The Impact of Orthodontic Extrusion on Keratinized Gingiva.

Background and Objectives: The key factor that enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion (OE) is the periodontal ligament. The reaction of periodontal tissues associated with changes in the gingiva is a part of orthodontic tooth displacement. The aim of this study was to examine the effect of OE on the width of the zone of the keratinized and attached gingiva, the position of the mucogingival junction, and the height of the interdental papillae in the region where the OE was performed as well as in the adjacent region. Materials and Methods: This research included 28 adult patients (both orthodontically treated and untreated). The treated group included 15 patients, in whom orthodontic extrusion of the upper or lower frontal teeth was indicated and performed. The untreated group included 13 patients, with no previous or undergoing orthodontic treatment. Patients with periodontal disease and periodontal pockets in the frontal region and patients allergic to iodine were excluded from the study. Gingivomorphometric measurements were performed on two occasions in three groups of teeth (24 extruded and 30 agonist teeth in the treated patients; 66 teeth in the untreated patients). Statistical analysis of the obtained data was performed using the software package SPSS version 26.0. Results: Orthodontic extrusion induced changes in the position of the mucogingival line and an increase in the width of the keratinized gingiva. There were no statistically significant effects on the depth of the gingival sulcus, the attached gingiva width, or the height of the interdental papillae. Conclusions: Orthodontic tooth extrusion has an effect on the periodontium in the observed region. Vertical orthodontic force, directed towards the coronal plane, affects the surrounding soft oral tissues.

Efficiency of an Alternative Physical Education Program for the Lower Grades of Elementary School Children.

(1) Introduction: This research was conducted with the aim of assessing whether an alternative physical education (PE) program could effectively substitute for the traditional PE curriculum and aid in accomplishing the essential goals and objectives of PE among younger elementary school children. (2) Materials and Methods: This longitudinal 6-month study included third-grade elementary school children of both genders, who were healthy, lived in urban areas, and were involved in an alternative PE program, as well as the regular PE classes. The sample of participants comprised 214 students, with 105 participants in the experimental group and 109 participants in the control group, who underwent pre- and post-intervention measurements. For the purposes of this study, 11 variables were applied to assess the parameters of growth and development, motor abilities, and physical and health education. MANCOVA and ANCOVA methods were used to determine the effects resulting from the alternative and regular PE programs, and differences between the groups, respectively. The data are reported as the mean and standard deviations, and were analyzed using the statistical package SPSS version 20.0 (SPSS Inc., Armonk, NY, USA). (3) Results: Based on the research results obtained for motor abilities and physical and health education, it was concluded that both the alternative and regular PE programs had positive effects in achieving the goals and objectives of PE, but without statistical significance at the multivariate and univariate levels. The differences between the two groups were found to be negligible (effect size, ES < 0.2). (4) Discussion: Sports and PE have distinct objectives and approaches. While sports emphasize competition and winning, PE aims to impart fundamental skills and knowledge, prioritizing inclusivity among younger students. Success in PE is measured by the number of students meeting these goals, potentially affecting both talented and struggling learners. (5) Conclusions: The results obtained from the conducted research indicate that both the alternative PE program and the regular PE program influence changes in motor abilities and physical and health education to a limited extent. The alternative PE program proposed in this study, with its modifications to the structure of existing, regular PE program, can fully replace the latter in schools that do not meet the required spatial and material standards.

The Role of Motivation and Physical Self-Concept in Accomplishing Physical Activity in Primary School Children.

BACKGROUND: The goal of this research is to identify correlations of motivation and physical self-concept with physical activity among students of younger school age, as well as the level of prediction of motivation and physical self-concept with physical activity of students in physical education classes. METHODS: The sample of respondents consisted of 411 students of the third and fourth grades from the territory of the Zlatibor district. A modified Self-Regulation Questionnaire was used to assess students' motivational orientations, while appropriate subscales of the Self-perception Profile for Children measuring instrument were used to assess physical self-concept. Physical activity is shown as volume and intensive physical activity (vigorous physical activity (VPA)), measured with a Suunto memory belt pedometer and heart-rate monitor. RESULTS: Boys' motivational predictor variables accounted for 14% (volume) and 28% (VPA) of their physical activity in class, with intrinsic motivation, introjective regulation (just for the level of physical activity), and identified regulation as the most important determinants of physical activity. For girls, the identified regulation variable (from the system of motivational predictor variables) was shown to be the primary predictor variable on both criterion variables (R2 = 0.34 and 0.36). CONCLUSION: The teaching of physical education for students of younger school age should be conceived by creating a motivational climate, in order to encourage physical activity.

