American Indian and Alaska Native Accessibility to Comprehensive Cleft Lip and Palate Treatment

American Indians and Alaska Natives (AI/AN) have the highest incidence of cleft lip and palate (orofacial clefts [OFCs]) when compared to other ethnic groups. We aim to determine the AI/AN populations' proximity and accessibility to American Cleft Palate-Craniofacial Association accredited centers (ACPA centers) for treatment of OFCs. Our hypothesis is an unacceptable proportion of the AI/AN population lacks reasonable accessibility to ACPA centers and comprehensive craniofacial care.

A cross-sectional study of ACPA centers and AI/AN populations were analyzed for possible disparities.

ACPA centers were mapped using Geographic Information Systems (GIS) and compared with 2018 census population data and 2017 Tribal Census Tract data to visually display possible disparities. Total annual potential pediatric cleft care need for selected high-density AI/AN populated lands were estimated.

GIS mapping demonstrates geographical isolation of AI/AN populations from ACPA centers. Two states with high AI/AN populated lands (ND, WY) have no ACPA centers. 47.1% of ACPA centers in high AI/AN populated lands have no craniofacial trained surgeons versus 78.9% craniofacial staffed ACPA centers nationally. The potential unmet cleft and craniofacial care need in selected high-density AI/AN populated lands is 1042 children.

AI/AN populations are likely underserved by ACPA centers and by craniofacial fellowship-trained staffed centers. Not addressing OFCs with comprehensive care can lead to worsened outcomes and further marginalization of these children. With future studies, we will be capable of making data-driven, informed decisions to more effectively ensure AI/AN access to comprehensive cleft and craniofacial care.

Updates on the Management of Non-Melanoma Skin Cancer (NMSC)

Non-melanoma skin cancers (NMSCs) are the most common malignancy worldwide, of which 99% are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of skin. NMSCs are generally considered a curable diseases, yet they currently pose an increasing global healthcare problem due to rising incidence. This has led to a shift in emphasis on prevention of NMSCs with development of various skin cancer prevention programs worldwide. This article aims to summarize the most recent changes and advances made in NMSC management with a focus on prevention, screening, diagnosis, and staging.

Changes in lung hyaluronidase activity associated with lung growth, injury and repair

We measured lung hyaluronidase activity in rats during postnatal life and during the repair of oxygen-induced lung injury. Hyaluronidase activity increased rapidly after birth and peaked at 16-fold the initial value at 8 days. The peak preceded decreased cell proliferation and the onset of differentiation; this is consistent with current concepts of the role of hyaluronidase. During the repair of lung injury, hyaluronidase activity increased to 2.5-fold the control value at 1 day post-injury, but had decreased by 3 days. This early peak is probably related to simultaneous cell proliferation and differentiation. We postulate that changes in hyaluronidase can influence lung growth and repair and that the system may be amenable to manipulation.