'Study of the maxillary yaw on cone beam computed tomography: A preliminary report and comparison between two different dento-skeletal malocclusions'

OBJECTIVES

To assess the skeletal and dental maxillary transverse compensation (yaw) on the cone beam computed tomography (CBCT) three-dimensional reconstructed image of the skull in two groups of patients, both clinically affected by a class III malocclusion with deviation of the lower midline.

MATERIALS AND METHODS

An observational retrospective study was designed to analyse differences in two groups of patients, the first one was composed by patients affected by horizontal condylar hyperplasia, the second one by patients affected by dento-skeletal asymmetric class III malocclusion. Each group was composed by 15 patients. Transverse analysis was performed by measuring five landmarks (three bilateral and two uneven) with respect to a mid-sagittal plane; sagittal analysis was performed by measuring the sagittal distance on the mid-sagittal plane between bilateral points. Means were compared through inferential analysis.

RESULTS

In the condylar hyperplasia group, all differences between the two sides were not statistically significant, nor for canines' difference (P = .0817), for molars (P = .1105) or for jugular points (.05871). In the class III group, the differences between the two sides were statistically significant for molars (P = .0019) and jugular points (P = .0031) but not for canines (P = .1158). Comparing the two groups, significant differences were found only for incisors' midline deviation (P = .0343) and canine (P = .0177).

CONCLUSION

The study of the yaw on CBCT should be integrated into three-dimensional cephalometry and could help in differentiating the various malocclusion patterns.

Novel therapeutic approaches based on the pathological role of gut dysbiosis on the link between nonalcoholic fatty liver disease and insulin resistance

The growing global epidemic of obesity and type 2 diabetes mellitus has determined an increased prevalence of NAFLD (non-alcoholic fatty liver disease), making it the most common chronic liver disease in the Western world and a leading cause of liver transplantation. In the last few years, a rising number of studies conducted both on animal and human models have shown the existence of a close association between insulin resistance (IR), dysbiosis, and steatosis. However, all the mechanisms that lead to impaired permeability, inflammation, and fibrosis have not been fully clarified. Recently, new possible treatment modalities have received much attention. To reach the review purpose, a broad-ranging literature search on multidisciplinary research databases was performed using the following terms alone or in combination: "NAFLD", "gut dysbiosis", "insulin resistance", "inflammation", "probiotics", "Chinese herbs". The use of probiotics, prebiotics, symbiotics, postbiotics, fecal microbiota transplant (FMT), Chinese herbal medicine, antibiotics, diet (polyphenols and fasting diets), and minor therapies such as carbon nanoparticles, the MCJ protein, water rich in molecular hydrogen, seems to be able to improve the phenotypic pattern in NAFLD patients. In this review, we provide an overview of how IR and dysbiosis contribute to the development and progression of NAFLD, as well as the therapeutic strategies currently in use.

Regorafenib monotherapy as second-line treatment of patients with RAS-mutant advanced colorectal cancer (STREAM): an academic, multicenter, single-arm, two-stage, phase II study

BACKGROUND

Maintaining angiogenesis inhibition and switching the chemotherapy backbone represent the current second-line therapy in patients with RAS-mutant metastatic colorectal cancer (mCRC). Regorafenib, an oral multikinase inhibitor, prolonged overall survival (OS) in the chemorefractory setting.

MATERIALS AND METHODS

STREAM was an academic, multicenter, single-arm phase II trial, evaluating the activity of regorafenib in RAS-mutant mCRC, in terms of the rate of patients who were progression-free after 6 months from study entry (6mo-PF). Patients were pretreated with fluoropyrimidine, oxaliplatin, and bevacizumab. According to Simon's two-stage design, ≥18 patients 6mo-PF were needed in the overall population (N = 46). Secondary endpoints were safety, objective response rate (ORR), progression-free survival (PFS), and OS. Early metabolic response by [¹⁸F]2-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography ([¹⁸F]-FDG PET/CT) scan was an exploratory endpoint. EudraCT Number: 2015-001105-13.

RESULTS

The number of patients 6mo-PF was 8/22 at the first stage and 14/46 in the overall population. The ORR was 10.9%, disease control rate was 54.6%, median (m)PFS was 3.6 months [95% confidence interval (CI) 1.9-6.7 months], mOS was 18.9 months (95% CI 10.3-35.3 months), and mPFS2 (from study entry to subsequent-line progression) was 13.3 months (95% CI 8.4-19.7 months). Long benefiter patients (>6mo-PF) significantly more often had a single metastatic site and lung-limited disease. No unexpected toxicity was reported. Grade ≥3 events occurred in 39.1% of patients, with hand-foot syndrome (13%), fatigue, and hyperbilirubinemia (6.5%) occurring mostly. Baseline metabolic assessment was associated with OS in the multivariate analysis, while early metabolic response was not associated with clinical outcomes.

CONCLUSIONS

The study did not meet its primary endpoint. However, regorafenib was well tolerated and did not preclude subsequent treatments. Patients with good prognostic features (single metastatic site and lung-limited disease) reported clinical benefit with regorafenib. The exploratory metabolic analysis suggests that baseline [¹⁸F]-FDG PET/CT might be useful to select patients with a favorable outcome. A chemotherapy-free interval with regorafenib was associated with durable disease control in a selected group of patients with favorable clinical characteristics.

Clinical efficacy of sequential treatments in KRASG12C-mutant metastatic colorectal cancer: findings from a real-life multicenter Italian study (CRC-KR GOIM)

Background

The presence of KRASG12C mutation in metastatic colorectal cancer (mCRC) correlates with poor outcome. Although different selective inhibitors are under clinical development, the optimal treatment remains uncertain. Thus, we conducted a retrospective analysis in a large cohort of patients with KRASG12C mCRC treated in 12 Italian oncology units.

Patients and methods

Patients with unresectable mCRC harboring KRASG12C mutation receiving a first-line chemotherapy doublet or triplet between 2011 and 2021 were included in the study. Evaluation of overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) analysis was carried out.

Results

A total of 256/6952 (3.7%) patients with mCRC displayed KRASG12C mutation; of these, 111 met the inclusion criteria. The ORR of first-line therapy was 38.7% (43/111). Median PFS (mPFS) was 9 months [95% confidence interval (CI) 7.5-10.5 months]. After progression, only 62% and 36% of the patients are fit to receive second or third lines of treatment, with limited clinical benefit. Median OS (mOS) was 21 months (95% CI 17.4-24.6 months). In patients receiving first-line triplet chemotherapy, ORR was 56.3% (9/16), mPFS was 13 months (95% CI 10.3-15.7 months) and mOS was 32 months (95% CI 7.7-56.3 months). For irinotecan-based doublets, ORR was 34.5 (10/29), mPFS was 9 months (95% CI 6.4-11.6 months) and mOS was 22 months (95% CI 16.0-28.0 months). With oxaliplatin-based doublets ORR was 36.4% (24/62), mPFS was 7 months (95% CI 4.6-9.4 months) and mOS was 18 months (95% CI, 13.6-22.4 months).

