Silicone implant for chin augmentation mimicking a low-grade liposarcoma

The silicone implant has been widely used in facial aesthetic surgery for chin augmentation. A case of a 71-year-old woman with a lesion in the anterior mandibular region detected by radiographies and suggestive of benign soft tissue tumor is presented. The patient denied previous surgical intervention in the mental area. A biopsy was performed and initially interpreted as low-grade liposarcoma. After an immunohistochemistry study showing CD-68-positive cells and complementary information regarding a silicone implant for chin augmentation, the definitive diagnosis was silicone granuloma. This case reinforces that silicone implant in the mandibular region can be misdiagnosed as malignant tumor and the correct diagnosis is heavily dependent on close collaboration between clinician and pathologist in order to avoid unnecessary surgical intervention. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e21-e23)

Chronic ethanol intake inhibits in vitro osteogenesis induced by osteoblasts differentiated from stem cells

The study investigated whether chronic ethanol (ETH) intake and subsequent ETH exposure of cell cultures affects osteoblast differentiation by evaluating key parameters of in vitro osteogenesis. Rats were treated with 5-20% (0.85-3.43 mM) ETH, increasing by 5% per week for a period of 4 weeks (habituation), after which the 20% level was maintained for 15 days (chronic intake). Bone-marrow stem cells from control (CONT) or ETH-treated rats were cultured in osteogenic medium which was either supplemented (ETH) or not supplemented (CONT) with 1.3 mm ethanol. Thus, four groups relating to rat treatment/culture supplementation were evaluated: (1) CONT/CONT, (2) ETH/CONT, (3) CONT/ETH and (4) ETH/ETH Cell morphology, proliferation and viability, total protein content, alkaline phosphatase (ALP) activity and bone-like nodule formation were evaluated. Chronic ethanol intake significantly reduced both food and liquid consumption and body weight gain. No difference was seen in cell morphology among treatments. Cell number was affected at 7 and 10 days as follows: CONT/CONT = CONT/ETH < ETH/CONT = ETH/ETH. Doubling time between 3 and 10 days was greater in groups of CONT animals: ETH/ETH = ETH/CONT < CONT/ETH = CONT/CONT. Cell viability and ALP activity were not affected by either animal treatment or culture exposure to ethanol. At day 21, the total protein content was affected as follows: ETH/ETH = CONT/ETH < ETH/CONT = CONT/CONT. Bone-like nodule formation was affected as follows: ETH/ETH < CONT/ETH < ETH/CONT < CONT/CONT. These results show that chronic ethanol intake, followed by the exposure of osteoblasts to ethanol, inhibited the differentiation of osteoblasts, as indicated by an increased proliferation rate and reduced bone-like nodule formation. Copyright (C) 2007 John Wiley & Sons, Ltd.

Comparison of differentiated dendritic cell infiltration of autoimmune and osteoarthritis synovial tissue

Objective. Infiltration of rheumatoid arthritis (RA) synovial tissue (ST) by differentiated dendritic cells (DC) is a consistent feature in patients with active disease. However, mononuclear cells (MNC), including DC, may be nonspecifically chemoattracted to inflammatory sites regardless of etiology, Therefore, to evaluate the specificity of ST infiltration by differentiated DC, synovial biopsies from patients with RA, spondylarthropathy (SpA), osteoarthritis (OA), and gout were examined. Methods. Formalin-fixed ST sections were analyzed by double immunohistochemical staining for vascularity and infiltration by differentiated DC, lymphocytes, and macrophages. Results, DC containing nuclear RelB were found in perivascular MNC aggregates from patients with all arthritides studied. Infiltration by differentiated DC was similar in RA and SpA ST, but reduced in OA ST. Differentiated DC were always observed in close association with lymphocytes, and the correlation between these variables suggested that the infiltration of inflammatory sites by DC and lymphocytes was associated. Conclusion, Perivascular infiltration by DC, lymphocytes, and macrophages is nonspecifically related to inflammation, but signals present in RA and SpA ST lead to more intense cellular infiltration and accumulation.

