Nanomedicine and nanoparticle-based delivery systems in plastic and reconstructive surgery.

BACKGROUND: Nanotechnology and nanomedicine are rising novel fields in plastic and reconstructive surgery (PRS). The use of nanomaterials often goes with regenerative medicine. Due to their nanoscale, these materials stimulate repair at the cellular and molecular levels. Nanomaterials may be placed as components of nanocomposite polymers allowing enhancement of overall biochemical and biomechanical properties with improved scaffold properties, cellular attachment, and tissue regeneration. They may also be formulated as nanoparticle-based delivery systems for controlled release of signal factors or antimicrobials, for example. However, more studies on nanoparticle-based delivery systems still need to be done in this field. Nanomaterials are also used as frameworks for nerves, tendons, and other soft tissues. MAIN BODY: In this mini-review, we focus on nanoparticle-based delivery systems and nanoparticles targeting cells for response and regeneration in PRS. Specifically, we investigate their roles in various tissue regeneration, skin and wound healing, and infection control. Cell surface-targeted, controlled-release, and inorganic nanoparticle formulations with inherent biological properties have enabled enhanced wound healing, tumor visualization/imaging, tissue viability, and decreased infection, and graft/transplantation rejection through immunosuppression. CONCLUSIONS: Nanomedicine is also now being applied with electronics, theranostics, and advanced bioengineering technologies. Overall, it is a promising field that can improve patient clinical outcomes in PRS.

Publishing in education: A parallel session at the IUBMB/PSBMB 2019 "Harnessing Interdisciplinary Education in Biochemistry and Molecular Biology" conference.

Ensuring currency with trends, knowledge, and understanding of teaching and learning is essential for all educators. Researching learning and teaching is an enormous field which can range from examining the practical impact of new classes to research into the processes of learning. The "Publishing in Education" conference session discussed some of the approaches and outcomes of researching and publishing in education.

Case Report: Massive epistaxis from juvenile angiofibroma in an adolescent with severe haemophilia A.

Epistaxis may be profuse in individuals with normal bleeding parameters, but in an individual with haemophilia, it may be life-threatening. It is even more dangerous when epistaxis is caused by an undetected concomitant juvenile angiofibroma, and only one such case has been reported in the English literature. We report another case, of an 18-year-old Filipino adolescent with severe haemophilia A who was referred for repeated massive epistaxis. The epistaxis had been attributed to his haemophilia and managed with nasal packing, multiple blood transfusions and Factor VIII administration. After two years of unsuccessful management, nasal endoscopy was performed for the first time, revealing an intranasal mass. Imaging showed a right intranasal vascular tumour supplied mainly by the right sphenopalatine artery. He subsequently underwent preoperative embolization and endoscopic excision of the tumour with Factor VIII transfused pre-, intra-, and post-operatively, and recombinant Factor VII added post-operatively. Final histopathology was consistent with juvenile angiofibroma. There has been no nasal obstruction or recurrence of epistaxis seven years since the surgery. Clinicians should be more meticulous in assessing epistaxis in any patient with a bleeding disorder and investigate more subtle symptoms such as nasal obstruction. Verification of the source by direct visualization and ancillary diagnostic techniques (such as imaging) when indicated should be the standard of care for all patients presenting with epistaxis, whether or not a concomitant bleeding disorder exists. A high index of suspicion for juvenile angiofibroma should be maintained in adolescent males with epistaxis and nasal obstruction.

External Auditory Canal Dimensions, Age, and Cerumen Retention or Impaction in Persons With Down Syndrome.

