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This systematic review aimed to evaluate the dental prosthetic rehabilitation (DPR) in patients after jaw reconstruction with fibula free flap. Four databases were searched from January 2000 to January 2023. Of the 2507 studies identified, 36 observational studies were included. Cancer was the most common surgical indications for jawbone resection with 58.3 % of cases followed by benign tumours which representing 24 %. The DPR rate was estimated at 51.6 % across the studies (ranging from 38 % to 55 % depending on the benign or malignant nature of the tumors). Implant-supported prostheses represented 58.9 % of cases of which 66.9 % were fixed and 33.1 % were implant-stabilized overdentures. Virtual surgical planning (VSP) was used in 20 % of studies and aimed to improve the position of the grafted fibula, quality, and aesthetics of DPR and to decrease ischemia and the operating time. One in two authors performed DPR 12 months after jaw reconstruction. If implant survival rate reached 93 % in non-irradiated fibula, it fell to 38 %, 55 %, and 77 % if implantation occurred in the 12, 17, and 24 months after radiotherapy, respectively. Various parameters should be better investigated in further studies including the typology of the prostheses (implant-supported vs removable), the use of VSP, and the optimal time for DPR taking into account the characteristics of the tumor, the size of bone defect, and the need for external irradiation therapy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Due to the location and toxicity of treatments, head and neck cancer (HNC) has a major impact on quality of life (QoL). Objective: to assess the effects of geriatric-assessment (GA)-driven interventions on QoL over 2 years in older adults with HNC.EGeSOR was a randomized study of HNC patients aged ≥65, receiving a pretreatment GA, a geriatric intervention and follow-up (intervention) or standard of care (control). The primary endpoint was QoL score using the European Organisation for Research and Treatment of Cancer's (EORTC QLQ-C30) and HNC (QLQ-HN35) QoL questionnaires over 24 months.In total, 475 patients were included (median age: 75.3; women: 31%; oral cancer: 44%). QoL scores improved over 24 months with various trajectories, without significant differences between the groups. A total of 74% of patients (interventional group) did not receive the complete intervention. Cancer characteristics, functional status, and risk of frailty were associated with change in the Global Health Status QoL score.There is a need to develop an alternative model of implementation such as patient-centered health-care pathways., Trial Registration: NCT02025062., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This systematic review aimed to evaluate the surgical techniques used for orbital floor reconstruction after Brown class III maxillectomy for cancer. Three databases were searched from January 1990 to January 2022. Of the 614 studies identified, 20 were retained after eligibility assessment. The surgical techniques were classified into four groups: free bone flaps (A), alloplastic implants (B), bone grafts (C), and soft-tissue reconstructions (D). Ectropion and diplopia concerned 42.6% and 6.6% of the patients, respectively. Soft tissue reconstruction was more likely to cause ectropion (17/27), followed by the reconstruction techniques of group B (34/79), group C (26/70), and group A (1/7). Postoperative enophthalmos was identified in 18 patients (9.6%), mostly in group D (5/35), followed by groups B (8/68), A (3/33), and C (2/52). Free bone flaps and alloplastic implants represent good reconstructive options in terms of postoperative ocular parameters., (© 2023 The Authors. Head & Neck published by Wiley Periodicals LLC.)

We introduce DeepNash, an autonomous agent that plays the imperfect information game Stratego at a human expert level. Stratego is one of the few iconic board games that artificial intelligence (AI) has not yet mastered. It is a game characterized by a twin challenge: It requires long-term strategic thinking as in chess, but it also requires dealing with imperfect information as in poker. The technique underpinning DeepNash uses a game-theoretic, model-free deep reinforcement learning method, without search, that learns to master Stratego through self-play from scratch. DeepNash beat existing state-of-the-art AI methods in Stratego and achieved a year-to-date (2022) and all-time top-three ranking on the Gravon games platform, competing with human expert players.

Localization behaviour is a characteristic feature of the p -type GeSn quantum well (QW) system in a metal-insulator-semiconductor device. The transition to strongly localized behaviour is abrupt with thermally activated conductivity and a high temperature intercept of 0.12 × e 2 ħ -1 at a hole carrier density 1.55 × 10 11 cm -2 . The activation energy for the conductivity in the localized state is 0.40 ± 0.05 meV compared to an activation energy of ∼0.1 meV for conductivity activation to a mobility edge at carrier densities >1.55 × 10 11 cm -2 . Insulating behaviour can occur from a system that behaves as though it is in a minimum metallic state, albeit at high temperature, or from a conductivity greater than a minimum metallic state behaviour showing that local disorder conditions with local differences in the density of states are important for the onset of localization. In the presence of a high magnetic field, thermally activated conductivity is present down to Landau level filling factor <1/2but without a magnetic-field-dependent carrier density or a variable range hopping (VRH) transport behaviour developing even with conductivity ≪ e 2 h -1 . In the localized transport regime in p -type doped Ge 0.92 Sn 0.08 QWs the VRH mechanism is suppressed at temperatures >100 mK and this makes this two-dimensional system ideal for future many body localization studies in disordered hole gases that can be thermally isolated from a temperature reservoir., (Creative Commons Attribution license.)

