carcinoma phenotypes in vitro.

BACKGROUND: Human papillomavirus (HPV) has been confirmed as the primary etiological factor that transforms cervical epithelia into cancer. The presence of HPV in oral cancers suggests that HPV may play a similar role in transforming the oral epithelia. A high degree of variability in the prevalence of HPV in oral cancers has been found, however, raising questions regarding its role in the transformation and development of oral cancers. The goal of this study was to test our hypothesis that high-risk HPV strains HPV16 and HPV18 will alter the phenotype of transformed oral squamous cell carcinoma cell lines, CAL27, SCC-15 and SCC-25 in vitro. RESULTS: CAL27 cells transfected with HPV18, HPV16, as well as HPV16/18 co-transfectants, demonstrated significant increases in proliferation, adhesion and cell spreading compared with non-transfected controls. These observed differences were correlated with a small level of increased cell survival. SCC-15 cells, however, displayed a differential response to HPV transfection, with only HPV18-transfectants demonstrated changes to proliferation. Interestingly, SCC-25 cells displayed a more complex response, with HPV16-induced increases in cell proliferation, viability and cell spreading, while HPV18- and 16/18-transfectants exhibited reduced adhesion and proliferation. CONCLUSION: Determining the potential of specific high-risk HPV strains to alter phenotypic behaviors of already transformed oral carcinomas is a critical step in providing more accurate prognosis and treatment options for oral cancer patients. The identification of differential responses to specific HPV strains among oral cancers suggests a more significant, complex and multifactorial role of HPV, not only in transforming, but also in modulating, the phenotype and treatment responsiveness of precancerous and cancerous oral lesions. This study provides some of the first evidence to help identify the important molecular markers for pathways that could be used to determine the most effective and appropriate treatment plans for oral cancer patients with concomitant oral HPV infections.