Suppression of SCARA5 by Snail1 is essential for EMT-associated cell migration of A549 cells.

Accumulating evidence indicates that epithelial-to-mesenchymal transition (EMT) might be a key event for cancer progression. The upregulation of Snail1, one of the most extensively studied EMT regulators, has been implicated in cancer metastasis, but the underlying mechanisms remain unclear. This study aims to identify that Snail1 targets regulating EMT-associated cancer cell migration. Human lung carcinoma A549 cells were treated with transforming growth factor beta 1 (TGF-ß1), and EMT-associated phenotypic and functional alterations were monitored. TGF-ß1 induced typical EMT-like morphological changes, 'cadherin switching' and cell migration in A549 cells. TGF-ß1 stimulation induced rapid and persistent upregulation of Snail1. Moreover, Snail1 upregulation was required for EMT-associated cell migration. Several metastasis suppressors with putative Snail1-binding sites in their promoters were dramatically repressed in A549 cells during TGF-ß1-induced EMT. Gain- and loss-of Snail1 function experiments demonstrated that scavenger receptor class A member 5 (SCARA5) was negatively regulated by Snail1. Importantly, SCARA5 downregulation was essential for EMT-induced migration in A549 cells. The chromatin immunoprecipitation assay revealed that Snail1 could bind to the E-box elements in SCARA5 promoter, implying that SCARA5 is a direct Snail1 target modulating cancer cell mobility during EMT. In addition, we showed that DNA methyltransferase 1 was physically associated with Snail1 to silence SCARA5 expression with an unidentified DNA methylation-independent mechanism, suggesting the complexity of Snail1-mediated epigenetic regulation. Collectively, our data demonstrated that EMT-regulator Snail1 suppresses the expression of SCARA5 to promote cancer progression, highlighting the possibility to target Snail1 and SCARA5 for cancer treatment.

Collagen sheeting implants in cosmetic and reconstructive surgery.

In this study, collagen sheeting is used for correction of various contour deformities of the face. This material, which was used in 16 patients, is easily implanted, does not lead to infection, and has an average resorption rate of 21% at 6 months. It provides excellent cosmetic results.

Facial reconstruction for radiation-induced skin cancer.

Radiation-induced skin cancers can be difficult to diagnose and treat. Typically, a patient who has received orthovoltage radiotherapy for disorders such as acne, eczema, tinea capitis, skin tuberculosis, and skin cancer can expect that aggressive skin cancers and chronic radiodermatitis may develop subsequently. Cryptic facial cancers can lead to metastases and death. Prophylactic widefield excision of previously irradiated facial skin that has been subject to multiple recurrent skin cancers is suggested as a method of deterring future cutaneous malignancy and metastases. The use of tissue expanders and full-thickness skin grafts offers an expedient and successful method of subsequent reconstruction.

Endotracheal intubation as an alternative to tracheostomy after intraoral or oropharyngeal surgery.

Patients who undergo oral or oropharyngeal surgery usually require a tracheostomy for postoperative airway maintenance. However, the development in recent years of soft endotracheal tubes now provides the alternative of short-term endotracheal intubation, with minimal sequelae. Our favorable experience with the use of short-term intubation in children with epiglottitis prompted us to apply the technique to adults. Over a 2-year period at the University of Chicago Medical Center, we successfully used postoperative endotracheal intubation for 19 adult and pediatric patients who underwent major intraoral procedures, thus avoiding the possible complications, discomfort, and anxiety associated with tracheostomy. The patients were given intravenous steroids and antibiotics concomitantly, so that tissue edema and inflammation were minimized. No complications related to intubation and no postextubation airway compromise were noted in any of the patients.

Invasive histoplasmosis of the mandible.

We present a case of an 82-year-old man with a 1-year history of a slowly enlarging, nontender, exophytic oral mucosal lesion with focal ulceration of the right alveolar ridge of the mandible associated with cortical bone resorption. Two consecutive biopsies revealed histoplasma capsulatum. A review of the literature confirms that this is an uncommon manifestation of this fungal disease, but must be considered in the differential diagnosis of an oral ulcerative lesion.

Implantable venous access device: use in patients with advanced head and neck cancer.

As a result of prolonged hospitalizations and the frequent administration of sclerosing antibiotics and/or chemotherapeutic agents, vascular access frequently becomes difficult in patients with advanced head and neck carcinoma. Eighty-six totally implantable venous access devices were placed in 83 patients with advanced head and neck cancer to facilitate the administration of continuous intravenous infusion chemotherapy. Complications relating to surgical placement or usage of the device occurred in 29 of 86 ports (34%), leading to the removal of eight devices (9%). The implantation of two devices required revision. There were no serious sequelae from any of the complications. The port facilitated the administration of home chemotherapy in 11 patients. Because of our favorable experience, we now routinely recommend placement of these devices to all patients with advanced head and neck cancer at our institution.

Epithelioid hemangioendothelioma (histiocytoid hemangioma) of the palate.

The first case of epithelioid hemangioendothelioma involving the oropharynx is described. A 25-year-old woman developed a mass on the palate which noted to enlarge during the first trimester of pregnancy. Biopsy revealed a cellular tumor initially considered to be of epithelial origin. Vascular differentiation of the tumor was confirmed, however, by positive lectin histochemistry for Ulex europaeus, by evidence of immunoreactivity for factor VIII-related antigen, and by ultrastructural identification of endothelial features. The patient remains free of tumor 21 months after complete excision. Because of the potential for misdiagnosis, epithelioid hemangioendothelioma should be considered in the differential diagnosis of oropharyngeal malignancies. The effect of pregnancy on the development and growth of vascular tumors such as epithelioid hemangioendothelioma remains uncertain.

Proliferative myositis of the masseter muscle.

The authors present a case of a 33-year-old white man with a 4-month history of a rapidly enlarging, tender, painful, circumscribed facial mass located in the masseter muscle. CT scan and fine needle aspiration cytology, coupled with clinical assessment, suggested the diagnosis of proliferative myositis. Curative intraoral excisional biopsy was done, thereby avoiding a parotidectomy incision and approach to the lesion. The pathology showed proliferative myositis. A review of the literature revealed 36 cases which indicated that proliferative myositis is a relatively rare etiology of a head and neck mass. Careful clinical, radiologic, and pathologic evaluations were required to make this unusual diagnosis and avoid any unnecessary facial mutilation in its treatment.