The aryl hydrocarbon receptor (AhR), a ligand-activated member of the basic helix-loop-helix fami... more The aryl hydrocarbon receptor (AhR), a ligand-activated member of the basic helix-loop-helix family of transcription factors, plays a significant role in polycyclic aromatic hydrocarbon (PAH)-induced carcinogenesis. In the upper aerodigestive tract of humans, tobacco smoke, a source of PAHs, activates the AhR leading to increased expression of CYP1A1 and CYP1B1, which encode proteins that convert PAHs to genotoxic metabolites. Inhibitors of Hsp90 ATPase cause a rapid decrease in levels of AhR, an Hsp90 client protein, and thereby block PAH-mediated induction of CYP1A1 and CYP1B1. The main objective of this study was to determine whether Zyflamend, a polyherbal preparation, suppressed PAH-mediated induction of CYP1A1 and CYP1B1 and inhibited DNA adduct formation and mutagenesis. We also investigated whether carnosol, one of multiple phenolic antioxidants in Zyflamend, had similar inhibitory effects. Treatment of cell lines derived from oral leukoplakia (MSK-Leuk1) and skin (HaCaT) with benzo[a]pyrene (B[a]P), a prototypic PAH, induced CYP1A1 and CYP1B1 transcription, resulting in enhanced levels of message and protein. Both Zyflamend and carnosol suppressed these effects of B[a]P. Notably, both Zyflamend and carnosol inhibited Hsp90 ATPase activity and caused a rapid reduction in AhR levels. The formation of B[a]Pinduced DNA adducts and mutagenesis was also inhibited by Zyflamend and carnosol. Collectively, these results show that Zyflamend and carnosol inhibit Hsp90 ATPase leading to reduced levels of AhR, suppression of B[a]P-mediated induction of CYP1A1 and CYP1B1, and inhibition of mutagenesis. Carnosol-mediated inhibition of Hsp90 ATPase activity can help explain the chemopreventive activity of herbs such as Rosemary, which contain this phenolic antioxidant. Cancer Prev Res; 5(4); 593-602. Ó2012 AACR.
Facial plastic surgery & aesthetic medicine, Oct 1, 2022
Importance: Minimally invasive methods for skin rejuvenation are in high demand. A diverse array ... more Importance: Minimally invasive methods for skin rejuvenation are in high demand. A diverse array of minimally invasive devices has been developed for aesthetical purposes and should be considered to help patients achieve their goals. Observations: Radiofrequency (RF) microneedling is a safe and effective intervention for treatment of various aesthetical and dermatological conditions in all skin types. This review highlights Morpheus8 (InMode, Inc., Irvine, CA) and what differentiates it from other similar devices. Conclusions and Relevance: RF microneedling addresses aesthetical and dermatological concerns for a diverse variety of patients in whom surgical intervention may not be desired. Morpheus8 has unique technological properties and advances that make it the preferred device for many practices.
Platelet-rich plasma (PRP) is an autogenously harvested blood plasma containing concentrated leve... more Platelet-rich plasma (PRP) is an autogenously harvested blood plasma containing concentrated levels of platelets and growth factors. PRP has been identified as a promising treatment for enhancing wound healing and has been used for decades in multiple medical specialties including cardiac surgery, oral surgery, ophthalmology, and orthopedic surgery. Growing evidence for multiple aesthetic surgery applications has recently been developed, particularly for hair restoration and skin rejuvenation. The goal of this article is to review the current medical literature on PRP and identify promising applications that may be integrated into a modern aesthetic surgery practice. The evidence for the use of PRP technology is rapidly expanding as a powerful therapy for select cosmetic surgery patients.
Background-Obesity is associated with increased adipose tissue in the tongue. Chronic white adipo... more Background-Obesity is associated with increased adipose tissue in the tongue. Chronic white adipose tissue (WAT) inflammation commonly occurs in the obese. We investigated whether WAT inflammation in the tongue impacts survival in patients with squamous cell carcinoma (SCC) of the oral tongue. Methods-In a retrospective cohort study, patients with T1-T2 oral tongue SCC who underwent curative-intent resection were included. Tongue WAT inflammation was defined by the presence of dead or dying adipocytes surrounded by macrophages forming crown-like structures. The primary and secondary endpoints were disease-specific survival (DSS) and overall survival (OS), respectively. Subgroup analyses were carried out in patients without lymph node involvement for whom adjuvant therapies were not indicated.
