IA IIA Research Articles

Distal Adding-On Phenomenon in Lenke IA and Lenke IIA: Risk Analysis and Selection of the Lowest Instrumented Vertebra

To analyze the risks of the distal adding-on phenomenon and identify the ideal lowest instrumented vertebra (LIV) for Lenke IA and IIA. A total of 84 patients with Lenke IA or Lenke IIA treated with posterior all-pedicle-screw instrumentation were enrolled in this cohort study. Radiographs that were obtained before, immediately after, and 2 years after the operation were measured. Patients were grouped based on the occurrence of the adding-on phenomenon. Independent risk factors were evaluated between these 2 groups via univariate analysis and logistic regression analysis. All patients obtained optimal correction of the main thoracic curve and lumbar curve after selective thoracic fusion. Eighteen patients among a total of 84 patients suffered from the distal adding-on phenomenon during the 2-year follow-up. Multivariable analysis revealed that the primary factors were preoperative thoracolumbar or lumbar curve size in supine side-bending films (odds ratio 0.75, P= 0.008), preoperative thoracic kyphosis (T5-T12) (odds ratio 0.743, P= 0.022), and the difference between the LIV and the LSTV (lowest substantial touched vertebra). All 7 (100%) patients whose LIVs were proximal to the LSTV suffered from distal adding-on phenomenon, whereas 7 of 40 (17.5%) suffered from distal adding-on phenomenon when the LIV was distal to the LSTV. Patients whose LIV was distal to the LSTV had the lowest incidence of the distal adding-on phenomenon (10.8%). An LIV located proximal to the LSTV should be avoided during selective thoracic fusion for Lenke IA and IIA to prevent the distal adding-on phenomenon. For patients who have a small thoracolumbar or lumbar curve size in bending films or a small T5-T12 angle before surgery, the next vertebra distal to the LSTV may be an optimal choice.

Multistage W-mineralization and magmatic-hydrothermal fluid evolution: Microtextural and geochemical footprints in scheelite from the Weondong W-skarn deposit, South Korea

Weondong deposit is one of the W-skarn deposits in South Korea, and main ore mineral is scheelite (CaWO4). Scheelite occurs in both a massive skarn zone (MSZ; Type I) and a quartz porphyry fracture zone (QPFZ; Type II), forming solid solution with powellite (CaMoO4). We examined the relationship between the evolution of ore-forming fluids and formation of multistage scheelites based on microtextural and geochemical features. Type I scheelites can be divided into Type Ia and Type Ib. Type Ia scheelites are characterized by complex internal textures with oscillatory zoning. The texturally associated clinopyroxene (diopside), garnet (andradite), and magnetite strongly suggest an oxidized prograde skarn origin. They are also characterized by enriched light rare earth elements (LREEs) and a negative Eu anomaly. Type Ib scheelites are W-enriched (74–81 wt% of WO3) with no internal zoning. Relict grossular garnet, calcite, pyrrhotite, serpentine, and vesuvianite indicate its relatively reduced retrograde skarn origin. Their rare earth element (REE) pattern is flat with a negative Eu anomaly. Type II scheelites can further be divided into Types IIa and IIb based on textural and geochemical differences. The former largely exhibit patchy zoning with minor oscillatory zoning that normally occurs along microfractures in association with fluorite. Type IIa scheelites show REE fractionation between W- and Mo-enriched zones (i.e., those containing 60–71 wt% of WO3 and 15–25 wt% of MoO3, respectively). Tungsten enriched scheelites show middle rare earth element (MREE)-enriched patterns with a strong negative Eu anomaly; Mo-rich zones are MREE-depleted and show a weak negative Eu anomaly. Type IIb scheelites are W-rich and rarely have zoned texture, similar to Type Ib scheelites. Type IIb scheelites generally coexists with sulfide minerals, indicating a relatively high sulfur fugacity (fS2) retrograde conditions. The REE pattern is flat with a negative Eu anomaly. These results indicate that Type Ia and Type IIa scheelites were formed during prograde conditions at each stage, followed by Type Ib and Type IIb in retrograde conditions. Type Ia scheelites have LREE-enriched patterns, which mimic the REE profile of juvenile magmatic fluids under open systems. Type IIa scheelites have MREE-enriched fractionation patterns that likely reflect a highly evolved magmatic fluid origin in a closed system. The flat REE pattern in Type Ib and IIb scheelites is due to meteoric water in retrograde conditions. This causes changes in the trace element composition of scheelites that reflect differences in the fluid origin and stages of evolution. The geochemical characteristics of both scheelite types match well with their microtextural features and provide crucial evidence for understanding the multistage formation of the Weondong W-skarn.

