Emre Vural

University of Arkansas at Little Rock, Little Rock, Arkansas, United States

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Publications (56)101.11 Total impact

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    ABSTRACT: Pathologic c-Myc expression is frequently detected in human cancers, including Merkel cell carcinoma (MCC), an aggressive skin cancer with no cure for metastatic disease. Bromodomain protein 4 (BRD4) regulates gene transcription by binding to acetylated histone H3 lysine 27 (H3K27Ac) on the chromatin. Super-enhancers of transcription are identified by enrichment of H3K27Ac. BET inhibitor JQ1 disrupts BRD4 association with super-enhancers, downregulates proto-oncogenes, such as c-Myc, and displays antitumor activity in preclinical animal models of human cancers. Here we show that an enhancer proximal to the c-Myc promoter is enriched in H3K27Ac and associated with high occupancy of BRD4, and coincides with a putative c-Myc super-enhancer in MCC cells. This observation is mirrored in tumors from MCC patients. Importantly, depleted BRD4 occupancy at the putative c-Myc super-enhancer region by JQ1 correlates with decreased c-Myc expression. Thus, our study provides initial evidence that super-enhancers regulate c-Myc expression in MCC.
    Epigenetics: official journal of the DNA Methylation Society 05/2015; DOI:10.1080/15592294.2015.1034416 · 5.11 Impact Factor
  • S. Bayrak, E. A. Vural
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    ABSTRACT: Objectives: (1) Evaluate the outcomes of patients who underwent total rhinectomies. (2) Give physicians a better understanding of prior treatment modalities, postoperative survival outcomes, and rehabilitation options.
    Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P176-P176. DOI:10.1177/0194599814541629a121 · 1.72 Impact Factor
  • S. Bayrak, A. Davis, E. A. Vural
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    ABSTRACT: Objectives: (1) Defining functional swallowing outcomes as well as determining an expected length of time for patients to safely return to a normal oral diet in transoral robotic surgery (TORS) for resection of supraglottic laryngeal cancer.
    Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P166-P167. DOI:10.1177/0194599814541629a92 · 1.72 Impact Factor
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    ABSTRACT: Objectives: Evaluate the indications for endovascular techniques in the management of patients with head and neck squamous cell carcinoma.
    Otolaryngology Head and Neck Surgery 08/2013; 149(2 Suppl):P192-P192. DOI:10.1177/0194599813496044a150 · 1.72 Impact Factor
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    ABSTRACT: To compare the removal rates of 8-hole angle strut plate and Champy line plate in repairing mandibular angle fractures. Retrospective chart review at a tertiary care academic center of adults who were at least 18 years old with at least 1 mandibular angle fracture of a traumatic origin who underwent open reduction and internal fixation by using single monocortical miniplate fixation in Champy line or by using 8-hole angle strut plate via transbuccal approach. The outcome measures were hardware removal rates and the reason for removal of the hardware. One hundred four patients with a total of 106 angle fractures met the inclusion criteria for this study. Seventy-three angle fractures were treated with the 8-hole strut, and 33 angle fractures were treated with the Champy line plates. There were 6 plates removed in both groups. This resulted in 8.2% of plates removed in the 8-hole strut plate group and 18.2% in the Champy line group (P = 0.133). Loose hardware was determined to be the cause of plate removal in 2 (2.7%) of the 8-hole strut plate group compared with all 6 (18.2%) of the Champy group (P = 0.005). Overall, removal rates between Champy line and 8-hole strut plates are not different in treating mandibular angle fractures, although the 8-hole strut plate has a lower rate of loose hardware-related plate removal compared with the Champy line plate.
    The Journal of craniofacial surgery 01/2013; 24(1):163-5. DOI:10.1097/SCS.0b013e31826468f5 · 0.68 Impact Factor
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    ABSTRACT: To report the technical feasibility of performing transoral robotic supracricoid partial laryngectomy with preservation of the thyroid cartilage. This is a case report from a tertiary-care academic institution. A patient with recurrent T2 glottic squamous cell carcinoma of the larynx underwent supracricoid partial laryngectomy with negative margins and preservation of the laryngeal framework using transoral robotic surgery, where an adequate exposure to the endolarynx was obtained by using a Feyh-Kastenbauer retractor. The patient was successfully decannulated in postoperative week 4, and his gastrostomy tube was removed in postoperative week 6. Transoral robotic surgery may be feasible in select glottic/subglottic laryngeal lesions, if adequate exposure is obtained.