Objective The objective of this study was to determine if tobacco smoke (TS), a risk factor for c... more Objective The objective of this study was to determine if tobacco smoke (TS), a risk factor for cancers of the aerodigestive tract, may contribute to oral carcinogenesis, in part, by suppressing local immunity. Methods Mice were placed in Plexiglas holders in which they breathed TS through the nose and mouth for 1 hour daily for 21 days. Control mice breathed room air in the same manner. One day after the last exposure, mice were immunized by application of oxazolone to each buccal mucosa. Control mice were mock immunized by application of vehicle alone. Five days later, all mice were challenged on the ears with oxazolone, and 24-hour ear swelling assessed as contact hypersensitivity. Results Mice exposed to TS had a significantly smaller contact hypersensitivity response compared with controls. When subsequently reimmunized on the glabrous skin, mice originally primed through TS-exposed mucosa could not be fully immunized, indicating induction of immunologic tolerance by exposure to hapten through TS-perturbed mucosa. Immunocompetent mice exposed to TS in this manner and challenged by submucosal placement of a syngeneic malignant tumor had significantly increased tumor growth over time compared with controls. No difference in growth rate was observed when the experiment was performed with natural killer cell–deficient, SCID (severe combined immunodeficiency) mice. In addition, exposure of epidermal Langerhans cells in vitro to an aqueous extract of TS impaired their ability to undergo maturation and to present antigen to responsive T cells. Conclusions Immunologic changes induced in the oral cavity by exposure to TS may play a role in the development of oral cancers.
Background-While obesity increases risk and negatively impacts survival for many malignancies, th... more Background-While obesity increases risk and negatively impacts survival for many malignancies, the prognostic implications in squamous cell carcinoma (SCC) of the oral tongue, a disease often associated with pre-diagnosis weight loss, are unknown. Methods-Patients with T1-T2 oral tongue SCC underwent curative-intent resection in this single-institution study. All patients underwent nutritional assessment prior to surgery. Body mass index (BMI) was calculated from measured height and weight and categorized as obese (≥30 kg/ m 2), overweight (25 to 29.9 kg/m 2), or normal (18.5 to 24.9 kg/m 2). Clinical outcomes including disease specific survival (DSS), recurrence free survival (RFS), and overall survival (OS), were compared by BMI group using Cox regression. Results-From 2000-2009, 155 patients (90 men, 65 women) of median age 57 (range 18 to 86) were included. Baseline characteristics were similar by BMI group. Obesity was significantly associated with adverse DSS compared with normal weight in univariable (hazard ratio [HR] = 2.65, 95% confidence interval [CI], 1.07 to 6.59; P = .04) and multivariable analyses (HR = 5.01; 95% CI, 1.69 to 14.81; P = .004). A consistent association was seen between obesity and worse RFS (HR =1.87; 95% CI, .90 to 3.88) and between obesity and worse OS (HR=2.03; 95% CI, .88 to 4.65) though without reaching statistical significance (P = .09 and P = .10 respectively) in multivariable analyses. Conclusions-In this retrospective study, obesity was an adverse independent prognostic variable. This association may not have been previously appreciated due to confounding by multiple factors including pre-diagnosis weight loss.
ObjectivesEvaluate an enhanced recovery after surgery (ERAS)–based free flap management protocol ... more ObjectivesEvaluate an enhanced recovery after surgery (ERAS)–based free flap management protocol implemented at our center.Study DesignProspective cohort study of patients after implementation of an ERAS‐based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group.SettingTertiary care academic medical center.Participants and MethodsAll patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30‐day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared.ResultsSixty‐one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, P =. 04) and postoperative (49.2% vs 27.2%, P =. 026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P <. 01) and ventilator support (63.9% vs 9.8%, P <. 01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, P =. 017). Length of stay, readmissions, and complication rates did not significantly differ between groups.ConclusionERAS‐based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor‐intensive flap monitoring, without adverse effects on outcomes.
