Comparison of Different Endodontic Access Cavity Designs on the Fracture Resistance of Tooth in WaveOne Gold and TruNatomy Instrumentation

Background

An important aspect of the preparation of the access cavity and biomechanical preparation of the root canal is to safeguard as much of the tooth's framework as possible without affecting access and visibility.

Objectives

To compare the impact of the conservative design of access preparation and traditional design of access preparation in association with TruNatomy endodontic instrumentation and WaveOne Gold endodontic instrumentation on resistance to fracture by the design of a cavity for endodontic access using finite element analysis.

Materials and Methods

Micro-CT radiographic images of 16 human first permanent molars of the mandible were included in the study to create representative finite element analysis computational models.

Results

A significant reduction in load for failure after endodontic preparation was observed in TDAP subcategories as compared to specimens with CDAP. However, the reduction in load for failure was comparable in both endodontic instrument systems within the CDAP and TDAP.

Conclusion

A significant reduction in load for failure after endodontic preparation was observed in the traditional design of access preparation subcategories as compared to specimens with the conventional design of access preparation.

Real world evidence for use of NACT in locally advanced external auditory canal cancer

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Background: The management of very locally advanced external auditory canal cancers (LAEACC) is complicated, has a dismal prognosis and there is limited literature available for guidance. At our institute, we have offered neoadjuvant chemotherapy (NACT) to such patients. The objective of the current analysis was to study the outcomes and adverse events with this approach. Methods: We identified 16 patients with LAEACC over a period of 10 years (2010-2020) from the neoadjuvant chemotherapy (NACT) database of the Head and Neck department at our hospital. All patients were seen in a multidisciplinary clinic before and after NACT. Further local therapy was planned as per the response and ECOG PS of the patient. SPSS version 20 was used for analysis. Descriptive statistics were performed and Kaplan-Meier analysis was done to evaluate overall survival and progression-free survival. Results: Out of 16 patients enrolled in the study, 14 patients eventually received NACT. The median age was 59.5 years (27 - 83), the male to female ratio was 7:1 and the ECOG PS was 0-1 in 14 (87.5%) and PS 2 in rest. The regimen offered was a 2 drug regimen of taxane and platinum in 11 patients and a 3 drug regimen of TPF in (7.14%) patients. The median cycle received was 2. Post NACT 6 (42.85%) patients underwent surgery, 5 (35.71%) received radical CTRT and 3 (21.42%) patients received palliative treatment. The median progression-free survival was 1.67 years [95% CI (0.364 - 6.175)] while the median overall survival was 2.0 years [95% CI (0.455 - 6.175)]. Conclusions: Locally advanced EACC where upfront surgery is not feasible, NACT can be considered an option as patients receiving NACT have a 44.44% response rate and surgical resection rate of 42.8%.

Neoadjuvent chemotherapy in rare sinonasal teratocarcinosarcoma: Long-term result from tertiary center

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Background: Sinonasal teratocarcinosarcoma (SNTCS) is a rare and highly aggressive disease entity having poor outcomes with available treatment modalities. Surgery followed by radiation or radical chemoradiation are considered standard therapy. However, in very locally advanced diseases surgery or radiation is not feasible and such patients are subjected to palliative therapy and have dismal outcomes. Methods: We identified 21 patients with very locally advanced SNTCS in our prospectively maintained head and neck cancer database over the last 8 years. All patients were seen in a multidisciplinary clinic prior to the start of therapy and were deemed unfit for local therapy. They were planned for 2 – 3 cycles of Neoadjuvant chemotherapy (NACT). They were then assessed in the multidisciplinary clinic for local therapy. Depending upon the response and performance status further therapy was planned. SPSS version 20 was used for the analysis. Descriptive statistics were performed and the Kaplan Meier method was used to evaluate overall survival(OS) and progression-free survival(PFS). Results: Median age was 50 years (range 27-80 Years) with male to female ratio being 6:1. ECOG PS was 0 in 3(14%), PS 1 in 14(67%) and PS 2 in 2 (9%) patients. 14 (67%) patients had Kadish C and the rest (33%) had Kadish D stage at presentation. Cisplatin & Etoposide was the chemotherapy of choice for the majority of patients (14/21 patients, 67%) with Docetaxel – Cisplatin (5/21 patients,19%), and Ifosfamide – Adriamycin (2/21 patients, 9%) being the other regimens. After NACT 14/21(66%) patients underwent surgery,1/21(4%) underwent radical Chemoradiation,1/21(4%) for palliative radiation therapy and rest for best supportive care. R0 resection was achieved in 11 out of 14 (78.6%) patients. The median PFS of the study was 17.5 months (95% CI 8.2 – 26.7) and the median OS was 19 months (95% CI = 0 -47). Those who underwent surgery after NACT have achieved a median OS of 37.3 months(95% CI 0-77.7) in comparison to 6.3 months (95% CI 0.3 -12.2) for those without surgery (p value 0.02). Conclusions: NACT in very locally advanced SNTCS achieves resectability in ⅔ patients who were unresectable upfront and would have received palliative therapy. This is important as patients who undergo surgery have prolonged overall survival.

