Anterior Area Research Articles

Does the fixture thread depth affect the accuracy of implant placement during fully guided immediate implant placement?: A human cadaver study.

The fixture thread depth reportedly influences the primary stability of dental implant, but its effect on the positional accuracy in immediate implant placement has not been reported previously. Fifty-six single-rooted, anterior and premolar teeth were extracted from six human cadavers, followed by installing either regular-threaded implants (RT group, N=30) or deep-threaded implants (DT group, N=26) completely relying on the surgical guide. Optical impressions taken after osteotomy and fixture installation were superimposed with the preoperative virtual planning data to measure the vertical, angular, platform and apex deviations that occurred during osteotomy and installation. While the osteotomy deviations were similar between the two groups, the angular and apex deviation of the DT group (2.67 ± 2.56°; 1.04 ± 0.49 mm, respectively) were significantly larger than those of the RT group (1.61 ± 1.04°; 0.67 ± 0.41 mm, respectively) during installation (p < .05). When the installation deviations were analysed in the anterior and premolar areas separately, the angular, platform and apex deviations of the DT group (3.05 ± 3.26°; 0.75 ± 0.32 mm; 1.08 ± 0.56 mm, respectively) were significantly larger than those of the RT group (1.56 ± 0.73°, 0.59 ± 0.28 mm; 0.62 ± 0.38 mm, respectively) in the anterior site (p < .05), whereas there was no significant intergroup difference in the premolar site. In immediate-implant surgery, using an implant with a deeper thread might increase the deviations during installation, especially in the anterior area.

The comparison of biomechanical effects of the conventional and bone-borne palatal expanders on late adolescence with unilateral cleft palate: a 3-dimensional finite element analysis

BackgroundPatients with unilateral cleft lip and palate were associated with different nasomaxillary complex from the normal population. Although the biomechanical effects of conventional rapid palatal expansion (Hyrax expansion) and bone-borne rapid palatal expansion (micro-implant-assisted expansion) in non-cleft patients have been identified by multiple studies, little is known in patients with unilateral cleft lip and palate. The purpose of this study was to investigate and compare the biomechanical effects of the conventional and bone-borne palatal expanders in a late adolescence with unilateral cleft lip and palate.MethodsA cone beam CT scan of a late adolescence with unilateral cleft lip and palate was selected to construct the three-dimensional finite element models of teeth and craniofacial structures. The models of conventional and born-borne palatal expanders were established to simulate the clinical maxillary expansion. The geometric nonlinear theory was applied to evaluate the Von Mises stress distribution and displacements in craniofacial structures and teeth.ResultsBone-borne palatal expander achieved more transverse movement than conventional palatal expander in the whole mount of craniofacial regions, and the maximum amount of expansion was occurred anteriorly along the alveolar ridge on cleft-side. The expanding force from born-borne palatal expander resulted in more advancement in nasomaxillary complex than it in conventional palatal expander, especially in the anterior area of the minor segment of maxilla. Stresses from the both expanders distributed in similar patterns, but larger magnitudes and ranges were generated using the bone-borne expander around the maxillary buttresses and pterygoid plates of sphenoid bone. The maximum expanding stresses from born-borne palatal expander were concentrated on palatal slope supporting minscrews, whereas those from conventional palatal expander were concentrated on the anchoring molars. In addition, the buccal tipping effect of teeth generated using the bone-borne expander was less than it using the conventional palatal expander.ConclusionBone-borne expander generated enhanced skeletal expansion at the levels of alveolar and palate in transversal direction, where the miniscrews contributed increased expanding forces to maxillary buttresses and decreased forces to buccal alveolar. Bone-borne expanders presented a superiority in correcting the asymmetric maxilla without surgical assistant in late adolescence with unilateral cleft lip and palate.

Morphometric analysis of paired fibula and mandible for optimal fibular mandibular reconstruction in a Chinese population