The objective of this chapter is to aid in the identification of factors that will affect the out... more The objective of this chapter is to aid in the identification of factors that will affect the outcome of hair treatment and to highlight conditions that may make patients appropriate or poor candidates. Consultation of the hair transplant (HT) patient begins with a thorough and open discussion of the patients' concerns and goals for treatment. Despite the benign effects of alopecia on physical health, hair loss patients can suffer significant psychosocial distress including decreased self-esteem, decreased satisfaction with their self-image, and decreased sexual quality of life [1, 2]. This distress may manifest in depressive symptoms and less frequent social engagement [3-5]. Experiments on the perceptions of alopecia also indicate that balding patients are more likely to be rated by others as less attractive, likable, and successful compared to non-balding peers, underscoring potential difficulties with finding romantic relationships and employment [6-8]. In a recent health utility study by Abt et al., adult observers were asked to determine the health states of patients with different conditions including alopecia and
6048 Background: Obesity is a risk factor for several malignancies and an independent predictor o... more 6048 Background: Obesity is a risk factor for several malignancies and an independent predictor of worse outcomes. In contrast, low body mass index (BMI) has been associated with increased risk of oropharyngeal cancers and poorer prognosis. In tongue SCC, impaired nutrition, smoking, and alcohol use impact BMI, and pre-diagnosis weight (wgt) loss negatively affects survival. The prognostic effect of obesity in tongue cancer is unknown. Methods: We conducted a single-institution, retrospective study of pts who underwent resection of T1/T2 SCC of the oral tongue. All pts underwent nutritional assessment prior to surgery. BMI was calculated from measured height and wgt at surgery and categorized as obese (≥30), overwgt (25-29.9), or normal (18.5-24.9). The association between BMI and the primary endpoint, disease specific survival (DSS), was evaluated by Cox regression. The effect of BMI on the secondary endpoints, recurrence free survival (RFS) and overall survival (OS), was also assessed. Results: From 2000 to 2005, 155 pts (90 men, 65 women) of median age 57 (range 18-86) were included. Clinicopathologic characteristics were similar by BMI group. Obesity was significantly associated with adverse DSS compared with normal wgt in univariable (Table) and multivariable analyses (HR 2.87; 95% CI, 1.08-7.67; p=0.04). Obesity was also significantly associated with adverse RFS (HR 2.53; 95% CI, 1.12-5.74; p=0.03). Overwgt subjects may also have worse RFS (HR 1.74; 95% CI, 0.85-3.55; p=0.13). In pts without pre-diagnosis wgt loss (n=94), obesity was significantly associated with adverse OS (HR 2.70; 95% CI, 1.12-6.54; p=0.03). Conclusions: These data suggest that obesity is associated with a worse prognosis in tongue cancer, which may not have previously been appreciated due to confounding by pre-diagnosis wgt loss. [Table: see text]
Objectives/HypothesisOver 3 million incidents of facial trauma occur each year in the United Stat... more Objectives/HypothesisOver 3 million incidents of facial trauma occur each year in the United States. This study aims to determine trends in operative middle and upper maxillofacial trauma in one of the largest US cities.Study DesignRetrospective case‐control study.MethodsRetrospective chart review of all operative middle and upper maxillofacial trauma from July 1993 to July 2010 presenting to Los Angeles County Hospital, a Level I Trauma Center. Data included demographics, mechanism of injury, and fracture characteristics.ResultsAnalysis was performed for a total of 4,299 patients and 5,549 facial fractures. Mean patient age was 34.6, and most patients were male (88%). Between the two time periods (1993–2001 and 2002–2010), there was a 42% reduction in operative maxillofacial trauma (3,510 to 2,039). Orbital floor and zygomaticomaxillary complex fractures were the most prevalent types of fractures. Panfacial fractures demonstrated the largest reduction in number of fractures (325 to 5, P<0.01). Assault and motor vehicle accidents (MVA) were the two most common mechanisms of injury. Operative fractures due to MVAs decreased (390 to 214, P = .74), whereas fractures due to assault increased (749 to 800, P<0.01). Compared to adults, pediatric facial trauma (age < 18) were caused by a higher percentage of MVAs (27% vs. 13%), auto versus pedestrian (9% vs. 5%), and gunshot wounds (8% vs. 4%) (P<0.01).ConclusionsOperative middle and upper maxillofacial trauma decreased over a 17‐year period. Assault was the most significant mechanism of trauma overall. These trends suggest that focusing future prevention strategies on curtailing interpersonal violence may more effectively address the burden of facial trauma.Level of Evidence3 Laryngoscope, 131:1985–1989, 2021
Facial Plastic Surgery Clinics of North America, May 1, 2020
Dihydrotestosterone is the primary mediator of follicular miniaturization and hair cycle changes ... more Dihydrotestosterone is the primary mediator of follicular miniaturization and hair cycle changes in androgenetic alopecia. Several key single-nucleotide polymorphisms are known to contribute to the polygenic inheritance pattern of androgenetic alopecia. Current evidence supports the Food and Drug Administration-approved use of 3 nonsurgical androgenetic alopecia treatments: minoxidil, finasteride, and low-light laser therapy.
