Smoking Behaviors of General Educational Development (GED) Recipients.

OBJECTIVE: Cigarette smoking is inversely associated with education, and despite this gradient effect, individuals with a General Educational Development (GED) diploma, obtained through a high school equivalency test, have the highest smoking prevalence. Considered the high school equivalency credential, it is unclear why individuals with a GED have a substantially higher smoking prevalence compared to high school graduates and dropouts. We conducted a qualitative study to understand life experiences, tobacco use patterns, and perceptions of tobacco among GED smokers and attitudes and behaviors around smoking cessation. METHODS: We recruited 40 GED smokers aged 18 to 35 years and conducted surveys and semi-structured individual interviews. Transcripts were independently coded, then coding differences were resolved and reviewed by a third team member. We independently determined themes within and between codes and met to determine final themes. RESULTS: GED recipients had many early life experiences and characteristics that made them highly vulnerable to tobacco dependence. With perceived high cognitive abilities, GED smokers were knowledgeable of many evidence-based smoking cessation strategies and were aware of health risks. Health risks and the financial burden of smoking were motivation to quit. The majority were uninterested or lacked confidence that nicotine replacement therapy, medications, counseling, or the quitline could help them quit. Nearly all were enthusiastic and confident that financial incentives had the potential to help them quit. CONCLUSIONS: Research is needed to determine whether financial incentives could improve smoking cessation outcomes in this unique population with an unequal burden of smoking.

Young adults' intention to quit using JUUL.

BACKGROUND: With research indicating some young audiences may desire to quit using JUUL, a high-nicotine e-cigarette, we sought to explore factors that may motivate them to quit. METHODS: This sequential, mixed methods study included a cross-sectional online survey of college students (n = 631) followed by in-person interviews (n = 51) with survey participants. Data were collected March-April 2019. The survey asked about intention to quit using JUUL. A latent class analysis (LCA) identified participant groups who would quit for various reasons. Participants were also asked 'Can you be too old to JUUL?' during the survey. During the interviews, participants were provided preliminary survey findings and asked about their perceptions of the data. Interview participants were also asked about their expectations for future use of JUUL. RESULTS: Four classes emerged from the LCA, indicating costs to self (i.e., harm to lungs/brain, price; 46.8%), financial costs (36.6%), all costs (e.g., social, monetary, health; 9.3%), and harm to self (7.3%) may have influenced our sample's decision to quit using JUUL. Interviewees affirmed desires to quit using JUUL, especially after leaving college. Only 27.19% of survey participants reported an age threshold for using JUUL (M = 31.8 years, SD = 10.0); however, several interviewees explained that although someone could not be too old to JUUL, it would be 'immature' or 'childish' for adults who were not trying to quit smoking to use JUUL socially. DISCUSSION: Comprehensive tobacco control strategies such as taxing e-cigarettes, marketing campaigns, and nicotine cessation programs are needed to help nicotine dependent young adults quit using high-nicotine e-cigarettes.

Oxalate uptake by everted sacs of rat colon. Regional differences and the effects of pH and ricinoleic acid.

Hyperoxaluria is a complication of disorders associated with steatorrhea. The colon is the presumed site of enhanced oxalate absorption in patients with steatorrhea. We performed studies of colonic mucosal oxalate uptake in everted sacs of rat colon to determine the kinetics of colonic oxalate transport and to evaluate the effect of both pH and ricinoleic acid, a hydroxy fatty acid, on colonic oxalate uptake. Our study demonstrated that oxalate is transported throughout the colon by passive diffusion. Tissue uptake increased linearly with increasing oxalate concentrations and was unaffected by metabolic inhibitors, oxygen deprivation, or temperature changes. There were pH-dependent regional differences of oxalate uptake both in the presence and absence of ricinoleic acid. In the absence of ricinoleic acid, the highest oxalate uptake occurred at the lower pH values (5.4 and 6.4). In the presence of ricinoleic acid oxalate uptake was enhanced at the higher pH values (7.4 and 8.4); a finding most likely related to decreased solubility of ricinoleic acid at pH 5.4 and 6.4. Intraluminal pH is an important determinant of colonic oxalate uptake in the presence and absence of ricinoleic acid.

Paired associate learning in senile dementia of the Alzheimer type.

A study was conducted to examine the potential explicit learning ability in senile dementia of the Alzheimer type (SDAT) as a function of (1) the difficulty of the to-be-remembered material and (2) the severity of the dementia. The Associate Learning task from the Wechsler Memory Scale was administered to healthy older adults and individuals with questionable, mild, and moderate SDAT. Individuals with SDAT showed poorer learning performance across trials than healthy older adults. Individuals with questionable and mild SDAT did show evidence for learning across trials for highly related paired associates. For unrelated-paired associates, however, only individuals with questionable SDAT showed some evidence for increased learning across trials.

