Greater Protrusion Research Articles

Salvage Radiosurgery for Recurrent Cardiac Sarcoma: A Case Report

<h3>Purpose/Objective(s)</h3> Primary cardiac sarcoma is a rare malignant tumor that arises from the cardiac myocardium. Surgical resection is the standard of care and median survival after a R0 resection is typically 6 to 12 months. However, after local recurrence, patients are frequently inoperable with a poor prognosis. The role of salvage chemotherapy and radiation is not well defined. A few case reports have described local control for up to eight months after hypo-fractionated radiosurgery. <h3>Materials/Methods</h3> A 53 year old female presented in October 2017 with acute congestive heart failure and underwent complete surgical resection of undifferentiated pleomorphic sarcoma of the left atrium followed by 6 cycles of adjuvant doxorubicin/hydroxydaunorubicin and ifosfamide. An MRI scan demonstrated an asymptomatic, 24 mm, recurrent atrial mass. The patient elected to proceed with salvage frameless robotic radiosurgery system stereotactic body radiosurgery. We fused CT, MRI, and PET imaging modalities in order to determine the target volume. The tumor was treated with a dose of 7200 cGy in 15 fractions to the 84% isodose line utilizing spine tracking with 4D CT to determine the ITV. Fractionation was used in order to achieve acceptable maximal doses to the main stem bronchus and esophagus. Repeat cardiac MRI at four weeks showed in-field local progression with greater protrusion into the left atrium. The tumor volume doubled in size with invasion of the left ventricle. The patient elected to proceed with salvage frameless robotic radiosurgery system treatment. 2500 cGy in 1 fraction was prescribed to the 76% isodose line in June of 2019. <h3>Results</h3> She tolerated treatment well without any acute toxicity. The patient was subsequently treated with a variety of chemotherapy regimens including TKIs and immunotherapy. Unfortunately, the patient relapsed in December with metastases in the spine and the pelvis. She underwent palliative radiation therapy to multiple bony sites with a partial response. She resumed chemotherapy treatment with TKIs but passed away in June 2020 due to septic shock without evidence of local failure. <h3>Conclusion</h3> Fractionated SBRT was ineffective at controlling our patient's cardiac sarcoma. Our patient demonstrated local control of disease at twelve months after salvage 25 Gy in one fraction radiosurgery without any evidence of cardiac toxicity. High dose single fraction radiosurgery is a reasonable palliative option for long term local control of unresectable cardiac sarcomas.

Efeitos do aparelho Jasper Jumper no tratamento da má oclusão de Classe II

OBJETIVO: o objetivo deste estudo foi avaliar os efeitos esqueléticos e dentoalveolares do tratamento de pacientes com má oclusão de Classe II com o aparelho Jasper Jumper associado ao aparelho ortodôntico fixo, comparados a um grupo controle não-tratado. MÉTODOS: a amostra foi constituída por 47 indivíduos, divididos em dois grupos: Grupo 1, contendo 25 pacientes com idade média de 12,72 anos, tratados com o aparelho Jasper Jumper por um tempo médio de 2,15 anos; Grupo 2 (controle), composto por 22 indivíduos com idade média de 12,67 anos, não-submetidos a tratamento ortodôntico e com má oclusão de Classe II, observados por um período médio de 2,12 anos. Foram avaliadas as telerradiografias ao início e ao final do tratamento ortodôntico para o Grupo 1 e do período de observação para o Grupo 2. As variáveis cefalométricas iniciais, finais e as alterações com o tratamento foram comparadas entre os grupos por meio do teste t independente. RESULTADOS: em comparação ao grupo controle, o grupo Jasper Jumper apresentou maior restrição do deslocamento anterior da maxila e maior retrusão maxilar, melhora da relação maxilomandibular, diminuição da convexidade facial, maior protrusão e intrusão dos incisivos inferiores e maior extrusão dos molares inferiores, além de maior diminuição dos trespasses horizontal e vertical e maior melhora da relação molar. CONCLUSÃO: a correção da Classe II no grupo tratado com o Jasper Jumper e aparelhagem fixa se deu principalmente devido à restrição do crescimento maxilar, protrusão e intrusão dos incisivos inferiores e extrusão dos molares inferiores.