Importance: Percutaneous radiofrequency-based skin tightening procedures can offer patients an op... more Importance: Percutaneous radiofrequency-based skin tightening procedures can offer patients an option to undergo a potential treatment for skin laxity and excess adipose of the face and neck with less downtime, lower cost, and decreased risk of complications compared with more aggressive open procedures such as neck lift, face and neck lift, and platysmaplasty. Observations: FaceTite and AccuTite can safely yet effectively deliver energy into the subdermal space, targeting the dermal collagen network and deeper fascial layer. Ideal candidates have early jowl formation, mild to moderate skin laxity, and submental adiposity. Relevance & Conclusions: From the perspective of facial plastic surgeons, these procedures can enhance the volume of an aesthetic practice by welcoming patients who may not otherwise present for face and neck rejuvenation out of fear from surgery. Furthermore, many of these minimally invasive patients will ultimately return for surgical rejuvenation later in life.
The aryl hydrocarbon receptor (AhR), a ligand-activated member of the basic helix-loop-helix fami... more The aryl hydrocarbon receptor (AhR), a ligand-activated member of the basic helix-loop-helix family of transcription factors, plays a significant role in polycyclic aromatic hydrocarbon (PAH)-induced carcinogenesis. In the upper aerodigestive tract of humans, tobacco smoke, a source of PAHs, activates the AhR leading to increased expression of CYP1A1 and CYP1B1, which encode proteins that convert PAHs to genotoxic metabolites. Inhibitors of Hsp90 ATPase cause a rapid decrease in levels of AhR, an Hsp90 client protein, and thereby block PAH-mediated induction of CYP1A1 and CYP1B1. The main objective of this study was to determine whether Zyflamend, a polyherbal preparation, suppressed PAH-mediated induction of CYP1A1 and CYP1B1 and inhibited DNA adduct formation and mutagenesis. We also investigated whether carnosol, one of multiple phenolic antioxidants in Zyflamend, had similar inhibitory effects. Treatment of cell lines derived from oral leukoplakia (MSK-Leuk1) and skin (HaCaT) with benzo[a]pyrene (B[a]P), a prototypic PAH, induced CYP1A1 and CYP1B1 transcription, resulting in enhanced levels of message and protein. Both Zyflamend and carnosol suppressed these effects of B[a]P. Notably, both Zyflamend and carnosol inhibited Hsp90 ATPase activity and caused a rapid reduction in AhR levels. The formation of B[a]Pinduced DNA adducts and mutagenesis was also inhibited by Zyflamend and carnosol. Collectively, these results show that Zyflamend and carnosol inhibit Hsp90 ATPase leading to reduced levels of AhR, suppression of B[a]P-mediated induction of CYP1A1 and CYP1B1, and inhibition of mutagenesis. Carnosol-mediated inhibition of Hsp90 ATPase activity can help explain the chemopreventive activity of herbs such as Rosemary, which contain this phenolic antioxidant. Cancer Prev Res; 5(4); 593-602. Ó2012 AACR.
Facial plastic surgery & aesthetic medicine, Oct 1, 2022
Importance: Minimally invasive methods for skin rejuvenation are in high demand. A diverse array ... more Importance: Minimally invasive methods for skin rejuvenation are in high demand. A diverse array of minimally invasive devices has been developed for aesthetical purposes and should be considered to help patients achieve their goals. Observations: Radiofrequency (RF) microneedling is a safe and effective intervention for treatment of various aesthetical and dermatological conditions in all skin types. This review highlights Morpheus8 (InMode, Inc., Irvine, CA) and what differentiates it from other similar devices. Conclusions and Relevance: RF microneedling addresses aesthetical and dermatological concerns for a diverse variety of patients in whom surgical intervention may not be desired. Morpheus8 has unique technological properties and advances that make it the preferred device for many practices.