To analyze the morphology of paired fibula and mandible aiming to choose optimal fibular segments for mandibular reconstruction in a Chinses population. A total of 118 cases of paired mandible and fibula was collected. All patients were received preoperative cone beam CT (CBCT) scans for mandibular evaluation and CT-angiographical (CTA) examination of the bilateral lower legs, respectively. The cross-sectional morphological differences between proximal (Side P), middle (Side M) and distal (Side D) segments of fibula and anterior, premolar and molar areas of mandible were compared. The most frequent cross-sectional shape at Side D, Side M and Side P portion of fibula was circular (75.4%), triangular (67.8%) and circular (49.2%), respectively. In anterior, premolar and molar areas of mandible, the most of the cross-section was s-shape (90.82%), straight (83.64%) and oblique (91.89%), respectively. The height and width of upper one third (W1) at Side M were significantly larger than those of Side D and Side P (p < 0.0001). There was significantly difference of width of lower one third (W2) among three groups (p < 0.0001). As for the height and widths of mandible, there was significant difference among anterior, premolar and molar regions (p < 0.0001). The rate of height between Side M of fibula and mandible (H (Side M/area)) was significantly larger than H (Side D/area) and H (Side P/area) (p < 0.01). The ratio of W1 between Side D of fibula and mandible (W1 (Side D/area)) was significantly larger than that of W1 (Side M/area) and W1 (side P/area) (p < 0.05). As for the ratio of W2 between fibula and mandible (W2 (plane/area)), there was significant difference among groups (p < 0.01). The distal and middle segments of fibula were suitable for reconstructing the anterior area of mandible and the proximal segment of fibula was more compatible with the premolar and molar areas of mandible.Clinical Relevance Presurgical morphometric analysis of paired fibula and mandible aids for optimal fibular-based mandibular reconstruction.

Effects of upper-molar distalization using clear aligners in combination with Class II elastics: a three-dimensional finite element analysis

IntroductionThe effects of upper-molar distalization using clear aligners in combination with Class II elastics for anchorage reinforcement have not been fully investigated yet. The objective of this study is to analyze the movement and stress of the whole dentition and further explore guidelines for the selection of traction methods.MethodsThree-dimensional (3D) finite element models are established to simulate the sequential molar distalization process, including the initial distalization of the 2nd molar (Set I) and the initial distalization of the 1st molar (Set II). Each group set features three models: a control model without Class II elastics (model A), Class II elastics attached to the tooth by buttons (model B), and Class II elastics attached to the aligner by precision cutting (model C). The 3D displacements, proclination angles, periodontal ligament (PDL) hydrostatic stress and alveolar bone von Mises stress in the anterior area are recorded.ResultsIn all of the models, the maxillary anterior teeth are labial and mesial proclined, whereas the distal moving molars exhibit distal buccal inclination with an extrusion tendency. With the combination of Class II elastics, the anchorage was effectively reinforced; model C demonstrates superior anchorage reinforcement with lower stress distribution in comparison with model B. The upper canines in model B present an extrusion tendency. Meanwhile, the mandibular dentition in models B and C experience undesired movement tendencies with little discrepancy from each other.ConclusionsClass II elastics are generally effective for anchorage reinforcement as the upper-molar distalization is performed with clear aligners. Class II elastics attached to an aligner by precision cutting is a superior alternative for maxillary anchorage control in cases that the proclination of upper incisors and extrusion of upper canines are unwanted.

Comparative analysis between early and late onset primary angle closure glaucoma

AbstractObjective: This prospective observational pilot study aimed at comparing the aetiology and clinical profile of early onset primary angle closure glaucoma (EPACG) with late onset primary angle closure glaucoma (LPACG).Methods: The early (18–40 year) and late (≥50 year) onset PACG patients without any surgical intervention or any other pathology (leading to secondary angle closure) were enrolled. One eye of each patient was considered for analysis. Clinico‐demographic details of the patients were noted. Anterior segment optical tomography (CASIA2, Tomey Corporation, Japan), Ultrasound biomicroscopy (Vumax, Sonomed, NY) were performed to identify the etiopathogenesis among two groups.Results: Mean age of participants was 32.8 ± 7.8 years EPACG (n = 45) and 55.83 ± 6.7 years in the LPACG group (n = 31). Relative pupillary block (90.32%, n = 28) was the commonest mechanism of angle closure in LPACG while non pupillary block [66.67%, n = 31, pseudoplateau iris‐ 44.44% (n = 20), plateau iris‐24.44% (n = 11)] was the commonest mechanism in EPACG group. The EPACG had significantly shorter axial length (22.1 ± 1.1 vs 22.93 ± 1; p = 0.003), thinner lens (4.35 ± 0.3 vs. 4.6 ± 0.2; p = 0.01), more anterior relative lens position (0.19 ± 0.01 vs. 0.2 ± 0.01; p = 0.007), lesser anterior chamber depth (2.1 ± 0.3 vs. 2.3 ± 0.32; p = 0.01) and lesser anterior chamber area (15 ± 3.3 vs. 16.7 ± 3.4; p = 0.04) compared to LPACG. EPACG had greater lens vault (0.79 ± 0.4 vs. 0.61 ± 0.2; p = 0.01) compared to LPACG. Among the EPACG, 15.55%, (n = 7, vs. none in LPACG) had nanophthalmos. The BCVA was worse in EPACG (0.2 (range 0–2) vs. 0.6 (0–2) logMAR in LPACG) despite refractive error being more emmetropic vs LPACG.Conclusions: Non pupillary block mechanisms are more common in EPACG as compared to LPACG. Despite thinner lens, early onset group has greater lens vault and shorter axial length contributing to greater angle crowding and present with greater visual morbidity.

