Incisal Margin Research Articles

Clinical short-term and long-term efficacy of endoscopic submucosal dissection in the treatment of early low rectal cancer and precancerous lesions

Objective: To evaluate the short-term and long-term efficacy of endoscopic submucosal dissection (ESD) in the treatment of early low rectal cancer and precancerous lesions. Methods: Inclusion criteria: (1) Distance from the lower margin of tumor to the anal was ≤ 5 cm. (2) Early low rectal cancers were any size rectal epithelial tumors with infiltration depth limited to the mucosa and submucosa, which were diagnosed by postoperative pathology as high-grade intraepithelial neoplasia or adenocarcinoma of the rectum with infiltration depth of intramucosal or submucosal cancer (M or SM stage). (3) Precancerous lesions included adenoma and low-grade intraepithelial neoplasia of the rectum. (4) Patients received ESD treatment. Patients with tumor invasion depth over submucosa by pathology were excluded. From January 2008 to January 2018, 63 patients meeting the above criteria in Peking University First Hospital were enrolled in this descriptive cohort study. The disease characteristics, clinical manifestations, pathological types, treatment time, hospitalization time, en bloc resection rate (resection of the whole lesion), complete resection rate (both the horizontal and vertical incision margins were negative), postoperative complications and follow-up results were analyzed. Cummulative survival rate was calculated by Kaplan-Meier. Results: The diameter of the lesion was (29.0±23.4) mm and the distance from the lesion to the anus was (2.7±1.8) cm. The median operation time was 45.0 (range, 10.0 to 360.0) minutes, the median hospitalization time was 3.0 (range, 2.0 to 12.0) days, en bloc resection rate was 100%, complete resection rate was 96.8% (61/63), and 1 case (1.6%) had postoperative bleeding. The follow-up rate was 87.3% (55/63) and the median follow-up time was 57.9 (range, 15.6 to 121.1) months. No local recurrence was found during the follow-up period and the 5-year survival rate was 100%. Conclusion: Short- and long-term efficacy of ESD are quite good in the treatment of patients with early low rectal cancer and precancerous lesions.

Talon Cusp: Two Case Reports

The talon is an accessory, irregular cusp on incisors and canines, involving in enamel and dentine with or without pulp tissue.It was also reported in association with syndromes, for example, Mohr Syndrome, Incontinenta pigmentii Achromians, Ellis-van Creveld Syndrome, Struge Weber Syndrome, Rubinstein Taybi Syndrome, and Alagille’s Syndrome. The aim of this paperwas to describe talon tubercules in two cases. In first case the talon cusp is seen on lingual surface of the maxillary left central tooth and there is a specific talon tubercle which extending from the incisal edge to the cervical edge, perpendicular to the mesiodistal surface of the tooth. In second case bilateral talon tubercles were detected extending from the cervical region less than half of the incisal margin on the lingual surface of the maxillary central and lateral teeth. This present two case reports radiograph gives a v-shaped radiopaque image.Talon tubercle is a dental anomaly we rarely encounter. Consequently this anomaly may occur with a systemic syndrome Therefore, clinicians should have adequate knowledge of this anomaly.

Clinical effects of upper eyelid blepharoplasty using the dermis orbicularis muscle flap technique

Objective To develop a new technique of upper eyelid blepharoplasty for reducing surgical complications and improving cosmetic results. Methods In this study, 721 cases (9 males and 712 females, range in age 17-32 years) with single eyelid were performed with double eyelid blepharoplasty using this method (dermis orbicularis muscle flap technique, DOMF), 698 cases of which were simultaneously operated with epicanthoplastic surgery. In the operation, DOMF was harvested in the dermis edge in lower incision margin. The flap was sutured to levatoraponeuros at the superior border of the tarsus. Patients were followed up for three months to three years. Results It was concluded that unfavorable results included low fold in 12 cases, relapse in 3 cases, asymmetric crease in 4 cases, puffy eyelids in 5 cases, and sunken appearance in 4 cases. The physicians and patients were satified with the results. The eyelid appeared smooth without fold depression on downward gaze or eyes closed, and it was gentle and not overly puff as eyes opening. Conclusions The DOMF technique mimics the movement of congenital crease fold, which is easy to perform, creating a delicate, firm and smooth upper lid orientation. Key words: Blepharoplasty; Surgery, plastic; Dermis; Immobilization; Orbicularis muscle flap