Conclusion

Patients with KRASG12C-mutant mCRC had a disappointing response to standard treatments. Within the limitations of a retrospective study, these results suggest that first-line chemotherapy intensification with FOLFOXIRI is a valid option in fit patients.

•

KRASG12C mutation is rare and occurs in 3.7% of the study population.

•

The presence of KRASG12C mutation is correlated with an aggressive disease, with reduced response to chemotherapy.

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Only 62% and 36% of patients with KRASG12C-mutant mCRC are fit to receive second or third lines of treatment, respectively.

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The use of chemotherapy triplets is associated with improved outcomes compared with chemotherapy doublets.

Correlation between generalised joint hypermobility and temporomandibular joint disc displacement in adolescent patients: Magnetic Resonance Imaging study

AIM

Temporomandibular disorders (TMD), in particular disc displacement, are recognised to have a multifactorial aetiology. Ligamentous laxity has been suggested as a potential risk factor for TMD. Ligamentous laxity can lead to generalised joint hypermobility (GJH) involving multiple joints, including the temporomandibular joint (TMJ). The aim of this work is to evaluate the correlation between GJH and disc displacement (DD) assessed on magnetic resonance images (MRI) of the TMJ in adolescent patients.

MATERIALS

The study was included 40 adolescent patients (10-16 years), divided into two groups, a Study Group (SG), composed of 20 subjects with GJH, and a Control Group (CG), composed of 20 subjects without GJH. The GJH was assessed by the Beighton test with a threshold value of ≥ 4. The severity of the TMD was determined using the Fonseca Questionnaire and a clinical evaluation of the type of TMD. The condylar-discal relationship and the condylar mobility of the TMJ were evaluated by MRI. Pearson's χ2 Test was performed for the analysis of the statistical correlation.

CONCLUSION

This study suggests that adolescents with GJH have a greater risk of developing TMJ disc displacement, especially disc displacement without reduction.

The cornea as a reference point in orthodontic diagnosing, a retrospective study

BACKGROUND

The aim of the study is to provide scientific evidence on the possibility of using the Corneal point a skin point for measu-rements that can be made on both standard and three-dimensional photographs. Also, we want to demonstrate the stability of corneal point during the growth, to use it as a reference point.

METHODS

A sample of 105 radiographs was reached. A descriptive and longitudinal statistical analysis was performed.

RESULTS

By data analysis we obtained more variability inter-subject of the millimetrically value of the SC plan. For this reason, we consi-dered the relationship between the SN and SC values and not a single value. In the cross-sectional study the T- test analysis did not show a different significant result of variations between SC and SN in both sexes; therefore, we considered these as unique sample.

CONCLUSION

Longitudinal study has a major importance for to esta-blishing the age-related changes. By cross-selection and longitudinal analysis we obtained an overlapping trend of the SN and SC plan. As the SN plan has always been used as a reference plan for cephalometric measurements, although its variations in growth, it can be concluded that the SC plan can be considered equally a reference plan.

Risk factors for diabetic foot ulcers: an Albanian retrospective study of inpatients with type 2 diabetes

OBJECTIVE

The aim of this study was to assess the impact of glucose control, diabetes-related complications and cardiometabolic risk factors on the risk of diabetic foot ulcers (DFUs) and DFU complications in Albanian adult inpatients with T2D.

PATIENTS AND METHODS

We conducted a retrospective case-control study on 482 Albanian adult inpatients with T2D. DFU was defined as a full-thickness skin lesion requiring ≥14 days for healing and was classified at the time of hospital admission. Demographic and biochemical parameters of the study participants, the presence of comorbidities and diabetes-related complications at the time of hospital admission were evaluated through a retrospective chart review.

RESULTS

Mean age of study participants was 54.8±10.7 years. Participants (284 males and 198 females) were divided into two groups: DFU (cases; n=104) and non-DFU (controls; n=378). Multivariate analysis (performed by a logistic regression model) revealed that the most relevant independent variables associated with DFU were BMI [OR=0.62; p=0.007], HDL-cholesterol [OR=0.00; p<0.0001], triglycerides [OR=7.48; p=0.0004], cigarette smoking [OR=26.46; p=0.005], duration of diabetes [OR=1.53; p<0.0001], fasting plasma glucose (FPG) [OR=1.06; p<0.0001], systolic blood pressure (SBP) [OR=1.13; p=0.0004] and insulin therapy alone [OR=0.11; p=0.02]. ROC curve analysis showed that FPG (AUC=0.83), glycated hemoglobin (HbA1c) (AUC=0.75), triglycerides (AUC=0.78) and HDL-cholesterol (AUC=0.82) were the most reliable biomarkers able to detect DFU. In the DFU group, the most relevant independent variables associated with previous minor lower-extremity amputations (LEAs) were represented by HbA1c [OR=1.47; p=0.03], age <55 years [OR=0.12; p=0.05] and female sex [OR=4.18; p=0.03]; whereas the most relevant independent variables associated with diabetic peripheral neuropathy (DPN) were HbA1c [OR=1.70; p=0.006], SBP [OR=1.08; p=0.05], BMI [OR=1.20; p=0.03] and lack of cigarette smoking [OR=0.07; p=0.01]. Correlation analysis (performed through the nonparametric Spearman's rank correlation test or through the parametric Pearson test, as appropriate) revealed a significant positive relationship between HbA1c and FPG (r=0.58; p<0.0001), ulcer surface area (r=0.50; p<0.0001), ulcer grade (r=0.23; p=0.02), minor LEAs (r=0.20; p=0.04), DPN (r=0.41; p<0.0001), and metformin therapy alone (r=0.72; p<0.0001). There was a significant inverse correlation between HbA1c and insulin therapy alone (r=-0.31; p=0.01) and combined metformin and insulin therapy (r=-0.60; p<0.0001). Both DFU and non-DFU groups exhibited suboptimal mean LDL-cholesterol levels (>100 mg/dl) and mean HbA1c values >7.5%. Moreover, in DFU group HbA1c values were markedly elevated (≥10%) particularly in patients with a grade 3 ulcer and an ulcer surface area ≥4 cm2, as well as in patients with history of minor LEAs and in patients affected by DPN.

CONCLUSIONS

The present study suggested that longer duration of diabetes, cigarette smoking, lower HDL-cholesterol levels, poor glucose control, and elevated triglyceride and SBP values may all represent major risk factors for the development of DFU in Albanian patients with T2D. Thus, community interventions and health policies aimed to improve the management of diabetes and related cardiometabolic risk factors should be urgently implemented in Albania, in order to prevent DFUs and other diabetes complications in patients with T2D.

Association between the temporomandibular joint disc position on magnetic resonance imaging and the mandibular deviation on posteroanterior cephalogram: a cross-sectional study in adolescents

OBJECTIVE

The aim of this cross-sectional research was to analyze the association between the disc position of the temporomandibular joint (TMJ) evaluated by magnetic resonance imaging (MRI) and the mandibular deviation evaluated by posteroanterior cephalometric (PA) in adolescents.