Anterior Quadratus Lumborum block area comparison in the three different volumes of Ropivacaine: a double-blind, randomized controlled trial in healthy volunteers

BackgroundIn abdominal surgery, ultrasound-guided anterior quadratus lumborum blocks (QLB) are performed to induce analgesia. However, no study reported suitable volumes of the anterior QLB for the different postoperative analgesia regions. Therefore, this prospective randomized controlled study assessed the dermatomal spread and analgesic effects of the three different volumes of a local anesthetic for anterior QLB.MethodsUltrasound-guided anterior QLB was performed at the L2 level on 30 healthy volunteers. The volunteers were randomized to receive 20 ml (n = 10), 30 ml (n = 10), and 40 mL (n = 10) of 0.375% ropivacaine. The cutaneous sensory blocked area (CSBA), the number of block dermatomes, and the block duration time were measured by determining the extent of the cold sensation.ResultsThe CSBA was significantly larger in the 40 ml group than in the 30 (P = 0.001; 1350.6 ± 234.4 vs. 1009.5 ± 151.6 cm2) and 20 ml groups (P < 0.001; 1350.6 ± 234.4 vs. 808.1 ± 120.5 cm2). Similarly, the number of blocked dermatomes was significantly higher in the 40 ml group than in the 30- and 20-ml groups. However, no significant difference was observed in block duration among the groups.ConclusionsNo difference was observed in block duration with the various volumes of 0.375% ropivacaine. However, the larger volume for anterior QLB contributed to a larger area of cutaneous sensory blockade. Appropriate volumes in anterior QLB can create suitable postoperative analgesia levels for the different operative sites.Trial registrationThe study was registered in the Chinese Clinical Trial Registration Center on www.chictr.org.cn on 27th April 2018 (registration number: ChiCTR-IOR-17010853).

Clinical application of laparoscopic sentinel lymph node mapping in early staged cervical cancer

Objective: To investigate the application of sentinel lymph node biopsy (SLNB) in early-staged cervical cancer by laparoscopy. Methods: It was a prospective, single-arm, single-center clinical study. Seventy-eight cases of cervical cancer patients were collected from July 2015 to December 2018 at the Fourth Hospital of Hebei Medical University. All the patients were injected with tracer into the disease-free block of cervical tissue after anesthesia by the same surgeon who learned sentinel lymph node (SLN) mapping technique in Memorial Sloan-Kettering Cancer Center, and underwent SLN mapping followed by complete pelvic lymphadenectomy. Moreover, all the dissected lymph nodes were stained with hematoxylin eosin staining (HE) pathological examination. Besides, the negative SLN on hematoxylin-eosin staining were detected by immunohistochemistry cytokeratin staining micro-metastasis. To analyze the distribution, detection rate, false negative rate the sensitivity and negative predictive value of the SLN in early-staged cervical cancer by laparoscopy, and explore the value of SLN mapping in predicting the lymph nodes metastasis in early-staged cervical cancer. Results: The overall detection rate of SLN in cervical cancer was 99% (77/78), bilateral detection rate was 87% (68/78). The average of 12.4 lymph node (LN) and 3.6 SLN were dissected for each patients each side. SLN of cervical cancer were mainly distributed in the obturator space (61.5%, 343/558), followed by external iliac (23.5%, 131/558), common iliac (7.3%, 41/558), para-uterine (3.8%, 21/558), internal iliac (2.2%, 12/558), para abdominal aorta (1.1%, 6/558), and anterior sacral lymphatic drainage area (0.7%, 4/558). Fourteen cases of LN metastasis were found among all 78 cases. There were a total of 38 positive LN, including 26 SLN metastasis and 12 none sentinel LN metastasis. Through immunohistochemical staining and pathological ultra-staging, 1 SLN was found to be isolated tumor cells (ITC), and 5 SLNs were found to be micro-metastases (MIC), accounting for 23% (6/26) of positive SLN. SLN mapping with pathological ultra-staging improved the prediction of LN metastasis in cervical cancer (2/14). Metastatic SLN mainly distributed in the obturator space (65%, 17/26), peri-uterine region (12%, 3/26), common iliac region (15%, 4/26), and external iliac region (8%, 2/26). The consistency of the diagnosis of lymph node metastasis by SLN biopsy and postoperative retroperitoneal lymph node metastasis showed that the Kappa value was 1.000 (P<0.001), indicated that the metastasis status of SLN and retroperitoneal lymph node were completely consistent. The sensitivity, specificity, accuracy, false-negative rate, and negative predictive value of SLN biopsy in the diagnosis of lymph node metastasis were 100%, 100%, 100%, 0, and 100%, respectively. Conclusions: SLN in early-staged cervical cancer patients were mainly distributed in the obturator and external iliac space, pathalogical ultra-staging of SLN could improve the prediction of LN metastasis. Intraoperative SLN mapping is safe, feasible and could predict the state of retroperitoneal LN metastasis in early-staged cervical cancer. SLNB may replace systemic pelvic lymphadenectomy.

