Initial Lesion Research Articles

HCO-RLF: Hybrid classification optimization using recurrent learning and fuzzy for COVID-19 detection on CT images

COVID-19 infection detection through initial lesion classification provides early diagnosis and prevents breathing difficulties. Detecting the infectious part of the lungs using computerized tomography (CT) images has become an instantaneous detection method. In this article, a Hybrid Classification Optimization (HCO) using Recurrent Leaning and Fuzzy (RLF) is proposed. The neural network classifies infected and non-infected regions using pixel distributions and their variations. This is performed by identifying missing features and training the recurrent network using regional differences. Based on the feature availability, recurrent learning classifies the region through the input dataset and recurrent training correlation. The fuzzy predicts missing features through substituted derivatives obtained between wide ranges of variations. In this process, the maximum fuzzy derivatives for feature substitution are used for infected region prediction. The least fuzzy derivatives are prevented from the training layer to reduce false rates in region classification. This joint process improves the training consistency to leverage the detection and region classification accuracies. The proposed HCO-RLF improves detection and classification accuracy, and precision by 11.96 %, 9.98 %, and 13.42 % for the varying classification rates. Besides, the results are obtained in comparison with the existing DR-MIL, DSAE, and BS-FSA methods discussed later in the article.

Biomimetic Regeneration Of Enamel Using SelfAssembling Peptides: A Systematized Review

Background: Noninvasive methods of treating initial caries lesions have been a widely researched topic in this scientific era. Various biomimetic materials are available on the market. Self-assembling peptides focus on the biomimetic regeneration of enamel and stand out from the others due to their ability to restore the enamel matrix Data: This systematized review was conducted on articles with the remineralization effects of SAP on initial enamel lesions published between 2019 January to 2024 September. Sources: The search of this review was carried out in the electronic databases PUBMED, COCHRANE, EMBASE, and Google Scholar. Only primary researches were included Results: Out of 122 articles obtained, 28 articles were included in this review after screening. The studies demonstrate the effect of SAP on reversing WSLs and its efficacy in comparing and combining with other remineralizing agents such as fluorides, and CPP-ACP. Conclusion: With the limited evidence, SAP can be used as a promising solution for WSLs in permanent as well as primary teeth

Five-year outcomes of fractionated stereotactic body radiotherapy for oligometastatic prostate cancer from the TRANSFORM phase II trial.

Metastasis-directed therapy (MDT) for oligometastatic prostate cancer (PCa), including stereotactic body radiotherapy (SBRT), has shown promise but is still considered investigational. This is the 5-year analysis of the TRANSFORM trial, the largest prospective cohort of men with oligometastatic PCa treated with SBRT-based MDT. The primary endpoint was 5-year treatment escalation-free survival (TE-FS), defined as freedom from any new cancer therapy other than further SBRT. In total, 199 men received SBRT; 76.4% were hormone-naïve at baseline. The rate of 5-year TE-FS was 21.7% (95% confidence interval [CI]: 15.7%-28.7%) overall and 25.4% (95% CI: 18.1%-33.9%) in the hormone-naïve subgroup. The subgroups with International Society of Urological Pathology Grade Groups 4-5 disease (hazard ratio [HR] = 1.48, 95% CI: 1.05-2.01, p = .026), a higher baseline prostate-specific antigen (PSA) (HR = 1.06, 95% CI: 1.03-1.09, p < .001) and those who received prior androgen deprivation therapy (ADT) (HR = 2.13, 95% CI: 1.40-3.26, p < .001), were at greater risk of treatment escalation. Outcomes for participants with four or five initial lesions were comparable to those with one to three lesions. At last follow-up, 18.9% (95% CI: 13.2%-25.7%) of participants were free from treatment escalation (median follow-up of 67.9 months) and two participants had an undetectable PSA level. No treatment-related grade three or higher adverse events were reported. The findings of this study demonstrate that SBRT-based MDT is an effective option for delaying systemic treatment escalation in the context of oligometastatic PCa. Future randomised trials comparing SBRT-based MDT to standard-of-care ADT-based approaches are required to evaluate the impact of delaying ADT on survival.

Implantable Microneedle-Mediated Eradication of Postoperative Tumor Foci Mitigates Glioblastoma Relapse.

Glioblastoma multiforme (GBM) remains incurable despite multimodal treatments after surgical debulking. Almost all patients with GBM relapse within a narrow margin (2-3cm) of the initial resected lesion due to the unreachable residual cancerous cells. Here, a completely biodegradable microneedle for surgical cavity delivery glioblastoma-associated macrophages (GAMs)-activating immune nano-stimulator that mitigates glioblastoma relapse is reported. The residual tumor lesion-directed biocompatible microneedle releases the nano-stimulator and toll-like receptor 9 agonist in a controlled manner until the microneedles completely degrade over 1 week, efferently induce in situ phonotypic shifting of GAMs from anti- to pro-inflammatory and the tumor recurrence is obviously inhibited. The implantable microneedles offer a significant improvement over conventional transdermal ones, as they are 100% degradable, ensuring safe application within surgical cavities. It is also revealed that the T cells are recruited to the tumor niche as the GAMs initiate anti-tumor response and eradicate residual GBM cells. Taken together, this work provides a potential strategy for immunomodulating the postoperative tumor niche to mitigate tumor relapse in GBM patients, which may have broad applications in other malignancies with surgical intervention.