Feasibility and validity of double-arm specimen extraction method after partial lung resection in single-port thoracoscopic surgery.

Few previous reports have evaluated lung specimen extraction method or how to improve lung specimen extraction method, especially with single-port thoracoscopic surgery. We evaluated the feasibility and surgical advantages of double-arm lung specimen extraction method by comparing double-arm vs. single-arm specimen extraction times. We retrospectively analyzed data for 268 patients undergoing partial lung resection via single-port thoracoscopy and specimen extraction using a specimen extractor in the Union Medical College Hospital of Fujian Medical University from November 2017 to June 2018. We divided patients into groups based on the specimen location as an upper-lobe group (group I), lower-lobe group (group II), and lung-segment group (group III). We then performed a subgroup analysis based on the degree of collapse of the lung lobe specimens during extraction as follows: good in group IA and IIA, and poor in group IB and IIB. The double-arm method required statistically significantly less time than the single-arm method: (69.6±31.9 vs. 89.9±47.8 s, respectively, P=0.037). We found no significant difference in lung specimen extraction time for double-arm vs. single-arm extraction in group I, II, or III (P=0.093, P=0.153, P=0.174, respectively). We also found no significant difference in lung specimen extraction time between the two methods in group IA and group IIA (P=0.165, P=0.649, respectively). However, in groups IB and IIB, extraction time with the double-arm method was significantly shorter compared with the single-arm method (64.4±12.3 vs. 89.1±12.1 s, P=0.034 and 113.8±27.1 vs. 160.0±31.8 s, P=0.042, respectively). In single-port thoracoscopic partial lung resection, double-arm specimen extraction method is more convenient and can shorten sample extraction time, especially for upper- and lower-lung lobes with poor degree of collapse. Double-arm specimen extraction method is feasible and effective after single-port thoracoscopic partial lung resection.

Lumbosacral Transitional Vertebrae: A Cadaveric Investigation of Prevalence and Relation to Lumbar Degenerative Disease.

This is a retrospective cohort study. The objective of this study was to verify the prevalence of lumbosacral transitional vertebrae (LSTV) in the general population and measure the resulting spinal arthritic changes. LSTV are a morphologic variation within the lumbar spine that has potentially significant clinical implications. LSTV prevalence has been investigated using nonrandom volunteer samples and patient populations presenting with medical complaints such as abdominal or lumbar pain warranting computed tomography and magnetic resonance imaging scans. The examination of LSTV prevalence and variations using a true random population to our knowledge has yet to be conducted, and the relation between LSTV and spinal arthritis has not been rigorously examined. A total of 560 cadaveric skeletons were obtained from the Hamann-Todd osteological collection. The transverse processes of the terminal lumbar vertebrae were examined and measured, since the classification at times is based on examination and at times is based on measurement. The lumbar degenerative disease was graded on each specimen. Our search revealed 489 (87.3%) nontransitional vertebrae and 71 (12.7%) transitional vertebrae, with the majority of these Castellvi type IA (N=28), type IB (N=19), and type IIA (N=11). Transitional vertebrae as a whole (standardized β=0.090, P=0.015), and in particular type Ia showed a correlation to osteoarthritis in the L4-L5 vertebral level (standardized β=0.089, P=0.015). This cadaveric study aids in establishing the prevalence of LSTV (12.7%) in a random population and the frequency of the various Castellvi LSTV morphologies. An association was found between type Ia morphology and L4-L5 osteoarthritis which has not been reported in the past, suggesting that mild LSTV may carry more significance to lumbar pathology than previously considered.

The security of radical trachelectomy in the treatment of IA-IIA cervical carcinoma requires further evaluation: updated meta-analysis and trial sequential analysis.

The aim of this study was to assess the security of radical trachelectomy (RT) in the treatment of IA-IIA cervical carcinoma and conducted a new survey based upon the results of previous researches. The PMC, PubMed, Web of Science, Cochrane and EMBASE databases were retrieved to collect prospective clinical controlled trials (CCTs) published from 1984 to 2018. The oncologic outcomes were evaluated by meta-analysis, trial sequence analysis (TSA) and statistical analysis. Five prospective CCTs were collected in this study. The recurrence rate and mortality of RT was similar to that of radical hysterectomy (RH), which was consistent with the oncologic outcomes of meta-analysis and TSA. Patients with tumors 2-4cm in diameter were more likely to receive RH, which may be a potential factor in the higher rate of adjuvant chemotherapy in the this group, and RH was significantly associated with the risk of intraoperative blood transfusion. It is notable that considerable negative margin was achieved by radical abdominal trachelectomy (RAT), and the clinical effect of RAT was slightly better than that of radical vaginal trachelectomy (RVT). However, the TSA results showed that the cumulative cases were not up to the required sample size to obtain the true negative or positive results. It is safe and effective for early-stage patients with cervical cancer whose lesions are less than 2cm to receive RVT. For those patients with lesions 2-4cm who desire fertility preservation and without any evidence of infertility, RAT can be a feasible alternative to RH under fully informed consent. However, more CCTs with larger sample size are still required for further validation.