MATERIALS AND METHODS

The sample was 53 adolescents aged 11-18 years. This cross-sectional study was based on the analysis of PA and bilateral TMJ MRI images retrospectively selected. The mandibular deviation was evaluated by PA and defined by the amount of menton (Me) deviation from the midsagittal reference line. The temporomandibular disc position was evaluated by MRI: normal (N), disc displacement with reduction (DDR) and disc displacement without reduction (DDNR). The DDNR was considered more severe than the DDR. The patients were classified into three groups based on the bilateral disc position: group I, the same bilateral disc position; group II, disc displacement more severe on the ipsilateral side of the menton deviation; group III, disc displacement more severe on the contralateral side of the menton deviation. ANOVA followed by post hoc Tukey's test was used to evaluate the interaction between the menton deviation and the bilateral disc position.

RESULTS

There was an association statistically significant between the bilateral disc position and the Me deviation (p<0.05). There were significant differences in the mean of the menton deviation between group II (4,40 ±2,26), and group I (2,17±1,93) and III (2,10±1,70).

CONCLUSIONS

The menton deviation was significantly correlated with the disc position in the TMJ exhibit more deflection to the side more affected.

Liver radiologic findings of chemotherapy-induced toxicity in liver colorectal metastases patients

There are a number of chemotherapy-effects that should be assessed with liver imaging since they have an influence on surgical morbidity. Chemotherapy-related complications, steatosis, chemotherapy-associated steatohepatitis (CASH), and SOS might impair the hepatic parenchyma, thus reducing the functionality and influencing the outcome following resection. The main role of a radiologist is to provide an accurate diagnosis of the lesion. With constant advances in medicine, a radiologist's role should extend beyond just reporting the data of tumor, providing additional information that may greatly improve patient care. Radiologists should assess both chemotherapy effects on the hepatic metastasis itself, as well as chemo-induced focal and diffuse modifications of non-tumor hepatic parenchyma, since it is important to avoid impaired hepatic function after hepatic resection.

199 Strategies to improve canine oocyte invitro maturation

Canine oocyte invitro maturation (IVM) is one of the challenges of animal reproduction because of low maturation and high degeneration rates. In the bitch, after ovulation, oocytes remain in an immature stage and acquire their competence in the intra- and extrafollicular (oviductal) environments. Oxidative stress and reactive oxygen species affect canine oocytes, which can be related to the high amount of lipids they contain. Therefore, the use of antioxidants such as insulin-transferrin-selenium (ITS) and lower oxygen tension during IVM could be beneficial for oocyte maturation and survival. The purpose of this study was to determine an optimum IVM culture medium and to evaluate the effect of ITS and lower oxygen tension in canine IVM. In experiment 1, TCM-199 and synthetic oviductal fluid (SOF) media were evaluated for their ability to promote nuclear maturation at 72 and 48h of culture. Also, two protein sources were used: 8% bovine serum albumin (BSA) and 2.5% fetal bovine serum (FBS), and media were supplemented with hormones. The results revealed that SOF with FBS and BSA had similar results to TCM-199 supplemented with FBS after 72 and 48h of IVM (MII rates of 7% and 4% for the 72-h group, and 4% and 10% for the 48-h group). Synthetic oviductal fluid supplemented with BSA but without FBS produced significantly higher degeneration rates compared with SOF with FBS and BSA (44% and 23%, respectively). Forty-eight hours of IVM decreased degeneration rates, with higher MII rates compared with 72h of IVM. In experiment 2, SOF medium supplemented with FBS and BSA was chosen. Oocytes were cultured in SOF with FBS and BSA supplemented at two concentrations of ITS (1 and 10μLmL−1 ITS). Supplementation with 1μLmL−1 ITS demonstrated a beneficial effect by improving maturation rates up to 20%, compared to control and 10μLmL−1 supplemented group (4% and 6% MII, respectively) after 72h of IVM. For experiment 3, oocytes were cultured in SOF medium with or without ITS (0 and 1μLmL−1 ITS) under two oxygen tensions (5% and 20% O2) for 48h. Results from this experiment demonstrated that the combination of low oxygen tension and ITS (5% O2 and 1μLmL−1 ITS) improved maturation rates up to 26.2%, although there were no statistically significant differences compared with high oxygen and ITS (20% O2 and 1μLmL−1 ITS) and low oxygen without ITS (5% O2 and 0μLmL−1 ITS) groups. These treatments were able to increase MII rates compared with the control group (20% O2 and 0μLmL−1 ITS). Parthenogenetic activation was performed on the low oxygen with or without ITS supplemented groups. The untreated group generated higher degeneration rates after 7 days of culture, and cleavage rates were low for both groups. Nevertheless, an oocyte at the 8-cell stage was obtained in the ITS-supplemented group. Taken together, these results indicate that ITS supplementation and low oxygen tension during IVM improve canine oocyte maturation.

General health & psychological distress in children with temporomandibular disorder

INTRODUCTION

Temporomandibular disorders (TMD) are an heterogeneous group of disorders affecting temporomandibular joints (TMJ), masticatory muscles, or both. The aim of this study is to evaluate the relationship between general health and psychological distress variables and the clinical diagnosis of TMD in children between 8 - 13 years old. Moreover, it will be underlined the different perception of psychological distress existing between patients and their parents.

MATERIALS AND METHODS

Patients were divided in two groups: the "case group", which includes patients with TMD, and the "control group", which included patients asymptomatic for TMD. The "case group" is composed by 29 patients, while the "control group" is composed by 22 patients. The patients were asked to fill in a questionnaire called Child Health Questionnaire (CHQ), to evaluate general health and psychological condition and, eventually, the presence of symptoms of stress, anxiety and/or depression. The CHQ is 87 - item questionnaire developed in USA specifically for children.

RESULT

As widely reported during the present work, the link between TMD and psychological distress is existing and quite strong, because of lack of number of patients many aspects worth of attentions have not been analyzed as they deserved.

CONCLUSION

That's way the conclusion must lead to the proposal of going on with the present study following, possibly, some aspects of research as an increase of the number of patients involved in the study; Individuate possible elements, internal and external, that could strongly influence differences between patient's results and parent's results, etc.