This study assesses the efficacy of Geriatric Assessment (GA)-driven interventions and follow-up on six-month mortality, functional, and nutritional status in older patients with head and neck cancer (HNC). HNC patients aged 65 years or over were included between November 2013 and September 2018 by 15 Ear, Nose, and Throat (ENT) and maxillofacial surgery departments at 13 centers in France. The study was of an open-label, multicenter, randomized, controlled, and parallel-group design, with independent outcome assessments. The patients were randomized 1:1 to benefit from GA-driven interventions and follow-up versus standard of care. The interventions consisted in a pre-therapeutic GA, a standardized geriatric intervention, and follow-up, tailored to the cancer-treatment plan for 24 months. The primary outcome was a composite criterion including six-month mortality, functional impairment (fall in the Activities of Daily Living (ADL) score ≥2), and weight loss ≥10%. Among the patients included ( n = 499), 475 were randomized to the experimental ( n = 238) or control arm ( n = 237). The median age was 75.3 years [70.4-81.9]; 69.5% were men, and the principal tumor site was oral cavity (43.9%). There were no statistically significant differences regarding the primary endpoint ( n = 98 events; 41.0% in the experimental arm versus 90 (38.0%); p = 0.53), or for each criterion (i.e., death (31 (13%) versus 27 (11.4%); p = 0.48), weight loss of ≥10% (69 (29%) versus 65 (27.4%); p = 0.73) and fall in ADL score ≥2 (9 (3.8%) versus 13 (5.5%); p = 0.35)). In older patients with HNC, GA-driven interventions and follow-up failed to improve six-month overall survival, functional, and nutritional status.

Metastasis of the oral cavity is a rare condition and should be investigated for a primary tumor in the lungs, breast, kidney and prostate. Involvement of the mandibular condyle frequently mimics TMJ dysfunction with pain, swelling and limitation of mouth opening. We report the case of atypic TMJ dislocation as an inaugural sign of condyle metastasis. We also discuss the diagnostic approach by a brief review of the literature., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Lipoma is the most common soft tissue mesenchymal neoplasm. Its occurrence is low in the oral cavity (1 to 4%) and in head and neck region (20 to 25%). Usually asymptomatic and slowly growing, lipoma can compress neighboring cervico-facial structures causing dysphagia, dyspnea, or obstructive sleep apnea. We describe an unusual case of giant cervico-parapharyngeal lipoma causing an obstructive sleep apnea in a 69-year-old man and with the complete remove of OSA after surgical procedure., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives: The aim of this study was to identify the factors responsible for free flap failure, the surgical complications, and the non-oral feeding period in patients treated for an oral squamous cell carcinoma., Materials and Methods: This multicentric study included 215 patients treated by tumour resection with immediate free flap reconstruction for an OSCC between 2010 and 2016. All of the patient medical files were reviewed and the data regarding the patient medical history, the tumour-related features, the surgical procedure, and the postoperative recovery were compiled. A statistical analysis with univariate and multivariate logistic regression was carried out., Results: The free flap success rate was 94.4% in our series. A postoperative complication occurred in 101 patients (41%). Minor surgical complications were shown to increase the free flap failure rate (OR 3.32; p = 0.04). A major surgical complication was encountered in 48 patients (22.3%), and these were linked to minor surgical complications (OR 2.89; p = 0.004) and the use of a tracheostomy (OR 5.76, p = 0.002). Conversely, a medical history of high blood pressure had a protective effect (p = 0.04). The non-oral feeding rate at the end of the hospital stay was 28.4%, and it correlated with the tracheostomy (p = 0.002), as well as the major and the minor surgical complications (p = 0.04)., Conclusion-Clinical Relevance: Free flap reconstruction is a safe and reliable technique with head and neck cancer reconstruction. Postoperative care favouring early and safe oral-feeding, and avoiding a tracheostomy can reduce the incidence of surgical complications after OSCC reconstruction.