Current applications of artificial intelligence in tumor histopathology

The tasks of artificial intelligence (AI) in tumor histopathology include image segmentation and classification. Currently, the specific contents including lymph node metastasis, pathological classification, grade and prognostic evaluation of malignant diseases, such as breast cancer, lung cancer and prostate cancer, have been studied by AI. Evaluation of sentinel lymph node metastasis of breast cancer has been the most mature application of AI technology, whose level can be analogous to the excellent pathologists. In the future, with the close cooperation of pathologists and engineers, the research of AI will be focus on improving the technology of simple and repetitive clinical diagnosis and differential diagnosis, such as the diagnosis of sentinel lymph node metastasis of breast cancer from biopsy frozen section and the judgment of incisal margin. Ultimately, AI will help us to precisely diagnose the tumor.

The clinicopathological features and curative effect of the bronchoscopic interventional therapy combined with radiotherapy for the treatment of locally recurrent lung adenoid cystic carcinoma

Objective: To explore the clinical value of endoscopic interventional therapy for locally recurrent primary lung adenoid cystic carcinoma (ACC). Methods: The clinical data of 42 patients with locally recurrent ACC were retrospectively analyzed, and the differences of tracheal and bronchial diameter, airway scoring grade and airway obstruction degree before and after treatment were compared among three treatment methods: bronchoscopic interventional therapy + palliative radiotherapy, interventional therapy alone, and non-interventional therapy. Log rank test and Cox proportional risk model multi-factor analysis were used to determine the prognostic factors of ACC patients with local recurrence, and the long-term effect of bronchoscopic interventional therapy on ACC with local recurrence was determined. Results: The median overall survival of 42 patients was 59 months and 5-year survival rate was 54.2%.Univariate analysis showed that vascularized cancer, pleural invasion, pulmonary atelectasis, incisal margin, microscopic classification, tumor diameter, initial TNM stage, ki-67 index, and treatment after local recurrence were associated with long-term survival of ACC patients with local recurrence (all P<0.05). Cox multivariate regression analysis showed that margin status (RR=0.272, P=0.011), tumor diameter (RR=2.586, P=0.005), initial TNM staging (RR=0.369, P=0.035), ki-67 index (RR=3.569, P<0.001), and treatment methods after local recurrence (RR=0.126, P<0.001) were independent factors influencing the prognosis of ACC patients with local recurrence. After three months of treatment, the tracheal bronchus diameters, rating of shortness of breath, and degree of airway obstruction were all improved significantly (all P<0.05), both in the interventional therapy + palliative radiotherapy group [(14.5±2.8 mm, 0.86±0.45, (14.50±10.67)%, respectively], and the interventional therapy alone group [(13.7±2.3) mm, 0.97±0.25, (15.38±12.02)%, respectively]. Meanwhile, the difference before and after non-interventional therapy was not statistically significant (all P>0.05). 5-year overall survival rates were 55.8%, 46.6% and 42.6% for patients undergoing interventional therapy+ palliative radiotherapy, interventional therapy alone, and non-interventional therapy after recurrence, with statistically significant differences (P=0.015). Patients underwent bronchial endoscopic interventional therapy and palliative radiotherapy had the best efficacy of treatment. Conclusion: Endoscopic interventional therapy plus palliative radiotherapy is an effective local palliative treatment for locally recurrent ACC patients, which can rapidly relieve airway stenosis, improve the quality of life of patients and prolong the survival time of patients.

Prognostic value of inflammation-based indexes for intrahepatic cholangiocarcinoma following curative resection.

It is widely acknowledged that inflammatory indices may serve as effective prognosis indicators for various malignancies. In the present study, the prognostic value of systemic inflammatory biomarkers for patients undergoing curative resection for intrahepatic cholangiocellular carcinoma (ICC) was investigated. Clinical data of ICC patients who underwent curative resection between September 2008 and July 2017 were collected. Inflammatory indictors were analyzed using the Area Under the Receiver Operating Characteristic Curve. Indictors that were significantly associated with the overall survival (OS) were used to establish a systemic inflammation-based score system and tested via nomogram using R software. The neutrophil To lymphocyte ratio (NLR) and lymphocyte to macrophages ratio (LMR) were significantly associated with the OS and disease-free survival of the patients. High NLR and low LMR were associated with worse clinicopathological and survival outcomes. The univariate and multivariate analyses indicated that tumor T stage, incisal margin, NLR and LMR were associated with the OS of the patients. The systemic inflammation-based scoring system based on LMR and NLR demonstrated a stronger discriminatory capacity and may serve as a useful prognostic parameter for patients undergoing curative resection for ICC. Low LMR and high NLR were observed to be associated with poor prognosis and worse clinical outcomes for patients with ICC undergoing curative surgery. A combined inflammation-based scoring system based on LMR and NLR may effectively predict the outcomes and serve as a novel prognostic predictor for these patients.