A polymer foam conduit seeded with Schwann cells promotes guided peripheral nerve regeneration.

Alternatives to autografts have long been sought for use in bridging neural gaps. Many entubulation materials have been studied, although with generally disappointing results in comparison with autografts. The purpose of this study was to design a more effective neural guidance conduit, to introduce Schwann cells into the conduit, and to determine regenerative capability through it in an in vivo model. A novel, fully biodegradable polymer conduit was designed and fabricated for use in peripheral nerve repair, which approximates the macro- and microarchitecture of native peripheral nerves. It comprised a series of longitudinally aligned channels, with diameters ranging from 60 to 550 microns. The lumenal surfaces promoted the adherence of Schwann cells, whose presence is known to play a key role in nerve regeneration. This unique channel architecture increased the surface area available for Schwann cell adherence up to five-fold over that available through a simple hollow conduit. The conduit was composed of a high-molecular-weight copolymer of lactic and glycolic acids (PLGA) (MW 130,000) in an 85:15 monomer ratio. A novel foam-processing technique, employing low-pressure injection molding, was used to create highly porous conduits (approximately 90% pore volume) with continuous longitudinal channels. Using this technique, conduits were constructed containing 1, 5, 16, 45, or more longitudinally aligned channels. Prior to cellular seeding of these conduits, the foams were prewet with 50% ethanol, flushed with physiologic saline, and coated with laminin solution (10 microg/mL). A Schwann cell suspension was dynamically introduced into these processed foams at a concentration of 5 X 10(5) cells/mL, using a simple bioreactor flow loop. In vivo regeneration studies were carried out in which cell-laden five-channel polymer conduits (individual channel ID 500 microm, total conduit OD 2.3 mm) were implanted across a 7-mm gap in the rat sciatic nerve (n = 4), and midgraft axonal regeneration compared with autografts (n = 6). At 6 weeks, axonal regeneration was observed in the midconduit region of all five channels in each experimental animal. The cross-sectional area comprising axons relative to the open conduit cross sectional area (mean 26.3%, SD 10. 1%) compared favorably with autografts (mean 23.8%, SD 3.6%). Our methodology can be used to create polymer foam conduits containing longitudinally aligned channels, to introduce Schwann cells into them, and to implant them into surgically created neural defects. These conduits provide an environment permissive to axonal regeneration. Furthermore, this polymer foam-processing method and unique channeled architecture allows the introduction of neurotrophic factors into the conduit in a controlled fashion. Deposition of different factors into distinct regions within the conduit may be possible to promote more precisely guided neural regeneration.

A modified transfacial approach to the clivus.

Anterior approaches to the clivus must provide excellent visualization of the lesion, give adequate access for dural repair, and be cosmetically acceptable. Most current approaches enter through the nasopharynx or oropharynx, with either palatal, maxillary, or mandibular splitting for greater exposure. We have modified the transfacial approach described by others, which provides excellent access to the clivus along its rostrocaudal extent. A lateral rhinotomy incision is used and carried along the base of the right alae nasi and columella. The nasal bones are osteotomized bilaterally, and the nose is rotated on a pedicle flap, thus opening the entire nasal cavity to view. The septum and medial maxillary walls are removed. This provides excellent visualization of the ethmoid, sphenoid, posterior nasopharynx, and upper oropharynx. At the conclusion of the procedure, the nasal incision is closed, with good cosmesis. A case of recurrent chordoma of the middle and lower clivus is presented to exemplify this technique. The approach has since been used to approach clivus tumors and midline aneurysms of the vertebrobasilar system.

Transfacial transclival approach for midline posterior circulation aneurysms.