Toxicity assessment of hydroxyapatite nanoparticles in rat liver cell model in vitro

Hydroxyapatite nanoparticles (HAP NPs) are widely used for preparations of biomedical and biotechnological fields such as drug delivery, gene therapy, and molecular imaging. However, the current toxicological knowledge about HAP NPs is relatively limited. The present study was designed to investigate the toxicity potentials of various concentrations (0–1000 µg cm−2) of HAP NPs in cultured primary rat hepatocytes. Cell viability was detected by 3-(4,5-dimethyl-thiazol-2-yl) 2,5-diphenyltetrazolium bromide (MTT) assay and lactate dehydrogenase (LDH) release, while total antioxidant capacity (TAC) and total oxidative stress (TOS) levels were determined to evaluate the oxidative injury. The DNA damage was also analyzed via scoring liver micronuclei rates and determining 8-oxo-2-deoxyguanosine (8-OH-dG) levels. The results of MTT and LDH assays showed that the higher concentrations of dispersed HAP NPs (300, 500, and 1000 µg cm−2) decreased cell viability. Also, HAP NPs increased TOS (500 and 1000 µg cm−2) levels and decreased TAC (300, 500, and 1000 µg cm−2) levels in cultured hepatocytes. On the basis of increasing doses, the NPs as depending on dose caused significant increases of the number of micronucleated hepatocytes and 8-OH-dG levels as compared to control culture. Furthermore, the highest concentration of HAP NPs (1000 µg cm−2) exhibited cytotoxic activity. Based on these results, HAP NPs have a dose-dependent toxic effect in rat hepatocytes. Further extensive research in this field is promising and reasonable.

362 DIFFERENT IN VITRO DEVELOPMENT AFTER AGGREGATION OF BOVINE AND FELINE PARTHENOGENETIC EMBRYOS

Embryo aggregation has been shown to improve embryo development in several species. However, the effects seem to be different among species. Thus, the aim of this study was to compare the effect of embryo aggregation over in vitro development and blastocyst quality of bovine and feline parthenogenetic (PA) embryos. To this aim, bovine cumulus-oocyte complexes (COC) were collected from slaughterhouse ovaries, whereas cat ovaries were obtained from ovariectomized animals. The COC were in vitro matured in TCM199 supplemented following standard protocols for each species. After 24 h, cumulus cells and zona pellucidae were removed. Matured oocytes were selected and activated by 5 µM ionomycin treatment for 4 min followed by incubation in 1.9 mM 6-DMAP. Bovine and feline PA embryos were cultured in SOF medium in the well of well system in two different groups: only one PA embryo per microwell (1X); and three PA embryos per microwell (3X, aggregated embryos). Cleavage and blastocyst rates from all groups were assessed at Days 2 and 7, respectively. Size of blastocysts was measured at Day 7 using a millimetre eyepiece, and total cell number was determined by Hoechst 33342 staining. Blastocyst rates and embryo size were analysed by Fisher's test (P < 0.05) and total cell numbers by Kruskal–Wallis test with Dunn's correction (P < 0.05). Statistical differences were found in PA blastocyst rates between experimental groups (1X: 15/104, 24.6% v. 3X: 27/37, 62.2% for feline; and 1X: 21/113, 19.4% v. 3X: 20/32, 62.5% for bovine), but no differences were found between species. In addition, there was no statistical difference in the number of blastocysts obtained per oocyte used in any of the experimental groups. Bovine aggregated PA blastocysts were significantly larger than non-aggregated embryos (>200 microns, 1X: 2/20, 10% v. 3X: 9/19, 47.4%), but no differences were found in cell number. On the other hand, cat aggregated PA blastocysts had significantly higher cell numbers (1X: 122.4 ± 79.66 cells v. 3X: 259.8 ± 137.1 cells), but no differences were found in blastocyst size. This observation can contribute in the understanding of embryo physiology, suggesting that benefits of embryo aggregation in parthenogenic embryos vary among these species.

Zingiberene attenuates hydrogen peroxide-induced toxicity in neuronal cells

In this experimental design, we explored the neuroprotective potential of zingiberene (ZGB), a monocyclic sesquiterpene, in hydrogen peroxide (H2O2)-induced toxicity in newborn rat cerebral cortex cell cultures for the first time. The rats were exposed to H2O2 for 6 h to determine the oxidative stress levels. To evaluate cell viability, both 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide and lactate dehydrogenase assays were carried out. Total antioxidant capacity (TAC) and total oxidative stress (TOS) parameters were used to evaluate oxidative changes. Besides determining 8-hydroxy-2-deoxyguanosine (8-OH-dG) levels in vitro, single-cell gel electrophoresis was also performed to measure the resistance of neuronal DNA to H2O2- exposed rats. Our results showed that survival and TAC levels of the cells decreased, while TOS, 8-OH-dG levels and the mean values of the total scores of cells showing DNA damage increased in the H2O2 alone-treated cultures. But pretreatment of ZGB suppressed the cytotoxicity, genotoxicity and oxidative stress that were increased by H2O2. Based on these observations, it is suggested that the sesquiterpene ZGB can be used as a novel and natural potential therapeutic in counteracting oxidative damages in the field of neurodegenerative disorders.

[Use of TachoSil® in the entero-colic anastomoses: results of an observational study]

AIM

In the last decade while many comparative studies examined hemostatic topics, adhesives and sealants, few clinical trials were made. We are focusing our attention particularly on TachoSil®, and studying its efficacy on reducing the frequency of anastomotic leakage, thought to be one of the causes of prolonged periods of patients' hospitalization.

METHODS

We examined 188 patients who underwent colorectal and enteric surgery at our department between January 2010 and March 2013. The efficacy of fibrin glue was evaluated on a cohort of patients at risk of anastomosis leakage. To test the relationship between the application of TachoSil® and the type of complications, a multiple logistic regression model was implemented. Fisher exact Test was used to compare the relations between two groups. The Mann-Whitney test was used to account for the days necessary for the follow-up of the patients in the various units participating in the study.

RESULTS

From the logistic regression model we can infer that TachoSil® is a highly protective factor though not statistically significant (OR=0.78; P>0.05). The results obtained analyzing the average days of patients hospitalization show a statistically significant decrease of such parameter in patients under treatment, especially those who underwent transverse colon resection (P<0.001).

CONCLUSION

The results of this study show that TachoSil® is a highly protective factor, but its efficacy is not statistically significant due to the small number of patients treated. It is important to call the attention to the reduced number of the hospitalization needed for the patients under treatment.