Recurrence Rate after Endoscopic vs. Open Approaches for Juvenile Nasopharyngeal Angiofibroma: A Meta-analysis.

Context The effect on recurrence rate between patients with juvenile nasopharyngeal angiofibroma (JNA), treated by an endoscopic versus open approach, has not been well established. Objective A meta-analysis of the available literature concerning recurrence rate in patients who underwent surgery for JNA. Methods A retrospective meta-analysis of studies analyzing recurrence rate after endoscopic or open surgery for patients with JNA was performed using the DerSimonian-Laird random-effects method. English and non-English articles were reviewed using Embase, Medline, and Cochrane databases. Results Among nine studies, including 362 patients from 1981 to 2015, with a mean follow-up of 49.4 months, a total of 89 patients (24.5%) had recurrence. Our analysis revealed a total effect size of -0.16 in favor of endoscopic approach (-0.25 to -0.06, CI [confidence interval] 95%). When analyzing tumor by stage (Radkowski's IA-IIIB n = 299), the endoscopic approach proved to be superior independent of tumor stage (2 vs. 17% for tumors stage IA-IIA, and 26 vs. 32% for tumor stage IIB-IIIB for endoscopic and open approaches respectively; p < 0.05). The endoscopic approach has a statistical significant lower recurrence rate in patients without intracranial compromise when compared with the open approach (13 vs. 28%; p < 0.02). No statistical difference was seen in patients with intracranial compromise ( p = 0.5) Conclusion The use of an endoscopic approach to treat JNA has a significantly lower recurrence rate when compared with open approaches. Independent of disease stage, an endoscopic approach should be the standard of care to surgically treat JNA. For cases with intracranial compromise, either approach can be used for surgical resection.

Multilobar Resections for 3T MRI-Negative Epilepsy: Worth the Trouble?

Multilobar resection in magnetic resonance imaging (MRI)-negative drug-resistant epilepsy warrants attention because they account for up to one third of MRI-negative epilepsy surgery. Despite their high prevalence, data are sparse, and the risk/benefit ratio continues to be debated. The present study investigated the postoperative seizure outcomes in this especially challenging subgroup. We retrospectively analyzed the data of 4 consecutive patients with 3T MRI-negative findings and drug-resistant focal epilepsy who had undergone multilobar epilepsy surgery at our institution. The mean age at first surgery was 28.5 years (range, 14-48); 1 patient required 2 consecutive reoperations. The final resection was in the frontotemporal and temporo-parieto-occipital regions in 2 patients each. Histopathological examination revealed mild malformations of cortical development in 2 patients and focal cortical dysplasia type Ia and type IIa in 1 patient each. At the last follow-up examination (median, 3.3 years; range, 1-11), 2 patients were completely seizure free (Engel class Ia), 1 patient had experienced some disabling seizures after surgery but had been free of disabling seizures for 2 years at the last follow-up examination (Engel class Ic), and 1 patient had experienced worthwhile improvement (Engel class IIb) and had been seizure free for 1 year at the last follow-up examination. No surgical complications developed. Our results have demonstrated that multilobar epilepsy surgery is effective for lasting seizure control for selected 3T MRI-negative candidates, leading to favorable outcomes for all 4 of our patients. Comprehensive multimodal preoperative evaluation is a prerequisite for postoperative success. Reevaluation should be considered for patients with seizure recurrence, because reoperation could be especially beneficial for selected patients who have not responded to an initially limited resection.