Comparison of lymph node dissection and short-term efficacy of laparoscopic radical operation in patients with different grades of prostate cancer

Objective To investigate and compare pelvic lymph node dissection and the short-term efficacy of laparoscopic radical operation in patients with different Gleason grades of prostate cancer. Methods The medical records of 98 patients with prostate cancer treated by laparoscopic radical operation in our hospital were analyzed retrospectively. According to the preoperative Gleason score, the patients were divided into group A (Gleason score ≤ 6 points, 37 cases), group B (Gleason score of 3+ 4=7 points or 4+ 3=7 points, 42 cases) and group C (Gleason score≥ 8 points, 19 cases). The situation of operation, the incidence of postoperative complications, preoperative and postoperative prostate specific antigen (PSA) levels and the probability of postoperative PSA level > 0.2 ng/mL were compared among the 3 groups. All patients were followed up to August 2017, and the biochemical recurrence rates of two groups were recorded. Results There was no patient undergoing lymph node dissection in group A, 38 patients undergoing pelvic lymph node dissection in group B, and all patients undergoing pelvic lymph node dissection in group C. There was no significant difference between group B and group C in the number of dissected lymph nodes (P>0.05). The operation time and intraoperative blood loss of group A were shorter or less than those of group B or group C (P 0.05). The positive rates of incisal margin in group A and group B (0% and 2.38%) were lower than that in group C (15.79%) (P 0.05). PSA levels in the 3 groups at 1 month after operation were lower than those before operation (P 0.05). The odds of PAS level > 0.2 ng/mL in group A and group B (0 and 2.38%) were significantly lower than that in group C (15.79%) (P<0.05). The biochemical recurrence rates of group A and group B (2.70% and 7.14%) were lower than that of group C (26.32%) (P<0.013). Conclusions Lymph node dissection should be carried out after evaluating the risk of pelvic lymph node dissection in patients with prostate cancer before laparoscopic radical operation. The lower the Gleason score is, the lower the positive margin rate of incisal margin and biochemical recurrence rate are. Key words: Prostatic Neoplasms; Laparoscopy; Lymph Node Excision

Use of a helical composite free flap for alar defect reconstruction with a supermicrosurgical technique.

The highly contoured nature of the nose and the abundant free margin makes it especially difficult to reconstruct. In this report, we describe the use of a new helical rim free flap technique for the reconstruction of full-thickness nasal alar defects via supermicrosurgery. Briefly, after a wide excision with a margin of 0.7 cm, an alar defect with a size of 1×1×0.5cm was obtained, which included the full thickness of the skin, mucosa, and lower lateral cartilage. Vessel dissection was performed in a straightforward manner, starting from the incision margin for flap harvest, without any further dissection for reach the greater trunk of the superficial temporal artery. The flap was inset in order to match the contour of the contralateral ala. We closed the donor site via rotation and advancement. No donor site morbidity was observed, despite the presence of a small scar that could easily be covered with hair. The alar contour was satisfactory, and the patient was satisfied with the results. The supermicrosurgical technique did not require further dissection to identify the vessels for anastomosis, leading to better cosmetic outcomes and a reduced operating time.