Sports Games and Motor Skills in Children, Adolescents and Youth with Intellectual Disabilities.

(1) Background: Sports games are one of the best ways of engaging in physical activity for individuals with intellectual disabilities (ID) and Down syndrome (DS). This systematic review of the current literature aims to identify and sum relevant data on motor skills and clarify whether there are positive effects of sports programs in motor skills games in children, adolescents, and youth with ID and DS. (2) Methods: The systematic review of the papers was carried out following the methodological guidelines and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consensus. The following electronic databases were researched: PubMed, MEDLINE, Google Scholar, ScienceDirect, and ERIC from 2001 to 2023. (3) Results: The basketball test battery can be used to improve and monitor basketball training. Basketball players with lower levels of ID achieved better results, especially those with disabilities of the II and III degrees. Futsal has a positive impact on the coordination, and the differences between the test results of the vertical jump with and without an arm swing, that can be seen indirectly as a coordination factor, were statistically significant. (4) Conclusions: Basketball is recommended as an effective and practical rehabilitation program for children, adolescents, and youth with ID and DS. Futsal is an interesting and helpful activity for individuals with ID as well.

Economic Justification Analysis of Minimally Invasive versus Conventional Aortic Valve Replacement.

There is no definitive consensus about the cost-effectiveness of minimally invasive aortic valve replacement (AVR) (MI-AVR) compared to conventional AVR (C-AVR). The aim of this study was to compare the rate of postoperative complications and total hospital costs of MI-AVR versus C-AVR overall and by the type of aortic prosthesis (biological or mechanical). Our single-center retrospective study included 324 patients over 18 years old who underwent elective isolated primary AVR with standard stented AV prosthesis at the Institute for Cardiovascular Diseases "Dedinje" between January 2019 and December 2019. Reintervention, emergencies, combined surgical interventions, and patients with sutureless valves were excluded. In both MI-AVR and C-AVR, mechanical valve implantation contributed to overall reduction of hospital costs with equal efficacy. The cost-effectiveness ratio indicated that C-AVR is cheaper and yielded a better clinical outcome with mechanical valve implantation (67.17 vs. 69.5). In biological valve implantation, MI-AVR was superior. MI-AVR patients had statistically significantly higher LVEF and a lower Euro SCORE than C-AVR patients (Mann-Whitney U-test, p = 0.002 and p = 0.002, respectively). There is a slight advantage to MI-AVR vs. C-AVR, since it costs EUR 9.44 more to address complications that may arise. Complications (mortality, early reoperation, cerebrovascular insult, pacemaker implantation, atrial fibrillation, AV block, systemic inflammatory response syndrome, wound infection) were less frequent in the MI-AVR, making MI-AVR more economically justified than C-AVR (18% vs. 22.1%).

Oral Health in 12- and 15-Year-Old Children in Serbia: A National Pathfinder Study.

The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were implemented to record: Decayed, Missing, and Filled Teeth/Surfaces Index (DMFT/DMFS), gingival bleeding, enamel fluorosis and other structural anomalies, dental erosion, dental trauma, and oral mucosal lesions. In addition, Silness and Löe plaque index and orthodontic status were assessed. A total of 36% of 12-year-olds and 22% of 15-year-olds in Serbia were caries-free. The mean DMFT was 2.32 ± 2.69 for 12-year-olds and 4.09 ± 3.81 for 15-year-olds. DMFT was made up largely by the decayed component. Gingival bleeding was present in 26% of examined 12-year-old and 18% of 15-year-old children. Dental plaque was observed in 63% of both 12- and 15-year-olds. Fluorosis, structural anomalies, dental erosion, dental trauma, and oral mucosal lesion were rarely detected. Low prevalence of malocclusions was found. Oral disease is still a common public health problem among schoolchildren in Serbia. A significant increase in the prevalence of caries disease between 12- and 15-year-old groups implies that preventive care for adolescents requires special attention. Corrective actions and reforms to the current school-based oral health prevention program are needed to further improve oral health in Serbian children.