OBJECTIVE: To investigate associations between age, external auditory canal (EAC) dimensions, and cerumen retention/impaction among persons with Down syndrome (DS). METHODS: This cross-sectional study evaluated EAC dimensions, cerumen retention/impaction, and middle ear status with pneumatoscopy after extraction in 130 persons with DS. Descriptive and inferential statistics correlated age, presence of impacted/retained cerumen, and EAC diameter. RESULTS: Of 260 ears in 67 males and 63 females with average age of 9.48 years, 72.3% (188) had EAC of ≤4 mm. Those ≤1 year were 4.97 times more likely to have cerumen problems than those >1 year (95% CI, 1.45-17.02, P = .011). The odds of having cerumen problems with an EAC diameter of ≤4 mm were 3.31 times higher than with a diameter of 5 mm (95% CI, 1.46-7.50, P = .004), and odds of having cerumen impaction were as much as 6.19 times higher (95% CI, 2.38-16.08, P < .001). Male gender and low-lying external ear were also associated with increased odds of cerumen problems. CONCLUSION: There is a high prevalence of cerumen retention/impaction in persons with DS compared to the general Philippine population and a higher prevalence rate for EAC stenosis than elsewhere. A canal diameter of 4 mm and below and age 1 year or less are associated with a significantly higher likelihood of cerumen retention/impaction.

Validity and Reliability of the Filipino Reflux Symptom Index.

OBJECTIVES: This study aimed to establish validity and reliability of the Filipino Reflux Symptom Index (FRSI) and to test it among patients with laryngopharyngeal reflux (LPR) before and after 6 months' trial of rabeprazole. STUDY DESIGN: A case-control study was carried out. METHODS: There were 35 LPR patients and 30 controls who were twice-administered the FRSI and Filipino Voice Handicap Index (FVHI) for test-retest reliability, and videostroboscopy was performed to obtain baseline reflux finding scores (RFSs). Patients took rabeprazole 20 mg twice daily for 6 months. The FRSI and FVHI were readministered a third time, repeat videostroboscopy was performed, and repeat RFS was obtained. Reliability, validity, and internal consistency were computed. RESULTS: A total of 58 participants, 29 patients and controls each, aged 22-65 years completed the study. FVHI 2:1 and FRSI 2:1 significantly correlated with no significant differences between FRSI 2:1. FRSI had good item-total correlations indicating psychometrically sound items. There were significant differences between patients and controls for FRSI scores and mean scores. FRSI 3 scores were significantly lower than FRSI 1 scores, suggesting symptoms improved after treatment. There were no significant differences between RFS 2 and 1. Significant differences between FRSI 3 and 1, but not between FVHI 3 and 1, suggest the FRSI was more sensitive to changes in reflux after 6 months' intervention than the FVHI. CONCLUSIONS: The FRSI is a valid and reliable tool for assessing LPR symptoms and may be used for primary care screening among Filipinos. Initial response to a 2-week empirical proton pump inhibitor trial may support an impression of LPR; non-response warrants specialist referral for further investigation.

Transient bilateral vocal fold paralysis after total thyroidectomy.

Vocal fold paralysis is a serious complication of thyroidectomy that is worrisome for health providers and potentially disastrous for the patient and family. A 56-year-old woman presented with bilateral vocal fold paralysis immediately after routine thyroidectomy and neck dissection for a large goiter with compressive symptoms. She was extubated the next day with full recovery of vocal fold motion. We discuss possible causes of vocal fold paralysis, including surgical, metabolic and anesthetic factors.

Oral Hemorrhage in a 3-year-old Boy Caused by Self-Mutilating Behavior.

A 3-year-old boy referred for persistent tongue bleeding was diagnosed with a rare self-mutilating disease that had also affected his lip and fingers. He underwent multiple odontectomy and partial glossectomy and continues to undergo behavior therapy and on-demand splints and restraints. He has stopped self-biting and has gained appetite and weight. Lesch-Nyhan Syndrome can cause significant morbidity including self-inflicted oral hemorrhage and emergent measures are not easily decided. The long-term management of its neurobehavioral symptoms is problematic and multidisciplinary, and health providers remain challenged to find the best treatment, prolong lifespan and improve quality of life within their respective contexts.