34 EFFECT OF DONOR CELLS SERUM STARVATION ON THE DEVELOPMENT OF AGGREGATED ZONA FREE CLONED EQUINE EMBRYOS

Donor cell synchronization for nuclear transfer (NT) is one of the crucial steps in the cloning procedure, and it has been shown that different methods affect embryo development. The goal of the present study was to determine the effect of serum starvation in combination with growth to confluence of the somatic donor cells, on in vitro embryo development and quality of aggregated cloned equine embryos. Oocyte collection, maturation, cloning, and activation procedures were performed as described previously by (Gambini et al. 2012 Biol. Reprod. 87, 15). Adult fibroblasts were obtained through culture of minced tissue from neck biopsies of 2 horses. They were cultured in Dulbecco's modified Eagle medium (DMEM) with 10% fetal bovine serum (FBS) and 1% antibiotics. After cell multiplication, they were cryopreserved and stored in liquid nitrogen. After thawing, 2 groups of cell synchronization were established. Group I: growth to confluence for 3 to 5 days before NT followed by serum starvation in DMEM supplemented with 0.5% FBS for 24 h prior to NT; group II: growth to confluence for 3 to 5 days before NT. After activation, reconstructed embryos (RE) were cultured in SOF in the well of well system, placing 3 RE per well. Cleavage and blastocyst formation at Day 7 to 8 were assessed. At Day 7 to 8, embryos were measured and some of each group were fixed with paraformaldehyde to measure DNA fragmentation through the DeadEnd fluorometric TUNEL system (Promega, Madison, WI, USA). In vitro embryo development, on a per embryo and cleaved RE basis, and blastocyst size was compared using the chi-squared test; the proportion test was used for statistical analysis of DNA fragmentation levels (fragmented DNA cells/total cells). There were no statistic differences on cleavage per RE (I: 136/177, 80.2%; II: 142/171, 79.6%), blastocyst rates at Day 7 (I: 29/58, 49.1%, II: 22/56, 39.2%), or on blastocyst size at Day 8. Statistical differences were observed in blastocyst rate at Day 8 (I: 42/58, 72.4%, II: 30/56, 53.5%) and in blastocyst DNA fragmentation levels (I: 202/2464, 8%; II: 173/1440 12%). In conclusion, the restriction of FBS to the cell culture medium 24 h before cloning seams to improve embryo development at Day 8 and also reduces the level of apoptosis in cloned blastocyst, suggesting a better embryo quality. For these reasons, we consider that the addition of the restriction of FBS to the growth to confluence is beneficial for cloned equine embryo development.

Malignant peripheral nerve sheath tumour (malignant epithelioid Schwannoma) of the parotid gland

PROBLEMS/OBJECTIVES

Malignant peripheral nerve sheath tumours are uncommon soft tissue tumours originating from Schwann cells or nerve sheath cells. Malignant epithelioid schwannoma is an aggressive variant of malignant peripheral nerve sheath tumour, and unfortunately is related with a high rate of recurrence and poor prognosis.

METHODOLOGY

In this study we present a rare case of malignant epithelioid schwannoma of the parotid gland and we discuss its origin, unusual presentation, and possible treatments options.

RESULTS

Patient underwent total parotidectomy without neck dissection. Postoperative radiotherapy and chemotherapy management were not necessary.

CONCLUSION

Patients with malignant epithelioid schwannomas typically present with pain and/or rapid enlargement of a pre-existing lesion but the diagnosis of these tumours remains difficult as it is based primarily on clinical suspicion. There is no recognized management for this tumour yet while the prognosis seems to correlate best with the extent of surgical resection (Fig. 4, Ref. 16).

35 EFFECT OF CULTURE AT LOW OR ATMOSPHERIC OXYGEN TENSION IN SOMATIC DONOR CELLS FOR HORSE NUCLEAR TRANSFER

Somatic donor cells play a major role during the NT procedure. In vitro culture conditions may affect the capability of these cells to be reprogrammed and to allow embryo development. The aim of this study was to evaluate the effect of in vitro culture at low (5%) or atmospheric (20%) oxygen tension in somatic donor cells for cloned equine embryo production. Adult fibroblasts were obtained through culture of minced tissue from neck biopsies of one horse skin. They were cultured in DMEM supplemented with 10% fetal bovine serum (FBS) and 1% antibiotics in 2 groups: (1) 5% CO2 and (2) 5% CO2 and 5% O2, both groups in humidified air at 39°C. Quiescence of donor cells was induced by growth to confluency for 3 to 5 days prior to NT. Oocyte collection, maturation, cloning, and activation procedures were performed as described by Gambini et al. (2012 Biol. Reprod. 87, 1–9.). After activation, reconstructed embryos (RE) were cultured in DMEM/F12 supplemented with 5% FBS in the well of the well system as 3 reconstructed embryos per well. Cleavage and blastocyst formation (7–8 days) of the experimental groups were assessed. In vitro development, on a per-well and RE basis, was compared using the chi-square test. No statistical differences were observed in cleavage [(1): 48/84, 57%; (2): 54/87, 62%). No difference was observed in blastocyst rates on a per-well basis [(1): 5/28, 18%; (2): 4/29, 14%] or on a per-RE basis [(1): 5/84, 6%; (2): 4/87, 5%]. This work suggests that the oxygen tension during the in vitro culture of somatic donor cells does not affect the quantity of the cloned equine blastocyst produced. Further studies are required to determine if these conditions would affect in vivo embryo development.

Vertigo in childhood: a methodological approach

Children complaints dizziness merit meticulous evaluation to differentially diagnose a vestibular disease. A syndrome mimicking certain classic signs and symptoms of adult vestibular disorders may be presents in children, such as benign paroxysmal positional vertigo, usually associated with aging. Benign paroxysmal vertigo, in which migraine is a manifestation, with sudden onset of dizziness is a rare peripheral vestibular disorder that is commonly ignored or misdiagnosed. This review covers the development of the diagnosis, evaluation and treatment approaches of vertigo of childhood, a valid support for physician that approach dizzy children (Ref. 25). Full Text in PDF www.elis.sk.

14 EQUINE CLONING AND EMBRYO AGGREGATION: EFFECT OF BOVINE, PORCINE, FELINE AND EQUINE OOPLAST

The low number of horse slaughterhouses is one of the reasons for the limited availability of horse oocytes for research in cloning. The aim of our study was to assess the capability of equine, bovine, porcine, or feline ooplast to produce cloned embryos when equine cells are used as donor nuclei and to evaluate if embryo aggregation improves their development. Oocytes from mentioned species were collected from ovaries derived from slaughterhouses, except for cat ovaries that were obtained from ovariectomized queens. Oocytes were matured in TCM199 supplemented following standard protocols for each species. After maturation, cumulus and zona pellucida were removed. Enucleation was performed by aspiration of the metaphase plate under ultraviolet light. Donor cell and ooplast were attached by phytohemagglutinin treatment and then electrofused. Activation protocols were ionomycin for 4 min, except for porcine, which were electrically activated, followed by culture in 1.9 mM 6-DMAP for bovine, feline and porcine, except for equine: 1 mM 6-DMAP with 5 mg mL–1 of cycloheximide. Reconstructed embryos (RE) were cultured in SOF in the well of well system in 2 different groups: only one RE per well (1X) and three RE per well (3X, aggregated embryos, AE). Blastocysts derived from homospecific clones were transferred to synchronized mares. Cleavage and maximum development stage achieved of all experimental groups were assessed. In vitro development was compared using the chi-square test. In group 1X, a total of 64, 49, 38 and 145 RE were performed for porcine, bovine, feline and equine, respectively and in group 3X, 88, 48, 48 and 195 RE. Cleavage of cloned embryos ranged from 67 to 87%. Aggregated of homospecific equine clones showed the highest blastocyst rates (1X: 5.5%, 3X: 34%) and after embryo transfer (4 recipients for each group), an ongoing pregnancy (day 300, at the time of submission) was only achieved with aggregated embryo confirming the positive effect of embryo aggregation in these clones. The stages with higher developmental arrest of heterospecific nonaggregated embryos were 2 to 4 cells for porcine ooplast (23/64, 36%) and 4 to 8 cells for bovine and feline ooplast (37/49, 75% and 18/38, 47%, respectively). Blastocyst stage was only reached using feline ooplast (group I: 2/38, 5.26% and group II: 2/16, 12.5%). Heterospecific aggregated clones were able to achieve 16-cell stage, showing statistic differences compared with group 1X. As we reported previously, embryo aggregation shows benefits for homospecific equine clones, although more studies are needed to clarify if aggregation of heterospecific clones has the same effect. All heterospecific ooplasm was able to support embryo development. The stage of major developmental arrests was similar to embryonic genomic activation stage. Our results suggest that cat oocyte seems to be the best receptor to support equine cloned embryo development.

