Clinical effectiveness of late maxillary protraction in cleft lip and palate: A methods paper

OBJECTIVES

A prospective parallel cohort trial was conducted to compare outcomes of patients treated with maxillary protraction vs LeFort 1 maxillary advancement surgery.

SETTING AND SAMPLE POPULATION

The primary site for the clinical trial is Children's Hospital Los Angeles; the satellite test site is Seattle Children's Hospital. All patients have isolated cleft lip and palate and a skeletal Class III malocclusion.

MATERIAL AND METHODS

A total of 50 patients, ages 11-14, will be recruited for the maxillary protraction cohort. The maxillary surgery cohort consists of 50 patients, ages 16-21, who will undergo LeFort 1 maxillary advancement surgery. Patients with additional medical or cognitive handicaps were excluded from the study.

RESULTS

Current recruitment of patients is on track to complete the study within the proposed recruitment period.

CONCLUSION

This observational trial is collecting information that will examine dental, skeletal, financial and quality-of-life issues from both research cohorts.

Galectin-1 is a poor prognostic factor in patients with glioblastoma multiforme after radiotherapy

Background

Galectin-1, a radioresistance marker, was found in our previous study to be a prognostic factor for cervical cancer. The aim of current study is to determine the prognostic significance of the galectin-1 expression level in patients with glioblastoma multiforme (GBM) undergoing adjuvant radiotherapy (RT).

Methods

We included 45 patients with GBM who were treated with maximal safe surgical resection or biopsy alone followed by adjuvant RT of EQD2 (equivalent dose in 2-Gy fractions) > or = 60 Gy for homogeneous treatment. Paraffin-embedded tissues acquired from the Department of Pathology were analyzed using immunohistochemical staining for galectin-1 expression. The primary endpoint was overall survival (OS).

Results

Patients with weak expression had a better median survival (27.9 months) than did those with strong expression (10.7 months; p = 0.009). We compared characteristics between weak and strong galectin-1 expression, and only the expression level of galectin-3 showed a correlation. The group with weak galectin-1 expression displayed a 3-year OS of 27.3% and a 3-year cancer-specific survival (CSS) of 27.3%; these values were only 5.9% and 7.6%, respectively, in the group with strong galectin-1 expression (p = 0.009 and 0.020, respectively). Cox regression was used to confirm that the expression level of galectin-1 (weak vs. strong) is a significant factor of OS (p = 0.020) and CSS (p = 0.022). Other parameters, such as the expression level of galectin-3, Eastern Cooperative Oncology Group (ECOG) performance, gender, surgical method, age ≥ 50 years, tumor size, or radiation field were not significant factors.

Conclusion

The expression level of galectin-1 affects survival in patients with GBM treated with adjuvant RT. Future studies are required to analyze the effect of other factors, such as O(6)-methylguanine-DNA methyltransferase (MGMT)-promoter methylation status, in patients with weak and strong galectin-1 expression.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4025-2) contains supplementary material, which is available to authorized users.

Increased expression of interleukin-23 associated with progression of colorectal cancer

BACKGROUND AND OBJECTIVES

The prognostic significance of interleukin-23 in colorectal cancer remains unclear. We designed this study to investigate the association between colorectal cancer and interleukin-23 (IL-23) or interleukin-23 receptor (IL-23R) expression and the resulting clinical features and survival.

METHODS

Immunohistochemical staining was performed for IL-23 and IL-23R in colorectal cancer samples. H-score was calculated to compare the expression of IL-23 and IL-23R. The median of H-score was used as the cut-off value to separate patients into high or low expression groups. The differences in clinicopathological features were evaluated. Cox regression hazard ratios were used for survival analysis.

RESULTS

A total of 129 colorectal cancer patients were enrolled. H-score for the late TNM stage patients was higher than that for the early TNM stage patients (P = 0.002). Patients with high IL-23 expression were associated with advanced pathological T category (P < 0.001) and late TNM stage (P = 0.003). High IL-23 expression was associated with poor 5-year disease-free survival and overall survival in patients (P = 0.048 and P = 0.028, respectively). Multivariate adjustment demonstrated a significant association between high IL-23 expression and overall survival (hazard ratio = 1.865, P = 0.041).

CONCLUSIONS

Elevated IL-23 expression was associated with poor outcome and can be used as a prognostic biomarker for colorectal cancer. J. Surg. Oncol. 2017;115:208-212. © 2016 Wiley Periodicals, Inc.