An initial survey of septorhinoplasty in crooked nose deformities

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Crooked  nose  deformity  is  a  commonly  seen  reason  for  septorhinoplasty  in  the otolaryngology clinic. The purpose of this study is to initially determine the different etiologies of  patients  with  crooked  nose  deformities  who  underwent  septorhinoplasty,  and  to  describe the different types of crooked nose by their level of deviation and surgical management in our institution.<br /><strong>METHODS:</strong><br /> <strong>  Design:</strong> Case Series<br />  <strong> Setting:</strong> Tertiary Public University Hospital<br /> <strong> Participants:</strong> A chart review of all patients with a crooked nose deformity who were admitted  at the otorhinolaryngology ward of the National University Hospital and underwent septorhinoplasty from January 2012 to January 2015 was conducted, and data consisting of age, sex, etiology of crooked nose deformity, level of deviation, cartilage source, and surgical intervention were obtained and analyzed.<br /><strong>RESULTS:</strong> A total of 21 patients underwent septorhinoplasty for crooked nose deformity  in  the study period. The most common etiology for crooked nose was physical violence (13/21 or 62%), followed by sports injury (4/21 or 19%), vehicular accidents (2/21 or 9%), and accidental fall (1/21 or 5%). There were more upper and middle third deviations than lower third deviations. Sixteen out of 21patients  (76%) underwent  open  rhinoplasty,  while  the  rest underwent an endonasal approach. Twelve (57%) underwent intervention  on  the  nasal  fracture after at least a year (old or  neglected  fracture) as compared to the 9 (43%) who had  immediate intervention after less than two weeks. Thirteen used septal cartilage, while 4 used conchal cartilage, and 1 used tragal cartilage. The most common grafts used were spreader  and camouflage, followed closely by dorsal onlay, and columellar strut grafts.<br /><strong>CONCLUSION:</strong> The majority of crooked nose deformities that were subjected to septorhinoplasty in our department were secondary to old nasal bone fractures caused by physical violence. Upper and middle  third level deviations were more common, and most underwent open rhinoplasty with autologous cartilage grafts. Future studies may increase our understanding of, and improve our techniques in septorhinoplasty for crooked nose deformities in Filipino noses in particular, and Asian noses in general. </p>

Advancing access to health information and publication: shifting paradigms, trends and innovations

@#<p>The World Health Organization Constitution "enshrines the highest attainable standard of health as a fundamental right of every human being. The right to health includes access to timely, acceptable, and affordable health care of appropriate quality ... as well as the underlying determinants of health, such as ... access to health-related education and information."1 On the other hand, "social determinants of health can themselves pose barriers to education ... and 'damaged brains and bodies' cannot learn optimally."2 While there are no clear-cut solutions to such multifactorial issues involving complex-systems, the sustainable developmental goals of the United Nations development agenda beyond 2015 address both health and education.3<br /> <br /> Health research fundamentally underpins the key aspiration of the sustainable development goals to realize universal health coverage.3 It is the responsibility of researchers and publishers to make this research available and accessible to all those who need it, in order to assist policymakers and practitioners to progressively realize the right to health of every global citizen. It would seem that the speed and reach of present-day information and communication technology would have facilitated the dissemination of health information. "However, despite the promises of the information revolution, and some successful initiatives, there is little if any evidence that the majority of health professionals in the developing world are any better informed than they were 10 years ago."4 This observation made over a decade ago still holds true today. <br /> <br /> How can we advance access to health information and publication in our current "glocal" situation? How can the health information produced by research conducted by our students, residents and fellows, be shared with all those who may need and use the information? The Philipp J Otolaryngol Head Neck Surg has been actively pursuing multiple means of ensuring the availability of our research and innovation through traditional means, including indexing on various Index Medici and databases. While our visibility has increased dramatically in the 10 years of my editorship, we need to explore new paradigms, trends and innovations, especially with regard the social media. This includes using Facebook, Twitter, LinkedIn and RSS feeds, to name a few. It also calls us to consider the transition to a full open access model and adopting Creative Commons licenses.<br /> <br /> It is timely that the Asia Pacific Association of Medical Journal Editors (APAME) will explore this very theme of shifting paradigms, trends and innovations in advancing access to health information and publication in the forthcoming APAME2015 Annual Convention and Joint Meeting with the Western Pacific Region Index Medicus at the Sofitel Philippine Plaza and WHO Western Pacific Region Office from August 24-26 (http://apame2015.healthresearch.ph) in conjunction with the Global Health Forum 2015 at the Philippine International Convention Center (http://www.forum2015.org). <br /> <br /> Close to a thousand editors, reviewers, authors, researchers, librarians, and publishers of medical journals from Asia Pacific states, local delegates representing various institutions and organizations, including the Department of Science and Technology - Philippine Council for Health Research and Development (PCHRD), Department of Health, University of the Philippines Manila, Medical and Health Librarians Association of the Philippines (MAHLAP), the Philippine Medical Association, the Philippine Nursing Association, the Philippine Dental Association and others will exchange ideas in three days of meetings, scientific sessions and workshops. At the same time, the over 70 conjoint Forum 2015 sessions across 2 tracks covering 6 themes will provide "a platform where several other thousand key global actors in health gather to learn, debate and shape the global agenda on research and innovation for health, to arrive at new solutions that are driving health equity and socio-economic development."<br /> <br /> Whether you are a beginning researcher or a seasoned scientist, a novice trainee or senior subspecialist, a community-based health worker or health policy-maker, there will be something for you to learn and share at these meetings that recognize "people (are) at the center of health research and innovation." Medical and health professions students, ORL-HNS residents and consultants of all training and academic institutions are particularly enjoined to participate in this rare opportunity that will benefit us as well as the people we serve. <br /> <br /> Meet me at the Forum!</p>