Validation of the Serbian version of the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Questionnaire short form (PISQ-12).

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) and pelvic organ prolapse (POP) significantly decrease quality of life and sexual health. This study aimed to evaluate the reliability and validity of a Serbian adaptation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) used in assessing sexual function in women with UI and/or POP. METHODS: This study included 416 women, 310 (74.5%) with UI and/or POP and 106 (25.5%) without UI and/or POP. The adaptation of the PISQ-12 to Serbian language was performed via back-translation. The content validity of the questionnaire was conducted by experts in the field. The reliability and validity of the PISQ-12 were analyzed. Evaluation of the data was performed using Content Validity Index (CVI), Cronbach's alpha, test-retest reliability, item total correlation and confirmatory factor analysis. RESULTS: Content validity of the Serbian PISQ-12 was 1.00 (100%). Item total correlations were between 0.459 and 0.819 (P < 0.001). The PISQ-12 had an adequate and high internal consistency (Cronbach's alpha 0.806) as well as high test-retest reliability (Pearson correlation coefficient r = 0.807; P < 0.001). Factor analysis results revealed strong construct validity. The mean scores of PISQ-12 were significantly better in the control group compared with the women with UI and/or POP. Sexual function was negatively affected by UI and/or POP as assessed with SF-36 and I-QoL questionnaires. CONCLUSIONS: This study showed that the Serbian version of the PISQ-12 is a reliable, consistent, valid and condition-specific instrument to assess sexual function in women with UI and/or POP.

Effects of Combined Plyometric and Shooting Training on the Biomechanical Characteristics during the Made Jump Shot in Young Male Basketball Players.

(1) Background: Shooting performance is one of the most important determinants of basketball success and is strongly influenced by vertical jump performance. A lot of research attention has been paid to training programs that may improve the vertical jump. However, the literature regarding the improvement of accuracy during the jump shot is limited. The aim of this study was to determine the effects of the combination of two training programs on explosive power of the lower extremities during the made jump shot. (2) Methods: A total of 61 male basketball players were assigned into training group (T, n = 31, age 15.32 ± 0.65) which was conducting a specific, i.e., experimental training program, and control group (C, n = 30, age 16.3 ± 0.71 years) involved in a regular training program. The experimental training program included specific plyometric training with shooting training which lasted for 10 weeks. The obtained data were processed by nonparametric statistics to determine the differences in the vertical jump outcomes, as well as to determine the level of impact of the experimental training program. Wilcoxon and Kruskal-Wallis tests were used. (3) Results: A significant improvement (p ≤ 0.05) was noticed in the T group, in every vertical jump variable (flight time, height of the jump, power, and speed of the jump during a jump shot for two and three points), while there was no improvement within the C group. (4) Conclusions: The combination of plyometric and shooting training has a positive impact on the explosive power of the lower extremities during the jump shot.

Venous malformations.

The often inexorable growth and expansion of congenital vascular malformations can result in substantial morbidity and, in some cases, premature death of these patients. Despite this, patients suffering from such lesions are often erroneously diagnosed and/or inadequately treated, due to a lack of expertise among primary care practitioners as well as specialists. Venous malformations are the most common type of congenital vascular malformations. Over the last two decades management of these lesions has significantly improved, predominantly due to the introduction and implementation of multidisciplinary team concept as well as improvement in diagnostic and treatment modalities. Relatively recently genetic studies are providing more insights into underlying pathophysiological mechanisms responsible for the development and progression of venous malformations and pharmacotherapy is becoming extensively evaluated for safety and efficacy in the treatment of these often challenging vascular lesions.

Safety and efficacy of foam sclerotherapy for treatment of low-flow vascular malformations in children.