    Journal of Robotic Surgery 12/2012; 6(4). DOI:10.1007/s11701-012-0349-0
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    ABSTRACT: Objective Concurrent chemoradiotherapy (CCRT) has become the treatment of choice for oropharyngeal and hypopharyngolaryngeal cancers in many centers. Although it has increased the rates of organ preservation, there has also been an increase in treatment-related complications. We aimed to evaluate the functional outcomes of CCRT in head and neck cancer.Study DesignCase series with chart review.SettingTertiary cancer center.Subjects and MethodsA retrospective study of patients treated with CCRT at the University of Arkansas for Medical Sciences was performed. Demographic data and treatment outcomes were extracted, specifically feeding tube and tracheotomy dependence and number of esophageal dilatations.ResultsOf the 243 patients treated with concurrent chemoradiotherapy (5-flourouracil + cysplatin and radiotherapy), 152 patients received a feeding tube. The median percutaneous gastrostomy tube (PEG) use was 9 months (range, 1-96 months). More than 70% of the patients who had a PEG more than 6 months had a T3 or T4 tumor. Thirty-seven patients underwent esophageal dilatations, (median, 1; range, 1-7). The median use of a tracheotomy was 7 months, and 77% of these patients were treated for hypopharyngolaryngeal cancer.Conclusions Despite major improvement in locoregional control rates, CCRT has a significant negative impact on the functional outcomes of head and neck cancer patients, with a high number of patients remaining PEG and tracheotomy dependent.
    Otolaryngology Head and Neck Surgery 09/2012; 145(2 Suppl). DOI:10.1177/0194599812459325 · 1.72 Impact Factor
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    ABSTRACT: Objective: The incidence of early squamous cell carcinoma of the oral tongue (SCCOT) is increasing, particularly among young patients. The development of loco-regional recurrence is associated with poor survival. We sought to identify the predictors for nodal recurrence in early (T1/T2) SCCOT presenting with a radiologically N0 neck. Method: Retrospective chart review of 50 consecutive patients primarily treated for T1/T2-N0 SCCOT at an academic tertiary institution between 1998 and 2007. N0 status confirmed by preoperative contrasted neck CT in all cases. Results: Twenty-six men and 24 women with a median age of 61 years (range, 24-90 years); 46% presented with a T1 and 54% with a T2. Depth of invasion >4 mm was present in 76%; positive margins in 8%; dysplasia at the margin 6%; perineural invasion 18%; and lymphovascular invasion 12%. Ipsilateral neck dissection was performed in 60% (20% microscopically positive) while adjuvant radiation was used in 32%. Twenty percent of the patients recurred in the neck, ipsilateral in all cases. It presented between 4 and 47 months and was associated with dysplasia at the margin (P = .037) and local recurrence (P = .002), while pathological T-stage (pT2/pT1) trended (P = .087). Conclusion: Pathological T-stage, field cancerization and development of local recurrence are predictors for regional failure in patients with early SCCOT. Neck recurrence appears to be primarily determined by biological behavior rather than treatment modality in this subset of patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2012.
    Otolaryngology Head and Neck Surgery 08/2012; 147(2 Suppl):P172-P173. DOI:10.1177/0194599812451426a151 · 1.72 Impact Factor
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    ABSTRACT: Edward Ellis Ill, Robert M. Kellman, and Emre Vural address questions for discussion and debate: 1. Are there specific indications for open versus closed treatment of subcondylar fractures? Are there any contraindications to open treatment, and do they supercede the indications for open treatment? 2. Does the presence of other fractures (mandible and/or midface) affect your choice of open versus closed treatment? (Is the selection of closed vs open treatment the same for unilateral vs bilateral fractures?) 3. If one chooses to perform closed treatment, how long a period of MMF is required? 4. What are the most important factors for success when closed treatment is used? 5. What is the best surgical approach to ORIF of subcondylar fractures? 6. Analysis: Over the past 5 years, how has your technique or approach evolved or what is the most important thing you have learned/observed in working with subcondylar fractures?