OBJECTIVE: To evaluate the use of an anterior, transfacial transclival approach to midline posterior circulation aneurysms in five patients. SURGICAL APPROACH: A skin incision is made on the right side of the nose with subsequent bony and cartilaginous disarticulation of the nasal complex. The nose remains attached along the left side and is reflected laterally. Removal of the nasal septum and bilateral ethmoidectomy, medial maxillectomy (usually bilateral), and opening of the sphenoid yield a large triangular exposure of the anterior clivus. After removal of the clivus with a drill, the vertebral and basilar arteries are exposed through a midline dural opening. RESULTS: The approach provided excellent exposure of basilar artery trunk aneurysms with room available for temporary clip placement in three patients. In a fourth patient, a midline posterior inferior cerebellar artery aneurysm was clipped using this technique. A basilar trunk dissection was treated by proximal basilar occlusion through this exposure in a fifth patient. Although three patients developed transient cerebrospinal fluid leaks with symptoms of meningitis, no permanent neurological morbidity resulted from the use of the approach. CONCLUSION: The transfacial transclival approach to midline aneurysms of the basilar trunk and its branches provided excellent exposure for surgical treatment in five patients. No patient had postoperative palatal dysfunction and cosmetic results were excellent. Cerebrospinal fluid leak and meningitis continue to be the major drawbacks to the use of this approach, although the availability of modern broad-spectrum antibiotics lessens the chance of permanent neurological sequelae.

Automatic and attentional priming in young and older adults: reevaluation of the two-process model.

Three experiments addressed the distinction between automatic and attentional mechanisms underlying semantic priming effects by factorially crossing prime-target relatedness, expectancy, and SOA in a task (pronunciation) that minimized postlexical checking processes. Also, possible age-related (young vs. older adults) differences in the automatic and attentional mechanisms were addressed. Across all experiments there was evidence of a Relatedness x Expectancy x SOA interaction, which is inconsistent with the notion of independent automatic and attentional mechanisms in semantic priming and the notion of a self-encapsulated modular lexicon. The results also indicated age-related differences in the build-up of the expectancy effect across SOAs when the prime was visually available for only 200 ms, independently of the prime-target SOA (Experiments 1 and 3), but not when the prime was visually available throughout the SOA (Experiment 2).

The importance of mandibular position in microvascular mandibular reconstruction.

The challenge of mandibular reconstruction rests in the difficulty of re-creating the intricate three-dimensional relationship of the oral cavity, thereby ensuring occlusal relationships, oral competence, and facial contour. Recent advances in microvascular surgery have made reliable transfer of autologous tissue possible, hut successful reconstruction depends on accurate insetting of the bone flap. The authors reviewed their five years of experience with mandibular reconstruction and found six patients with a poor reconstructive result secondary to improper insetting of the bone flap. Anteromedially rotated and free-floating proximal mandibular segments appeared to be the most significant contributor to incorrect placement of the bone flap. Based on their findings, the authors devised a simple technique for stabilizing proximal mandibular segments.

Limited septoplasty as treatment for recurrent epistaxis in a child with Glanzmann's thrombasthenia.

Recurrent epistaxis can be a serious problem in children with coagulation disorders. We present a case of severe, recurrent nosebleeds in a 3-year-10-month-old boy with Glanzmann's thrombasthenia. The nature of Glanzmann's disease and medical treatment of epistaxis in children is reviewed. A method of controlling recurrent epistaxis with a very simple and limited septoplasty is described. This technique should be applicable to patients with recurrent nosebleeds and other more common coagulation disorders.

Early temporalis muscle transposition for the management of facial paralysis.

Temporalis muscle transposition is a reliable surgical technique for the reanimation of patients with long-standing facial paralysis. It is often employed when facial nerve reinnervation via crossover or cable grafting is not possible. Temporalis muscle transposition can also be used for the immediate treatment of complete facial paralysis due to insults leaving the facial nerve anatomically intact but requiring a prolonged recovery time (more than 1 year). Because temporalis muscle transposition does not interfere with neuronal regeneration, it may be employed early in the management of complete facial paralysis when recovery is predicted to be extended and incomplete. The authors report their experience with early temporalis muscle transposition in the management of facial paralysis in 56 patients with an anatomically intact facial nerve. More than 90% of these patients achieved improved symmetry at rest as well as purposeful movement at the corner of the mouth. In the last 30 patients, the temporoparietal fascial flap was simultaneously harvested and successfully used to obliterate the donor site defect. In conjunction with the immediate implantation of a gold weight in the ipsilateral upper eyelid, this approach to the early management of facial paralysis helps reduce the period of facial disability from years to weeks in a select group of patients.

Combining free flap reconstruction and craniofacial prosthetic technique for orbit, scalp, and temporal defects.