OBJECTIVE: Congenital vascular malformations are a heterogeneous group of lesions with the potential to cause significant lifelong morbidity in children. Diagnosis and treatment of these lesions may be complex and require a multidisciplinary approach. Sclerotherapy is widely used for the treatment of low-flow vascular malformations (LFVMs) as an alternative to surgical resection in adults; however, limited data of its use in a pediatric setting are available. The purpose of this study was to evaluate the efficacy and safety of sclerotherapy for pediatric LFVMs. METHODS: In this retrospective study, we reviewed our multidisciplinary vascular malformations team database for all patients younger than 18 years treated for congenital vascular malformations from 2008 to 2017. Of these, patients with LFVM treated with foam sclerotherapy were included. Dynamic contrast-enhanced magnetic resonance imaging was used to select patients for sclerotherapy by the multidisciplinary team. Foam sclerotherapy was performed with either polidocanol or sodium tetradecyl sulfate. Patients' characteristics, including demographics, presenting symptoms, and anatomic location of malformation, were assessed. Outcomes included treatment response, number of procedures, and postprocedural complications. RESULTS: The 61 patients with 61 LFVMs included 27 boys (44.3%) and 34 girls (55.7%), with mean age of 10.3 years (standard deviation, ± 5.3 years). The cohort included 32 venous (52.5%), 16 lymphatic (26.2%), and 8 mixed venous and lymphatic (13.1%) malformations along with 5 (8.2%) associated with Klippel-Trénaunay syndrome. Primary indications for intervention included pain and swelling (n = 12 [19.6%]), pain alone (n = 23 [37.7%]), swelling alone (n = 15 [24.6%]), functional impairment (n = 8 [13.1%]), and bleeding (n = 3 [4.9%]). Anatomic distributions varied, with 13 head and neck (21.3%), 5 truncal (8.2%), 10 upper extremity (16.4%), 27 lower extremity (44.3%), and 6 diffuse (9.8%). Among the head and neck lesions, 8 (13.1%) extended to the face; and of the extremity lesions, 5 (8.2%) extended to the hand and 17 (27.9%) to the foot. Overall, sclerotherapy resulted in significant improvement or complete resolution of symptoms in 53 patients (86.9%). Complications were observed in seven patients (11.4%); six cases (9.8%) of superficial skin ulceration resolved without intervention, and one infection (1.6%) required antibiotics. No patients experienced adverse hemodynamic consequences or venous thromboembolism. CONCLUSIONS: This series of pediatric LFVMs, the largest of its kind to date, demonstrates that sclerotherapy with foam-based agents effectively reduces symptoms with an acceptable rate of complications. Further study is needed to determine the optimal sclerosing agents for individual subsets of LFVMs in the pediatric population.

Report of the Society for Vascular Surgery and the American Venous Forum on the July 20, 2016 meeting of the Medicare Evidence Development and Coverage Advisory Committee panel on lower extremity chronic venous disease.

On July 20, 2016, a Medicare Evidence Development and Coverage Advisory Committee panel assessed the benefits and risks of currently used lower extremity chronic venous disease (CVD) treatments and their effects on health outcome of the American adult population. The main purpose of the meeting was to advise the Centers for Medicare & Medicaid Services on coverage determination for interventions used for treatment of CVD. A systematic review of the Agency for Healthcare Research and Quality was presented, followed by lectures of invited experts and a public hearing of representatives of professional societies and the industry. After discussing critical issues, the panel voted for key questions. This report summarizes the presented evidence to support recommendations of the Society for Vascular Surgery/American Venous Forum coalition and the presentations on selected discussion topics. These included important venous disease evidence gaps that have not been sufficiently addressed, venous disease treatment disparities and how they may affect the health outcomes of Medicare beneficiaries, and mechanisms that might be supported by the Centers for Medicare & Medicaid Services to improve the evidence base to optimize the care of patients with lower extremity CVD.

Right gonadal vein transposition for the treatment of anterior nutcracker syndrome in a patient with left-sided inferior vena cava.