    Facial plastic surgery clinics of North America 08/2012; 20(3):365-82. DOI:10.1016/j.fsc.2012.05.002 · 1.18 Impact Factor
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    ABSTRACT: To determine the factors contributing to failure of interpolation flaps in nasal reconstruction. Retrospective medical chart review. Tertiary care academic center. A total of 107 patients with nasal defects needing reconstruction, performed at the University of Arkansas for Medical Sciences, Little Rock. Patients underwent nasal reconstruction with 2-stage paramedian forehead or nasolabial flaps (PMFF and NLF, respectively) from 2002 to 2011. Defect thickness, location, flap type, use of cartilage grafts, and comorbidities, including diabetes mellitus, peripheral vascular or coronary artery disease, and smoking habits, were recorded. Full success, partial failure, or full failure of the respective flap. Eighty-two of the patients (77%) underwent 2-stage PMFF repair and 25 (23%) underwent 2-stage NLF repair. Fifty-eight defects (54%) were full thickness, in which 46 repairs used PMFF and 12 used NLF for reconstruction. The overall failure rate was 6%. Five PMFF failed (6%); 3 of these were used for full-thickness repairs. There was only 1 NLF failure (4%), which was also performed for the repair of a full-thickness defect. Use of cartilage in the reconstruction did not affect failure rates of the different soft tissue flaps. No single comorbidity was noted to have a statistically significant effect on failure rates, although 83% of failures were observed in smokers. The overall success rate of interpolation flaps in nasal reconstruction was 94.4%. Defect thickness, use of a cartilage graft, type of flap used, and presence of comorbidities did not affect outcome. Although the comparison was not statistically significant (P = .21), flap failures were more commonly observed in smokers.
    Archives of otolaryngology--head & neck surgery 03/2012; 138(4):367-71. DOI:10.1001/archoto.2012.69 · 1.75 Impact Factor
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    ABSTRACT: To determine the safety and efficacy of photodynamic therapy in the treatment of oral leukoplakia with 5-aminolevulinic acid and pulsed dye laser. Nonrandomized, single-arm, single-site phase 1/2 pilot study. Academic referral center. A total of 23 patients, aged 37 to 79 years, having a confirmed diagnosis of leukoplakia with or without dysplasia measuring at least 10 mm in diameter. Application of 5-aminolevulinic acid to lesions followed by activation with high-power 585-nm pulsed dye laser. Maximum tolerated dose of laser, postprocedure complications, objective response to treatment, and immunohistochemical changes in treated tissue. No significant adverse events occurred; minor local adverse effects were observed during and following photodynamic therapy in the safety phase of the study. The maximum tolerated dose was 8 J/cm(2). Of 17 patients, 7 (41%) had more than 75% regression (significant response) and 9 (53%) had more than 25% regression (partial response), for an overall response rate of 94% at 90 days. This response rate was far higher than the null-hypothesis 20% rate (P < 10(-10)) and the alternative-hypothesis 50% rate (P = .0001) for which the study was powered. When compared with baseline levels immunohistochemically, p53 expression was increased in 8 of 11 available samples (73%) and Ki-67 expression was decreased in 7 of 12 available samples (58%). Photodynamic therapy with 5-aminolevulinic acid and pulsed dye laser could be used to achieve regression of oral leukoplakia. The treatment is safe and well tolerated. An application time of 1.5 hours and laser radiant exposure of 8 J/cm(2) with 1.5-ms pulse time were found to be the optimal settings in this study. The high-power laser used in this study allows completion of laser therapy within 1 to 3 minutes. Further studies are necessary to determine the optimal laser radiant exposure and drug application to maximize the response rate.
    Archives of otolaryngology--head & neck surgery 11/2011; 137(11):1117-23. DOI:10.1001/archoto.2011.178 · 1.75 Impact Factor
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    ABSTRACT: Objective: 1) Compare the rate of removal of Champy’s plates vs 8-hole strut plates used for repair of mandible angle fracture. 2) Determine the reason for removal of these plates.
    Otolaryngology Head and Neck Surgery 09/2011; 145(2 Suppl):P53-P53. DOI:10.1177/0194599811416318a41 · 1.72 Impact Factor
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    ABSTRACT: Objective: There is continued debate as to whether to perform a neck dissection as a planned vs “wait and see” procedure in patients with head and neck cancer treated with chemoradiotherapy. In this study we aimed to review our results to help with the decision making process.