Dissociation and hierarchy of human visual pathways for simultaneously coding facial identity and expression

Humans have an extraordinary ability to recognize facial expression and identity from a single face simultaneously and effortlessly, however, the underlying neural computation is not well understood. Here, we optimized a multi-task deep neural network to classify facial expression and identity simultaneously. Under various optimization training strategies, the best-performing model consistently showed ‘share-separate’ organization. The two separate branches of the best-performing model also exhibited distinct abilities to categorize facial expression and identity, and these abilities increased along the facial expression or identity branches toward high layers. By comparing the representational similarities between the best-performing model and functional magnetic resonance imaging (fMRI) responses in the human visual cortex to the same face stimuli, the face-selective posterior superior temporal sulcus (pSTS) in the dorsal visual cortex was significantly correlated with layers in the expression branch of the model, and the anterior inferotemporal cortex (aIT) and anterior fusiform face area (aFFA) in the ventral visual cortex were significantly correlated with layers in the identity branch of the model. Besides, the aFFA and aIT better matched the high layers of the model, while the posterior FFA (pFFA) and occipital facial area (OFA) better matched the middle and early layers of the model, respectively. Overall, our study provides a task-optimization computational model to better understand the neural mechanism underlying face recognition, which suggest that similar to the best-performing model, the human visual system exhibits both dissociated and hierarchical neuroanatomical organization when simultaneously coding facial identity and expression.

Prevalence of proximal contact loss between implant-supported fixed prosthesis and adjacent teeth and associated factors: A systematic review and meta-analysis.

Background. This systematic review and meta-analysis investigated the prevalence of proximal contact loss and its associated factors. Methods. A bibliographic search was conducted in June 2021 with no limitation in the article date or language and updated in January 2022 by hand searching. There was no time limit on the search to retrieve all studies. The search included randomized controlled trials or quasi-experiments, and cross-sectional or cohort studies were included in the absence of these studies. Two authors screened the title and abstract. After evaluating the full texts of selected articles, irrelevant studies and or non-English papers that were impossible to translate were excluded. Disagreements between the re-viewers' selection process were resolved by debate on the eligibility of studies. Standardized critical appraisal instruments from the Joanna Briggs Institute for different types of studies were used to assess the studies' quality. Comprehensive Meta-Analysis (CMA) software (Version 2.2; Biostat, Englewood, NJ) was used for data analysis. Results. The proximal contact loss (PCL) frequency was %29. According to the results, the frequencies of PCL for the distal and mesial aspects were %7 and %21, respectively. The meta-analysis results showed that the contact loss events on the mesial aspect were statistically higher than on the distal aspect (P<0.0001). There were no significant differences between other associated factors such as the mandibular or maxillary arch, retention type, opposing dentition, implant type, molar or non-molar, parafunction behaviors, and vitality of adjacent teeth. There was a significant association between bone loss and PCL, and in individuals with bone loss >%50, the proximal contact loss was higher (OR: %95[ 2.43 CI: 4.03‒1.47], P=0.0006). The PCL in the anterior area was lower than in the posterior area (P=0.004). Although the frequency of contact loss in females was higher than in males, this rate was not statistically significant. Conclusion. The PCL on the mesial aspect and the posterior area was high. In individuals with bone loss >%50, the proximal contact loss was higher than in others.

A Comparative Study of Surgical and Non-Surgical Interventions for the Management of Radicular Cysts

Background: Periapical cysts are slow-growing cysts that are often asymptomatic until they become secondary infections. Periapical cysts are seen in the periapical region. The choice of therapy may be influenced by a number of criteria, including the extent of the lesion, its connection to important structures, its point of origin, clinical features, the patient's level of cooperation, and the patient's overall health. As a result of this, the current research was carried out to evaluate the effectiveness of surgical and non-surgical intervention in the treatment of radicular cysts.Materials and Methods: The investigation included a total of 28 instances, 20 of which were men and 8 of which were females. All of the patients exhibited gradually growing swelling in the anterior area. Clinical examination and radiographs of all of the patients produced conclusive evidence of the presence of a radicular cyst. Both the non-surgical intervention group and the surgical intervention group received an equal share of the overall group. For the purpose of analysis, a t-test on independent samples and a Chi-square test were carried out.Results: The non-surgical group had a mean radiographic lesion of 1.78 + 0.1 and 0.44 + 0.11 at the first and sixth months, respectively, whereas the surgical group had a mean lesion of 1.22 + 0.11 and 0.21 + 0.12. The p values for the two groups, which showed a statistically significant difference, were P = 0.01 and P = 0.00, respectively. After one month, 11 patients in the surgical group were extremely pleased, and after six months, patients in both groups were very satisfied. However, the degree of satisfaction did not demonstrate a significant amount of relevance. The number of patients in the surgery group who had severe pain was somewhat higher than in the non-surgical group; however, after the first month, pain was much less severe in the surgical group as compared to the non-surgical group.Conclusion: Combination procedures, such as the root canal, apicoectomy and decompression or marsupialization , have superior results in treating radicular cysts with non-vital pulp than using each one of these procedures alone.