Background: Osteosarcoma (OS) is the most common cancer of bone. Jaw osteosarcoma (JOS) is rare and it differs from other OS in terms of the time of occurrence (two decades later) and better survival. The aim of our work was to develop and characterize specific mouse models of JOS., Methods: Syngenic and xenogenic models of JOS were developed in mice using mouse (MOS-J) and human (HOS1544) osteosarcoma cell lines, respectively. An orthotopic patient-derived xenograft model (PDX) was also developed from a mandibular biopsy. These models were characterized at the histological and micro-CT imaging levels, as well as in terms of tumor growth and metastatic spread., Results: Homogeneous tumor growth was observed in both the HOS1544 and the MOS-J JOS models by injection of 0.25 × 10 6 and 0.50 × 10 6 tumor cells, respectively, at perimandibular sites. Histological characterization of the tumors revealed features consistent with high grade conventional osteosarcoma, and the micro-CT analysis revealed both osteogenic and osteolytic lesions. Early metastasis was encountered at day 14 in the xenogenic model, while there were no metastatic lesions in the syngenic model and in the PDX models., Conclusion: We describe the first animal model of JOS and its potential use for therapeutic applications. This model needs to be compared with the usual long-bone osteosarcoma models to investigate potential differences in the bone microenvironment.

Spontaneous regeneration of bone tissue after mandibular resection is rare in adults, although it does often take place in children. Periosteum conservation appears to play a major role in this healing process. We here report regarding a 5-year-old boy who exhibited a large mandibular trabecular juvenile ossifying fibroma. The lesion was treated by mandibulectomy, with careful preservation of the periosteal layer and immediate reconstruction with a costal graft by an intraoral approach. Monitoring over the course of a year revealed spontaneous mandibular regeneration, and it allowed for a series of measurements of the graft to be made. During this follow-up period, the mandibular height increased from 41.5% to 75.2% (P=0.0008) of the height of the unaffected mandibular height, while the width grew from 34.4% to 82.8% (P=0.0078) of the width of the healthy side, thus demonstrating the importance of a conservative approach regarding the periosteum in such situations. The costal graft acted as a support for bone regeneration by immobilizing the remaining bone fragments and by preventing soft-tissue prolapse., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Learning from demonstrations is a paradigm by which an apprentice agent learns a control policy for a dynamic environment by observing demonstrations delivered by an expert agent. It is usually implemented as either imitation learning (IL) or inverse reinforcement learning (IRL) in the literature. On the one hand, IRL is a paradigm relying on the Markov decision processes, where the goal of the apprentice agent is to find a reward function from the expert demonstrations that could explain the expert behavior. On the other hand, IL consists in directly generalizing the expert strategy, observed in the demonstrations, to unvisited states (and it is therefore close to classification, when there is a finite set of possible decisions). While these two visions are often considered as opposite to each other, the purpose of this paper is to exhibit a formal link between these approaches from which new algorithms can be derived. We show that IL and IRL can be redefined in a way that they are equivalent, in the sense that there exists an explicit bijective operator (namely, the inverse optimal Bellman operator) between their respective spaces of solutions. To do so, we introduce the set-policy framework that creates a clear link between the IL and the IRL. As a result, the IL and IRL solutions making the best of both worlds are obtained. In addition, it is a unifying framework from which existing IL and IRL algorithms can be derived and which opens the way for the IL methods able to deal with the environment's dynamics. Finally, the IRL algorithms derived from the set-policy framework are compared with the algorithms belonging to the more common trajectory-matching family. Experiments demonstrate that the set-policy-based algorithms outperform both the standard IRL and IL ones and result in more robust solutions.

