Authoring and generation of individualized patient education materials

ABSTRACT Although the pre-surgical patient-surgeon encounter is the opportunity to educate the patient, it is essential that the patient be given educational materials to complement the face-to-face exchange. This is virtually impossible to do well with brochures, because many combinations of procedures are possible, different patients have different concerns, and patients have varying levels of literacy and knowledge. In the extreme, a patient would either be given a set of brochures selected from 100s of variants, or all patients would be given the same set of brochures without regard for differing needs. We have been developing an information brochure generator that customizes material for every individual patient regardless of the complexity of the surgical intervention

Expansion and Characterization of Human Melanoma Tumor-Infiltrating Lymphocytes (TILs)

Various immunotherapeutic strategies for cancer are aimed at augmenting the T cell response against tumor cells. Adoptive cell therapy (ACT), where T cells are manipulated ex vivo and subsequently re-infused in an autologous manner, has been performed using T cells from various sources. Some of the highest clinical response rates for metastatic melanoma have been reported in trials using tumor-infiltrating lymphocytes (TILs). These protocols still have room for improvement and furthermore are currently only performed at a limited number of institutions. The goal of this work was to develop TILs as a therapeutic product at our institution.TILs from 40 melanoma tissue specimens were expanded and characterized. Under optimized culture conditions, 72% of specimens yielded rapidly proliferating TILs as defined as at least one culture reaching ≥3×10(7) TILs within 4 weeks. Flow cytometric analyses showed that cultures were predominantly CD3+ T cells, with highly variable CD4+:CD8+ T cell ratios. In total, 148 independent bulk TIL cultures were assayed for tumor reactivity. Thirty-four percent (50/148) exhibited tumor reactivity based on IFN-γ production and/or cytotoxic activity. Thirteen percent (19/148) showed specific cytotoxic activity but not IFN-γ production and only 1% (2/148) showed specific IFN-γ production but not cytotoxic activity. Further expansion of TILs using a 14-day "rapid expansion protocol" (REP) is required to induce a 500- to 2000-fold expansion of TILs in order to generate sufficient numbers of cells for current ACT protocols. Thirty-eight consecutive test REPs were performed with an average 1865-fold expansion (+/- 1034-fold) after 14 days.TILs generally expanded efficiently and tumor reactivity could be detected in vitro. These preclinical data from melanoma TILs lay the groundwork for clinical trials of ACT

Vasoconstrictor effect of endothelin-1 (ET-1) in human skin, the role of et[subscript]a and et[subscript]b receptors

grantor: University of TorontoEndothelin-1 (ET-1) has been implicated in skin flap ischemia and skin vasospastic disorders but the mechanism of ET-1-induced vasoconstriction in human skin remains controversial. This information is important for drug development for treatment of ET-1-induced skin vasospasm. The objective of this thesis, therefore, was to investigate the vasoconstrictor potency of ET-1 and the functional importance of ET\rm\sb{A} and ET\rm\sb{B} receptors in mediating ET-1-induced vasoconstriction in human skin using the isolated human paraumbilical skin flap model perfused by Krebs buffer containing 6.5% albumin, gassed with 95% O\sb2 and 5% CO\sb2 at 37\sp\circC and pH 7.4. It was observed that ET-1 (10\sp{-10}{-}10\sp{-8} M) and norepinephrine (NE, 10\sp{-9}{-}10\sp{-5} M) caused a cumulative concentration-dependent increase in perfusion pressure with the potency of ET-1 $\sim$200-fold higher than NE. ET\rm\sb{B} receptor agonists (BQ3020 and sarafotoxin S6c, 10\sp{-9}{-}10\sp{-7} M) had no vasoconstrictor effect. The ET-1-induced increase in perfusion pressure was blocked (p $<$ 0.01) by 5\times10\sp{-6} M BQ123 (ET\rm\sb{A} receptor antagonist) but not by 10\sp{-6} M BQ788 (ET\rm\sb{B} receptor antagonist). Dermofluorometry confirmed that changes in vascular reactivity were occurring in the dermal circulation. Furthermore, microsomal membrane receptor binding assays for ET\rm\sb{A} and ET\rm\sb{B} receptors of endothelium-denuded perforator arteries and veins in human skin, respectively, indicated the presence of 83 $\pm$ 2% and 78 $\pm$ 2% high-affinity binding ET\rm\sb{A} receptors. These novel results demonstrated that ET-1 is an extremely potent vasoconstrictor in human skin and its effect is mediated by ET\rm\sb{A} receptors, with no significant participation from ET\rm\sb{B} receptors.M.Sc

Perforator Flaps in Head and Neck Reconstruction

This article attempts to put perforator flaps, as they apply to head and neck reconstruction, into perspective. The importance of existing flaps is emphasized. Specific indications for perforator flaps are highlighted. The deep inferior epigastric artery perforator flap is used as the flap of choice for subtotal glossectomy defects by the authors. The anterolateral thigh flap is the most common flap currently used. Indications for its use are highlighted. Facial artery perforator flaps are introduced, and their roles as local flaps in head and neck reconstruction are highlighted. With our better understanding of vascular anatomy, existing flaps such as the submental flap have been recategorized as perforator flaps. Its role in reconstruction, particularly of lower facial defects, is discussed. Finally the internal mammary artery perforator flap is described and its advantages over the deltopectoral flap and the pectoralis major flap outlined

Authoring and generation of tailored preoperative patient education materials

In reconstructive surgery, multiple interventions during one surgical episode are common. Each intervention must be explained, its intended and potential consequences articulated, and informed consent of the patient secured. Although the pre-surgical encounter between the patient and the surgeon is the opportunity to accomplish this, i