Platelet-rich plasma (PRP) is an autogenously harvested blood plasma containing concentrated leve... more Platelet-rich plasma (PRP) is an autogenously harvested blood plasma containing concentrated levels of platelets and growth factors. PRP has been identified as a promising treatment for enhancing wound healing and has been used for decades in multiple medical specialties including cardiac surgery, oral surgery, ophthalmology, and orthopedic surgery. Growing evidence for multiple aesthetic surgery applications has recently been developed, particularly for hair restoration and skin rejuvenation. The goal of this article is to review the current medical literature on PRP and identify promising applications that may be integrated into a modern aesthetic surgery practice. The evidence for the use of PRP technology is rapidly expanding as a powerful therapy for select cosmetic surgery patients.
Background-Obesity is associated with increased adipose tissue in the tongue. Chronic white adipo... more Background-Obesity is associated with increased adipose tissue in the tongue. Chronic white adipose tissue (WAT) inflammation commonly occurs in the obese. We investigated whether WAT inflammation in the tongue impacts survival in patients with squamous cell carcinoma (SCC) of the oral tongue. Methods-In a retrospective cohort study, patients with T1-T2 oral tongue SCC who underwent curative-intent resection were included. Tongue WAT inflammation was defined by the presence of dead or dying adipocytes surrounded by macrophages forming crown-like structures. The primary and secondary endpoints were disease-specific survival (DSS) and overall survival (OS), respectively. Subgroup analyses were carried out in patients without lymph node involvement for whom adjuvant therapies were not indicated.
Objective The objective of this study was to determine if tobacco smoke (TS), a risk factor for c... more Objective The objective of this study was to determine if tobacco smoke (TS), a risk factor for cancers of the aerodigestive tract, may contribute to oral carcinogenesis, in part, by suppressing local immunity. Methods Mice were placed in Plexiglas holders in which they breathed TS through the nose and mouth for 1 hour daily for 21 days. Control mice breathed room air in the same manner. One day after the last exposure, mice were immunized by application of oxazolone to each buccal mucosa. Control mice were mock immunized by application of vehicle alone. Five days later, all mice were challenged on the ears with oxazolone, and 24-hour ear swelling assessed as contact hypersensitivity. Results Mice exposed to TS had a significantly smaller contact hypersensitivity response compared with controls. When subsequently reimmunized on the glabrous skin, mice originally primed through TS-exposed mucosa could not be fully immunized, indicating induction of immunologic tolerance by exposure to hapten through TS-perturbed mucosa. Immunocompetent mice exposed to TS in this manner and challenged by submucosal placement of a syngeneic malignant tumor had significantly increased tumor growth over time compared with controls. No difference in growth rate was observed when the experiment was performed with natural killer cell–deficient, SCID (severe combined immunodeficiency) mice. In addition, exposure of epidermal Langerhans cells in vitro to an aqueous extract of TS impaired their ability to undergo maturation and to present antigen to responsive T cells. Conclusions Immunologic changes induced in the oral cavity by exposure to TS may play a role in the development of oral cancers.
Background-While obesity increases risk and negatively impacts survival for many malignancies, th... more Background-While obesity increases risk and negatively impacts survival for many malignancies, the prognostic implications in squamous cell carcinoma (SCC) of the oral tongue, a disease often associated with pre-diagnosis weight loss, are unknown. Methods-Patients with T1-T2 oral tongue SCC underwent curative-intent resection in this single-institution study. All patients underwent nutritional assessment prior to surgery. Body mass index (BMI) was calculated from measured height and weight and categorized as obese (≥30 kg/ m 2), overweight (25 to 29.9 kg/m 2), or normal (18.5 to 24.9 kg/m 2). Clinical outcomes including disease specific survival (DSS), recurrence free survival (RFS), and overall survival (OS), were compared by BMI group using Cox regression. Results-From 2000-2009, 155 patients (90 men, 65 women) of median age 57 (range 18 to 86) were included. Baseline characteristics were similar by BMI group. Obesity was significantly associated with adverse DSS compared with normal weight in univariable (hazard ratio [HR] = 2.65, 95% confidence interval [CI], 1.07 to 6.59; P = .04) and multivariable analyses (HR = 5.01; 95% CI, 1.69 to 14.81; P = .004). A consistent association was seen between obesity and worse RFS (HR =1.87; 95% CI, .90 to 3.88) and between obesity and worse OS (HR=2.03; 95% CI, .88 to 4.65) though without reaching statistical significance (P = .09 and P = .10 respectively) in multivariable analyses. Conclusions-In this retrospective study, obesity was an adverse independent prognostic variable. This association may not have been previously appreciated due to confounding by multiple factors including pre-diagnosis weight loss.