Objectives: The effect of amino-bisphosphonates on osteoblastic lineage and its potential contribution to the pathogenesis of bisphosphonate-associated osteonecrosis of the jaw (BONJ) remain controversial. We assessed the effects of zoledronic acid (ZOL) on bone and vascular cells of the alveolar socket using a mouse model of BONJ., Material and Methods: Thirty-two mice were treated twice a week with either 100 μg/kg of ZOL or saline for 12 weeks. The first left maxillary molar was extracted at the third week. Alveolar sockets were assessed at both 3 weeks (intermediate) and 9 weeks (long-term) after molar extraction by semi-quantitative histomorphometry for empty lacunae, preosteoblasts (Osterix), osteoclasts (TRAP), and pericyte-like cells (CD146). Also, the bone microarchitecture was assessed by micro-CT., Results: Osteonecrotic-like lesions were observed in 21% of mice. Moreover, a decreased number of preosteoblasts contrasted with the increased number of osteoclasts at both time points. In addition, osteoclasts display multinucleation and detachment from the endosteal surface. Furthermore, the number of pericyte-like cells increased at the intermediate time point. The alveolar bone mass increased exclusively with long-term ZOL treatment., Conclusion: The severe imbalance between bone-forming cells and bone-resorbing cells shown in this study could contribute to the pathogenesis of BONJ., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: Facial clinical signs and their integration are the basis of perception than others could have from ourselves, noticeably the age they imagine we are. Facial modifications in motion and their objective measurements before and after application of skin regimen are essential to go further in evaluation capacities to describe efficacy in facial dynamics. Quantification of facial modifications vis à vis gravity will allow us to answer about 'control' of facial shape in daily activities., Methods: Standardized photographs of the faces of 30 Caucasian female subjects of various ages (24-73 year) were successively taken at upright and supine positions within a short time interval. All these pictures were therefore reframed - any bias due to facial features was avoided when evaluating one single sign - for clinical quotation by trained experts of several facial signs regarding published standardized photographic scales., Results: For all subjects, the supine position increased facial width but not height, giving a more fuller appearance to the face. More importantly, the supine position changed the severity of facial ageing features (e.g. wrinkles) compared to an upright position and whether these features were attenuated or exacerbated depended on their facial location. Supine station mostly modifies signs of the lower half of the face whereas those of the upper half appear unchanged or slightly accentuated. These changes appear much more marked in the older groups, where some deep labial folds almost vanish. These alterations decreased the perceived ages of the subjects by an average of 3.8 years., Conclusion: Although preliminary, this study suggests that a 90° rotation of the facial skin vis à vis gravity induces rapid rearrangements among which changes in tensional forces within and across the face, motility of interstitial free water among underlying skin tissue and/or alterations of facial Langer lines, likely play a significant role., (© 2015 Society of Cosmetic Scientists and the Société Française de Cosmétologie.)

A new reference clinical atlas of facial signs dedicated to photoaging was applied to 301 Chinese women of various ages through standardized photographs. Such approach aimed at better describing the facial changes induced by both real/chronological age and sun exposure and their respective impact on two subcohorts of different behavior with regard to sun exposure. A total of 28 various facial signs were individually graded according to their severity by a panel of experts, and a perceived apparent age of each subject was assessed. Results showed that the severity of major signs significantly increased rather linearly with age, with a higher rate in sun-exposed subjects as compared with subjects who regularly avoid sun exposure. The severity of facial signs, all impacted by sun exposure, better correlated with perceived apparent age than real/chronological age. The protocol used in the present work, similar to that previously applied to two cohorts of French women, assigned a greater impact of sun exposure in the facial aging signs of Asian women - all clinical signs are influenced by extrinsic factors - as compared with Caucasian women of comparable ages, likely related to much more intense ultraviolet (UV) radiation.

Purpose: To evaluate the efficiency and toxicity of postoperative brachytherapy (POBT) in the treatment of resectable mobile tongue squamous cell carcinoma., Patients and Methods: This was a retrospective single-center study of patients with SSC of the mobile tongue who were treated between August 1992 and June 2013 by glossectomy and neck dissection followed by (192)Ir interstitial brachytherapy of the tumor bed. Endpoints were local control, cancer-specific survival (CSS), overall survival (OS), and morbidity. Independent prognostic factors were analyzed in a Cox regression model., Results: A total of 112 patients were identified (median age, 55 years [range, 15-84]; 76% male). Patient and tumor characteristics were: T1T2N0 (85%), pN+ (13%), positive surgical margins (14%), negative margins <5 mm (29%), dysplasic margins (14%), lymphatic vessel invasion (5%), and perineural spread (5%). Median followup was 6.7 years (1.5 months to 17.7 years). Local control, CSS, and OS rates at 2 years were 79%, 81%, and 72%, respectively. The corresponding 5-year rates were 76%, 67%, and 56%, respectively. After POBT, 22% of patients presented grade ≥2 necrosis and 8% experienced chronic pain. Independent prognostic factors were positive surgical margins for poor local control and tumor recurrence and lymphatic vessel invasion for poor OS., Conclusion: POBT provided good local control and better CSS and OS than reported for surgery alone. Morbidity was higher than that reported for brachytherapy alone but may be considered acceptable in a well-selected patient population at high risk of local recurrence., (Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

Skin pigmentary disorders and uneven skin tone represent common cosmetic concerns in Japan where fairer skin is culturally desirable. As the demographics of Asian countries continue to evolve, there is a need to understand the impact of cosmetic skin concerns on quality of life (QoL). 199 Japanese women self-claiming facial skin pigmentation disorders were asked to complete the BeautyQoL questionnaire, and the results were compared with those of a control group of 200 women. Of the five dimensions of the BeautyQoL questionnaire, the dimension "mood" appeared to be significantly lower in the group presenting facial dark spots, as compared with the control group (p < 0.05). In the group presenting facial dark spots, the five dimensions and the global score showed that subjects concerned had lower scores than subjects less concerned, even if statistical significance was not reached. This study confirms that common pigmentary disorders such as facial black spots may negatively impact QoL. Further comparative studies with a controlled randomized design would be necessary to confirm these findings.