Vascular smooth muscle cell phenotypic modulation in culture is associated with reorganisation of contractile and cytoskeletal proteins

Smooth muscle cells (SMC) exhibit a functional plasticity, modulating from the mature phenotype in which the primary function is contraction, to a less differentiated state with increased capacities for motility, protein synthesis, and proliferation. The present study determined, using Western analysis, double-label immunofluorescence and confocal microscopy, whether changes in phenotypic expression of rabbit aortic SMC in culture could be correlated with alterations in expression and distribution of structural proteins. Contractile state SMC (days 1 and 3 of primary culture) showed distinct sorting of proteins into subcellular domains, consistent with the theory that the SMC structural machinery is compartmentalised within the cell. Proteins specialised for contraction (alpha -SM actin, SM-MHC, and calponin) were highly expressed in these cells and concentrated in the upper central region of the cell. Vimentin was confined to the body of the cell, providing support for the contractile apparatus but not co-localising with it. In line with its role in cell attachment and motility, beta -NM actin was localised to the cell periphery and basal cortex. The dense body protein alpha -actinin was concentrated at the cell periphery, possibly stabilising both contractile and motile apparatus. Vinculin-containing focal adhesions were well developed, indicating the cells' strong adhesion to substrate. In synthetic state SMC (passages 2-3 of culture), there was decreased expression of contractile and adhesion (vinculin) proteins with a concomitant increase in cytoskeletal proteins (beta -non-muscle [NM] actin and vimentin). These quantitative changes in structural proteins were associated with dramatic chan-es in their distribution. The distinct compartmentalisation of structural proteins observed in contractile state SMC was no longer obvious, with proteins more evenly distributed throughout die cytoplasm to accommodate altered cell function. Thus, SMC phenotypic modulation involves not only quantitative changes in contractile and cytoskeletal proteins, but also reorganisation of these proteins. Since the cytoskeleton acts as a spatial regulator of intracellular signalling, reorganisation of the cytoskeleton may lead to realignment of signalling molecules, which, in turn, may mediate the changes in function associated with SMC phenotypic modulation. (C) 2001 Wiley-Liss, Inc.

Can medical education be fun as well as educational?

Today's challenge to medical educators is to provide continuing education that supports excellence in clinical practice while finding new approaches to make learning more stimulating, motivating, and entertaining. At our hospital we are experimenting with innovative teaching techniques, incorporating games and debate, which encapsulate core concepts of the theory of adult learning: active participation by learners, application of knowledge, informal presentation, and feedback(1).

Relationships between nutrition screening checklists and the health and well-being of older Australian women

Objectives: To examine associations between nutrition screening checklists and the health of older women. Design: Cross-sectional postal survey including measures of health and health service utilisation, as well as the Australian Nutrition Screening Initiative (ANSI), adapted from the Nutrition Screening Initiative (NSI). Setting: Australia, 1996. Subjects: In total, 12 939 women aged 70-75 years randomly selected as part of the Australian Longitudinal Study on Women's Health. Results: Responses to individual items in the ANSI checklist, and ANSI and NSI scores, were associated with measures of health and health service utilisation. Women with high ANSI and NSI scores had poorer physical and mental health, higher health care utilisation and were less likely to be in the acceptable weight range. The performance of an unweighted score (TSI) was also examined and showed similar results. Whereas ANSI classified 30% of the women as 'high-risk', only 13% and 12% were classified as 'high-risk' by the NSI and TSI, respectively. However, for identifying women with body mass index outside the acceptable range, sensitivity, specificity and positive predictive values for all of these checklists were less than 60%. Conclusions: Higher scores on both the ANSI and NSI are associated with poorer health. The simpler unweighted method of scoring the ANSI (TSI) showed better discrimination for the identification of 'at risk' women than the weighted ANSI method. The predictive value of individual items and the checklist scores need to be examined longitudinally.

Well-formedness judgment: A comparison of offline and online performance in Broca's aphasics

0na eg rcarmitimcaal tfieca tcuorem opfr ethhee nospieornat iodneafli cdietf i(nAitiCoDn )o ft hthaet frequently co-occurs with Broca’s aphasia is above-chance performance on well-formedness judgment tasks for many syntactic constructions, but impaired performance where syntactic binding of traces to their antecedents occurs. However, the methodologies used to establish this aspect of the performance profile of the ACD have been predominantly offline. Offline well-formedness tasks entail extralinguistic processing (e.g. perception, attention, short-term memory, conscious reflection) in varying amounts and the influence of such processes on parsing mechanisms is yet to be fully established. In order to (a) further understand the role of extra-linguistic processing on parsing, and (b) gain a more direct insight into the online nature of parsing in Broca’s aphasia, 8 subjects underwent a series of wellformedness judgment investigations using both offline and online test batteries. The sentence types and error types used were motivated by three current theories about the nature of the ACD, namely, the Trace-Based Account (Grodzinsky, 2000), the Mapping Hypothesis (Linebarger et al., 1983) and Capacity proposals (e.g. Frazier & Friederici, 1991). The results from the present investigation speak directly to the three aforementioned theories and also demonstrate the important role that extralinguistic processing plays during offline assessment. The clinical implications of the different outcomes from the offline vs. online tasks are also discussed.