Surgical Repair of umbilical hernia in children

Background: Elective repair of an umbilical hernia is one of the most common surgical operations performed by pediatric surgeons, although most of them resolve spontaneously during the first 3 years of life. The exact technique and steps involved in the repair differ widely among pediatric surgeons. Many pediatric surgeons prefer the transverse interrupted suture technique in rectus sheath closure than the purse string or continuous technique as it isolates the tension to each individual stitch, ensures correct suture placement and precise coaptation of edges. It is less likely to devascularize the incision margin. Interrupted sutures also have the advantage that they can be removed individually if infection or haematoma formed, while the purse string suture or the continuous closure has the disadvantage of being a single suture line holding the fascia together and most of wound dehiscence occurs because sutures cut through the fascia. In this study we give a chance to assess the efficacy of the purse string technique. Objective: The aim of our study is to compare between umbilical hernia repair of rectus sheath with closure by interrupted sutures and purse string technique regarding operative time, intra operative complications (bleeding, intestinal injury), and post-operative complications (edema, hematoma formation, seroma formation, cosmetic appearance & recurrence). Materials & Methods: A total of 30 umbilical hernias in children (17 females and 13 males) were operated in Ain Shams University hospital and El Galaa teaching hospital from September 2017 till May 2018. Results: In this prospective study, 30 cases of umbilical hernia in children aging from two years till the age of ten years including 17 female and 13 male with a ratio of 1.3: 1 were randomly selected from the outpatient clinic of Ain Shams University hospital and Al Galaa teaching hospital were divided into two equal groups, group A underwent the repair of the rectal sheath with purse string suture technique while group B underwent the repair with transverse interrupted suture technique. Conclusion: Conclusively, there are no significant differences between both techniques regarding the intra operative complications and post-operative complications in short term follow up; however, transverse interrupted suture technique appears to consume more time than the purse string technique.

Risk Factors Associated with Anastomotic Leakage in Colorectal Cancer

Anastomotic leakage (AL) is a serious complication of colorectal surgery as it greatly increases morbidity and mortality and has been associated with augmented local recurrence and diminished survival. Many risk factors have been identified to date, but sizable studies on AL after colorectal resection are lacking. This study aimed to identify the risk factors and postoperative complications of AL after colorectal surgery in the first affiliated hospital of Sun Yat-sen University. One thousand two hundred seventy-five patients who underwent colorectal cancer surgery between January 2010 and June 2013 were retrospectively studied. Twelve preoperative, 17 operative, and 11 postoperative variables were examined by the chi-square test or Fisher’s exact test for univariate analysis and were then further examined by multivariate logistic regression analysis, among which one operative and three postoperative variables were examined in 426 rectal cancer surgeries. Additionally, eight postoperative complications and short-term prognostic variables were also examined by the chi-square test or a Fisher’s exact test. AL was identified in 60/1158 (5.2%) total patients, 20/732 (2.7%), and 40/426 (9.4%) of whom had colonic and rectal cancer, respectively. Univariate analysis identified preoperative variables: sex (p = 0.012), preoperative carcinoembryonic antigen (CEA) level (p < 0.001), and hemoglobin level (p = 0.089); operative variables: surgical time (p = 0.009), anastomotic methods (p = 0.003), surgical staging (p = 0.016), and operative sites (p < 0.001); and postoperative pathologic variables: distance from tumor to distal incisional margin (p < 0.001). For rectal cancer, the variables included rectal procedures (p = 0.022), rectal segments (p = 0.010), distance from the tumor to the dentate line (p = 0.011) and total mesorectal excision (TME) (p = 0.046). All of these variables were included in the multivariate analysis, which identified the surgical time (p = 0.021), preoperative CEA level ≥ 41 μg/L (p < 0.001), and double-stapled anastomosis (p = 0.007); for rectal cancer, the middle or lower rectal segment (p = 0.008, 0.005, respectively) was included as an independent predictive factor for AL. Of the eight postoperative complications or short-term prognostic variables, postoperative hospital stay, abdominal infection, urologic infection, and incisional infection were considered significant. The rate of AL after rectal cancer is much higher than that of colon cancer. Surgical time, tumor biomarkers, anastomotic methods, and rectal segments may have the potential to increase the occurrence of AL. Additionally, AL may increase patients’ hospital costs, length of stay and other relevant complications.

EFFECT OF USING Er: YAG LASER TOOTH PREPARATION ON MICROLEAKAGE OF PORCELAIN LAMINATE VENEERS

The Er: YAG laser was proven to successfully ablate enamel. This study was aimed to investigate the applicability of using this laser in preparing the enamel surface for porcelain laminate veneering in comparison with the high speed handpiece regarding the fracture strength loading of the veneers. Twenty human maxillary central incisors extracted were selected. They were divided into two equal groups [group I and group II], group I: High speed handpiece prepared specimens and group II: Er: YAG laser prepared specimens for measuring microleakage by a binocular stereomicroscope. The results of the microleakage assessment showed significant difference in the microleakage scores at the incisal margins of [Gr. I (group I)] the high speed handpiece compared to [Gr. II (group II)] the Er: YAG laser and significance comparing the microleakage scores at the cervical margins of both groups (Gr. I) and (Gr. II). Also, there were significant differences comparing incisal to those at the cervical margins of (Gr. I) the high speed handpiece, while in (Gr. II) the Er:YAG laser group, a marked significant difference were found between the microleakage scores at the incisal margins compared to the cervical margins. Conclusion: The difference in microleakage assessment between laser and the high speed hand piece specimens was significant and affect the longevity of the porcelain laminate veneers

An electrical plasma dissection tool for surgical treatment of chronic ulcers: Results of a prospective randomised trial.