Objectives: AGING SIGNS CAN BE CLASSIFIED INTO FOUR MAIN CATEGORIES: wrinkles/texture, lack of firmness of cutaneous tissues (ptosis), vascular disorders, and pigmentation heterogeneities. During a lifetime, skin will change in appearance and structure not only because of chronological and intrinsic processes but also due to several external factors such as gravity, sun and ultraviolet exposure, and high levels of pollution; or lifestyle factors that have important and obvious effects on skin aging, such as diet, tobacco, illness, or stress. The effect of these external factors leads to progressive degradations of tegument that appear with different kinetics. The aim of this study was to clinically quantify the effect of sun exposure on facial aging in terms of the appearance of new specific signs or in terms of increasing the classical signs of aging., Materials and Methods: This study was carried out on 298 Caucasian women from 30 years to 78 years old. The participants were divided into two groups according to their sun exposure history: 157 women were characterized as sun-seeking, and the other 141 were classified as sun-phobic. This division was made possible by dermatologist grading of heliodermal status on the basis of several observations of classic criteria: wrinkles, sagging, pigmentation heterogeneities, vascular disorders, elastosis, and so on. This work was an opportunity to complete clinical photographic tools by adding in our portfolio new scales for signs observed in the two groups. Thus, 22 clinical parameters were investigated by a panel of twelve trained experts to characterize each woman's face regarding standardized photographic scales, and thus describe the aging process., Results: By calculating statistical correlations between the four clinical clusters (wrinkles/texture, ptosis, vascular disorders, and pigmentation disorders), and real age and apparent age on the one hand and heliodermal status on the other hand, we identified a link between each clinical cluster and aging and the photoaging process. By comparing evaluations of clinical signs between the two groups for each 10-year cluster, we demonstrated that whatever the age, a prevalence of pigmentation disorders for the sun-seeking group (ie, pigmentation) is strongly linked to ultraviolet (UV) exposure. Meanwhile, clinical signs of ptosis are linked more to chronological aging and do not present differences between the two groups, nor, therefore, photoaging. Wrinkles and texture are affected by the two aging processes. Finally, clinical signs of vascular disorders present no evolution with age., Conclusion: Clinical signs of aging are essentially influenced by extrinsic factors, especially sun exposure. Indeed UV exposure seems to be responsible for 80% of visible facial aging signs.

The facial skin tone of two groups of Chinese women from Shanghai was compared using standard colorimetric space techniques during a 6-month interval between January and July 2011. During the study period, one group of women (n = 40) applied a potent sun-protective cosmetic product daily, while the other group (n = 40) did not use any sun protection. The results, based on images taken using a standardized digital camera coupled to a spectroradiometer, showed that sun protection largely mitigated changes in the components of skin tone, ie, lightness, melanization, and individual typology angle parameters. The skin darkening process appeared to be reduced or prevented in the sun-protected group when compared with the control group. The sun-protected women had participated in an earlier study in 2008, which confirmed that seasonal skin darkening occurs from winter through summer in Shanghaiese women. Comparing the data obtained in the winters of 2008 and 2011, we were able to identify better the impact of 3 years of aging on the components of skin tone. Comparing data between seasons on the same women with (2011 study) and without (2008 study) sun protection highlights the role of the test product in preventing skin darkening.