53 EFFECTS OF DEMECOLCINE ON MICROTUBULE COMPOSITION AND CHEMICALLY ASSISTED ENUCLEATION OF BOVINE OOCYTES

The developmental competence of enucleated oocytes is a key factor that determines the overall success of animal cloning. Enucleation is an invasive procedure in traditional nuclear transfer (NT). The objective of this work was to evaluate the effects of demecolcine, a microtubule-depolymerizing agent, on metaphase II (MII) bovine oocytes and to verify the capacity of embryonic development after NT using chemically assisted enucleation. In the first experiment, oocytes after 21 h of IVM were exposed for 2 h to several concentrations of demecolcine: 0 (control), 0.025, 0.05, 0.2, and 0.4 µg mL–1, and evaluated in relation to membrane protrusion formation. After the best concentration of demecolcine was determined, the nuclear and microtubular dynamics of the treated oocytes were evaluated by immunofluorescence microscopy of tubulin and chromatin (Liu et al. 1998 Biol. Reprod. 5, 537–545) in a second experiment. The results were analyzed by Duncan and Tukey tests in Experiments I and II, respectively, and a level of 5% significance was used. In Experiment III, embryonic development following NT was determined using adult donor cells, derived from a skin biopsy. After 19 h of IVM, oocytes were exposed to demecolcine (0.05 µg mL–1) for 2 h, and enucleation was performed in oocytes that presented membrane protrusions. Samples of cytoplasts were stained with Hoechst 33342 for 10 min (10 µg mL–1) for evaluation of enucleation effectiveness. The remaining oocytes were reconstituted by NT, fused (two pulses of 2.0 kV cm–1 for 20 µs each, in 0.28 m mannitol solution), chemically activated (5 mm ionomycin for 5 min and 2 mm 6-DMAP for 4 h), and cultured in SOF medium with 2.5% FCS and 0.5% BSA. The 0.05 µg mL–1 concentration resulted in greater protrusion rates (55.1%; 211/388) in comparison to 0, 0.025, 0.2, and 0.4 µg mL–1 concentrations (0, 42.6, 45.1, and 39.3%, respectively). In Experiment II, at the beginning of treatment, the majority of the oocytes were in MII (40.7%) or anaphase I/telophase I (AI/TI; 22.4%). Effects of demecolcine occurred within only 0.5 h of treatment, with a significant increase in oocytes with complete depletion of microtubules (21.8%; initial average: 1.9%) and a reduction in the proportion at MII (13.5%) and AI/TI (8.2%). New polymerization of microtubules was observed when treated oocytes were then cultured in drug-free medium for 6 h (42.4% oocytes with two evident sets of microtubules). In Experiment III, we verified the effectiveness of the chemically assisted enucleation technique (90.6%; 77/85). We evaluated 515 oocytes, of which 219 (42.5%) had protrusions and were enucleated. After losses in the NT procedure and fusion, 58 reconstructed 1-cells were cultured resulting in cleavage and blastocyst rates of 84.5% (49/58) and 27.6% (16/58), respectively, with great variation in blastocyst production between the three replicates (12.5% to 47%). In conclusion, demecolcine can be used at lower concentrations than those used routinely, and the chemically assisted enucleation method has proven highly efficient and does not appear to inhibit embryonic development in the bovine. This work was supported financially by FAPESP.

Brain surface protrusion during enflurane, halothane, and isoflurane anesthesia in cats.

Using a noncontact displacement transducer, the authors measured protrusion of the feline cortical surface through a standardized craniotomy during acute equi-MAC exposures to enflurane, halothane, and isoflurane. Each agent was studied at 0.5, 1.0, and 1.5 MAC concentrations (plus 75% N2O) without support of blood pressure. A repeat 1.0 MAC exposure was made, during which angiotensin was infused to maintain mean arterial pressure (BP) at approximately 145 mmHg. Normocapnia was maintained during all studies. In the absence of BP support, halothane produced significantly greater protrusion of the brain surface than did equi-MAC concentrations of isoflurane at all levels and greater protrusion than enflurane at 1.0 and 1.5 MAC. Halothane-induced protrusion exceeded that seen during isoflurane administration by a factor of 2.5 at 0.5 MAC (P The results indicate that enflurane (1.0 and 1.5 MAC) and isoflurane (all levels) cause markedly less protrusion of the brain into a craniotomy than does halothane. The findings roughly parallel the known effects of these agents on cerebral blood flow and probably reflect differences in anesthetic-induced changes in cerebral blood volume. If applicable to human anesthesia, they suggest that in situations during intracranial surgery where administration of a volatile anesthetic is deemed preferable to the use of an additional fixed agent, that isoflurane may be the volatile agent of choice.