Maximum downward slope of sleep slow waves as a potential marker of attention-deficit/hyperactivity disorder clinical phenotypes

BackgroundAttention-Deficit/Hyperactivity Disorder (ADHD) is a highly heterogeneous diagnostic category, encompassing several endophenotypes and comorbidities, including sleep problems. However, no predictor of clinical long-term trajectories or comorbidity has yet been established. Sleep EEG has been proposed as a potential tool for evaluating the synaptic strength during development, as well as the cortical thickness, which is presumed to be altered in ADHD. We investigated whether the slope of the Slow Waves (SWs), a microstructural parameter of the sleep EEG, was a potential predictive parameter for psychiatric comorbidities and neuropsychological dimensions in ADHD. Methods70 children (58 m; 8.76 ± 2.77 y) with ADHD who underwent psychiatric and neurologic evaluations and a standard EEG recording during naps were investigated. After sleep EEG analysis, we grouped the extracted SWs in bins of equal amplitude and then measured the associations, through generalized linear regression, between their maximum downward slopes (MDS) and the individual scores obtained from clinical rating scales. ResultsThe presence of Multiple Anxiety Disorders was positively associated with MDS of medium amplitude SWs in temporo-posterior left areas. The Child Behavior Checklist scores showed negative associations in the same areas for small SWs. The presence of autistic traits was positively associated with MDS of high amplitude SWs in bilateral anterior and temporal left areas. The WISC-IV Processing Speed Index showed negative associations with MDS of small-to-medium SWs in anterior and temporal right areas, while positive associations in posterior and temporal left areas. ConclusionsConsistency of association clusters' localization on the scalp suggests that variations in the local MDS, revealing alterations of local synaptic strength and/or in daytime use of certain cortical circuits, could underlie specific neurodevelopmental trajectories resulting in different ADHD clinical phenotypes.

Abstract 12425: The Interplay Between Left Atrial and Mitral Valvular Remodeling in Subtypes of Mitral Regurgitation

Background: The interaction between left atrial (LA) mechanics and mitral valve remodeling patterns in patients with mitral regurgitation (MR) is poorly described. Objectives: To assess three-dimensional (3D) LA volumes and strain in relation to 3D mitral valve morphology in patients with degenerative vs. functional MR. Methods: Patients included in the 3D-PRIME (3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation) study at our heart valve clinic between 2020-2022 and with moderate or severe MR by combined transthoracic/transesophageal assessment were examined. LA remodeling was assessed by 3D maximum and minimum LA volume, reservoir strain (LASr) and contraction strain (LASct). Mitral valve annulus area, anterior and posterior leaflet length and area, tenting volumes and non-planar angle were measured using dedicated 3D mitral valve software. Results: 100 patients with moderate or severe MR were included. Patients with atrial functional MR (n=26) were older, more often women and had higher heart rate compared to degenerative MR (n=54) and ventricular functional MR (n=20) (p &lt;0.05). They also had larger LA volumes and severely impaired LASr and LASct despite smaller MR regurgitation volumes compared to MR by other mechanisms (Figure). Mitral annulus area was comparable between groups, but anterior mitral leaflet was higher, with larger area and the non-planar angle wider in functional MRs (p &lt;0.05). In multivariable analysis, low LASr (below median) was associated with larger LA volume, and higher anterior mitral leaflet height independent of age, sex, heart rate, left ventricular global longitudinal strain, and right ventricular stroke volume (Nagelkerke R 2 0.67, p &lt;0.01). In a similar model, low LASct was only associated with larger LA volumes. Conclusions: Patients with atrial functional MR have large LAs with severely impaired LA function and a specific mitral valve remodeling pattern at lower MR regurgitation volumes.

Damage to temporoparietal cortex is sufficient for impaired semantic control.

