[Therapeutic Strategies for the Reconstruction of Extensive Mandibular Defects.]

[Therapeutic strategies for the reconstruction of extensive mandibular defects.]

Filed under: Rehab Centers

HNO. 2012 Dec 29;
Freier K, Mertens C, Engel M, Hoffmann J

Tumours of the mandibular bone or adjacent soft tissue often necessitate mandibular resection. Subsequent primary bone reconstruction to achieve optimal functional and aesthetic results has been made possible by microvascular surgical techniques and now represents the international gold standard. Microvascular reanastomosis of autologous bone grafts from the iliac crest or fibula is the most common procedure for reconstruction of the mandible. The localisation and extent of the expected defect, as well as a patient’s overall condition and ability to tolerate long surgical procedures must be carefully considered before deciding upon the course of treatment. Additional microvascular reanastomosis of soft tissue flaps and stereolithographic models facilitate preoperative planning and broaden the surgical spectrum. Following successful reconstruction of the bone, insertion of dental implants and prosthetic rebuilding are required to complete rehabilitation, including restoration of the patient’s ability to chew and speak. The authors recommend specialised oncologic centres for such complex surgical reconstructions.
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Circulating endothelial and progenitor cells: Evidence from acute and long-term exercise effects.

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World J Cardiol. 2012 Dec 26; 4(12): 312-26
Koutroumpi M, Dimopoulos S, Psarra K, Kyprianou T, Nanas S

Circulating bone-marrow-derived cells, named endothelial progenitor cells (EPCs), are capable of maintaining, generating, and replacing terminally differentiated cells within their own specific tissue as a consequence of physiological cell turnover or tissue damage due to injury. Endothelium maintenance and restoration of normal endothelial cell function is guaranteed by a complex physiological procedure in which EPCs play a significant role. Decreased number of peripheral blood EPCs has been associated with endothelial dysfunction and high cardiovascular risk. In this review, we initially report current knowledge with regard to the role of EPCs in healthy subjects and the clinical value of EPCs in different disease populations such as arterial hypertension, obstructive sleep-apnea syndrome, obesity, diabetes mellitus, peripheral arterial disease, coronary artery disease, pulmonary hypertension, and heart failure. Recent studies have introduced the novel concept that physical activity, either performed as a single exercise session or performed as part of an exercise training program, results in a significant increase of circulating EPCs. In the second part of this review we provide preliminary evidence from recent studies investigating the effects of acute and long-term exercise in healthy subjects and athletes as well as in disease populations.
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Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research.

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Plast Reconstr Surg. 2013 Jan; 131(1): 62e-71e
van der Heijden P, Dijkstra PU, Stellingsma C, van der Laan BF, Korsten-Meijer AG, Goorhuis-Brouwer SM

: In the past two decades, presurgical nasoalveolar molding has been applied increasingly in the care of patients with a cleft to improve nasal symmetry and facilitate closure of the lip and secondary rhinoplasty. Many cleft centers do not apply presurgical molding, because its effect is disputed. This review aims to quantify the effect of nasal symmetry in the long term.: A systematic review of the literature with the intention of performing a meta-analysis was performed. The search terms “cleft” AND (“molding” OR “moulding”) were used in three databases. Twelve studies met the following inclusion criteria: (1) participants were humans with nonsyndromic unilateral cleft; (2) data concerning the effect of nasoalveolar molding on symmetry of the nose are reported or can be deduced; (3) article was written in English, German, or Dutch.: The heterogeneity of the study designs, outcome variables, outcome variable expressions, follow-up periods, and inadequate data reporting made it impossible to calculate effect sizes and to perform a meta-analysis. All studies had a low Grading of Recommendations Assessment, Development and Evaluation level. Five studies reported exclusively positive effects on nasal symmetry, six studies reported mixed effects, and one study reported exclusively no effects.: Results of studies of nasoalveolar molding are inconsistent regarding changes in nasal symmetry; however, there is a trend toward a positive effect. Studies concerning nasoalveolar molding in unilateral cleft lip, jaw, and palate are heterogeneous and lack adequate reporting. Recommendations for future research were provided to construct a consensus about the effect of nasoalveolar molding.: Therapeutic, III.
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Psychometric Properties of the Readiness for Return to Work Scale in Inpatient Occupational Rehabilitation in Norway.

Filed under: Rehab Centers

J Occup Rehabil. 2012 Dec 28;
Braathen TN, Brage S, Tellnes G, Eftedal M

Aim To investigate internal consistency and construct validity of the Readiness for return to work (RTW) scale in a sample participating in a Norwegian inpatient occupational rehabilitation program. Methods A cross-sectional study was conducted on baseline measures from a prospective cohort study evaluating a 5 days inpatient occupational rehabilitation program. The participants in the program were 18-67 years, on sickness absence or at risk of sickness absence (N = 193). The Readiness for RTW scale, sociodemographic-, work- and health-related questionnaires were answered by the participants on their first day in the program. Statistical analysis included exploratory factor analyses, reliability analyses and correlations with related instruments. Results In the scale for those not working (N = 124) two factors were found, representing (1) RTW inability and (2) RTW uncertainty. These factors corresponded to the precontemplation and contemplation stages in a previous Canadian study. The original prepared for action stages were not identified in this sample. In the scale for those working shortly before the program (N = 60) two factors were identified, representing (1) Uncertain work maintenance and (2) Proactive work maintenance, comparable to the stages in the Canadian study. The factors had satisfactory internal consistency (Cronbach’s alpha >0.7), except for proactive work maintenance (Cronbach’s alpha = 0.59). Expected relationships were found between the readiness for RTW stages and the pain stages of change, fear avoidance beliefs for work, subjective health complaints, decision control and coping at work. Conclusion Internal consistency and construct validity of the readiness for RTW stages found were satisfactory, except for proactive work maintenance. The results indicate that the construct of readiness for RTW may vary by culture and patient setting.
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