In this report we describe a patient with anterior renal nutcracker syndrome caused by extrinsic compression of the left-sided inferior vena cava between the aorta and the superior mesenteric artery, as it crossed the midline, with resultant left renal vein hypertension. The patient was successfully treated by transposition of the right ovarian vein, which created a bypass of the compressed inferior vena cava and resulted in complete resolution of symptoms.

Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence.

There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by combining ultrasound with hemodynamic studies. Accordingly, at the instigation of Dr Angelo Scuderi, the Union Internationale de Phlebologie (UIP) executive board commissioned a large number of experts to assess all aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein thrombosis indicating their pathophysiological and clinical significance. Chapter 3 describes the hemodynamic changes that occur in different classes of chronic venous disease and their relation to the anatomic extent of disease in the macrocirculation and microcirculation. The next four chapters (Chapters 4-7) describe the hemodynamic changes resulting from treatmen by compression using different materials, intermittent compression devices, pharmacological agents and finally surgical or endovenous ablation. Chapter 8 discusses the unique hemodynamic features associated with alternative treatment techniques used by the CHIVA and ASVAL. Chapter 9 describes the hemodynamic effects following treatment to relieve pelvic reflux and obstruction. Finally, Chapter 10 demonstrates that contrary to general belief there is a moderate to good correlation between certain hemodynamic measurements and clinical severity of chronic venous disease. The authors believe that this document will be a timely asset to both clinicians and researchers alike. It is directed towards surgeons and physicians who are anxious to incorporate the conclusions of research into their daily practice. It is also directed to postgraduate trainees, vascular technologists and bioengineers, particularly to help them understand the hemodynamic background to pathophysiology, investigations and treatment of patients with venous disorders. Hopefully it will be a platform for those who would like to embark on new research in the field of venous disease.

Multidisciplinary treatment of extremity arteriovenous malformations.

Congenital vascular malformations (CVMs) are a complex group of lesions that arise by embryologic dysmorphogenesis without increased endothelial proliferation that leads to structural and functional anomalies of the vascular system characterized by a wide range of presenting symptoms and often unpredictable clinical course. A recent advancement in the diagnostic and treatment modalities has resulted in a better understanding of the pathophysiology and natural history of CVMs and improved management of these lesions. The multidisciplinary approach and diagnostic algorithm used to distinguish high-flow (HFVM) from low-flow vascular malformations (LFVM) have been validated as clinically applicable for making an accurate anatomic and hemodynamic diagnosis of CVMs; they serve as a basis for proper treatment selection and significantly facilitate communication among different medical specialists. Dynamic contrast-enhanced magnetic resonance imaging is able to definitively distinguish HFVM from LFVM with accuracy of approximately 84%. In inconclusive cases, confirmatory angiography is required. Symptomatic, diffuse, extensive, macrocystic LFVMs and LFVMs that involve multiple tissue planes and vital structures are best treated with foam sclerotherapy. Primary surgical resection is the treatment of choice for localized, septated, and microcystic LFVMs. The management of HFVMs is characterized by multimodal treatment including preoperative embolization followed by complete surgical resection or sclerotherapy of the remaining venous component. Treatment of extensive CVMs is palliative and goal oriented. Implementation of the proposed diagnostic protocols and therapeutic algorithms in a multidisciplinary setting results in favorable outcomes with acceptable complication rates in this challenging patient population.

Emerging role of contrast-enhanced MRI in diagnosing vascular malformations.

Vascular malformations comprise a diverse and rare group of lesions which generally pose a formidable treatment challenge. Requisite for optimal surgical planning are imaging modalities capable of delineating involved anatomy and malformation flow characteristics. In this regard, we and others have purported the advantages of contrast-enhanced MRI. Here, we review the current body of literature regarding the emerging of role of contrast enhanced MRI for the management of vascular malformations.

Genomics of varicose veins and chronic venous insufficiency.