Overexpression of Transient Receptor Protein Cation Channel Subfamily A Member 1, Confers an Independent Prognostic Indicator in Nasopharyngeal Carcinoma

Background: Detection of oncogenes provides chances to understand tumor development and progression. Transient receptor protein cation channel subfamily A, member 1 (TRPA1) transcript was significantly upregulated in nasopharyngeal carcinoma (NPC) with a stepwise upregulation from low- to high-stage NPCs from a preliminary data analysis in the Gene Expression Omnibus database. The TRPA1 gene is a member of the TRP channel family, encoding integral membrane proteins that functions as cation channels. Loss of calcium homeostasis takes place in cancer cells.

Methods: Immunostaining of TRPA1 was analyzed on 124 biopsies from NPC patients retrospectively. The H-score method was used to evaluate the immunoexpression of TRPA1. The correlations between H-score of TRPA1 protein level and clinicopathological factors, as well as the significances of TRPA1 protein level for disease-specific, distal-metastasis-free and local recurrence-free survivals were assessed.

Results: These patients were characterized to be no initial metastasis and medicated with the traditional procedure. The TRPA1 score was found to be associated with clinicopathological parameters and patient survivals. Along with the guideline of 7^th edition of the American Joint Committee on Cancer, we found that TRPA1 upregulation (50%) was associated with advanced primary tumor (P = 0.009) and overall clinical stage (P = 0.019). In univariate log-rank testing, primary tumor, nodal status, stage and TRPA1 protein level significantly contributed to worse disease-specific survival, distal metastasis-free survival and local recurrence-free survival. In multivariate analysis, high TRPA1 protein level and tumor stage emerged as independent prognostic indicators for inferior disease-specific survival (P = 0.014; P = 0.003), distal metastasis-free survival (P = 0.004; P = 0.034) and recurrence-free survival (P = 0.017; P = 0.015).

Conclusions: The upregulation of TRPA1 protein level is frequently correlated to unfavorable prognosticators and gives rise to cancer progression in NPC patients.

The clinicopathological significance of NAB2-STAT6 gene fusions in 52 cases of intrathoracic solitary fibrous tumors

NAB2-STAT6 gene fusion drives STAT6 nuclear expression and is the pathognomonic hallmark of solitary fibrous tumors (SFTs). However, no study has systematically analyzed the clinicopathological features, STAT6 immunoexpression status, or the fusion variants of NAB2-STAT6 in intrathoracic SFTs. Fifty-two intrathoracic SFTs were retrieved to appraise histopathology, assess STAT6 immunoexpression, and determine NAB2-STAT6 fusion variants by RT-PCR. Location-relevant histologic mimics served as controls. Thirty-one pleura-based, 12 mediastinal/pericardial, and nine intrapulmonary lesions were histologically categorized into eight malignant, eight atypical, and 36 conventional or cellular SFTs, including two fat-forming and two giant cell angiofibroma-like SFTs. STAT6 distinctively decorated the tumoral nuclei in 51 (98%) SFTs. However, no nuclear staining was observed in the histological mimics. NAB2-STAT6 fusion was detected in 34 SFTs. Twenty-nine (85.3%) exhibited the major NAB2ex4-STAT6ex2/3 variant and 5 (14.7%) the minor NAB2ex6-STAT6ex16/17. NAB2ex4-STAT6ex2 was significantly associated with older age (P = 0.01) and pleuropulmonary tumors (P = 0.025). After a median follow-up of 33.9 (range, 0.3-174.6) months, adverse outcomes occurred in one atypical and five malignant SFTs, including two local relapses, one intrapulmonary metastasis, and three extrathoracic metastases. Inferior disease-free survival was univariately associated with atypical/malignant histology (P = 0.001) and a mitosis >4/10 HPFs (P = 0.0012) but was unrelated to fusion variants. In conclusion, the majority of intrathoracic SFTs exhibited STAT6 nuclear staining, and NAB2ex4-STAT6ex2/3 was the predominant fusion type. However, clinical aggressiveness is associated with atypical/malignant histology primarily contributed by increased mitosis but was unrelated to the NAB2-STAT6 fusion variants.