Assessment of endoscopic Doppler to guide hemostasis in high risk peptic ulcer bleeding

Introduction: Rebleeding or emergency surgery in failed endoscopic therapy of peptic ulcer bleeding are associated with high rates of morbidity and mortality. The clinical benefit of an endoscopic Doppler (ED) examination prior to endoscopic injection therapy was evaluated in high risk ulcer patients for rebleeding episode. Standard injection therapy (non-Doppler (ND)) was compared with targeted injection therapy after examination of the supplying vessel in the ulcer base by the ED.Materials and methods: Sixty patients with peptic ulcer bleeding (Forrest Ia–IIa; Rockall score of 5 or higher) were included in the study. Patients were assigned to ED or ND group with conventional therapy by chance. In the ND group injection was directed by the visual aspect of the ulcer, whereas in ED therapy was directed by ED.Results: Thirty-five patients were allocated to the ED group, and 25 to the ND group, respectively. No significant differences in patient or ulcer characteristics were observed regarding ulcer size, localization, Forrest classification or endoscopic treatment. Recurrent bleeding was observed in 7/35 (20%) in the ED group and in 13/25 (52%) of patients in the ND group (p = .013). Fewer ED patients needed surgery for rebleeding (1/35 vs. 6/25; p = .017). Bleeding related, but not all-cause mortality was significantly lower in the ED group (1/35 vs. 6/25, p = .017).Discussion: In this comparative analysis, use of ED to guide hemostatic therapy was associated with a significant reduction in recurrence of bleeding, surgical intervention and bleeding associated mortality.

Anatomical Study of the Superficial Palmar Arch, its Relation to the Kaplan Cardinal Line and Literature Review

Introduction The superficial palmar arch is the main contributor to the vascular supply of the hand. Numerous anatomical variants have been described and there are multiple classifications of the superficial palmar arch available. The Kaplan cardinal line is used occasionally as a reference to identify the deep structures of the hand. However, there are also multiple variants of the line and multiple reports regarding the structures that can be identified with it. Material and Methods Ten anatomical dissections of hands were performed in seven cadaveric specimens. The anatomical variants of the superficial palmar arch were recorded, as well as their relationship with the Kaplan cardinal line. A review of the available literature was made. Results According to the classification by Coleman et al, the most common type was the complete superficial palmar arch, present in seven hands, while the incomplete superficial palmar arch was found in three hands. The most frequent complete palmar arch was type IB, followed by type IIB, and finally type IA and type IIA. The most common relation was with the Kaplan cardinal line type A to the apex of the arch and with type B to the curvature of the ulnar artery. Conclusions There is a great anatomical variability in the superficial palmar arch. There was a greater frequency of the complete superficial palmar arch, with the ulnar artery being the dominant vascular supply. The Kaplan cardinal line can be used as a safety limit to avoid the superficial palmar arch if it is drawn to intersect the pisiform bone. Clinical Relevance It is important to be aware of the anatomical variants of the superficial palmar arch, as well as of its relationship with the superficial structures of the hand to be able to perform invasive or reconstructive procedures and to preserve the vascularity of the hand.

Staging of Mycosis Fungoides and Sézary Syndrome: Time for an Update?

Mycosis fungoides (MF) is the most common variant of cutaneous T cell lymphoma and frequently presents as early-stage disease with skin patches and plaques with an indolent course, but patients experience significant morbidity from itch and disfigurement. Around 30% of patients with MF present in the advance stages with skin tumours, erythroderma, and extensive nodal or visceral involvement. Sézary syndrome (SS) is the leukaemic cutaneous T cell lymphoma variant. The staging of MF or SS was revised in 2007 to include skin, nodal, visceral, and blood (tumour- node-metastasis-blood classification) to determine nine stages (IA–IVB). While most patients with early disease (Stages IA–IIA) have a good prognosis, 25% progress to advanced disease, with a poor life expectancy of around 3 years; however, some patients do survive for ≥10 years. Accurate staging is crucial since management strategies are stage-based, with skin-directed therapy recommended in early-stage disease and with no curative therapeutic options to improve symptoms and reduce skin tumour burden. In contrast, advanced-stage patients mostly require systemic therapy. Most treatments have only partial response rates, around 40%, and allogeneic bone marrow transplant may provide a more long-lasting therapeutic option for advanced patients. Relevant prognostic factors within the tumour-node-metastasis-blood classification are discussed in this review and their relevance to overall IA–IVB staging and outcomes are debated. Several important prognostic features have been identified that may be used alongside staging to give further prognostic information. These prognostic features include age &gt;60 years at diagnosis, large cell transformation of the skin, and raised serum lactate dehydrogenase levels, which could be developed into a prognostic index to identify patients at risk of progression and requiring more aggressive therapy. The PROCLIPI study, a prospective cutaneous lymphoma international study, has been ongoing since 2015 to collect such data, with the aim of developing a prognostic index for MF and SS.