Background: Infiltrating squamous cell carcinoma (SCC) of the lower lip is a highly curable cancer. We retrospectively analyzed oncologic, functional, and cosmetic outcomes after interstitial low-dose rate brachytherapy at 58 Gy (50-62) of lower lip SCC treated in our institution., Methods: There were 89 patients (44 T1, 33 T2, 2 T3, and 10 after wedge-excision). All tumors were N0 at the time of treatment. We calculated survival rates and assessed functional and cosmetic results de visu., Results: After a median follow-up of 36 months (range, 9-127), 5-year local control rate was 95% and 5-year disease-free survival was 82%. Only 6 patients (5 T2 and 1 T3) developed secondary cervical nodal involvement. Sixty-one patients were reassessed and 11 patients presented mild functional troubles. Cosmetic results were good (77%) or fair (21%)., Conclusion: Brachytherapy provided a high local disease control rate, excellent functional results, and good cosmetic outcomes for SCCs of the lip. Risk of cervical node involvement was low with small tumors., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Artemisinin-based combination therapy (ACT), the treatment of choice for uncomplicated falciparum malaria, is unaffordable and generally inaccessible in the private sector, the first port of call for most malaria treatment across rural Africa. Between August 2007 and May 2010, the Uganda Ministry of Health and the Medicines for Malaria Venture conducted the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study to test whether access to ACT in the private sector could be improved through the provision of a high level supply chain subsidy., Methods: Four intervention districts were purposefully selected to receive branded subsidized medicines - "ACT with a leaf", while the fifth district acted as the control. Baseline and evaluation outlet exit surveys and retail audits were conducted at licensed and unlicensed drug outlets in the intervention and control districts. A survey-adjusted, multivariate logistic regression model was used to analyse the intervention's impact on: ACT uptake and price; purchase of ACT within 24 hours of symptom onset; ACT availability and displacement of sub-optimal anti-malarial., Results: At baseline, ACT accounted for less than 1% of anti-malarials purchased from licensed drug shops for children less than five years old. However, at evaluation, "ACT with a leaf" accounted for 69% of anti-malarial purchased in the interventions districts. Purchase of ACT within 24 hours of symptom onset for children under five years rose from 0.8% at baseline to 26.2% (95% CI: 23.2-29.2%) at evaluation in the intervention districts. In the control district, it rose modestly from 1.8% to 5.6% (95% CI: 4.0-7.3%). The odds of purchasing ACT within 24 hours in the intervention districts compared to the control was 0.46 (95% CI: 0.08-2.68, p=0.4) at baseline and significant increased to 6.11 (95% CI: 4.32-8.62, p<0.0001) at evaluation. Children less than five years of age had "ACT with a leaf" purchased for them more often than those aged above five years. There was no evidence of price gouging., Conclusions: These data demonstrate that a supply-side subsidy and an intensive communications campaign significantly increased the uptake and use of ACT in the private sector in Uganda.

The pigmentation patterns of facial skin of 354 healthy Chinese women aged 18-80 years were investigated clinically and instrumentally. Chromasphere(®) was used to acquire pictures from the cheeks of subjects. Facial skin tone was described by L* parameter from the L,a,b system as well as Individual Typology Angle (ITA). Results show that skin tone becomes significantly darker along the life span. Both size of hyper-pigmented spots and their contrast with surrounding skin were found increased with age. As additional study, 40 women from these 354 subjects were asked to apply daily a whitening cosmetic product for a 2-month period. Such application led to a significantly lighter skin tone, although this study was not vehicle controlled and we cannot exclude that the increase in L* observed was in some part because of cumulative effects of previously used whitening products, there was an association with lighter skin tone as assessed through both instrumental measurements and self-perception by most subjects., (© 2011 The Authors. ICS © Society of Cosmetic Scientists and the Société Française de Cosmétologie.)

The facial skin of 354 women, aged 18-80, living in Shanghai, was investigated over two successive 6-month periods, summer and winter. Results from clinical assessments indicate that aging signs, such as wrinkling and sagging, are unaffected over such period. However, physical measurements revealed alterations in some functional criteria of the skin, such as sebum output, skin colour, melanin content of pigmented spots, skin hydration, all being increased during summer. The relationships between all criteria, as well as technical or applied inferences/consequences from this study, are discussed., (© 2011 L'Oreal. ICS © 2011 Society of Cosmetic Scientists and the Société Française de Cosmétologie.)

Background: The aim of this study was to identify factors predicting poor prognosis at the time of early oral tongue carcinoma diagnosis., Methods: A retrospective cohort study was carried out on 70 patients with T1 or T2 squamous cell carcinoma of the mobile tongue treated with primary surgical treatment., Results: In all, 47% of patients received adjuvant treatment. Local recurrence was observed in 29% and regional recurrence in 26%. With a median follow-up of 7.3 years for living patients, 5-year actuarial overall, disease-specific, and disease-free survival rates were 48%, 61%, and 42%, respectively. The presence of poor histological differentiation increased the overall risk of death. Tumor thickness and posterior lingual location independently increased overall and disease-specific risk of death. Concurrent or previous diagnosis of oral lichen significantly increased the risk of disease-specific death and disease recurrence., Conclusions: This study corroborates several known prognostic factors and indicates that diagnosis of oral lichen planus may be a risk factor for disease recurrence., (Copyright © 2010 Wiley Periodicals, Inc.)