From here and now to infinity and eternity: a message to new medical doctors(*).

Commencement means both an end and a beginning; the end of the academic year and the beginning of the rest of your life as new physicians. For such a beginning, it is useful to view it in retrospect, from the point of view of the end, by conducting a pre-mortem on your life. Taking the existentialist (ex sistere, to stand forth) stance, each of us can be classified into one of four basic types of person, based on our characteristic space and time (or spatio-temporal) context or horizon. Our space can be limited to the "here" and our time to the "now;" or our space may extend to "infinity" and our time embark on "eternity." In-between these poles, most have space contexts rooted in their home and work "turf" and time involving their "lifetime," while some expand their space to include the "world" and their time to encompass "history." From the "here and now" and "turf and lifetime" contexts, the horizons of "world and history," and "infinity and eternity" are examined, challenging new medical doctors to realize their full potential. The new physician is exhorted not to wait for a post-mortem to define (des finitus, to set limits) his or her life. He or she should stand forth, to live, and give life. The new medical doctor is encouraged to look to the sunrise, draw strength from the sunshine, to be brave, and strong and true.

Arco-palato-uvular flap: a new surgical technique for the treatment of palatal snoring in tonsillectomized patients.

OBJECTIVES: We describe a new surgical technique called "arco-palato-uvular flap (APUF)" which can be used for the surgical management of palatal snoring in previously tonsillectomized patients. PATIENTS AND METHODS: Among patients who were admitted to the Military Hospital of Novi Sad between January 2000 and December 2004, 36 patients (19 males, 17 females; mean age 45.3 years; range 21 to 60 years) who had previously undergone tonsillectomy for various reasons and who were thought to have palatal snoring based on physical and endoscopic examinations were evaluated on the basis of the visual analog scale (VAS), Epworth sleepiness scale (EPSS) and apnea hypopnea index (AHI) scores and underwent APUF surgery after giving informed consent. RESULTS: Twenty-seven patients with a body mass index (BMI) of <30 kg/m2 had socially-bothersome snoring and nine had mild sleep apnea (AHI 5-15/hour, SO2 >90%). The mean visual analog scale scores were 8.6 ± 1.0 preoperatively and 2.3 ± 1.5 postoperatively. The Epworth Sleepiness Scale scores averaged 10.0 ± 3.0 preoperatively and 4.0 ± 1.0 postoperatively. In patients with mild apnea, the average preoperative AHI was 11.58 ± 3.58 and dropped to 4.75 ± 2.92 postoperatively. Statistical analysis revealed significant reductions in all variables (p<0.001). CONCLUSION: The APUF procedure may treat palatal snoring and mild obstructive sleep apnea in previously tonsillectomized patients by widening the oropharyngeal airway, and stabilizing the uvulopalatal segment. Further studies are needed to determine the long-term success rates of the technique and to modify the patient selection and exclusion criteria.