Semantic control allows us to focus semantic activation on currently relevant aspects of knowledge, even in the face of competition or when the required information is weakly encoded. Diverse cortical regions, including left prefrontal and posterior temporal cortex, are implicated in semantic control, however; the relative contribution of these regions is unclear. For the first time, we compared semantic aphasia (SA) patients with damage restricted to temporoparietal cortex (TPC; N=8) to patients with infarcts encompassing prefrontal cortex (PF+; N=22), to determine if prefrontal lesions are necessary for semantic control deficits. These SA groups were also compared with semantic dementia (SD; N=10), characterised by degraded semantic representations. We asked whether TPC cases with semantic impairment show controlled retrieval deficits equivalent to PF+cases or conceptual degradation similar to patients with SD. Independent of lesion location, the SA subgroups showed similarities, whereas SD patients showed a qualitatively distinct semantic impairment. Relative to SD, both TPC and PF+SA subgroups: (1) showed few correlations in performance across tasks with differing control demands, but a strong relationship between tasks of similar difficulty; (2) exhibited attenuated effects of lexical frequency and concept familiarity, (3) showed evidence of poor semantic regulation in their verbal output - performance on picture naming was substantially improved when provided with a phonological cue, and (4) showed effects of control demands, such as retrieval difficulty, which were equivalent in severity across TPC and PF+groups. These findings show that semantic impairment in SA is underpinned by damage to a distributed semantic control network, instantiated across anterior and posterior cortical areas.

PSAT289 Extranodal Marginal Zone B-Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue (MALT) Type of the Thyroid: A Rare Tumor That Requires a Second Look

Abstract Background Extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type of the thyroid, or MALT lymphoma of the thyroid, is a rare, indolent tumor that accounts for only 1-2% of extranodal lymphomas. It is often associated with lymphocytic thyroiditis - a benign condition that might not be given additional investigation. Clinical case A 79-year-old male consulted due to a 3-year history of a gradually enlarging, painless anterior neck mass accompanied by hoarseness. He denied fever, weight loss, dysphagia, dyspnea, palpitations, heat or cold intolerance, or changes in bowel movement. On physical exam, a 4×3×1 cm firm, fixed, non-tender right anterior neck mass and a 2×2 cm right supraclavicular mass were palpated. Thyroid function tests showed: TSH 3.301 uIU/mL (0.55 - 4.78 uIU/ml), FT3 2.560 pg/mL (2.30 - 4.20 pg/mL) and FT4 0.720 ng/dL (0.89 - 1.76 ng/dL). Neck ultrasound revealed multiple cervical lymph nodes measuring 1-2 cm in the right anterior, posterior, submandibular, and left submandibular areas. A lobulated heterogeneous mass measuring 9.7×2.9×4.3 cm occupied almost the entire right thyroid lobe, with intralesional and peripheral vascularity. The left thyroid lobe had an irregular, solid, isoechoic nodule measuring 0.9×0.5×0.9 cm. Fine needle aspiration biopsy of the right thyroid mass showed lymphocytic thyroiditis (Bethesda category II). The patient underwent total thyroidectomy with frozen section and selective neck dissection on the right (levels II, III, IV, and V). Final histopathology and immunohistochemical stains revealed extranodal marginal zone lymphoma of the thyroid gland, with high grade transformation to diffuse large B-cell lymphoma in 10% of the tumor. Level II, III and V lymph nodes were positive for marginal zone lymphoma. Histopathology also showed an adenomatous goiter with lymphocytic thyroiditis. The patient was started on levothyroxine 75 mcg once daily. He completed 1 cycle of chemotherapy (R-CHOP). Two weeks after chemotherapy, he developed febrile neutropenia and expired due to sepsis. Conclusion In thyroid nodules and masses where lymphocytic thyroiditis is identified on fine needle aspiration biopsy, particularly in large masses accompanied by cervical lymphadenopathy, the possibility of an existing MALT lymphoma of the thyroid should be considered, and further investigation may be warranted. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Preservation of language function by mapping the arcuate fasciculus using intraoperative corticocortical evoked potential under general anesthesia in glioma surgery.

Intraoperative language mapping under general anesthesia is imperative for brain tumor surgery because awake surgery is not always feasible. Monitoring corticocortical evoked potential (CCEP) is known to be a useful method for tracking neuronal connectivity and localizing functional areas. The authors evaluated the clinical benefit of intraoperative CCEP monitoring for language function preservation in patients undergoing glioma surgery. Between January 2019 and June 2021, the authors performed a total of 29 consecutive glioma surgeries using CCEP monitoring under general anesthesia because of a risk of speech impairment; these were analyzed. Language area mapping was implemented by the anterior language area to posterior language area CCEP method for arcuate fasciculus mapping, and tumor resection was performed while avoiding the localized language areas. Language function before and after surgery was evaluated by the Controlled Oral Word Association Test (COWAT). Intraoperative CCEP was successfully monitored in 25 patients (86.2%), and a valid signal was undetectable in the other 4 patients. Language function evaluation was possible before and after surgery in a total of 20 patients. Overall, the preservation rate of language function was 65.0%, and the deterioration rate was 35.0% after tumor resection with CCEP monitoring. Among those 8 patients with preoperative COWAT scores ≥ 18, 5 patients (62.5%) successfully preserved their language function, with COWAT scores > 18 after tumor resection. Among the 12 patients with preoperative deteriorated language function (COWAT score < 18), 8 patients (66.7%) showed improvement or preserved language function after surgery. Intraoperative CCEP monitoring of the arcuate fasciculus is an acceptable technology for the preservation of language function under general anesthesia in glioma surgery in patients in whom awake surgery is not feasible.