ANZUS - Alive and well after fifty years

Marking its fiftieth anniversary in late 2001, the ANZUS alliance remains Australia's primary security relationship and one of the United States' most important defence arrangements in the Asia-Pacific region. It is argued here that ANZUS has defied many common suppositions advanced by international relations theorists on how alliances work. It thus represents an important refutation of arguments that they are short-term instruments of mere policy expediency and are largely interest-dependent. Cultural and normative factors are powerful, if often underrated, determinants for ANZUS's perpetuation. ANZUS may thus constitute an important test case for expanding our understanding of alliance politics beyond the usual preconditions and prerogatives normally associated with such a relationship.

Do personality factors predict job satisfaction?

Two studies investigated the relationships between personality traits and aspects of job satisfaction. In Study 1, job applicants (n=250) completed the Eysenck Personality Profiler and the Work Values Questionnaire (WVQ), which requires respondents to rate various work-related facets according to the extent to which they contribute to their job satisfaction. These facets were combined into two composites (hygiene and motivator) based on previous research. The three personality superfactors accounted for a small percentage of the variance in importance ratings (about 5%). In Study 2, employees (n=82) completed a measure of the 'Big Five' personality traits and the Job Satisfaction Questionnaire (JSQ), which assesses both what respondents consider as important in their work environment as well as their satisfaction with their current job. Importance ratings were again combined into two composites while job satisfaction ratings were factor analyzed and three factors, differentiated along hygiene versus motivator lines, emerged. Personality traits again accounted for a small percentage of the total variance both in importance ratings and in levels of job satisfaction. It is concluded that personality does not have a strong or consistent influence either on what individuals perceive as important in their work environment or on their levels of job satisfaction. (C) 2002 Published by Elsevier Science Ltd.

The impact of participation in activities while on vacation on senior's psychological well-being: A path model application

This article extends earlier research regarding the relationships between senior travelers’ participation in activities while on vacation, their overall satisfaction with their travel experiences, and their psychological well-being. A path model was developed to depict the direct and indirect relationships between these variables by using a sample of senior tourists traveling on North American escorted tour itineraries. Whereas the direct effect accounted for 98% of the relationships between the senior tourists’ levels of participation in activities and their psychological well-being, the indirect effect was negligible. The study concluded that senior tourists’activity levels were significantly related to their psychological well-being, but their satisfaction with the tours was not.

Mental health: How well are occupational therapists equipped for a changed practice environment?

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How well do general practitioners deliver palliative care? A systematic review

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

Characterization of a distinct plasma membrane macrodomain in differentiated adipocytes

Caveolae are small invaginations of the cell surface that are abundant in mature adipocytes. A recent study (Kanzaki, M., and Pessin, J. E. (2002) J. Biol Chem 277, 25867-25869) described novel caveolin- and actin-containing structures associated with the adipocyte cell surface that contain specific signaling proteins. We have characterized these structures, here termed caves, using light and electron microscopy and observe that they represent surface-connected wide invaginations of the basal plasma membrane that are sometimes many micrometers in diameter. Rather than simply a caveolar domain, these structures contain all elements of the plasma membrane including clathrin-coated pits, lipid raft markers, and non-raft markers. GLUT4 is recruited to caves in response to insulin stimulation. Caves can occupy a significant proportion of the plasma membrane area and are surrounded by cortical actin. Caveolae density in caves is similar to that on the bulk plasma membrane, but because these structures protrude much deeper into the plane of focus of the light microscope molecules such as caveolin and other plasma membrane proteins appear more concentrated in caves. We conclude that the adipocyte surface membrane contains numerous wide invaginations that do not represent novel caveolar structures but rather large surface caves.