    Otolaryngology Head and Neck Surgery 09/2011; 145(2 Suppl):P63-P63. DOI:10.1177/0194599811416318a72 · 1.72 Impact Factor
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    ABSTRACT: Objective: Determine whether the type (paramedian forehead [PMFF] vs nasolabial [NLF]) or the defect thickness (full vs partial) play a role in take rates of interpolation flaps in nasal reconstruction.
    Otolaryngology Head and Neck Surgery 09/2011; 145(2 Suppl):P48-P48. DOI:10.1177/0194599811416318a24 · 1.72 Impact Factor
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    ABSTRACT: Objective: Provide prognostic data for the physicians and patients when a decision is made for primary or salvage ablative surgery of the upper aerodigestive tract with the aide of microvascular reconstruction.
    Otolaryngology Head and Neck Surgery 09/2011; 145(2 Suppl):P159-P160. DOI:10.1177/0194599811415823a84 · 1.72 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the potential role of variable microRNA (miRNA) expression in the development of multidrug resistance (MDR) in head and neck cancer. Head and neck squamous cell carcinoma cell lines UMSCC-1 and SQ20B were treated with docetaxel at increasing concentrations to develop resistant cell lines. Parental and resistant cells were treated with cisplatin, 5-fluorouracil, paclitaxel, methotrexate, and doxorubicin to confirm cross-resistance. The miRNA pattern of resistant cells was then compared with their parental cells. Docetaxel treatment successfully induced resistance primarily and induced multidrug cross-resistance. Resistant cells showed significant downregulation of miR-100, miR-130a, and miR-197 and upregulation in miR-101, miR-181b, miR-181d, and miR-195 expression when compared with their parent cells (p < .01). Real-time polymerase chain reaction (PCR) analysis confirmed statistically significant downregulation in miR-100 and miR-130a and upregulation in miR-181d expression (p < .001). Alterations in miRNA expression has direct relationship to MDR in head and neck cancer and may serve as biomolecular targets for reversal of MDR.
    Head & Neck 06/2011; 33(6):786-91. DOI:10.1002/hed.21540 · 3.01 Impact Factor
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    ABSTRACT: To identify unique epigenetic signature in cancer stem cells (CSCs) in head and neck squamous cell carcinoma (HNSCC). Molecular and microarray studies. Tertiary referral center. Head and neck CSCs were isolated in HNSCC cells by CD44 staining and flow cytometry sorting. CSCs with highest CD44 expression (CD44(hi)) and non-stem cells (non-SCs) with lowest CD44 expression (CD44(low)) were then characterized for stemness gene expression and their responses to chemotherapeutic agents, followed by high-throughput epigenetic profiling using the Illumina BeadChip Array, targeting 28,544 CpG sites covering more than 14,956 genes. CD44(hi) CSCs expressed higher levels of stem cell markers and were more resistant to chemotherapeutic agents as compared to CD44(low) non-SCs. By DNA methylation microarray analysis, 17 hypomethylated and 9 hypermethylated genes were identified in CD44(hi) CSCs as compared to non-SCs in most HNSCC cell lines. Cluster analysis using these 26 genes showed that CD44(hi) CSCs were epigenetically distinct from the CD44(low) non-SCs in all 5 HNSCC cell lines. A unique epigenetic profile consisting of 17 hypomethylated and 9 hypermethylated genes was seen in HNSCC CSCs. These genes may be critically required in maintaining the stemness or pluripotency of CSCs and may represent novel molecular targets for anticancer therapies aimed at eradicating CSCs in HNSCC.