203 EQUINE EMBRYO IN VITRO DEVELOPMENT AFTER INTRACYTOPLASMIC SPERM INJECTION FOLLOWED BY CHEMICAL ACTIVATION

Intracytoplasmic sperm injection (ICSI) is an alternative method for producing in vitro-fertilized embryos in horses. Some authors have suggested that using the piezo drill to inject the spermatozoon is required to obtain acceptable blastocyst rates after ICSI. In order to avoid the use of this equipment, the aim of our study was to evaluate 4 different chemical activation protocols and their effect on embryo development. Cumulus–oocyte complexes were recovered from ovaries of slaughtered mares. The maturation medium was DMEM/F12 supplemented with 10% fetal bovine serum (FBS), 1 μL mL–1 of insulin-transferrin-selenium, 1 mM sodium pyruvate, 100 mM cysteamine and 0.1 mg mL–1 of FSH at 39°C in a humidified atmosphere of 6.5% CO2 in air for 24 h. The ICSI was carried out in 20-μL droplets of TALP-HEPES with a 9-μm pipette, using frozen-thawed spermatozoa from 1 stallion. Spermatozoa were held separate in 100-μL droplets of Modified Whittens. Motile spermatozoa were aspirated and transferred to a 5-μL drop of 7% (v/v) polyvinylpyrrolidone, where 1 sperm was immobilized by swiping the injection pipette across its tail; then, the sperm was injected into the oocyte. All injected oocytes were subjected to 8.7 μM ionomycin for 4 min, followed by 1 of 3 further activation treatments: (1) 4-h culture in 1 mM 6-DMAP and 10 mg mL–1 of cycloheximide, starting 3 h after ionomycin; (2) 5-h culture in 10 mg mL–1 of cycloheximide, starting 10 min after ionomycin; (3) An extra incubation with 5 mM ionomycin for 4 min, starting 3 h after ionomycin. Some injected oocytes were left without a further activation protocol (group 4). After activation, injected oocytes were cultured in 100-μL droplets of DMEM/F12 with 5% of FBS at 39°C in a humidified atmosphere of 5% O2, 5% CO2 and 90% N2. Cleavage (48 h after activation) and blastocyst formation (7–8 days) of all experimental groups were assessed. Culture medium was renewed on Day 3 with fresh DMEM/F12 with 5% of FBS. At Day 9, the zona pellucida of some blastocysts was removed and the blastocysts were maintained in culture until Day 15. Blastocyst growth was determined every 24 h. Statistical differences (using chi-square analysis) were observed in cleavage with treatments 1 and 3 when compared to the other groups (1: 30/52, 58%; 2: 8/40, 20%; 3: 9/25, 36%; and 4: 10/38, 26%). There was no difference on blastocyst rates based on injected oocytes (1: 5/52, 9.6%; 2: 2/40, 5%; 3: 1/25, 4%; and 4: 2/38, 5.3%). On Day 7, blastocyst quality did not differ among treatments and on Day 15, blastocysts from groups 3 and 4 reached 1130 μm and 4300 μm, respectively. Despite the difference observed in cleavage, this work suggests that equine blastocysts could be obtained with all of the activation protocols, without the use of the piezo drill. Further studies are required to assess the effect of chemical activation on in vivo development of produced blastocysts to confirm that they are not parthenogenetic. We are grateful to Mr. Willem Melchior, La Vanguardia Polo Club for some financial support and encouragement to undertake this project.

[Enteric anastomosis and Tachosil®]

AIM

Anastomotic leakage is a common complication of colorectal surgery. To date, no clinical study exists showing a significant effect in reducing its frequency by sealing the anastomosis with a fibrin glue-coated collagen patch; the aim of this study was to demonstrate the efficacy of Tachosil®.

METHODS

We considered patients undergoing open resective colorectal surgery. In selected cases, the Tachosil® patches were wrapped around the anastomotic line. The onset of anastomotic leakage was either defined clinically and investigated by contrast enema and CT scan.

RESULTS

From January 2010 to February 2011, 63 patients underwent colorectal surgery at our Institute. Tachosil® was used in 24 cases. We recorded six major surgical complications; all complicated cases were in the no-Tachosil® group. A shorter mean postoperative stay of 7.2 days was observed for patients where Tachosil® was applied compared to 9.3 days for patients of no- Tachosil® group. These difference was mainly related to anastomotic insufficiencies recorded in the no-Tachosil®, group. Fibrin-coated collagen glue is used in different fields of surgery to improve hemostasis and anastomotic healing. Our experience confirmed its safety with a low incidence of anastomotic leak. These experience is based on few, non-randomized cases and therefore cannot demonstrate a real efficacy of Tachosil® in anastomotic leak prevention.

CONCLUSION

Anastomotic leakage is a relatively common and potentially catastrophic complication after gastrointestinal surgery. Our initial experience with Tachosil® has confirmed the safety of this patch and we can therefore suggest a possible positive effect on anastomotic healing.

[Treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy]

Pinto Peritoneal carcinomatosis (PC) had for long been regarded as a terminal disease, characterized by a very poor survival and worthy of being treated with palliative therapy only. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) provide a promising additional treatment option for patients with peritoneal carcinomatosis, resulting in recently published series enable to obtain long-term survival. In spite of the need for more high quality studies, there is now a consensus among many international experts about the use of this new strategy as gold standard for treating with intent of cure selected patients with PC. We summarized the present status and possible future progress of this treatment modality, in particular outlining its rationale, current practice and general outcomes.

Intermediate nerve schwannoma: a rare tumour

The intermediate nerve (IN), also called the nerve of Wrisberg, is a relatively small nerve with a variable anatomical course. Currently, this nerve is not addressed well in the pertinent literature. Pre-operative diagnosis of IN tumours is clinically challenging due to the lack of related symptoms. Symptoms are typically caused by the functional deterioration of neighbouring anatomical structures. In this report, we describe a patient with a schwannoma that arose at the porus acusticus of the internal auditory canal; during surgery, this proved to originate from the IN. We discuss our findings in the context of previously reported cases of IN schwannomas and analyse the vague characteristics and symptoms of this rare tumour.

Otosclerosis associated with type B-1 inner ear malformation

Malformations of bony inner ear are rare anomalies occurring in approximately 20% of patients with congenital sensorineural hearing loss. Conductive hearing loss is usually associated with abnormalities of the external and middle ear. Recent reports of patients with lateral semicircular canal malformations indicate inner ear malformations to be associated with sensorineural or conductive hearing loss. Differential diagnosis of conductive hearing loss should include otosclerosis, isolated ossicular deformities, inner ear anomalies or a combination of these. In this report, a case is described with right vestibule-lateral semicircular canal dysplasia presenting at our centre with bilateral otosclerosis.