Efficacy and safety of topical 2% dorzolamide and 0.5% timolol in cases of open angle glaucoma in a tertiary care hospital of East Singhbhum: an observational, prospective and comparative study

Background: Present study was undertaken to evaluate and compare the efficacy and side effects of 2% dorzolamide and 0.5% timolol in patients with open angle glaucoma.Methods: There were 60 randomly selected patients were equally divided into Group I (n=30) and Group II (n=30). Further both groups were divided into IA (n=10), IB (n=20), IIA (n=10) and IIB (n=20). 2% Dorzolamide hydrochloride in Group IA and IIA and 0.5% Timolol maleate in Group IB and IIB was administered for 24 weeks. Patients were evaluated for general and ocular examinations on day of enrolment and then at the end of 1st, 4th, 8th and 24th week. Adverse effects of the drug during study period were also noted. Mean±SD, t value, p value and comparison between groups were analysed by graph pad software.Results: At the end of 24 weeks difference in mean reduction of IOP was not significant with 6.2±1.85mm Hg (Right eye) and 5.55±1.68mm Hg (left eye) and 4.72±2.97mm Hg (Right eye) and 5.37±1.24mm Hg (left eye) in Group IA and Group IIA respectively. At the end of 24 weeks difference in mean reduction of IOP was not significant with 5.06±1.62mm Hg (Right eye) and 4.40±1.96mm Hg (left eye) and 4.30±1.41mm Hg (Right eye) and 4.12±2.08mm Hg (left eye) in Group IB and Group IIB respectively. Fall in both systolic and diastolic blood pressure in both the groups were significant. Both drug regimens were well-tolerated, and no serious drug-related adverse effects were reported.Conclusions: Dorzolamide was more efficacious for reduction of intra ocular pressure, well-tolerated, had low allergic response and had a favourable ocular, cardiovascular and respiratory safety profile than Timolol.

Study of the efficacy of carboxytherapy in alopecia.

Management of alopecia areata (AA) and androgenetic alopecia (AGA) is often challenging. The use of carboxytherapy may be a novel therapeutic option for such cases. To evaluate the clinical efficacy and safety of carboxytherapy in alopecia areata and androgenetic alopecia. This study was conducted on 80 patients with alopecia divided into two groups; Group I included 40 AA patients (Group IA received carboxytherapy and Group IB control received placebo), and Group II included 40 AGA patients (Group IIA received carboxytherapy and Group IIB control received placebo), and followed up monthly for 3months. They were evaluated clinically (by assessment of Severity of Alopecia Tool (SALT) score in group I, and Sinclair scale and Norwood-Hamilton scale in group II), by dermoscopy and digital dermoscopy at each visit. Group IA patients showed significant clinical improvement in SALT score and dermoscopic improvement after carboxytherapy and at the end of follow-up period with significant reduction in dystrophic hair, black dots, yellow dots, and tapered hair coinciding with significant emergence of regrowing hair. Group IIA patients showed significant clinical and dermoscopic improvement after carboxytherapy with significant increase in hair density measured by digital dermoscopy. However, regression of these results was observed during the follow-up period but was still significantly better than before treatment. There were statistically significant improvements in clinical score, global assessments, dermoscopic, and digital dermoscopic findings in both group IA and group IIA received carboxytherapy in comparison with group IB and group IIB received placebo injections, respectively. Carboxytherapy seems to be a promising therapeutic option for patchy AA and could be helpful as an adjuvant therapy of AGA but more than 6 sessions are required and adjuvants are recommended for maintenance of the results.

RESPONSE BY STAGE IN CD30‐POSITIVE (CD30+) CUTANEOUS T CELL LYMPHOMA (CTCL) PATIENTS RECEIVING BRENTUXIMAB VEDOTIN (BV) VS PHYSICIAN'S CHOICE (PC) IN THE PHASE 3 ALCANZA STUDY