ObjectivesEvaluate an enhanced recovery after surgery (ERAS)–based free flap management protocol ... more ObjectivesEvaluate an enhanced recovery after surgery (ERAS)–based free flap management protocol implemented at our center.Study DesignProspective cohort study of patients after implementation of an ERAS‐based perioperative care protocol for patients undergoing free flap reconstruction of the head and neck as compared with a historical control group.SettingTertiary care academic medical center.Participants and MethodsAll patients undergoing free flap reconstruction were prospectively enrolled in the ERAS protocol group. A retrospective control group was identified by randomly selecting an equivalent number of patients from a records search of those undergoing free flap surgery between 2009 and 2015. Blood transfusion, complications, 30‐day readmission rates, intensive care unit (ICU) and hospital length of stay, and costs of hospitalization were compared.ResultsSixty‐one patients were included in each group. Patients in the ERAS group underwent less frequent flap monitoring by physicians and had lower rates of intraoperative (70.5% vs 86.8%, P =. 04) and postoperative (49.2% vs 27.2%, P =. 026) blood transfusion, were more likely to be off vasopressors (98.3% vs 50.8%, P <. 01) and ventilator support (63.9% vs 9.8%, P <. 01) at the conclusion of surgery, and had shorter ICU stays (2.11 vs 3.39 days, P =. 017). Length of stay, readmissions, and complication rates did not significantly differ between groups.ConclusionERAS‐based perioperative practices for head and neck free flap reconstruction can reduce time on the ventilator and in the ICU and the need for vasopressors, blood transfusions, and labor‐intensive flap monitoring, without adverse effects on outcomes.
The objective of this chapter is to aid in the identification of factors that will affect the out... more The objective of this chapter is to aid in the identification of factors that will affect the outcome of hair treatment and to highlight conditions that may make patients appropriate or poor candidates. Consultation of the hair transplant (HT) patient begins with a thorough and open discussion of the patients' concerns and goals for treatment. Despite the benign effects of alopecia on physical health, hair loss patients can suffer significant psychosocial distress including decreased self-esteem, decreased satisfaction with their self-image, and decreased sexual quality of life [1, 2]. This distress may manifest in depressive symptoms and less frequent social engagement [3-5]. Experiments on the perceptions of alopecia also indicate that balding patients are more likely to be rated by others as less attractive, likable, and successful compared to non-balding peers, underscoring potential difficulties with finding romantic relationships and employment [6-8]. In a recent health utility study by Abt et al., adult observers were asked to determine the health states of patients with different conditions including alopecia and
6048 Background: Obesity is a risk factor for several malignancies and an independent predictor o... more 6048 Background: Obesity is a risk factor for several malignancies and an independent predictor of worse outcomes. In contrast, low body mass index (BMI) has been associated with increased risk of oropharyngeal cancers and poorer prognosis. In tongue SCC, impaired nutrition, smoking, and alcohol use impact BMI, and pre-diagnosis weight (wgt) loss negatively affects survival. The prognostic effect of obesity in tongue cancer is unknown. Methods: We conducted a single-institution, retrospective study of pts who underwent resection of T1/T2 SCC of the oral tongue. All pts underwent nutritional assessment prior to surgery. BMI was calculated from measured height and wgt at surgery and categorized as obese (≥30), overwgt (25-29.9), or normal (18.5-24.9). The association between BMI and the primary endpoint, disease specific survival (DSS), was evaluated by Cox regression. The effect of BMI on the secondary endpoints, recurrence free survival (RFS) and overall survival (OS), was also assessed. Results: From 2000 to 2005, 155 pts (90 men, 65 women) of median age 57 (range 18-86) were included. Clinicopathologic characteristics were similar by BMI group. Obesity was significantly