Recent sequencing of the human genome has opened up new areas of investigation for genetic aberrations responsible for the pathogenesis of many human diseases. To date, there have been no studies that have investigated the entire human genome for the genetic underpinnings of chronic venous insufficiency (CVI). Utilizing Gene Chip Arrays we analyzed the relative expression levels of more than 47,000 transcripts and variants and approximately 38,500 well-characterized genes from each of 20 patients (N (CVI)=10; N (Control Group)=10). Relative gene expression profiles significantly differed between patients with CVI and patients unaffected by CVI. Regulatory genes of mediators of the inflammatory reaction and collagen production were up-regulated and down-regulated, respectively in CVI patients. DNA microarray analysis also showed that relative gene expression of multiple genes which function remains to be elucidated was significantly different in CVI patients. Fundamental advancements in our knowledge of the human genome and understanding of the genetic basis of CVI represents an opportunity to develop new diagnostic, prognostic, preventive and therapeutic modalities in the management of CVI.

Analysis of the treatment of congenital vascular malformations using a multidisciplinary approach.

BACKGROUND: Vascular malformations are a rare and complex group of lesions which may present serious pitfalls in diagnosis and management. We sought to evaluate the efficacy and safety of our imaging protocol and therapeutic algorithm in the treatment of low-flow and high-flow vascular malformations in a large series of patients. METHODS: A prospective database of all patients treated by the multidisciplinary vascular malformation team at our institution between 2006 and 2011 was reviewed. Management decisions were based on patients' clinical profile as well as critical lesion characteristics, and included conservative care, sclerotherapy, embolization, surgical resection, or a combination of these modalities. Treatment goals and expectations were established by the patient and physician at the time of initial evaluation. An outcomes grading system based on patient- and physician-derived treatment goals and assessment of response to management was applied (1 = worse; 2 = unchanged, 3 = significantly improved, 4 = completely resolved), and postprocedural complications were identified. RESULTS: The 136 vascular malformations in 135 patients included 59 (43.7%) males and 76 (56.3%) females, ranging in age from under 1 year to 68 years (mean, 25.3 ± 17.0 years). In order to facilitate application of the therapeutic algorithm, all patients underwent dynamic contrast-enhanced magnetic resonance imaging to determine critical lesion characteristics, including flow quality and lesion extension. Of the 105 low-flow vascular malformations (LFVM), 23 (21.9%) were managed conservatively, 38 (36.2%) were treated with sclerotherapy (sodium tetradecyl sulfate, polidocanol, and/or ethanol), 18 (17.1%) were surgically resected, and eight (7.6%) were managed with a combination of modalities. Of the 31 high-flow vascular malformations (HFVM), eight (25.8%) were managed conservatively, eight (25.8%) were treated with transcatheter arterial embolization, six (19.4%) required embolization followed by sclerotherapy, and five (16.1%) were primarily resected. Patients in all groups managed conservatively had minimal alteration in status. Response to sclerotherapy in the LFVM group resulted in improvement in 32 (84.2%) patients, surgical resection resulted in improvement in 16 (88.9%) patients, and combination therapy resulted in improvement in eight (100%) patients. Treatment with embolization in the HFVM group resulted in improvement in seven (87.5%) patients, while combination therapy resulted in improvement in six (100%), and surgical resection led to improvement in four (80%). Complications were observed in six (6.8%) patients treated for LFVMs (0 with sodium tetradecyl sulfate or polidocanol, four with ethanol, two with resection), and two (7.4%) patients treated for HFVMs with embolization or combination therapy. CONCLUSIONS: In this large cohort of vascular malformation patients, implementation of the proposed diagnostic and therapeutic algorithms in a multidisciplinary setting resulted in favorable outcomes with an acceptable complication rate in this challenging patient population.

A 6-year experience treating vascular malformations with foam sclerotherapy.

In this study, the authors present an analysis of the outcomes of 105 low-flow vascular malformation patients treated over a 6-year period and report specific lesion characteristics that correlate with those vascular malformations that will benefit from sodium tetradecyl sulfate foam sclerotherapy (STS FS) versus surgical resection as well as morphological characteristics of vascular malformations that are associated with a poor response to FS treatment. Improvement in symptoms was documented in 92.9% of patients treated with STS FS. There were no complications. Low-flow vascular malformations that were morphologically characterized by microcystic, septated vessels did not respond to FS, and these vascular malformations are best treated with surgical resection. Primary surgical resection is also the treatment of choice for localized, microcystic, and superficial low-flow vascular malformations. Symptomatic, diffuse, extensive, macrocystic malformations that involve multiple tissue planes and vital structures are best treated with FS.

