Rate of occult metastasis in lip squamous cell carcinoma: A systematic review and meta-analysis.

OBJECTIVES: The rate of occult metastasis in lip cancer is poorly studied. Management of the regional nodal basin in lip cancer is thus controversial. This study sought to understand the true rate of micrometastasis in lip cancer. MATERIALS AND METHODS: Systematic review and meta-analysis was conducted of English language studies reporting lip cancer sentinel node biopsy results. Studies were obtained from the PubMed database between the years 2000 and 2023 using the search terms "sentinel node biopsy" and "squamous cell carcinoma." Random effect and fixed effect meta-analyses were performed. RESULTS: Thirteen studies met inclusion criteria. Low heterogeneity was noted among the studies, as indicated by the I2 inconsistency test (I2 = 0%). The rate of occult metastasis ranged between 0 and 33% (mean 9%). A total of 189 lip sentinel node biopsies had been performed. Of these, 21 revealed occult nodal metastasis (11.1%, 95% CI 7.36%-16.44%). One step, generalized linear mixed modeling revealed the true rate of occult nodal metastasis to be 10% (95% CI (0.0504, 0.1746), p < 0.0001). CONCLUSION: The rate of occult metastasis in lip cancer approaches the threshold for elective management of the regional nodal basin. Sentinel node biopsy is optimally suited for management of high-risk early T stage lip cancer.

The L1 family of cell adhesion molecules: a sickening number of mutations and protein functions.

L1-type proteins are transmembrane cell adhesion molecules with an evolutionary well-conserved protein domain structure of usually six immunoglobulin and five fibronectin type III domains. By engaging in many different protein-protein interactions they are involved in a multitude of molecular functions and are important players during the formation and maintenance of metazoan nervous systems. As a result, mutations in L1-type genes cause a great variety of phenotypes, most of which are neurological in nature. In humans, mutations in the L1CAM gene are responsible for L1 syndrome and other L1-type genes have been implicated in conditions as varied as mental retardation, autism, schizophrenia, multiple sclerosis, and other disorders. Equally, the overexpression of L1-type proteins appears to have deleterious effects in various types of human tumor cells, where they generally contribute to an increase in cell mobility and metastatic potential.

Variation in ambulatory surgery utilization in Michigan.

BACKGROUND: The practice of ambulatory surgery has expanded greatly as a result of advances in surgical technology and rising financial pressures. We sought to characterize the utilization of ambulatory surgical practices for common general surgical procedures in Michigan. MATERIALS AND METHODS: We identified 33,655 patients within the Michigan Surgery Quality Collaborative clinical registry undergoing general surgical procedures performed on an ambulatory basis between 25% and 75% of the time. Our primary outcome was the incidence of ambulatory surgery. Using multilevel mixed-effects logistic regression models, we adjusted ambulatory surgery utilization rates for patient comorbidities, procedure composition, and hospital characteristics. We then assessed the incidence of postoperative complications across hospitals grouped by their ambulatory surgery utilization rates. RESULTS: Adjusted utilization rates of ambulatory surgery varied widely across 34 hospitals from 29%-75% (mean = 54%). Risk-adjusted complication rates for ambulatory cases were similar between hospitals performing the least (2.2%) and the most ambulatory surgery (2.3%, P = 0.365). Patient factors and hospital characteristics accounted for 23.3% of the between-hospital variability in ambulatory surgery utilization, whereas most variation was explained by effects at the surgeon level. CONCLUSIONS: Despite wide variation in ambulatory surgery utilization for general surgical procedures, we were unable to explain observed differences by patient comorbidities, case mix, or hospital characteristics. These data suggest that understanding factors associated with ambulatory surgery utilization may represent a novel avenue for quality improvement within our statewide surgical collaborative.

A phylogenetic analysis of the L1 family of neural cell adhesion molecules.

L1-type genes form one of several distinct gene families that encode adhesive proteins, which are predominantly expressed in developing and mature metazoan nervous systems. These proteins have a multitude of different important cellular functions in neuronal and glial cells. L1-type gene products are transmembrane proteins with a characteristic extracellular domain structure consisting of six immunoglobulin and three to five fibronectin type III protein folds. As reported here, L1-type proteins can be identified in most metazoan phyla with the notable exception of Porifera (sponges). This puts the origin of L1-type genes at a point in time when primitive cellular neural networks emerged, approximately 1,200 to 1,500 million years ago. Subsequently, several independent gene duplication events generated multiple paralogous L1-type genes in some phyla, allowing for a considerable diversification of L1 structures and the emergence of new functional features and molecular interactions. One such evolutionary newer feature is the appearance of RGD integrin-binding motifs in some vertebrate L1 family members.