OBJECTIVES: To identify factors leading to successful application of prosthetic techniques following free flap reconstruction of the orbit, scalp, and temporal region. STUDY DESIGN: Retrospective review. METHODS: Twenty-eight patients who underwent free flap reconstruction for defects of these regions between 1989 and 1996 were reviewed for clinical parameters, flap loss, patient survival, and implant loss rate. Prosthetic usage rates were compared before and after introduction of a site-specific reconstructive algorithm. RESULTS: Free flap success rate was 93%, whereas osseointegrated implant loss rate was 11%. In addition to implants, a reconstructive strategy that provided thin, vascular tissue between bone and skin, a flat platform in the temporal region, and preservation of orbital cavity depth led to increased prosthetic usage. CONCLUSIONS: Craniofacial prosthetic techniques can significantly augment the results of free flap surgery for the orbit, scalp, and temporal region. Successful combination of these techniques requires a site-specific surgical approach.

Isolated uvulitis secondary to marijuana use.

Isolated uvulitis is a rarely reported disease. Known etiologies include bacterial infection and trauma following the use of instrumentation in the airway. Three cases of isolated uvulitis secondary to heavy marijuana smoke inhalation are reported. Specific recommendations regarding diagnosis and treatment of this disorder are made.

A novel, biodegradable polymer conduit delivers neurotrophins and promotes nerve regeneration.

OBJECTIVE/HYPOTHESIS: A wide variety of substances have been shown to promote neuritic extension after nerve injury. An obstacle to achieving the maximal benefit from these substances has been the difficulty in effectively delivering the substances over a protracted time course that promotes maximal, directed growth. In this study the delivery of a growth-promoting substance through a biodegradable conduit, using materials originally designed for drug delivery applications, was hypothesized to promote more robust neural regeneration than through conduits lacking the substance. The objectives of this study were to create a growth factor-loaded biodegradable nerve guidance conduit, and to assess in vivo nerve regeneration through the conduit compared with that through conduits lacking the substance. MATERIALS/METHODS: Inosine, a purine analogue thought to promote axonal extension following neural injury, was loaded into cylindrical polymer foams composed of a polylactide-co-glycolide copolymer. First, in vitro extravasation of inosine was measured over a several week period using spectrophotometry. Second, the foams were fashioned into single-channel cylindrical nerve guidance conduits via a novel, low-pressure injection molding technique. The conduits were then used to bridge 7-mm defects in the rat sciatic nerve (n = 8). Control conduits lacking inosine were implanted into another set of animals as controls (n = 12). RESULTS: In vitro spectrophotometric measurements indicated appreciable leaching of inosine from the loaded foams over a period of at least 9 weeks. In the in vivo model, after 10 weeks, a higher percentage cross sectional area composed of neural tissue existed through the inosine-loaded conduits compared with controls (mean 44%, SD 7.5% vs. 36%, SD 8.6%, respectively). A difference was also found in mean fiber diameter between the two groups, with the inosine-loaded tubes showing a statistically significantly larger diameter than controls (P < .05). CONCLUSIONS: A nerve regeneration conduit was successfully created that delivers growth promoting substances over a protracted time course. In an in vivo model, the presence of inosine, a purine analogue, yielded neural regeneration whose histological features suggest possible superior long-term motor function.

Blindness as a complication of rhinoplasty.

Blindness following elective cosmetic surgery can be a devastating complication, for the patient as well as the surgeon. A case of unilateral blindness secondary to central retinal artery occlusion following an open septorhinoplasty is presented. Possible causes of blindness following rhinoplasty and steps to prevent this complication are addressed.

The use of calvarial bone in nasal reconstruction.

OBJECTIVE: To demonstrate the utility of calvarial bone as a primary graft choice in nasal reconstruction. DESIGN: Case series. SETTING: Academic tertiary care center. PATTERN: Thirty-five consecutive patients who underwent split calvarial bone grafting to the nasal dorsum between June 1988 and September 1993 and who had post-operative follow-up. OUTCOME MEASURES: Serial clinical examination to assess volume loss, movement of the graft, and complications. Standardized photographs to assess nasal contour. RESULTS: Fixation of the graft was accomplished using a technique that promotes bone-to-bone healing without fixation screws or wires. The most common complication was seroma or hematoma of the scalp (8%). There were no dural tears or intracranial complications. Long-term donor site morbidity consisted of one case of local alopecia (2.8%). A good nasal contour was achieved in 97% of patients. CONCLUSION: Based on the experimental evidence reviewed and our clinical experience, split calvarial bone is recommended as a material of choice for nasal dorsal reconstruction.

An anatomic study of the temporoparietal fascial flap.