NAB2-STAT6 fusion types account for clinicopathological variations in solitary fibrous tumors

Solitary fibrous tumor (SFT) is characterized by the inv12(q13q13)-derived NAB2-STAT6 fusion, which exhibits variable breakpoints and drives STAT6 nuclear expression. The implications of NAB2-STAT6 fusion variants in pathological features and clinical behavior remain to be characterized in a large cohort of SFTs. We investigated the clinicopathological correlates of this genetic hallmark and analyzed STAT6 immunoexpression in 28 intrathoracic, 37 extrathoracic, and 23 meningeal SFTs. These 88 tumors were designated as histologically nonmalignant in 75 cases and malignant in 13, including 1 dedifferentiated SFT. Eighty cases had formalin-fixed and/or fresh samples to extract assessable RNAs for RT-PCR assay, which revealed NAB2-STAT6 fusion variants comprising 12 types of junction breakpoints in 73 fusion-positive cases, with 65 (89%) falling into 3 major types. The predominant NAB2ex4-STAT6ex2 (n=33) showed constant breakpoints at the ends of involved exons, whereas the NAB2ex6-STAT6ex16 (n=16) and NAB2ex6-STAT6ex17 (n=16) might exhibit variable breakpoints and incorporate NAB2 or STAT6 intronic sequence. Including 73 fusion-positive and 7 CD34-negative SFTs, STAT6 distinctively labeled 87 (99%) SFTs in nuclei, exhibited diffuse reactivity in 73, but did not decorate 98 mimics tested. In seven fusion-negative cases, 6 were STAT6-positive, suggesting rare fusion variants not covered by RT-PCR assay. Regardless of histological subtypes, intrathoracic SFTs affected older patients (P=0.035) and tended to be larger in size (P=0.073). Compared with other variants, NAB2ex4-STAT6ex2/4 fusions were significantly predominant in the SFTs characterised by intrathoracic location (P<0.001), older age (P=0.005), decreased mitoses (P=0.0028), and multifocal or diffuse STAT6 staining (P=0.013), but not found to correlate with disease-free survival. Conclusively, STAT6 nuclear expression was distinctive in the vast majority of SFTs, including all fusion-positive tumors, and exploitable as a robust diagnostics of CD34-negative cases. Despite the associations of NAB2-STAT6 fusion variants with several clincopathological factors, their prognostic relevance should be further validated in large-scale prospective studies of SFTs.

Differences in the distribution and presentation of bronchogenic cysts between adults and children

BACKGROUND

Bronchogenic cysts are rare congenital malformations that occur in adults and children, with differences in distribution and presentation.

METHODS

The study population comprised 16 infants and children (aged 7 days to 18 years) and 23 adults (aged 20-78 years) who received pathological diagnoses of bronchogenic cysts over a 14-year period (1999-2012). Cyst distribution and presentation were reviewed.

RESULTS

Half (8/16) of the infants and children presented with palpable masses in the neck (n=6) or on the skin (n=2), and only one (12.5%) presented with symptoms of mild stridor. Another eight pediatric patients had mediastinal (n=7) or pulmonary (n=1) bronchogenic cysts, and respiratory symptoms were present in six (75%) patients. Thirteen of 23 (56.5%) adult patients had asymptomatic cysts (neck, n=1; mediastinum, n=11; lung, n=1). Symptomatic presentations occurred in 10/23 (43.5%) patients, including 2 with palpable mass in the neck, 3 in the mediastinum, 4 in the lung, and 1 in the retroperitoneum. Among the 13 asymptomatic patients, 6 were identified during regular health screening, 5 during routine chest computed tomographic surveys for cancer, and 2 incidentally found during thyroid and parathyroid surgery. Bronchogenic cysts tended to be larger in symptomatic than in asymptomatic adults.

CONCLUSION

The clinical spectra of bronchogenic cysts differ between adults and children and are closely related to cyst location and, probably, size.

Orthodontic spring guidance of bilateral mandibular distraction in rabbits

Although distraction osteogenesis can lengthen congenitally small mandibles, the distraction procedure can be difficult to control. To study the efficacy and safety of orthodontic spring guidance on bilateral mandibular distraction, an 8-mm anterior open bite was experimentally produced and corrected during bilateral mandibular distraction in rabbits. Orthodontic springs were attached to the anterior maxilla and mandible to redirect an ongoing distraction procedure. Sixteen rabbits underwent mandibular distraction: 6 rabbits received heavy springs (8 oz), 6 rabbits received light force springs (2 oz), and 4 rabbits served as control animals with anterior open bites without spring guidance. Nickel-titanium springs were applied during the last week of osseous distraction and the first week of consolidation. Distractors were left in place throughout a 2-month consolidation period. None of the animals developed fibrous union as a result of spring guidance. The 8-mm open bite did not close in the control group or in the light spring group after 2 weeks of spring wear or during the consolidation period. Heavy springs completely closed the experimental open bites within 2 weeks (P <.01, analysis of variance). Bite corrections did not change during the consolidation period. This study indicated that the addition of an orthodontic spring to a mandibular distraction procedure did not impair bone healing. With the distraction device in place, heavy spring forces redirected an ongoing mandibular distraction procedure and corrected an open bite, distraction side effect. Direct measurements, radiographic measurements, and tissue histologic factors described changes in segment position and shape of the distraction site.