The wandering ventriculoperitoneal shunt and the scope of its salvage

PURPOSE

Distal shunt tube migration following ventriculoperitoneal (VP) shunt placement in children is mostly managed by an initial shunt diversion/removal and subsequent replacement. Lately, shunt salvage is being used as an alternative in certain conditions. We have focused on the situations where one can consider or disregard shunt salvage in such cases.

METHOD

A retrospective study of children treated for distal shunt migration following VP shunt placement between January 2013 and December 2019.

RESULT

Seventeen children were managed for over 7 years. These included cutaneous extrusions (n = 4), hollow viscus perforation (n = 6), inguinal hernias (n = 5), and umbilical extrusion (n = 2). The surgical treatment varied from a cutaneous wound closure (with a tube in situ), temporary external shunt diversion, and laparotomy with shunt reposition into the peritoneal cavity. Shunt salvage was possible in three cases, whereas in 2 cases even though shunt salvage was possible, it was not feasible due to a short residual shunt length.

CONCLUSION

VP shunt salvage is possible in certain cases of distal shunt migration with a functional uninfected shunt. Small cutaneous extrusions can be covered by a local skin flap. Also, one should consider the residual intraperitoneal shunt length before its salvage in small children.

Angiotensin-converting Enzyme Inhibitors: Can it be a Potential Treatment of Infantile Hemangioma

Aims

The aim of the sudy was to evaluate potential role of oral captopril, an angiotensin-converting enzyme (ACE) inhibitor, and in treatment of infantile hemagioma (IH) and report our preliminary results.

Methods

This prospective study included 18 children with IH admitted in the department of pediatric surgery with no history of prior treatment of any type. Baseline blood pressure (BP), electrocardiogram, two-dimensional echocardiography, serum electrolytes, and renal function test (RFT) were noted. Oral captopril was started as first-line drug at a dose of 0.1 mg/kg orally 12 h with gradually increase of dosage up to 2.0 mg/kg 12 h over the period of 10 days with monitoring of BP, serum electrolytes, RFT, and occurrence of any side effect. If no side effects were noted and patients were stable, they were discharged and followed up until 6 months after stopping treatment. During follow-up, response to treatment was documented clinically and photographically. Development of any side effect was also noted.

Results

Excellent response to captopril was noticed in nine patients over 16-18 months. Four patients showed good response. Oral propranolol had to be administered alternatively in one patient showing fair response during the initial 4 months but no response afterward and in four patients showing no response at all. One patient developed an allergic reaction to propranolol and was started oral corticosteroid. These five patients had near complete resolution of lesion for the next 8-10 months.

Conclusions

ACE inhibitors might have a role, though slow, in the involution of IHs. Therefore, these may have the potential to emerge as an alternative treatment for IH in future after confirmation with randomized studies with propranolol.

Yolk sac tumor in intraabdominal undescended testis in a child with normal serum alpha-fetoprotein: a rare case report

Background

Intraabdominal testicular tumors are rare in prepubertal children, and most of the cases reported are intraabdominal testicular teratoma. The present study reports the first case of intraabdominal testicular yolk sac tumor (YST) with normal preoperative serum alpha-fetoprotein levels and diagnosis confirmed on histopathology and immunohistochemistry.