Introduction: The phase 3 ALCANZA study showed significant improvements in rate of objective response lasting ≥4 months (ORR4) with BV vs PC of methotrexate (MTX) or bexarotene (Bex) for the treatment of CD30+ CTCL. Here, we examine response according to disease stage and across disease compartments in patients (pts) treated on the ALCANZA study. Methods: Adults with previously treated CD30+ mycosis fungoides (MF) or primary cutaneous anaplastic large cell lymphoma (pcALCL) were randomized to BV 1.8 mg/kg IV, Q3W, for up to 16 three-week cycles, or PC of MTX 5–50 mg PO, QW, or Bex 300 mg/m2 (target dose) PO, QD, for up to 48 weeks. Pts were classified according to baseline Tumor-Node-Metastasis-Blood (TNMB) stage per investigator (INV) as part of global assessment; presence of baseline blood disease was also determined by independent review (IRF). Pts with B2 disease were ineligible. ORR4 was determined by IRF of global response in all compartments using consensus criteria (modified severity weighted assessment tool for skin evaluation by INV, radiographic assessment by IRF, and MF Sézary cell count by IRF). We compared ORR4, ORR, and complete response (CR) rate by disease stage, TNMB stage, and baseline blood disease in the intent-to-treat (ITT) population. Results: The ITT population included 128 pts (97 MF, 31 pcALCL). After a median follow-up of 22.9 months, ORR4 with BV was greater than PC in both MF (50% vs 10%) and pcALCL (75% vs 20%). This was consistent across all MF disease stages; stage IA–IIA, 40% vs 22% (95% CI for rate difference: −16.6%, 49.4%); stage IIB, 63% vs 5% (25.4%, 80.9%); stage IIIA–IIIB, 50% vs 0% (−45.2%, 98.7%); stage IVA, 100% vs 0% (14.9%, 100.0%); and stage IVB, 29% vs not applicable. Table 1 shows response according to baseline clinical and TNMB stage per INV. For MF, ORR4 was 25% (1/4) with BV vs 13% (1/8) with PC for pts with blood involvement (≥B1), and 43% (10/23) with BV vs 12% (3/26) with PC for pts with nodal involvement (≥N1). Out of 35 MF pts with blood disease per IRF (non-B0 blood stage), ORR in the blood compartment was 94% with BV vs 41% with PC; CR rate in the blood compartment was 89% vs 41%. In pcALCL pts, the ORR4 was 89% (8/9) with BV vs 27%% (3/11) with PC in pts with skin-only disease (95% CI for rate difference: 17.9%, 88.3%), and 57% (4/7) with BV vs 0% (0/4) with PC in pts with extracutaneous disease (−9.0%, 93.2%). Conclusions: Significant and durable clinical activity was observed across disease stages and compartments with BV in CTCL pts requiring systemic therapy. Total N (%) ORR4 n (%) ORR n (%) CR n (%) Total N (%) ORR4 n (%) ORR n (%) CR n (%) Keywords: brentuximab vedotin; CD30; cutaneous T-cell lymphoma (CTCL).

ADAR1 overexpression is associated with cervical cancer progression and angiogenesis

BackgroundThis study aimed to assess the role of RNA-dependent adenosine deaminase (ADAR1) in cervical squamous cell carcinoma occurrence and progression.MethodsADAR1 expression levels in stage IA and stage IIA cervical squamous cell carcinoma (group A), cervical intraepithelial neoplasia (CIN) specimens (group B), as well as normal and inflamed cervical tissue samples (group C) were assessed by immunohistochemistry. Clinical and pathological data of cervical squamous cell carcinoma patients undergoing surgery were retrospectively evaluated. Chi-square test, comparative analysis of survival curve, disease-free survival and COX risk assessment method were used to understand the association of ADAR1 with the occurrence and progression and prognostic significance of cervical squamous cell carcinoma.ResultsADAR1 is expressed in the cytoplasm and nuclei. The expression level was high in squamous cell carcinoma tissues (81.18%), while relatively low in the CIN group (21.56%). And there was no expression in non-cancerous tissues. The differences between them were statistically significant using P < 0.05 as criterion. One-factor analysis revealed that ADAR1 was significantly correlated with tumor diameter, horizontal diffusion diameter, vascular invasion, parametrial invasion, vaginal involvement, and pathologically diagnostic criteria for perineural invasion (PNI). Meanwhile, the overall survival rate of ADAR1 positive patients was significantly lower compared with that of patients with no ADAR1 expression (P < 0.05). Analysis also showed that disease-free survival time of ADAR1 positive patients was shorter than that of ADAR1 negative patients, and the difference was significant (P < 0.01). Finally, COX risk assessment showed that parametrical invasion had independent prognostic factors for overall survival of squamous cell carcinoma.ConclusionsResults indicated that ADAR1 might play an important role in the occurrence, progression and prognosis of cervical squamous cancer.

Clinical and radiographic assessment of periapical pathology in single versus multivisit root canal treatment: An in vivo study.