Bending of the distraction site during mandibular distraction osteogenesis in the rabbit: a model for studying segment control and side effects

PURPOSE

The purpose of this investigation was to develop an animal model for studying and correcting mandibular distraction side effects.

MATERIALS AND METHODS

Twenty-nine rabbits underwent bilateral mandibular distraction. Bending of the mandible was accomplished by offsetting a linear distraction by 35 degrees from the occlusal plane (4 screws per distractor), rotating the anterior segment inferiorly (2 screws per distractor), and removing a 3- or 6-mm wedge of the distraction site. The amount of bite opening varied according to the surgical design. Direct measurements, radiographs, and histology samples were compared.

RESULTS

Linear distraction produced a 4-mm anterior open bite and a Class III malocclusion after 2 weeks of distraction. Segmental rotation produced an 8-mm anterior open bite without complications. Removal of a wedge initiated rotation of the anterior segment. A large wedge (6 mm) produced fibrous union in the distraction site. The amount of bite opening or closure depended on the number of surgical screws and position of the distractor. Serial histologic sections showed bone formation at the rotated, triangular distraction site.

CONCLUSION

Bite opening or closure can occur from loss of segment control or by altering surgical design. This information is needed to counter unwanted side effects or to plan segment rotations.

Distraction osteogenesis: application to dentofacial orthopedics

Distraction osteogenesis is a surgical-orthopedic method for lengthening bone by separating or distracting a fracture callus. This technique has a long history in limb lengthening and has recently been used to lengthen mandibles and maxillae in human patients. Distraction osteogenesis represents a powerful method of producing unlimited quantities of living bone which can be formed along any plane of space. Because this method uses local host tissue, it offers many advantages over bone grafting. In the author's experience, large (10-22 mm) antero-posterior and vertical corrections of mandibles can be achieved using this technique. The purpose of this article is to review its biological basis and discuss recent clinical applications. This article reviews the history, theory, current management, and limitations of distraction osteogenesis in treating craniofacial anomalies.

Asymptomatic reopening of ductus arteriosus after successful closure by indomethacin in premature infants

Indomethacin has been demonstrated to be effective for closure of hemodynamically symptomatic patent ductus arteriosus (PDA) in premature infants. The five cases in this study had acquired asymptomatic reopening of PDA a long time after successful closure by oral indomethacin. Providing adequate oxygen, giving another course of indomethacin, preventing excessive fluid intake and keeping hematocrit level greater than 40% had been tried to close the ducti but all in vain. However, most could be expected to close spontaneously later. Herein, the possible contributing factors and the treatment rationale are discussed.

Congenital chylothorax managed by partial pleurodesis: report of one case

Congenital chylothorax, a rare cause of respiratory distress in neonate, presented here with respiratory distress from two days of age. Thoracocentesis was performed at six days, revealing a clear fluid with high protein content. Thoracotomy was performed at the age of 33 days because of a profuse amount of chest tube drainage. A leak of chyle was found near the esophageal hiatus of the costophrenic angle. Partial pleurodesis was performed because of difficulty in identifying the exact leakage point. Respiratory status improved very quickly after the operation, and oral intake was well-tolerated during follow-up.

[Short-term ceftriaxone treatment of typhoid fever in children]

Ten children, diagnosed as having typhoid fever, were enrolled in this study between April and September, 1989. Ceftriaxone was administered intravenously, in two dosages adding to 50-100 mg/kg/day over as short a period as five days. The mean period of defervescence was 3.2 days. No adverse reactions to the drug occurred; all those fulfilling the prescribed course were cured. To date, no relapse has been reported nor has any patient become a chronic carrier. Shortterm use of Ceftriaxone had the advantages of rapid response, abscence of serious side effects, and low failure rate in treating children with typhoid fever.

Epidermolysis bullosa: report of one case

Epidermolysis bullosa (EB) is a group of inherited skin diseases manifested as bullae formation induced by minor trauma. According to the anatomical level of skin splitting, it could be classified mainly into three types: simplex, junctional and dystrophic EB. We have a female term newborn noted to have had skin defect and ulceration over lower legs concurrent with oral mucosal ulceration and blister formation since birth. New blisters occurred over friction and pressure areas shortly after birth. The histopathologic pictures revealed dystrophic type of EB. These lesions seemed responsive to phenytoin and topical skin care, healing gradually with minimal scarring and atrophy. However, it is important to follow these patients to help alleviate complications of extracutaneous involvement which may occur during later life.