LBODP099 A Young Patient With Undifferentiated And Advanced Medullary Thyroid Carcinoma With Negative RET - CASE REPORT

Abstract A Young Patient With Undifferentiated And Advanced Medullary Thyroid Carcinoma With Negative RET – CASE REPORT INTRODUCTION: Medullary Thyroid Carcinoma (MTC) is a rare and aggressive form of thyroid cancer that arises from C cells, representing 5% of all thyroid malignancy. The biochemical characteristic of MTC is the elevation of serum calcitonin (CTN), which aids in the initial diagnosis and surveillance of this disease. Another important, but less specific marker in the follow-up is the carcinoembryogenic antigen (CEA). Although, it is observed in the Undifferentiated MTC that there is a disproportion between the expected values of CEA and CTN. Case Report A previously healthy 16 years old female patient was hospitalized for the investigation of cervical discomfort, involuntary weight loss and progressive back pain for 9 months. She had a BMI of 14.9kg/cm2, a palpable thyroid nodule measuring approximately 2. 0cm and painful cervical lymph node enlargement. Laboratory tests showed CTN 79.1pg/mL, CEA 4999.42ng/mL added with an independent PTH hypercalcemia. Thyroid US showed a solid nodule with lobulated contours, heterogeneous echotexture, predominantly hypoechogenic, with its longest axis parallel to the skin, measuring approximately 2.4×0.9×0.9 cm, located in the lower middle third of the right thyroid lobe (TI -RADS 4) added to multiple lymph nodes inthe anterior cervical area (in agreement with the neck CT). Regarding the staging Chest CT showed a metastasis suggestive nodulation; Cranial CT, bone scan and total spine MRI showed evidence of several infiltrative nodular formations with heterogeneous enhancement affecting the skullcap, sacrum, iliac bones and multiple vertebral bodies. Sacral bone biopsy was performed giving us the diagnose of a metastatic Medullary Thyroid Carcinoma (MTC). A FineNeedle Aspiration (FNA) of the thyroid nodule and cervical lymph node showed calcitonin levels of 31.1pg/mL added with positive immunohistochemistry for chromogranin,synaptophysin, CD56 and Calcitonin in a focal manner, confirming the hypothesis of Undifferentiated CMT. Genetic testing was performed by next-generation sequencing of the genes ATM, ATR, CDKN2A, EGLN1, FH, HRAS, KIF1B, KMT2D, MAX, MDH2, MERTK, MET, NF1, PIK3CA, RET, SDHA, SDHAF2, SDHB, SDHC, SDHD, TMEM127, TP53 (including promoter), VHL, which results were negative for all pathogenic variants, probably pathogenic or VUS therefore being considered a sporadic MTC. Patient was referred for cervical radiotherapy and started Vandetanib. Conclusion Serum CTN is the main diagnostic and surveillance marker of MTC. CEA is another marker that must be taken into account. We report the case of a young patient diagnosed with metastatic RET negative MTC with disproportionate values of CTN and CEA, which suggests its undifferentiated feature, revealing the importance of joint assessment of these two markers. Presentation: No date and time listed

Multiple Lymph Node and Bone Metastases From An Occult Breast Cancer: A Case Report

Cancer of unknown primary is defined as cancer with an unknown primary origin. Occult breast cancer (OBC) is a rare diagnosis in which physical examination, imaging methods, and even surgical procedures are insufficient to put on a primary tumoral site in the breasts. This definition leads to only 0.3-1% of all breast cancer cases. The diagnosis of OBC is usually obtained with an axillary lymph node biopsy. A 52-year-old female presented with right arm weakness and a neck lump. On the physical examination, multiple masses were palpated at the right axillary, right supraclavicular, and anterior cervical areas. Mammography, breast ultrasonography, breast magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) scan could not show a suspicious tumoral area as the primary origin. 18-FDG PET scan put on the massive tumoral burden at multiple bones and lymph nodes, but there were no lesions to suspect as the tumoral origin. Finally, the supraclavicular lymph node biopsy result has revealed the diagnosis; hormone receptor-positive and C-erbB2 positive occult breast cancer. Cervical lymph node metastasis is also a scarce condition for breast cancer. The lymphatic drainage pathway is not clear in explaining the breast cancer involvement of the cervical.