Impact of endovascular simulator training on vascular surgery as a career choice in medical students.

OBJECTIVE: The primary goal of this study was to determine whether exposure to endovascular simulator training increases interest in vascular surgery among medical students. Secondary goals were to determine whether interest in vascular surgery is inversely related to the time after exposure, to identify factors associated with interest, and to identify students' characteristics that positively influence performance metrics. METHODS: This was a prospective, randomized, crossover study comprising 80 medical students who were randomized into group A (n = 40) and group B (n = 40). Participants completed a survey of their interest in vascular surgery and attitudinal factors using Vascular Surgery Interest Form (VSIF) before exposure to the simulator (pretest). At 1 month after exposure of group A to the simulator, both groups were tested using VSIF (test). Upon completion of testing, group B was exposed to simulator training, whereas group A received no further training. At 2 months after exposure of group B to the simulator, both groups were posttested using VSIF, which asked the students' level of interest in vascular surgery using a 1 to 10 scale. Performance metrics were recorded during each exposure. Differences among cohort demographics were determined using Pearson χ(2) analysis. Differences in interest were determined with paired sample correlations. Linear regression and analysis of variance were used to correlate VSIF responses with interest and the performance metrics. RESULTS: Both student cohorts had significant increases in interest after exposure to simulation. In group A, test interest (mean ± standard deviation) was significantly higher than pretest and posttest interests (5.51 ± 1.73 vs 4.00 ± 1.88 vs 4.18 ± 1.82; P < .05). In group B, posttest interest was significantly higher than pretest and test interests (5.62 ± 2.03 vs 3.96 ± 1.61 vs 4.08 ± 1.64; P < .05). The increase in interest was reciprocally related to the time passed since the initial exposure. Resident and attending lifestyle, length of training, radiation concerns, gender identification of a mentor, and personality fit with occupation were not correlated with interest. Sex, medical school year, comfort with endovascular procedures, willingness to work long hours, interest in performing percutaneous procedures, and commitment to surgical career did not affect impact performance metrics. CONCLUSIONS: One exposure of students to endovascular simulator training is associated with an increase in vascular surgery interest. Acquired interest is reciprocally related to the time demonstrating the temporal importance of the exposure.

Micro-RNA-181a regulates osteopontin-dependent metastatic function in hepatocellular cancer cell lines.

BACKGROUND: Osteopontin (OPN) is a variably expressed, secreted glycophosphoprotein that mediates the growth and metastases of hepatocellular cancer (HCC). MicroRNAs (miRNAs) may be responsible for variant OPN expression, interrupting translation by binding OPN messenger RNA (mRNA) in 3'-untranslated regions (UTRs). METHODS: A microarray analysis identified miRNAs of interest. Plasmid constructs using a luciferase reporter with variable OPN 3'UTR mutations were transfected into 2 HCC cell lines to determine miRNA regulation of OPN expression. Western blot analyses confirmed variable OPN expression in both cell lines. Invasion, adhesion, and migration evaluated metastatic behavior in Hep G2 and Hep 3B with modified miRNA and OPN expression. RESULTS: Hep 3B produces 36 x miRNA 181a compared with Hep G2. Luciferase activity after transfection with miRNA 181a precursor was decreased in both cell lines (P < .01); luciferase activity increased with miRNA 181a inhibitor transfection in both cell lines (P < .01). Hep 3B transfected with mutated OPN 3'UTR increased luciferase activity 108% (P < .01). Hep G2 transfected with miRNA precursor decreased OPN expression 5 x (P < .01) in Western blot analyses. Hep 3B transfection with miRNA precursor increased OPN expression 3 x (P < .01) in Western blot analyses. In vitro metastatic correlates increased in Hep 3B lines after transfection with siOPN and/or miRNA 181a inhibitor (P < .01). CONCLUSION: MiRNA 181a decreases OPN expression in HCC cell lines. This previously undescribed mechanism may confer metastatic characteristics to HCC.