Cutaneous ulceration is a difficult medical problem and a major source of morbidity for patients. In the surgical treatment of ulcers, debridement is the first step, and it can be carried out using several surgical tools. Recently, new surgical devices have emerged using plasma-mediated electrical discharges with a lower peak temperature. A prospective single-blind trial was conducted on chronic ulcers not responsive to common non-surgical management. Patients were randomly separated into 2 groups: Group A received surgical debridement with conventional electrocautery, and Group B received surgical debridement using the plasma-mediated device. Histological samples were collected intraoperatively to evaluate the thermal damage during the surgical procedure and 2 weeks after surgery to evaluate the inflammatory response and collagen deposition. The width of coagulation necrosis at the incision margins in Group B was significantly shorter compared with Group A (P = .001). The inflammatory cell infiltration showed a cellular distribution percentage that was quite equal between the 2 groups. The granulation tissue showed an abundant deposition of dense and mature collagen in Group B, compared with Group A, where the mature collagen appeared in small quantities (P < .001). Microbial culture showed a lower incidence of postoperative infections in Group B compared with the control group (P < .05). The study demonstrated, based on the results, that the new technology with the use of a lower temperature electrosurgical device represents an effective therapeutic weapon for the surgical treatment of skin ulcers, both vascular and extravascular types.

Histological observation of the post-surgery healing of an incision in the Amur sturgeon Acipenser schrenckii