Case Presentation

A 2-year-old boy presented with bilateral nonpalpable undescended testes (UDT) and abdominal mass. Preoperative serum alpha-fetoprotein was normal. Contrast-enhanced computed tomography (CECT) scan of whole abdomen revealed a heterogeneous mildly enhancing space-occupying lesion in midline and left side of pelvis, left intraabdominal testis and nonvisualization of right testis. During surgery, the mass was found to involve right testis with one turn of torsion of its pedicle. Derotation of testis was performed, and right radical orchiectomy was performed. Left orchiopexy was also performed at the same time. Histopathology and immunohistochemistry confirmed diagnosis of intraabdominal testicular YST. There was no recurrence or distant metastasis at 12-month follow-up after surgery.

Conclusion

In a case of nonpalpable UDT and abdominal mass/pain, one should always consider possibility of intraabdominal testicular tumor and should investigate the case with serum tumor markers and ultrasound/CECT abdomen. Further, histology of tumor helps in guiding treatment of condition.

Neo-adjuvant chemotherapy followed by either continuous hyper-fractionated accelerated radiation therapy week-end less or conventional chemo-radiotherapy in locally advanced NSCLC-A randomised prospective single institute study

Context

Better locoregional control and increased overall survival by continuous hyper fractionated accelerated radiotherapy have been shown in unresectable nonsmall cell lung carcinoma (NSCLC). Dose escalation and neoadjuvant chemotherapy (NACT) along with continuous hyperfractionated accelerated radiotherapy week end-less (CHARTWEL) were also tried for improved survival. In this present study, we compared the results of NACT followed by CHARTWEL against NACT followed by conventional concurrent chemo-radiation therapy.

Aims

The aim of this study is to compare the locoregional control and toxicities in NSCLC Stage IIIA and B in both arms.

Settings and Design

Randomized, prospective single-institutional study with a study population comprising all locally advanced unresectable NSCLC patients enrolled in 2014 at our institute.

Subjects and Methods

All enrolled patients were randomized into two arms-CHARTWEL and concomitant chemo-radiotherapy (CCRT), after three weeks of the fourth cycle of NACT. In CHARTWEL arm 30 patients received two-dimensional radiotherapy (RT) 58.5 Gy/39 fr/2.5 weeks while in CCRT arm 30 received 66 Gy/33 fr/6.5 weeks. Disease response was evaluated at 6 months and toxicity assessment during and after treatment completion. Data were analyzed using tools such as percentage, mean, Chi-square test and P value. Chi-square and P value was calculated by statistical online software (http://quantpsy.org).

Results

28% of patients in study arm and 20% in control arm had complete response at 6 months after RT. Locoregional disease control was observed in 44% in study arm and 32% in control arm of patients. There was no statistical difference in grades of toxicities or overall survival (OS)/disease-free survival except persistent esophagitis Grade III seen in two patients of study arm.

Conclusions

Study suggests that CHARTWEL in combination with NACT is an effective strategy to treat patients with locally advanced lung cancer with the advantage of a smaller dose and shorter duration. Although large multivariate studies still needed.

Oral Propranolol in the Treatment of Ulcerated Bleeding Scrotal Arteriovenous Malformation

Arteriovenous malformations (AVMs) of the scrotum are very rare, with only 35 adult cases in the literature. An 8-year-old boy presented with an ulcerated bleeding AVM of the scrotum. The patient was resuscitated and managed conservatively initially. After the control of bleeding, oral propranolol was started. There was a decrease in the size of scrotal and penile swelling, healing of ulcer with total healing by 1 month, and no recurrence of bleeding episode. To the best of our knowledge, this was the first case of pediatric scrotal AVM treated by oral propranolol.

Low-cost oral metronomic chemotherapy versus intravenous cisplatin in patients with recurrent, metastatic, inoperable head and neck carcinoma: an open-label, parallel-group, non-inferiority, randomised, phase 3 trial

BACKGROUND

Regimens for palliation in patients with head and neck cancer recommended by the US National Comprehensive Cancer Network (NCCN) have low applicability (less than 1-3%) in low-income and middle-income countries (LMICs) because of their cost. In a previous phase 2 study, patients with head and neck cancer who received metronomic chemotherapy had better outcomes when compared with those who received intravenous cisplatin, which is commonly used as the standard of care in LMICs. We aimed to do a phase 3 study to substantiate these findings.