Background: The most recommended technique for the management of patients with a difficult airway is fiberoptic intubation (FOI). The aim of this study was to compare propofol and sevoflurane for FOI performance in patients who were difficult to intubate., Methods: Seventy-eight patients scheduled for maxillo-facial surgery were included in this prospective, randomized study. The airway was topically anesthetized with lidocaine 5% before performance of FOI with propofol TCI (group P) or sevoflurane (group S). The following parameters were recorded: rate of success, duration of the induction and of the FOI, BIS and PETCO2 values. A visual analogic scale (VAS) was used to monitor the technical difficulties as well as the recall of patients and their satisfaction. The respiratory and hemodynamic complications were also evaluated., Results: Induction and procedure duration were significantly shorter in group S compared with group P. The rate of successful FOI was not different: 38 cases (97%) in group P and 35 cases (90%) in group S. No significant differences were observed between groups regarding BIS values and VAS values for technical difficulties and for patient recall and satisfaction. The incidence of hypertension or tachycardia was significantly higher in group S compared with group P. The incidence of respiratory complications was not significantly different between the groups, but three patients experienced obstructive dyspnea with hypoxemia., Conclusion: Propofol and sevoflurane provide a high success rate for the performance of FOI in patients who are difficult to intubate.

Background/purpose: The aim of this study was to demonstrate the effects of selected plant extracts in a cosmetic cream on the dermal network components after a 3-month treatment using an in vivo multiphoton tomographic device., Methods: Twenty-four Caucasian women aged between 45 and 65 applied randomly a cosmetic emulsion B containing active ingredients (soy and jasmine) twice a day on one arm and its vehicle A (without active ingredients) on the other arm during 3 months. Measurements were performed on the internal side of the forearm before starting the treatment (T0), after 4 week (T4) and 12 weeks (T12) treatment. Measurements consisted of a multi-layers acquisitions using a multiphoton tomograph with subcellular resolution. Optical sections (about 6 microm thick) were recorded from 0 to about 200 microm using two different wavelengths: 760 and 820 nm. To compare the series of images and obtain an objective quantification of the signal of second harmonic generation (SHG) and autofluorescence, the method used consisted of taking the integrated brightness of an image (same rectangular area for all images) as a measure of the signal. Following this step, a ratio between brightness of images from the area treated with cream A or B and brightness of untreated area was calculated and used as an assessment of treatment efficacy. The parameter used for statistical analysis (variance analysis) is the difference before and after 12 weeks of treatment by either cream A or B of the signal ratios calculated in the upper dermis (118-130 microm) and those from a deeper region of the upper dermis (165-178 microm)., Results: Signals (autofluorescence+SHG) of extracellular matrix do not change significantly with time (weeks 0, 4 and 12) when cream A (vehicle with no active ingredient) is applied. Treatment with cream B results in an enhancement in the signal level of extracellular matrix at week 12. The comparison of signals, in both areas (118-130 microm and 160-178 microm), show an higher increase in the deeper region than in the more superficial one for product B while we do not notice any change with product A., Conclusion: The multiphoton tomograph provided excellent high-resolution images, which describe clearly the different skin layers, single cells and extracellular matrix components in all the 24 volunteers. Statistic analyses reveal a real effect for product B with selected plant extracts, known to increase collagen synthesis. Changes observed are characteristics of modifications in dermal collagen and elastin content. To our knowledge, it is the first time that it was possible to demonstrate in vivo the effect of a cosmetic product on the superficial dermal layer, in a non-invasive and non-destructive process, i.e. without cutting the skin.

Objectives: This study reports on the results of a large-scale targeted condom social marketing campaign in and around areas where female sex workers are present. The paper also describes the method that was used for the routine monitoring of condom availability in these sites., Methods: The lot quality assurance sampling (LQAS) method was used for the assessment of the geographical coverage and quality of coverage of condoms in target areas in four states and along selected national highways in India, as part of Avahan, the India AIDS initiative., Results: A significant general increase in condom availability was observed in the intervention area between 2005 and 2008. High coverage rates were gradually achieved through an extensive network of pharmacies and particularly of non-traditional outlets, whereas traditional outlets were instrumental in providing large volumes of condoms., Conclusion: LQAS is seen as a valuable tool for the routine monitoring of the geographical coverage and of the quality of delivery systems of condoms and of health products and services in general. With a relatively small sample size, easy data collection procedures and simple analytical methods, it was possible to inform decision-makers regularly on progress towards coverage targets.