PDF HTML阅读 XML下载 导出引用 引用提醒 施氏鲟外科手术后切口愈合过程的组织学观察 DOI: 作者: 作者单位: 1. 中国科学院水生生物研究所, 湖北 武汉 430072;2. 中国科学院大学, 北京 100049;3. 中国水产科学研究院长江水产研究所, 湖北 武汉 430223;4. 华中农业大学水产学院, 湖北 武汉 430070 作者简介: 杨俊琳(1991-),男,硕士,研究方向为动物学.E-mail:yangjunlin19910517@163.com 通讯作者: 中图分类号: S965 基金项目: 国家973计划项目（2015B150702）. Histological observation of the post-surgery healing of an incision in the Amur sturgeon Acipenser schrenckii Author: Affiliation: 1. Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, China;2. University of Chinese Academy of Sciences, Beijing 100049, China;3. Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan 430223, China;4. Fisheries College, Huazhong Agricultural University, Wuhan 430070, China Fund Project: 摘要 | 图/表 | 访问统计 | 参考文献 | 相似文献 | 引证文献 | 资源附件 | 文章评论 摘要:通过肉眼观察和组织学方法对施氏鲟（）外科手术后不同时期的切口及周围组织进行观察，研究切口愈合过程，探讨施氏鲟组织修复能力，为术后管理提供数据支持。采用150 mg/L的MS-222对30尾2龄施氏鲟进行快速麻醉，于腹中线第3~5腹骨板处切开约5 cm的切口。采用间断缝合法对切口进行缝合，于术后4 d、7 d、14 d、28 d、42 d、56 d，通过肉眼观察和组织学方法观察切口愈合过程中的宏观和微观的变化。结果发现：术后4~7 d表皮沿切口边缘向腹腔内延伸，并与腹膜相连。切口边缘出现炎性渗出物，并有少量网状或束状的Ⅲ型胶原纤维生成。术后14~42 d切口显著愈合，红肿明显减少（<0.05），并高于周围与对照组。切口边缘出现大量的成纤维细胞聚集和新生血管，形成肉芽组织。42~56 d表皮完全愈合，与对照组无差异。肉芽组织中I型胶原含量显著增加（<0.05），成纤维细胞和血管明显减少，形成瘢痕组织。研究结果表明，施氏鲟具有较强的组织愈合能力，术后56 d切口完成愈合。14~42 d是切口愈合的主要时期，这一时期应作为术后管理关注的重点时期。相比于表皮细胞的快速迁移，真皮及皮下组织的愈合速度缓慢，是愈合过程中的限制因素。 Abstract:The Amur sturgeon () is one of the eight species of Acipenseriformes that occur in China. The range of the Amur sturgeon is mainly restricted to the middle and lower Amur River. Sometimes sturgeons enter the Ussuri River, but they rarely occur in the Sungari River. This species supports fisheries, but stocks are declining significantly because of overfishing. Developing artificial cultures could reduce market dependence on wild fish and would assist in conservation of the wild stock. Although Amur sturgeons are gonochoristic, they exhibit no apparent sexual dimorphism and have no indicators of their sex for their first 1-2 years of life. Currently, the most reliable method of determining sex and gonad maturation in Amur sturgeons at an early age is through a surgical incision and visual examination of the gonads. The eggs of artificial spawning are also commonly obtained via an abdominal incision or caesarian section. The incisions may not always heal properly; thereby, causing infections, inflammation, and ulcerations that lead to adhesions or in some cases to mortality. Thus, it is critical to close the incisions for the recovery of Amur sturgeons post-surgery. The goals of this research were to study the process of incision healing, through visual and histological evaluations of the surgical incision at different stages post-surgery, to explore the repair capability of Amur sturgeons, and to provide data for the establishment of post-surgery system management. A total of 30 2-year-old Amur sturgeons were anesthetized quickly by immersion into a tank containing a 150 mg/L solution of tricaine methanesulfonate (MS-222). Once the fish reached a surgical plane of anesthesia, a sterile surgical blade was used to make a 5 cm incision through the ventral middle skin and linea alba into the coelomic cavity. The incisions were closed with three simple interrupted stitches. Samples were taken at 4, 7, 14, 28, 42, and 56 days post-surgery. A study on the healing of the incisions was conducted, through visual assessments and histological observations. The results indicated that the epidermal cells migrated into the coelomic cavity along the edge of incision and had contact with the peritoneum at 4 to 7 days post-surgery. The inflammatory infiltrate and Type Ⅲ collagen appeared at the incision margin. The incisions healed, and redness and swelling indexes significantly decreased ( < 0.05) from 14 to 42 days post-surgery. The epidermis covered the incision, and there was an overlap between the epidermis on the front of both sides. The epidermal cell layers at the incision margin significantly increased and were greater than that around the incision and the control. A large number of fibroblasts gathered at the edge of the incision, and new capillaries were regenerated, forming granulation. From 42 to 56 days post surgery, the epidermis healed completely, exhibiting no differences from that of the control. In the granulation, type I collagen substantially increased, but fibroblasts and capillaries decreased and disappeared. A scar remained. These results indicated that the Amur sturgeon had a strong repair capability. It took 56 days to close the surgical incisions. The surgical incision healed mainly during the period from 14 to 42 days post-surgery. It took longer to complete healing of the dermis and hypodermis, compared with that of the epidermis. The healing of the dermis and hypodermis was constraint with the progress of incision closure. 参考文献 相似文献 引证文献

Clinical evaluation of three adhesive systems in class V carious lesions

Purpose The purpose of this study was to evaluate the clinical performance of three types of adhesive systems (Futurabond universal adhesive in a self-etch mode, Tetric N-bond self-etch adhesive, and Single bond universal adhesive in a total etch mode) in class V carious lesions over 1 year. Materials and methods A total of 20 patients with three carious cervical lesions were participated in this study after obtaining informed consent. A total of 60 restorations were placed. The distributions of adhesive materials and the teeth locations were randomized. Cavities were prepared limited to just removal of carious lesions with incisal and gingival margins in enamel and beveling of incisal cavosurface margin. All adhesives were applied following manufacturer's directions. All cavities were restored with Grandio SO composite resin following manufacturer's directions. Finishing and polishing was performed using finishing burs and polishing discs. Each restoration was clinically evaluated at baseline (24 h), 6 months and 1 year for retention, margin integrity, margin discoloration, secondary caries, and postoperative sensitivity using modified United state public health service (USPHS) criteria. Results The recall rate was 100% after 1 year. Also the retention rate for all restorations was 100% after 1 year. Using χ2-test, there was no statistically significant differences between the tested groups at all evaluation periods regarding marginal adaptation, marginal discoloration, and postoperative sensitivity (P > 0.05). None of restoration had secondary caries at any evaluation period. Conclusion Within the limitation of this short-term evaluation, there was no significant clinical difference between adhesives. Clinical significances All tested adhesive systems achieved excellent results after 1 year of clinical service.