Objective:The objective of the study was to compare and evaluate the clinical and radiographic outcome of single- versus multivisit endodontic treatment in teeth with periapical pathology at the end of 1, 3, and 6 months.Materials and Methods:Sixty single- and multi-rooted teeth indicated for root canal treatment with periapical pathology were included in the study. The teeth were assigned randomly into two groups Group I and Group II (n = 30 each), which were further subdivided into subgroup IA, subgroup IB and subgroup IIA, subgroup IIB (n = 15 each), respectively. Group I was medicated with ApexCal paste and obturated using the standardized protocol in second visit 7–10 days later, whereas Group II was obturated at the first visit. In subgroup IA and subgroup IIA, obturation was done using Apexit Plus sealer, whereas, in subgroup IB and subgroup IIB, AH Plus sealer was used. Patients were recalled at intervals of 1, 3, and 6 months to evaluate teeth for periapical healing.Results:Kruskal–Wallis and one-way ANOVA test showed no significant difference between Groups I and II, whereas Wilcoxon signed-rank test showed improvement in all the subgroups with highly significant P value (≤0.001).Conclusion:Single-visit root canal treatment can be considered as a viable option for treatment of teeth with periapical pathology.

Overexpression of β-Catenin and Cyclin D1 is Associated with Poor Overall Survival in Patients with Stage IA–IIA Squamous Cell Lung Cancer Irrespective of Adjuvant Chemotherapy

IntroductionThis study was aimed at understanding the effect of β-catenin and cyclin D1 on overall survival in patients with early-stage NSCLC and at evaluating if the prognostic effect can be modified by adjuvant chemotherapy. MethodsWe retrospectively analyzed the expression of β-catenin and cyclin D1 using immunohistochemistry in formalin-fixed paraffin-embedded tissues from 576 patients with early-stage NSCLC. ResultsThe median duration of follow-up was 5.1 years. Overexpression of β-catenin and cyclin D1 was found in 56% and 50% of 576 cases, respectively. Overexpression of β-catenin and cyclin D1 was significantly associated with poor overall survival (p = 0.003 and p = 0.0009, respectively; log rank test) in squamous cell carcinomas, not in adenocarcinomas. The prognostic significance of each protein in the squamous cell carcinomas was limited to stages IA, IB, and IIA. In addition, simultaneous overexpression of β-catenin and cyclin D1 in the squamous cell carcinomas synergistically increased hazard ratios (HRs) 15.79 (95% confidence interval [CI] = 1.09–51.23; p =0.04) for stage IA, 10.30 (95% CI = 2.29–46.41; p = 0.002) for stage 1B, and 3.55 (95% CI = 1.22–10.36; p = 0.02) times for stage 2A compared to those without overexpression of the two proteins, after adjusting for confounding factors. In addition, the effect was not dependent on adjuvant chemotherapy. ConclusionsThe present study suggests that simultaneous overexpression of β-catenin and cyclin D1 may be associated with poor overall survival irrespective of platinum-based adjuvant chemotherapy in stage IA–IIA squamous cell carcinoma of the lung.

Minimal Treatment of Low-Risk, Pediatric Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the Children's Oncology Group.

Children's Oncology Group study AHOD03P1 was designed to determine whether excellent outcomes can be maintained for patients with low-risk, pediatric lymphocyte-predominant Hodgkin lymphoma (LPHL) with a strategy of resection alone or minimal chemotherapy. Patients with stage IA LPHL in a single node that was completely resected were observed without further therapy; recurrences were treated with three cycles of doxorubicin/vincristine/prednisone/cyclophosphamide (AV-PC). Patients with unresected stage IA or stage IIA LPHL were treated with three cycles of AV-PC. Patients with less than a complete response (CR) to AV-PC received 21-Gy involved-field radiation therapy (IFRT). A total of 183 eligible patients were enrolled; 178 were evaluable. Of these, 52 patients underwent complete resection of a single node. There were 13 relapses at a median of 11.5 months; 5-year event-free survival (EFS) was 77% (range, 62% to 87%). A total of 135 patients received AV-PC; 126 were treated at diagnosis and nine at relapse after surgery alone. Eleven patients receiving AV-PC had less than CR and received IFRT. Fourteen first events occurred among 135 patients (12 relapses and two second malignancies). Two relapses occurred in patients who had received IFRT. Five-year EFS was 88.8% (95% CI, 81.8% to 93.2%). Five-year EFS for the entire cohort was 85.5% (95% CI, 79.2% to 90.1%); overall survival was 100%. Some 75% of highly selected pediatric patients with LPHL may be spared chemotherapy after surgical resection alone. Pediatric LPHL has excellent EFS with chemotherapy that is less intensive than standard regimens; > 90% of patients can avoid radiation therapy. The salvage rate for the few relapses is high, with 100% survival overall.