OBJECTIVE: To clarify the neurovascular relationships in the temporoparietal fascial flap and to access its possible use as a sensate free of a pedicled flap. DESIGN: Anatomic dissections (gross) and examinations (histologic) were performed on 10 fresh cadaver heads. SETTING: Academic tertiary care facility, Boston, Mass. MAIN OUTCOME MEASURES: To determine the relationship of the sensory innervation (the auriculotemporal nerve) to the vascular supply (the superficial temporal artery) of the temporoparietal fascial flap, in addition to determining safe incisions and the level of flap elevation that will preserve the sensory supply to the flap. RESULTS: There is a consistent relationship of the auriculotemporal nerve to the superficial temporal artery allowing for auriculotemporal nerve preservation with standard flap elevation techniques and easy nerve identification in this cadaveric study. CONCLUSION: A clear understanding of the anatomic pattern allows for the potential creation of a sensate fascial flap or vascularized nerve graft that would add a potential additional dimension to this fascial flap.

Microvascular transplantation and replantation of the rabbit submandibular gland.

BACKGROUND: Xerostomia is a devastating complication of radiation therapy. Previous research has demonstrated that submandibular glands may be removed from the neck and transplanted using microvascular techniques, with good gland survival. However, microvascular transplantation and replantation has never been attempted on a composite tissue such as a salivary gland. OBJECTIVE: To evaluate the ability of a rabbit submandibular gland to undergo 2 successive microvascular transplantations. SUBJECTS AND DESIGN: Study rabbits underwent a midline neck incision with dissection of a submandibular gland to its arterial and venous pedicle. Microvascular techniques were then used to transplant the gland to the femoral system of the right groin. The incisions were reopened later under surgical conditions. The transferred gland was examined for survival and patency of its artery and vein. Healthy glands were dissected and transferred to a suitable artery and vein within the neck, where they were again reanastamosed using microvascular surgical techniques. After additional time, the gland was again examined for survival and pedicle patency, then removed and evaluated for histopathological evidence of survival. RESULTS: Surgical technique evolved during the course of this work to avoid encountered pitfalls. After refining the technique, we have determined that the rabbit submandibular gland is able to withstand successive microvascular transplantation and replantation with good likelihood of long-term survival, according to histopathological criteria. CONCLUSIONS: The rabbit submandibular gland is able to undergo microvascular transplantation and replantation with evidence of long-term survivability and preserved function. The body's natural response to surgery and tissue transplantation makes replantation a technical challenge; however, methods delineated herein alleviate many of the potential pitfalls. Extending these results to humans, patients who are to undergo radiation therapy could have a disease-free gland removed from the neck, transferred outside of the field of radiation, and then returned to the neck at the completion of radiation therapy. This may enable them to maintain salivary gland function and maintain oral cavity function and comfort.

The temporoparietal fascial flap in head and neck reconstruction.

The technique for using the temporoparietal fascial flap in head and neck reconstruction is described. The advantages and applications of this flap are discussed and illustrated with case reports. Donor site morbidity is discussed, and the details of flap harvesting are reviewed. We have found the flap to be useful in the reconstruction of a variety of defects that require thin, vascular, and durable coverage.

A tissue-engineered conduit for peripheral nerve repair.

BACKGROUND: Peripheral nerve repair using autograft material has several shortcomings, including donor site morbidity, inadequate return of function, and aberrant regeneration. Recently, peripheral nerve research has focused on the generation of synthetic nerve guidance conduits that might overcome these phenomena to improve regeneration. In our laboratory, we use the unique chemical and physical properties of synthetic polymers in conjunction with the biological properties of Schwann cells to create a superior prosthesis for the repair of multiply branched peripheral nerves, such as the facial nerve. OBJECTIVES: To create a polymeric facial nerve analog approximating the fascicular architecture of the extratemporal facial nerve, to introduce a population of Schwann cells into the analog, and to implant the prosthesis into an animal model for assessment of regeneration. RESULTS: Tubes of poly-L-lactic acid (molecular weight, 100000) or polylactic-co-glycolic acid copolymer were formed using a dip-molding technique. They were created containing 1, 2, 4, or 5 sublumina, or "fascicular analogs." Populations of Schwann cells were isolated, expanded in culture, and plated onto these polymer films, where they demonstrated excellent adherence to the polymer surfaces. Regeneration was demonstrated through several constructs. CONCLUSIONS: A tubular nerve guidance conduit possessing the macroarchitecture of a polyfascicular peripheral nerve was created. The establishment of resident Schwann cells onto poly-L-lactic acid and polylactic-co-glycolic acid surfaces was demonstrated, and the feasibility of in vivo regeneration through the conduit was shown. It is hypothesized that these tissue-engineered devices, composed of widely used biocompatible, biodegradable polymer materials and adherent Schwann cells, will be useful in promoting both more robust and more precisely directed peripheral nerve regeneration.