Image-guided surgery using near-infrared Turn-ON fluorescent nanoprobes for precise detection of tumor margins.

Complete tumor removal during surgery has a great impact on patient survival. To that end, the surgeon should detect the tumor, remove it and validate that there are no residual cancer cells left behind. Residual cells at the incision margin of the tissue removed during surgery are associated with tumor recurrence and poor prognosis for the patient. In order to remove the tumor tissue completely with minimal collateral damage to healthy tissue, there is a need for diagnostic tools that will differentiate between the tumor and its normal surroundings.Methods: We designed, synthesized and characterized three novel polymeric Turn-ON probes that will be activated at the tumor site by cysteine cathepsins that are highly expressed in multiple tumor types. Utilizing orthotopic breast cancer and melanoma models, which spontaneously metastasize to the brain, we studied the kinetics of our polymeric Turn-ON nano-probes.Results: To date, numerous low molecular weight cathepsin-sensitive substrates have been reported, however, most of them suffer from rapid clearance and reduced signal shortly after administration. Here, we show an improved tumor-to-background ratio upon activation of our Turn-ON probes by cathepsins. The signal obtained from the tumor was stable and delineated the tumor boundaries during the whole surgical procedure, enabling accurate resection.Conclusions: Our findings show that the control groups of tumor-bearing mice, which underwent either standard surgery under white light only or under the fluorescence guidance of the commercially-available imaging agents ProSense® 680 or 5-aminolevulinic acid (5-ALA), survived for less time and suffered from tumor recurrence earlier than the group that underwent image-guided surgery (IGS) using our Turn-ON probes. Our "smart" polymeric probes can potentially assist surgeons' decision in real-time during surgery regarding the tumor margins needed to be removed, leading to improved patient outcome.

ASSESSMENT OF ACCURACY OF DIFFERENT CAD/CAM FABRICATED PORCELAIN LAMINATE VENEERS

Objectives: The aim of the current study was to compare the accuracy of different restorative materials currently used in porcelain laminate veneers (PLV) fabrication, in terms of external and internal adaptation, and to evaluate the longevity of the PLV seal in response to thermocycling, in terms of microleakage. Methods: 30 (PLV) preparations were performed on maxillary central incisor to be restored with restorations fabricated by milling ceramic blocks using a CAD/CAM system. Samples were divided randomly into three groups (n=10) according to the restorative material ([Prettau, Zirkonzahn, Pustertal, Italy], [IPS e.max CAD, Ivoclar, Schaan, Liechtenstein] and VITA SUPRINITY, VITA Zahnfabrik, Bad Sackingen, Germany]). The veneers were cemented using total-etch resin cement according to manufacturer instructions, then subjected to artificial aging program after which they were immersed in basic fuchsine dye for 24 hours. All specimens were sectioned in labio-lingual direction using a precision cutting machine, and vertical gap distance, internal adaptation, and dye penetration were measured using stereomicroscope. Data were statistically-analyzed using one-way ANOVA, two-way ANOVA, Tukey’s post-hoc and Student t-tests (P≤0.05). Results: The highest statistically significant marginal gap distance and lowest internal adaptation values were recorded with Prettau group followed by IPS e.max CAD group while the lowest statistically significant marginal gap distance and highest internal adaptation values were for VITA SUPRINITY group. For the microleakage, the highest statistically significant leakage values were recorded with IPS e.max CAD group followed by Prettau group. The lowest statistically significant leakage values were for VITA SUPRINITY group. Irrespective of material’s group, it was found that incisal margin recorded statistically significant higher marginal gap distance mean values than cervical one. For the microleakage, the reverse was found. Conclusions: Under the test conditions, the following could be concluded: 1. All ceramic materials used in this study were within the clinically acceptable range of marginal accuracy. 2. CAD/CAM technology does not necessarily present highly accurate restorations, in terms of external and internal adaptation. 3. Lithium disilicate-based restorations showed better external and internal adaptation, and microleakage than monolithic Zirconia-based restorations. 4. The correlation between external and internal adaptation and microleakage is still questionable.

Full incisal margin pathological examination for endoscopic submucosal dissection specimens

Full incisal margin pathological examination for endoscopic submucosal dissection specimens

The value of computer-assisted navigation for bone reconstruction after tumor resection.