NUMERICAL ANALYSIS OF LEGENDRE-GAUSS-RADAU AND LEGENDRE-GAUSS COLLOCATION METHODS

In this paper, we provide numerical analysis of so-called Legendre Gauss-Radau and Legendre-Gauss collocation methods for ordinary differential equations. After recasting these collocation methods as Runge-Kutta methods, we prove that the Legendre-Gauss collocation method is equivalent to the well-known Gauss method, while the Legendre-Gauss-Radau collocation method does not belong to the classes of Radau IA or Radau IIA methods in the Runge-Kutta literature. Making use of the well-established theory of Runge-Kutta methods, we study stability and accuracy of the Legendre-Gauss-Radau collocation method. Numerical experiments are conducted to confirm our theoretical results on the accuracy and numerical stability of the Legendre-Gauss-Radau collocation method, and compare Legendre-Gauss collocation method with the Gauss method.

Postoperative complications do not impact on recurrence and survival after curative resection of gastric cancer

BackgroundWe assessed the impact of complications on recurrence and survival after curative gastric cancer resection. MethodsPatients undergoing R0 resections between 1990 and 2009 were identified in a prospectively maintained database and were categorized by presence of any complication Clavien-Dindo (CD) ≥ II, sepsis or intra-abdominal sepsis. Cox regression analyses to relate complications and clinico-pathological variables to time to recurrence (TTR) and overall survival (OS) were performed. ResultsA total of 271 patients were included with a median follow-up of 149.9 months (range 140.1–159.9). Complications CD ≥ II occurred in 162 (59.8%) patients, sepsis in 66 (22.5%), and intra-abdominal sepsis in 37 (13.6%). Recurrence developed in 88 (32.4%) patients. Independent predictors of short TTR were pTNM stage (IIIB-IIIC vs. IA-IIA) (hazard ratio [HR] = 37.55, 95% confidence interval [CI] 17.57–80.24; p < 0.001), D1 lymphadenectomy (HR = 3.14, 95% CI 1.94–5.07; p < 0.001), and male gender (HR = 1.65, 95% CI 1.06–2.57; p = 0.026). pTNM stage (IIIB–IIIC vs. IA–IIA, HR = 10.28, 95% CI 6.51–16.23; p < 0.001), male gender (HR = 1.64, 95% CI 1.17–2.31; p = 0.005), age (HR = 1.03, 95% CI 1.02–1.05; p < 0.001), and adjuvant therapy (HR = 0.55, 95% CI 0.37–0.83; p = 0.004) were identified as independent predictors of OS.. ConclusionsEvidence provided by this study does not support a negative impact of postoperative complications CD ≥ II, sepsis, and intra-abdominal sepsis on the oncologic outcome after curative gastric cancer resection.

Dietary Cholesterol Protects Anesthesia-Induced Cognitive Deficits in Wistar Rats

Purpose : To evaluate the effect of cholesterol on frequent exposure of anesthesia-induced cognitive impairment in wistar rats. Methods : Healthy wistar rats were divided in two groups, the gp I rats fed with regular diet and gp II with cholesterol diet. These groups were further divided into sub-groups as gp Ia (n=8) and gp IIa (n=8). These sub-groups received weekly exposure of anesthesia for 6 weeks. Animals were anesthetized by subcutaneous sodium thiopental injection. Cortical nerve growth factor levels were measured by indirect sandwich enzyme-linked immunosorbent assay (ELISA) while total protein was determined by Bradford protein assay. Results : Group IIa (cholesterol-fed animals) as well as Group IIb (cholesterol-fed followed by anesthesia) showed significant increase in body weight (25 to 50 g, p < 0.03), but no such increase was observed in other groups. However, group Ib showed a significant (43.07 %, p ˂ 0.001) decrease in the level of nerve growth factor when compared with group Ia. Moreover, significantly decreased cytokines IL-1β levels (59.09 %, p < 0.005) and TNF-α (20 %, p < 0.025) of group IIa more effectively than in group Ia rats. Microglial marker showed significantly increase (16.66 %, p < 0.025) in cholesterol diet group. Overall increase in leakage of anti-rat IgG (blood brain barrier marker) was found in both groups (IIa and IIb). Conclusion : The results suggest that dietary cholesterol protects or neutralizes anesthesia-induced cognitive deficits in rats. Keywords : Cognitive deficit, Cholesterol diet, Blood-brain barrier, Nerve growth factor, Inflammation marker, Microglial marker, Cytokines