Management of tinnitus: oral treatment with melatonin and sulodexide

The main problem arising from tinnitus is the disturbance it causes in day-to-day life and disturbance in sleep leading to fatigue and general discomfort. We attempted to study the effect of melatonin in conjunction with Sulodexide as a treatment method for tinnitus and evaluate its effectiveness. We studied 102 patients suffering from tinnitus with a Prospective Randomised Controlled Study conducted in a tertiary care ENT department. After randomisation, 34 patients were treated with melatonin and Sulodexide, another 34 were treated with melatonin alone, and the remaining 34 (control group) were managed without therapy in order to evaluate spontaneous variations in quality of tinnitus. Patients were assessed prospectively with Tinnitus Handicap Inventory and Acufenometry both pre-treatment and post-treatment. Among the patients we studied, we found better results with both Tinnitus Handicap Inventory and Acufenometry in the group who received melatonin and Sulodexide as against melatonin alone. Any improvement was noted in the control group. In conclusion, our opinion is that melatonin in combination with Sulodexide is a viable treatment option for patients suffering from central or sensorineural tinnitus.

Treatment of central and sensorineural tinnitus with orally administered Melatonin and Sulodexide: personal experience from a randomized controlled study

Since very little is understood about the exact aetiology of tinnitus, this has made treatment of the condition difficult. Even though approximately 10-15% of the general population suffer from tinnitus, only 2% consider it serious enough to warrant any treatment. The main problem arising from tinnitus is the disturbance it causes not only in day to day life but also in sleep, leading to fatigue and general discomfort. The present study focused on the effect of Melatonin in conjunction with Sulodexide as a treatment method for tinnitus. Overall, 102 patients suffering from tinnitus were evaluated in a prospective randomised controlled study conducted in a tertiary care ENT department. After randomisation, 34 patients were treated with Melatonin and Sulodexide, another 34 were treated with Melatonin alone, while the remaining 34 (control group) were managed without treatment in order to evaluate spontaneous variations in the quality of tinnitus. Patients were assessed prospectively with the Tinnitus Handicap Inventory and Acufenometry, both pre- and post-treatment. Among the patients studied, better results with both Tinnitus Handicap Inventory and Acufenometry were found in the group who received Melatonin and Sulodexide compared to those receiving Melatonin alone. No improvement was observed in the control group. In conclusion, Melatonin in combination with Sulodexide is, in our opinion, a viable treatment option for patients suffering from central or sensorineural tinnitus.

Neo-adjuvant treatment of rectal cancer with capecitabine and oxaliplatin in combination with radiotherapy: a phase II study

BACKGROUND

Preoperative chemoradiation is now standard treatment for stages II-III rectal cancer. Capecitabine (CAP) and oxaliplatin (OX) are synergistic with radiotherapy (RT) and active in colorectal neoplasms.

PATIENTS AND METHODS

Two cycles of CAP 825 mg/m(2) b.i.d. (days 1-14) and OX 50 mg/m(2) (days 1 and 8) every 3 weeks were given concomitantly with pelvic conformal RT (45 Gy). Patients with a > or =T3 and/or node-positive rectal tumour were eligible. The pathologic tumour response was defined according to the tumour regression grade (TRG) scale.

RESULTS

Forty-six patients were enrolled. Gastrointestinal adverse events were mostly G1-G2; only two patients experienced G3 vomiting and diarrhoea and six patients had G1 peripheral neuropathy. Haematological toxicity was rare. G2 proctitis and anal pain occurred in two patients. Pathological complete response (TRG1) was observed in nine patients (20.9%; 95% CI 8.7%-33.1%); TRG2 in 19 patients (44.2%); TRG3 in 12 patients (27.9%); and TRG4 in three patients (7%). Overall, nine patients recurred: five with distant metastases, one with local recurrence, and three with both local recurrence and distant metastases.

CONCLUSIONS

CAP-OX-RT as preoperative treatment for rectal cancer induces a remarkable rate of complete or near-complete pathologically documented response and is well tolerated.

Management of recurrent otitis media with rapid maxillary expansion: our experience

Management of recurrent otitis media with rapid maxillary expansion: our experience.

PROBLEMS/OBJECTIVES

Recurrent otitis media is a frequent problem in the paediatric population. It is commonly associated with adenoid hypertrophy and occasionally with skeletal development syndrome characterised by maxillary anatomical alterations. When this syndrome is present in conjunction with adenoid hypertrophy, surgical management with adenoidectomy and/or myringotomy with ventilation tube positioning does not necessarily ensure a resolution of conductive hearing disorders.

METHODOLOGY

We used maxillary rapid expansion in 27 children with a mean age of 7 years affected by recurrent otitis media associated with skeletal development syndrome and adenoid hypertrophy.

RESULTS

Rapid maxillary expansion acting directly on the median palatine suture expands the palate and the nasal floor, improving nasal breathing. In addition, maxillary expansion stretches elevator and tensor palatine muscles, helping to restore normal Eustachian tube function, even in the presence of adenoid hypertrophy.

CONCLUSION

In our opinion, rapid maxillary expansion results in an improvement in skeletal-facial abnormalities associated with skeletal development syndrome and it can be considered a valid treatment for preventing recurrent otitis media in children affected by maxillary anatomical alterations.

Delayed facial nerve paralysis post middle ear surgery: herpes simplex virus activation

Delayed facial nerve paralysis post middle ear surgery: herpes simplex virus activation.

PROBLEM

Facial nerve paralysis following middle ear surgery is a nightmare for the otology surgeon. Usually this is caused by surgical trauma or local anaesthetic use. It is uncommon to see onset of facial nerve palsy more than 72 hours following the surgery.

METHODOLOGY

We report a case of facial nerve paralysis appearing 11 days following a successful canal wall-down mastoidectomy.

RESULTS

Viral screening for Herpes Virus type 1 confirmed the viral aetiology of the delayed facial paralysis.

CONCLUSION

When an ipsilateral facial nerve palsy appears more than 72 hours after an uneventful middle ear procedure, without symptoms of any infection, suspect a viral reactivation.