Neuromagnetic representation of melodic contour processing in human auditory cortex.

The pattern of ups and downs in a sequence with varying pitch can be heard as a melodic contour. Contrary to single pitch, the neural representation of melodic contour information in the auditory cortex is rarely investigated, and it is not clear whether the processing entails a hemispheric asymmetry. The present magnetoencephalography study assessed the neuromagnetic responses of N = 18 normal-hearing adults to four-note sequences with fixed vs. varying pitch that were presented either monaurally or diotically; data were analyzed using minimum-norm reconstructions. The first note of the sequences elicited prominent transient activity in posterior auditory regions (Planum temporale), especially contralateral to the ear of entry. In contrast, the response to the subsequent notes originated from more anterior areas (Planum polare) and was larger for melodic contours than for fixed pitch sequences, independent from the ear of entry and without hemispheric asymmetry. Together, the results point to a gradient in the early cortical processing of melodic contours, both in spatial and functional terms, where posterior auditory activity reflects the onset of a pitch sequence and anterior activity reflects its subsequent notes, including the difference between sequences with fixed pitch and melodic contours.

Association between Peri-Implant Soft Tissue Health and Different Prosthetic Emergence Angles in Esthetic Areas: Digital Evaluation after 3 Years' Function.

The aim of the present retrospective study was to assess peri-implant soft tissue health for implants restored with different prosthetic emergence profile angles. Patients were treated with implants supporting fixed dentures and were followed for 3 years. Buccal emergence angle (EA) measured at 3 years of follow-up visits (t1) were calculated for two different groups: Group 1 (153 implants) for restorations with angle between implant axis and prosthetic emergence angle from ≥30°, and Group 2 (67 implants) for those with angle ≤30°, respectively. Image J software was used for the measurements. Moreover, peri-implant soft tissue parameters such as pocket probing depth (PPD), plaque index (PI) and gingival index (GI) were assessed, respectively. A total of 57 patients were included in the analysis and a total of 220 implants were examined. Mean (±SD) EA in Groups 1 and 2 was 46.4 ± 12.2 and 24.5 ± 4.7 degrees, respectively. After 3 years of follow-up, a PPD difference of 0.062 mm (CI95% -0.041 mm; 0.164 mm) was calculated between the two groups and was not statistically significant (p = 0.238). Similar results were found for PI (OR = 0.78, CI95% 0.31; 1.98, p = 0.599). Furthermore, GI scores of 2 and 3 were found for nine implants (5.9%) in Group 1, and for five implants in Group 2 (7.5%). A non-significant difference (p = 0.76) was found. Peri-implant soft-tissue health does not seem to be influenced by EA itself, when a proper emergence profile is provided for implant-supported reconstructions in anterior areas.

Clinical Outcomes of Implant-Assisted Removable Partial Dentures According to Implant Strategic Position.

To retrospectively analyze the success of implant-assisted removable partial dentures (IARPDs) according to three types of strategic positions in distal extension areas of Kennedy Class I and II arches. The data included 102 arches in 95 patients with Kennedy Class I/II arches treated with IARPDs with implants in three strategic positions: Type 1a, assisted by P-1a implants on the anterior area adjacent to the abutment tooth; Type 1b, assisted by P-1b implants on the anterior area apart from the abutment tooth with or without P-1a; Type 2, assisted by P-2a implants on the posterior area adjacent to the natural tooth or P-2b implants on the posterior area apart from the abutment tooth to modify from Kennedy Class I /II to Class III. The success was defined as the IARPDs without abutment tooth-related, denture-related, and implant-related complications. Kaplan-Meier curves and the multivariable Cox regression model were used to analyze the success of IARPDs and implants. The overall success rate of IARPD treatment was 66.7%; 77.8% in Type 1a, 60.0% in Type 1b, and 68.0% in Type 2. There was no significant effect of treatment type on success rate of IARPDs. However, there was significant differences at the level of implant supporting IARPDs: 83.3% in Type 1a implants, 62.6% in Type 1b implants, and 73.2% in Type 2 implants. The implants of IARPD's adjacent to the natural tooth abutments (P-1a and P-2a) had higher success rates than those away from the natural tooth abutments. Within the limitations of this study, there was no significant difference in the prosthodontic complications of IARPDs depending on the treatment type. However, the success of implants of IARPD is associated with the strategic position. Strategic implant abutments adjacent to the natural tooth had higher success rates than those away from the natural teeth abutments.