METHODS

We did an open-label, parallel-group, non-inferiority, randomised, phase 3 trial at the Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India. We enrolled adult patients (aged 18-70 years) who planned to receive palliative systemic treatment for relapsed, recurrent, or newly diagnosed squamous cell carcinoma of the head and neck, and who had an Eastern Cooperative Oncology Group performance status score of 0-1 and measurable disease, as defined by the Response Evaluation Criteria In Solid Tumors. We randomly assigned (1:1) participants to receive either oral metronomic chemotherapy, consisting of 15 mg/m² methotrexate once per week plus 200 mg celecoxib twice per day until disease progression or until the development of intolerable side-effects, or 75 mg/m² intravenous cisplatin once every 3 weeks for six cycles. Randomisation was done by use of a computer-generated randomisation sequence, with a block size of four, and patients were stratified by primary tumour site and previous cancer-directed treatment. The primary endpoint was median overall survival. Assuming that 6-month overall survival in the intravenous cisplatin group would be 40%, a non-inferiority margin of 13% was defined. Both intention-to-treat and per-protocol analyses were done. All patients who completed at least one cycle of the assigned treatment were included in the safety analysis. This trial is registered with the Clinical Trials Registry-India, CTRI/2015/11/006388, and is completed.

FINDINGS

Between May 16, 2016, and Jan 17, 2020, 422 patients were randomly assigned: 213 to the oral metronomic chemotherapy group and 209 to the intravenous cisplatin group. All 422 patients were included in the intention-to-treat analysis, and 418 patients (211 in the oral metronomic chemotherapy group and 207 in the intravenous cisplatin group) were included in the per-protocol analysis. At a median follow-up of 15·73 months, median overall survival in the intention-to-treat analysis population was 7·5 months (IQR 4·6-12·6) in the oral metronomic chemotherapy group compared with 6·1 months (3·2-9·6) in the intravenous cisplatin group (unadjusted HR for death 0·773 [95% CI 0·615-0·97, p=0·026]). In the per-protocol analysis population, median overall survival was 7·5 months (4·7-12·8) in the oral metronomic chemotherapy group and 6·1 months (3·4-9·6) in the intravenous cisplatin group (unadjusted HR for death 0·775 [95% CI 0·616-0·974, p=0·029]). Grade 3 or higher adverse events were observed in 37 (19%) of 196 patients in the oral metronomic chemotherapy group versus 61 (30%) of 202 patients in the intravenous cisplatin group (p=0·01).

INTERPRETATION

Oral metronomic chemotherapy is non-inferior to intravenous cisplatin with respect to overall survival in head and neck cancer in the palliative setting, and is associated with fewer adverse events. It therefore represents a new alternative standard of care if current NCCN-approved options for palliative therapy are not feasible.

FUNDING

Tata Memorial Center Research Administration Council.

TRANSLATIONS

For the Hindi, Marathi, Gujarati, Kannada, Malayalam, Telugu, Oriya, Bengali, and Punjabi translations of the abstract see Supplementary Materials section.

Supernumerary Kidney Associated With Horseshoe Malformation and Ureteric Stricture With Hydroureteronephrosis - A Rare Case

Supernumerary kidney is an accessory kidney with its own vasculature, collecting-system and encapsulated parenchyma with about 100 cases reported in the literature. However, there is no report of supernumerary kidney associated with horseshoe malformation with ureteric stricture. We report a rare case of 20 months old female admitted with left-sided abdomen lump and mild abdominal pain. During surgery, supernumerary kidney with horseshoe component with grossly-dilated left-sided pelvicalyceal system and proximal 1-cm of left-ureter, distal to which whole of left-ureter was noncanalized, was seen. Right-ureter was normal. Distal dilated part of left-ureter was anastomosed to bladder-dome after excision of strictured segment of left-ureter with placement of nephrostomy.

Synthesis and characterization of Ag-Co-Ni nanowires

This work provides an electrodeposition-based methodology for synthesizing multicomponent nanowires containing Ag, Co and Ni atoms. Nanowire morphology was obtained by using an anodic alumina membrane with cylindrical pores of ∼ 200-nm diameter. Structural, compositional and magnetic characterization revealed that the as-synthesized nanowires adopted a core-shell microstructure. The core (axial region) contained pure Ag phase volumes with a plate-like morphology oriented perpendicular to the nanowire axis. The shell (peripheral region) contained pure Ag nanoparticles along with superparamagnetic Co and Ni rich clusters.