associated with adverse DSS compared with normal wgt in univariable (Table) and multivariable analyses (HR 2.87; 95% CI, 1.08-7.67; p=0.04). Obesity was also significantly associated with adverse RFS (HR 2.53; 95% CI, 1.12-5.74; p=0.03). Overwgt subjects may also have worse RFS (HR 1.74; 95% CI, 0.85-3.55; p=0.13). In pts without pre-diagnosis wgt loss (n=94), obesity was significantly associated with adverse OS (HR 2.70; 95% CI, 1.12-6.54; p=0.03). Conclusions: These data suggest that obesity is associated with a worse prognosis in tongue cancer, which may not have previously been appreciated due to confounding by pre-diagnosis wgt loss. [Table: see text]
Objectives/HypothesisOver 3 million incidents of facial trauma occur each year in the United Stat... more Objectives/HypothesisOver 3 million incidents of facial trauma occur each year in the United States. This study aims to determine trends in operative middle and upper maxillofacial trauma in one of the largest US cities.Study DesignRetrospective case‐control study.MethodsRetrospective chart review of all operative middle and upper maxillofacial trauma from July 1993 to July 2010 presenting to Los Angeles County Hospital, a Level I Trauma Center. Data included demographics, mechanism of injury, and fracture characteristics.ResultsAnalysis was performed for a total of 4,299 patients and 5,549 facial fractures. Mean patient age was 34.6, and most patients were male (88%). Between the two time periods (1993–2001 and 2002–2010), there was a 42% reduction in operative maxillofacial trauma (3,510 to 2,039). Orbital floor and zygomaticomaxillary complex fractures were the most prevalent types of fractures. Panfacial fractures demonstrated the largest reduction in number of fractures (325 to 5, P<0.01). Assault and motor vehicle accidents (MVA) were the two most common mechanisms of injury. Operative fractures due to MVAs decreased (390 to 214, P = .74), whereas fractures due to assault increased (749 to 800, P<0.01). Compared to adults, pediatric facial trauma (age < 18) were caused by a higher percentage of MVAs (27% vs. 13%), auto versus pedestrian (9% vs. 5%), and gunshot wounds (8% vs. 4%) (P<0.01).ConclusionsOperative middle and upper maxillofacial trauma decreased over a 17‐year period. Assault was the most significant mechanism of trauma overall. These trends suggest that focusing future prevention strategies on curtailing interpersonal violence may more effectively address the burden of facial trauma.Level of Evidence3 Laryngoscope, 131:1985–1989, 2021
Facial Plastic Surgery Clinics of North America, May 1, 2020
Dihydrotestosterone is the primary mediator of follicular miniaturization and hair cycle changes ... more Dihydrotestosterone is the primary mediator of follicular miniaturization and hair cycle changes in androgenetic alopecia. Several key single-nucleotide polymorphisms are known to contribute to the polygenic inheritance pattern of androgenetic alopecia. Current evidence supports the Food and Drug Administration-approved use of 3 nonsurgical androgenetic alopecia treatments: minoxidil, finasteride, and low-light laser therapy.
Importance: Percutaneous radiofrequency-based skin tightening procedures can offer patients an op... more Importance: Percutaneous radiofrequency-based skin tightening procedures can offer patients an option to undergo a potential treatment for skin laxity and excess adipose of the face and neck with less downtime, lower cost, and decreased risk of complications compared with more aggressive open procedures such as neck lift, face and neck lift, and platysmaplasty. Observations: FaceTite and AccuTite can safely yet effectively deliver energy into the subdermal space, targeting the dermal collagen network and deeper fascial layer. Ideal candidates have early jowl formation, mild to moderate skin laxity, and submental adiposity. Relevance & Conclusions: From the perspective of facial plastic surgeons, these procedures can enhance the volume of an aesthetic practice by welcoming patients who may not otherwise present for face and neck rejuvenation out of fear from surgery. Furthermore, many of these minimally invasive patients will ultimately return for surgical rejuvenation later in life.
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Papers by Amit Kochhar