Objective: This study evaluated the effectiveness of a protocol to prevent bleeding after dental extraction in patients with hemophilia, von Willebrand's disease (VWD), or platelet disorders., Study Design: Replacement therapy was used in cases involving general anesthesia, and nerve trunk infiltration was used in patients with severe bleeding disorders (severe-to-moderate hemophilia or type 2-3 VWD). Desmopressin was used in good responders with mild hemophilia A, type 1 VWD, and platelet disorders. Local hemostatic measures and antifibrinolytic treatment were used systematically., Results: Ninety-three patients underwent 103 dental extractions; 2 of these patients had secondary bleeding requiring surgical hemostasis., Conclusion: The indication for replacement therapy depended on the type of anesthesia that was used. Coagulation factor concentrates or desmopressin were necessary to avoid upper airway hematoma with general anesthesia or nerve trunk infiltration. With local anesthesia, substitutive treatment was indicated in patients with severe-to-moderate hemophilia and type 2-3 VWD. Inexpensive desmopressin was effective in those who responded well. Local hemostatic measures and antifibrinolytic treatment were performed systematically.

Objectives/hypothesis: Delta aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) is a fluorescent sensitizer that permits detection and treatment of squamous cell carcinoma of the oral cavity. An exogenously induced decrease in tissue pH was evaluated for its effect in enhancing cellular uptake of ALA and facilitating its transformation into PpIX., Study Design: Mice grafted with HT29 colonic cancers had been given glucose and amiloride to modify the pH of tissues. Influence of pH changes has been evaluated on ALA-induced PPIX fluorescence by optic fiber spectrofluorimetry as well as on tumor growth., Results: The pH in HT 29 tumor decreased from 7.1 to 6.67 (P < .05) after intraperitoneal injection of glucose and amiloride. The PpIX fluorescence ratios in tumor or muscle before, between, and 2 hours after glucose and amiloride injection were not higher than control ratios. Aminolevulinic acid-photodynamic therapy was more efficient on HT 29 tumor-bearing mice when the pH value was decreased with glucose and amiloride, showing a difference in the tumor growth index ratio from the 1st to 14th day of 22% between amiloride-glucose aminolevulinic acid-photodynamic therapy and aminolevulinic acid-photodynamic therapy alone (P < .05)., Conclusions: Glucose and amiloride did not change PpIX fluorescence in HT 29 tumor after intraperitoneal injection of aminolevulinic acid but enhanced aminolevulinic acid-photodynamic therapy efficacy. This was probably a result of mechanisms other than an increase in aminolevulinic acid cellular penetration and PpIX production, such as susceptibility to free radical toxicity or alteration of cellular repair enzymes under acidotic conditions. If a decrease of pH induces a more efficient photodynamic therapy as suggested by our results, an easier way to obtain this decrease than glucose and amiloride would be necessary for clinical applications.

Purpose: The authors analyze the advantages and disadvantages of mandibular reconstruction with a fibula free flap in a retrospective study of 29 cases, and make comparisons with the iliac free flap and the lateral brachial free flap., Material and Methods: Twenty-nine patients (22 male, 7 female) aged 5 to 70 years were studied. Functional and esthetic evaluations were performed together with radiologic examination of the bony calluses., Results: The fibula free flap has advantages for mandibular reconstruction, such as the length of bone available, low morbidity of the donor site, and the possibility of using a skin paddle. However, there is the disadvantage of not being able to reconstruct large soft tissue defects. In addition, bone vascularization is reduced when a large number of osteotomies are required., Conclusion: This reconstruction technique is satisfactory for mandibular defects measuring over 20 cm.

A new non-invasive technique for assessing the efficacy of topical non-steroidal anti-inflammatory drugs (NSAID) in man is proposed. The NSAID are initially applied to the skin under occlusion before inflammation is induced by a methyl nicotinate solution. The inflammatory response is quantified in terms of cutaneous blood flow by a laser Doppler velocimeter (LDV). The efficacy of NSAID preparations is calculated by comparing the responses of the LDV to the methyl nicotinate challenge on the pretreated and the non-treated skin sites. This protocol has been used to investigate the effect of three different NSAID preparations (indomethacin, niflumic acid, palmitoyl collagenic acid) and the influence of the vehicle on the efficacy of indomethacin. The three preparations tested gave positive results but with different amplitudes in response. The efficacy of indomethacin varied with the vehicle used.