A passive acoustic device for real-time monitoring of the efficacy of shockwave lithotripsy treatment

Extracorporeal shockwave lithotripsy (ESWL) is the preferred modality for the treatment of renal and ureteric stone disease. Currently X-ray or ultrasound B-scan imaging are used to locate the stone and to check that it remains targeted at the focus of the lithotripter during treatment. Neither imaging modality is particularly effective in allowing the efficacy of treatment to be judged during the treatment session. A new device is described that, when placed on the patient's skin, can passively monitor the acoustic signals that propagate through the body after each lithotripter shock, and which can provide useful information on the effectiveness of targeting. These acoustic time histories are analyzed in real time to extract the two main characteristic peak amplitudes (m(1) and m(2)) and the time between these peaks (t(c)). A set of rules based on the acoustic parameters was developed during a clinical study in which a complete set of acoustic and clinical data was obtained for 30 of the 118 subjects recruited. The rules, which complied with earlier computational fluid dynamics (CFD) modeling and in vitro tests, allow each shock to be classified as "effective" or "ineffective." These clinically-derived rules were then applied in a second clinical study in which complete datasets were obtained for 49 of the 85 subjects recruited. This second clinical study demonstrated almost perfect agreement (kappa = 0.94) between the number of successful treatments, defined as >50% fragmentation as determined by X-ray at the follow-up appointment, and a device-derived global treatment score, TS(0), a figure derived from the total number of effective shocks in any treatment. The acoustic system is shown to provide a test of the success of the treatment that has a sensitivity of 91.7% and a specificity of 100%. In addition to the predictive capability, the device provides valuable real-time feedback to the lithotripter operator by indicating the effectiveness of each shock, plus an indication TS(t) of the cumulative effectiveness of the shocks given so far in any treatment, and trends in key parameters. This feedback would allow targeting adjustments to be made during treatment. An example is given of its application to mistargeting because of respiration.

Post-traumatic lipoma of the parotid gland: case report

The incidence of lipoma among parotid tumours ranges from 0.6% to 4.4%, with most series reporting an incidence of 1%. The most common origin of these tumours, in the parotid gland, is from the superficial lobe and, only rarely, from the deep lobe. Lipomas, upon clinical history, are found to be most frequently related to an episode of trauma. Computed Tomography scan and Magnetic Resonance Imaging can lead to a pre-operative diagnosis of lipoma. The case is described of lipoma of the superficial lobe of the parotid gland.

Prognostic relevance of proliferative activity evaluated by Mib-1 immunostaining in node negative breast cancer

AIM

The purpose of this prospective observational study was to analyze the role of Mib-1 immunostaining as a proliferation index in breast cancer. Correlations between Mib-1 expression and clinico-pathological characteristics as well as its prognostic value have been studied in a series of 432 node negative breast cancers.

METHODS

Mib-1 expression was evaluated by immunohistochemistry. Tumor sections from highly cellular invasive areas of cancer were stained by monoclonal antibody Mib-1 (Dako) and cells whose nuclei stained positive were counted in 10 randomly chosen HPFs and expressed as percentages of all epithelial cells. A minimum of 400 cells were counted. Correlation between Mib-1 staining and clinico-pathological factors was investigated by means of univariate and multivariate analyses. The prognostic impact on actuarial disease free (DFS) and overall survival (OS) was evaluated by univariate analysis using the log-rank test and by multivariate analysis using Cox regression model.

RESULTS

Tumors were considered as positive for Mib-1 expression when more than 15% of cells counted were stained. Mib-1 positivity was found in 190/432 cases and resulted in being significantly related to tumor grade, tumor size and absence of estrogen receptors at multivariate analysis. With a median follow-up of 66 months, Mib-1 positivity resulted in being the only independent predictor of OS (RR 2.92), and an independent predictor of DFS (RR 2.01) together with absence of estrogen receptors (RR 2.15).

CONCLUSIONS

Mib-1 index of proliferative activity correlates well to other established prognostic factors of breast cancer. Mib-1 index may improve the tailoring of adjuvant therapy in early breast cancer, and our experience adds evidence to its effectiveness as prognostic factor. Efforts to reach uniformity in the methodology and in the scoring system should be done to warrant a standardized procedure and make Mib-1 determination definitively reliable in the current clinical practice.

Nasal septal polyps: a report of two cases

PROBLEM

It is common to see nasal polyps arising from the lateral wall of the nose; however, polyps arising from the nasal septum are rare. Diagnosis of such lesions is usually made by nasal endoscopy and confirmed by computer tomography.

METHODOLOGY

Two cases of isolated nasal septum polyps were diagnosed from 150 consecutive functional endoscopic sinus surgeries. Both patients had septal deviation; only one had a history of allergy. The polyps were completely excised in both cases; the septal deviations were not corrected.

RESULTS

Both patients remain disease-free after two and three years of follow-up.

CONCLUSIONS

Nasal septal deviation does not seem to play an important role in septal polyp development, whereas local nasal inflammatory factors appear to be important for the genesis of septal polyps. Limited resection using a functional endoscopic surgical approach is the best choice of treatment to prevent recurrence of polyps.

A data acquisition and analysis system for the biomechanical evaluation of patient moving and transferring equipment and procedures

Patients and people with various disabilities are frequently moved and transferred by nurses and carers and consequently it is important to assess the risks involved when undertaking such tasks. People with disabilities are often able to bear some of their weight and this has led to the development of non-mechanical aids designed to reduce the load on the nurse or carer when undertaking a transferring manoeuvre. It is essential that aids are assessed thoroughly in order to ensure that transfers are safe and that advice and guidance can be given on the most appropriate equipment in a given situation. This paper describes a data acquisition and analysis system that has been developed to assist in such assessments. The system integrates measurements of spine movements, foot pressure and knee flexion with video recording of a transferring manoeuvre. A biomechanical model provides an estimate of the loading at the bottom of the lumbar spine for comparison with National Institute for Occupational Safety and Health (NIOSH) guidelines. A pilot assessment of non-mechanical aids prior to a full user trial demonstrated that such a system can provide valuable data from which to assess risk during patient transferring manoeuvres.

Breast cancer local recurrence: risk factors and prognostic relevance of early time to recurrence

BACKGROUND

Local recurrence occurs in 10%-20% of patients treated with breast-conserving surgery for stage I-II breast cancer. The aim of the present study was to investigate breast cancer local recurrence, potential risk factors, and prognostic impact.

METHODS

A total of 503 patients treated with breast-conserving surgery were included in the study. All patients underwent axillary dissection and postoperative radiotherapy, and all patients had negative margins at pathological examination. Median follow-up was 82 months. Local recurrence was classified as early when it occurred within 2 years from surgery. The risk factors for local recurrence and overall survival were estimated by univariate and multivariate analyses.

RESULTS

Forty-six cases (9.1%) of local recurrence were observed, 11 of which occurred within 24 months of surgery; the other 35, sometime later. Statistically significant risk factors for local recurrence were premenopausal status, peritumoral vascular invasion, multifocality, and absence of estrogen receptors. Independent negative prognostic factors for overall survival at 5 and 10 years were N stage, absence of estrogen receptors, and early time to recurrence. Overall survival at 10 years was 10.0% for patients with early recurrence, 87.5% for patients with late recurrence, and 87.9% for patients without recurrence.

CONCLUSIONS

None of the studied clinicopathological characteristics alone is a determinant for the choice of surgical treatment. Younger patients treated with breast-conserving surgery should receive aggressive postsurgical treatment and should be followed with an intensive follow-up program when metastatic axillary lymph nodes, negative estrogen receptors, or peritumoral vascular invasion are present.