    Otolaryngology Head and Neck Surgery 06/2011; 144(6):900-9. DOI:10.1177/0194599811398786 · 1.72 Impact Factor
  • Jennings R Boyette, Emre Vural
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    ABSTRACT: To present the authors' experience and outcomes in the reconstruction of midfacial defects using cervicofacial advancement-rotation flaps (CARFs) based on a method of determining forward or reverse design in relation to the proportions of the defect. Case series with retrospective chart review. Tertiary care academic medical center. Patients who underwent CARF reconstruction and the subset of patients with midfacial defects medial to the lateral canthus were included. CARF was designed in a forward fashion with an anteromedial movement for the defects with a larger vertical dimension and in a reverse fashion with a posterosuperior movement for the defects with a larger horizontal dimension. Thirteen of 45 patients who underwent CARF reconstruction qualified for the analysis as a subset based on defect location. CARF was used in a forward fashion in 7 patients and in a reverse fashion in 6 patients. The largest defect in this subset was measured as 9 × 6 cm, while the smallest defect was 3 × 2 cm. Average follow-up was 11.5 months. None of the patients developed partial or total flap loss. Six patients had mild ectropion, which was managed with conservative measures only. The outcome of the reconstruction was satisfactory in all cases. Designing the CARF based on the proportion of the vertical and horizontal diameters of the selected midfacial defects as described allows for closure of the defects with minimal tension and minimizes the amount of discarded healthy skin overlapping at the suture lines.
    Otolaryngology Head and Neck Surgery 02/2011; 144(2):196-200. DOI:10.1177/0194599810391391 · 1.72 Impact Factor
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    ABSTRACT: To compare the diagnostic adequacy of ultrasound-guided fine-needle aspiration biopsy (USFNA) of the head and neck with immediate on-site microscopic evaluation and feedback by a cytopathologist (IMMEDIATE) versus delayed examination without immediate feedback (DELAYED). Retrospective chart review of office-based USFNA performed in both IMMEDIATE and DELAYED settings by the same otolaryngologist. A total of 199 USFNA procedures in the head and neck were performed by one practitioner. Of these procedures, 137 biopsies were performed in the DELAYED setting, whereas 62 biopsies were performed in the IMMEDIATE setting. Cytopathology reports were reviewed for diagnostic conclusions as well as adequacy of biopsies. The results from both settings were compared using Pearson χ2 test. The ability to obtain a diagnosis from USFNA was 73.0% in the DELAYED group as compared with 90.3% in the IMMEDIATE group. The rate of adequate cells on biopsy was 89.1% in the DELAYED group as compared with 96.8% in the IMMEDIATE group. There was a statistically significant difference between observed and expected diagnostic rates (χ(2)[1] = 7.568, P = .006) and a trend toward a significant difference between the observed and expected adequacy rates (χ(2)[1] = 3.259, P = .071) when IMMEDIATE evaluation by a cytopathologist was performed. An immediate microscopic evaluation of USFNA specimens to confirm adequacy of sampling is strongly recommended. Diagnostic conclusions were increased when an evaluation of the specimen was performed at the time of biopsy. The specimen adequacy rate tended to increase with an immediate cytopathologic assessment. Laryngoscope, 2010.
    The Laryngoscope 10/2010; 120(10):1979-84. DOI:10.1002/lary.21061 · 2.03 Impact Factor
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    ABSTRACT: To compare the "take" rates of skin grafts between myeloid-selective hypoxia-inducible factor (HIF) 1alpha knockout (KO) and wild-type (WT) mice. Production of the alpha subunit of HIF-1alpha is increased in healing wounds, which stimulates expression of vascular endothelial growth factor (VEGF) to promote angiogenesis. Therefore, the take rate of skin grafts may be closely associated with the presence or absence of HIF-1alpha production in the recipient bed. The percentage of healthy graft areas obtained by planimetry and scores for epithelialization and granulation tissue formation obtained by histopathologic analysis were compared in 12 KO and 12 WT mice following skin grafting. The graft take rate was significantly impaired in the KO group (P = .009), whereas epithelialization (P = .46) or granulation (P = .41) tissue formation scores did not reveal any significant differences. Hypoxia-inducible factor 1alpha in myeloid cells may be an important molecule for revascularization of avascular tissues such as skin grafts, probably owing to its stimulating effect on angiogenesis.
    Archives of otolaryngology--head & neck surgery 07/2010; 136(7):720-3. DOI:10.1001/archoto.2010.103 · 1.75 Impact Factor

Publication Stats

510 Citations
101.11 Total Impact Points


  • 2000–2013
    • University of Arkansas at Little Rock
      • Department of Psychology
      Little Rock, Arkansas, United States
  • 2007–2011
    • University of Arkansas for Medical Sciences
      • • Department of Otolaryngology-Head and Neck Surgery
      • • Department of Surgery
      Little Rock, Arkansas, United States
  • 2008–2009
    • Central Arkansas Veterans Healthcare System
      Washington, Washington, D.C., United States