This study was designed to evaluate the use of computer-assisted navigation with computed tomography (CT) images for bone reconstruction after resection in malignant bone tumor treatment. Forty-five patients with malignant bone tumors were recruited for this study. CT scan images in a computer-assisted navigation system were used to assist during the osteotomy, the pairing with allografts, and the monitoring of the allograft and joint lines to perform joint reconstruction. Our results show that osteotomy and allograft pairing were successful in all patients. The average duration of the osteotomy procedures was 46.8±12.3 min; and the average pairing time was 32.5±9.8 min. The anatomical registration points and the three-dimensional virtual CT images were successfully matched. The average error of registration was 0.36±0.09 mm. Also, the range of tumor resection and allograft osteotomy were successfully paired, with an average error of 0.11±0.03 mm. No complications such as unequal limbs length or joint deformities occurred after reconstruction. The average follow-up time was 11.6±3.9 months. The tumor recurrence rate was 11.1% (5/45) and the survival rate 95.6% (43/45). The average healing time for the allograft and host bone was 5.5±1.2 months and no unexpected internal fixations, fractures or joint collapses occurred. The average knee joint functionality MSTS score was 25.5±6.6 points. No significant differences were found in the length of tumor resection, rate of negative incision margin, duration of osteotomy or of pairing, registration error or allogeneic bone and defect matching error averages between those patients with tumor recurrence and those without it (p>0.05). Based on our results, the computer-assisted navigation system for bone reconstruction after malignant tumor resection allows for high precision during osteotomy, delivers a high success rate of pairing, results in great limb function and low complication rates, and is thus a highly successful and safe approach benefiting bone cancer patients.

HP-09-001 The role of the Tachosil and SIS as grafts after inflatable penile prosthesis implantation and plaque incision: Surgical and functional outcomes from a single center prospective comparative study

Among the straightening manoeuvres aiming to correct a residual curvature in Peyronie’s disease (PD) after inflatable penile prosthesis (IPP) implantation, Plaque incision with grafting (PIG) has been widely described in the scientific literature. However, it is still under debate the definition of the best graft to apply after this procedure. The aim of our study is to compare the surgical and functional outcomes in 2 groups of patients underwent IPP implantation and PIG for residual curvature using 2 different grafts: SIS-small intestinal submucosa (Group A) and Tachosil (Group B). From January 2007 to January 2015, 60 consecutive patients affected by PD with concomitant erectile dysfunction (ED) and penile curvature, underwent IPP implantation (AMS 700 CX) and PIG. SIS (A) was used as a graft in 34 cases whereas Tachosil was applied respectively in the remnants. The main difference between the two grafts was that the SIS was fixed to the albuginea’s incision margins with a running 3-0 Vycril suture. On the other hand the Tachosil was directly applied on the albugineal defect. The Buck’s fascia was reconstructed in both cases to control any possible haematoma. We selected as variables for the surgical outcomes the intraoperative complications, the hospital stay, the postoperative complications (haematoma, infections, prosthetic mechanical failures, recurrent curvatures). Nevertheless, the IIEF questionnaire was administered to all patients before and 12 months after surgery to Assess the functional outcomes of the procedure.

Efficacy of Palatal Applications on Fracture Resistance of Reattached Maxillary Central Incisors: AnIn VitroStudy

The purpose of this study was to evaluate the effects of different palatal applications on fracture strength of the fractured anterior tooth. Sixty caries-free human maxillary incisors were used. Endodontic treatments of the teeth were performed. Then, the teeth were divided randomly into five groups (n = 12). Crowns of all teeth in groups A–D were cut with diamond discs at a fixed distance of 3 mm from the incisal margin in a plane normal to the buccal surface. In all groups, coronal fragments were reattached to the remaining teeth by bonding with hybrid composite resin. After then, the teeth were restored to the following; group A, bonding and palatal laminate; group B, bonding and creation of a vertical groove; group C, bonding and creation of two slot grooves; group D, bonding only; and group E, intact tooth. It was lesser in group B than in groups C and E (p = 0.007 and p = 0.006, resp.) and lesser in group D than in groups A, C, and E (p = 0.002, p < 0.001, and p < 0.001, resp.). Within the limitations of this in vitro study, it can be concluded that methods employing palatinal laminate and small grooves are clinically feasible for the reattachment of tooth fragments to incisors.