Coupled molecular dynamics-stochastic model for thermal conductivity of ethylene glycol based copper nanofluid

A coupled molecular dynamics (MD)-stochastic simulation based model has been proposed here for the thermal conductivity of ethylene glycol (EG) based copper nanofluid. The model is based on the thermal evolution of the nanoparticles dispersed in the nanofluid which is in contact with a heat source. It is natural that the nanoparticles dispersed in the nanofluid would move randomly by Brownian motion and repeatedly collide with the heat source. During each collision the nanoparticles would extract some heat by conduction mode from the heat source and this heat would be dissipated to the base fluid during Brownian motion by a combination of conduction and microconvection mode. Thus, in addition to normal conductive heat transfer through the base fluid (EG) itself (without nanoparticles) some amount of heat is transferred by the collision of the nanoparticles with the heat source. The extent of this additional heat transfer has been estimated in the present model to estimate the enhancement in thermal conductivity of EG based copper nanofluid, as a function of volume fraction loading of nanoparticles. The prediction of the present model has been compared with the experimental data available in literature, and it has shown a reasonable agreement between the theoretical prediction and the experimental data.

Addressing maternal and child health in post-conflict Afghanistan: the way forward

Afghanistan's maternal and child mortality rates are among the highest in the world. The country faces challenges to meet the Millennium Development Goals set for 2015 which can be attributed to multiple causes related to accessibility, affordability and availability of health-care services. This report addresses the challenges in strengthening maternal and child health care in Afghanistan, as well discussing the areas to be prioritized. In order to ensure sound maternal and child health care in Afghanistan, policy-makers must prioritize monitoring and surveillance systems, integrating maternal and child health care with rights-based family planning methods, building human resources, offering incentives (such as the provision of a conditional cash transfer to women) and promoting action-oriented, community-based interventions. On a wider scale, the focus must be to improve the health infrastructure, organizing international collaboration and expanding sources of funding.

Use of glutaraldehyde and benzalkonium chloride for minimizing post-harvest physio-chemical and microbial changes responsible for sucrose losses in sugar cane

Sugar cane is sensitive to enormous sucrose losses induced by physio-chemical and microbial changes, the severity being increased during the time lag between harvest and crushing in the mills. Minimization of the sucrose losses in the field is essential for better sugar recovery and prevention of sucrose losses. An experiment was conducted to evaluate the efficacy of glutaraldehyde and benzalkonium chloride for their effects on the microbial counts and physio-chemical changes responsible for sucrose losses. Glutaraldehyde and benzalkonium chloride (1000 + 250 ppm) reduced the losses in sucrose content to 7.1% as compared to the 30.8% loss in the control, thus improving the performance by 76.9%. The application of chemicals reduced the acid invertase activity (by 60%), lowered weight loss, titrable acidity, reducing sugars content, dextran, ethanol, and ethylene production and respiration rates. The application led to the reduction in the total bacterial, fungal, Leuconostoc, and yeast counts by 67.92, 51.3%, 26.08, and 51.2%, respectively.

Spontaneous bifocal Clostridium septicum gas gangrene

Clostridium septicum gas gangrene (myonecrosis) is an acutely painful and rapidly fatal infection occurring in the absence of trauma. Urgent surgery is essential both to control pain and to ensure survival. Most patients who develop this infection have an underlying malignancy and clinicians should be aware of this association. We present a case of bifocal myonecrosis which to our knowledge has not been reported previously.

Amino acid comparisons in male sterile wheat derived fromTriticum timopheevi zhuk. cytoplasm and its fertile counterpart

Anthers, seeds, seedlings and flag leaves of fertile and cytoplasmic male sterile (Triticum timopheevi) lines of bread wheat were examined for free and acid-hydrolyzable (bound) amino acids. Free asparagine was found to be high in anthers of the male sterile line and free proline high in anthers of the fertile line.Among the bound amino acids, proline was lower, and aspartic and glutamic acid were higher, in male sterile than in fertile anthers. Retardation of glutamic and aspartic acid conversion to proline was believed to be a cause of proline deficiency in the male sterile line.The total amount of bound amino acids was higher in anthers, seed and flag leaves of the male sterile line compared with the fertile analogue.