Remineralizing Effect and Ion Release of Pearl Powder versus Casein Phosphopeptide Amorphous Calcium Phosphate on Non-cavitated Initial Enamel Lesions: An In Vitro Study

Remineralizing Effect and Ion Release of Pearl Powder versus Casein Phosphopeptide Amorphous Calcium Phosphate on Non-cavitated Initial Enamel Lesions: An In Vitro Study

When cervical microglandular hyperplasia coincides with high-risk human papillomavirus infection: Diagnostic challenges and evidence

Cervical microglandular hyperplasia (MGH) is a benign cervical lesion mimicking cervical malignancy, thereby making its pathogenesis diagnostically challenging for gynecologists and pathologists. While MGH is often associated with physiological or external hormonal factors, several cases remain unexplained. In this report, we present a case of a young primiparous woman without evident hormonal risk factors seeking gynecologic evaluation owing to abnormal vaginal discharge. During her clinical examination, we observed an irregular cervical lesion raising malignancy-related concerns and consequently planned a colposcopy. The human papillomavirus (HPV) polymerase chain reaction tested positive for two high-risk HPV genotypes (16 and 52), denoting that the patient did not have an HPV infection history. During colposcopy, we identified a friable papillary cervical mass at the transformation zone, bleeding significantly with minimal handling, from which we obtained multiple biopsies. Our subsequent histopathological examinations eventually confirmed the MGH diagnosis, ruling out malignancy. Intriguingly, a follow-up colposcopy 7 months later revealed the resolution of the initial cervical lesion, coinciding with negative HPV test and Pap smear cytology results. This case highlights the rare encounter of MGH concurrent with an initial high-risk HPV infection. Beyond a comprehensive review of related literature and clinical guidelines, we discuss the clinical and histopathological results in such a case.

Tactile sensation in relation to roughness and reflection of active initial lesions in primary (deciduous) and permanent dentition in vitro

ObjectivesThis study evaluated whether a relationship exist between tactile sensation, roughness and reflection intensity in active enamel lesions of primary (deciduous) and permanent dentition. MethodsFreshly extracted teeth of the primary (n=29) and permanent (n=60) dentition of patients who underwent serial extractions under general anesthesia due to multiple deep caries lesions showing active lesions (International Caries Detection and Assessment System scores of 2) were selected. The mean linear (Ra), area-related (Sa), volume-related (Vmc) roughness and vertical reflection intensity (VRI) of sound (S) and carious (C) areas were determined by using a 3D-laser-scanning-microscope and a multi-sensor microscope with two different chromatic-confocal optics. Furthermore, two blinded examiners evaluated the roughness by tactile examination using three different explorers (S23H,405CP11, S3C). ResultsMean differences (95%CI) between S and C for teeth of the primary dentition were: Ra:-1.9(-2.3;-0.4)µm, Sa:-31.8(-1.8;0.0)µm, Vmc:-1.8(-1.6;-0.0)ml/m2, VRI:29(20;43) and for teeth of the permanent dentition: Ra:-4.0(-2.5;-1.0)µm, Sa:-4.8(-3.0;-1.1)µm, Vmc:-4.6(-3.4;-0.5)ml/m2, VRI:34(19;44) differing significantly between S and C (p<0.05,Wilcoxon test). No significant difference was observed between 1st and 2nd dentition (p>0.05, Kruskal-Wallis test) as well as commercial and experimental optic (p>0.05). The highest positive predictive value (PPV) was achieved by examiner 1 with explorer S3C (1st dentition 67%;2nd dentition 100%;pooled dentition 88%)), while examiner 2 revealed the highest PPV with explorer S23H (89%;86%;88%). ConclusionDifferences in roughness and reflectance between sound and caries-active enamel surfaces could be evaluated in both primary and permanent dentition. These differences could also be reliably detected using three different explorers with good validity. However, the most predictive explorer seems to differ between examiners. Clinical SignificanceIn both primary (deciduous) and permanent dentition active caries lesions exhibit significantly higher roughness and lower vertical reflection intensity compared with sound enamel. These differences are detectable by blind tactile examination and objective methods such as 3D-laser-scanning or multi-sensor microscopy, highlighting their utility in caries diagnosis in both dentitions.

Effect of consolidation radiation therapy on treatment outcomes of early-stage favorable Hodgkin lymphoma

Background. Early (stage I–II) classical Hodgkin lymphoma is a highly treatable malignant neoplasm. For many years, the standard treatment of early Hodgkin lymphoma has been combination therapy: polychemotherapy with subsequent consolidating radiation therapy. Aim. To retrospectively evaluate the results of treatment of stage I–II classical Hodgkin lymphoma in a favorable prognosis group using monotherapy and combination therapy (chemotherapy followed by consolidating radiotherapy). Materials and methods. The study included 58 patients aged 19–81 years (median age 36 years) diagnosed with stage I–II classical Hodgkin lymphoma with favorable prognosis; 23 (39.7 %) patients were men, 35 (60.3 %) were women. Depending on the treatment received, the patients were divided into two groups: 40 (69 %) patients received ABVD polychemotherapy, and 18 (31 %) patients received polychemotherapy followed by consolidating radiation therapy to the initial lesion zones with standard fractionation regimen (total dose 30 Gy). The Kaplan–Mayer method was used to evaluate overall, progression-free, recurrence-free, and event-free survival. Odds ratios and their 95 % confidence intervals were also calculated. The statistical significance of differences in survival was assessed using the log-rank test. The level of statistical significance was 0.05. Statistical data processing was carried out using the IBM SPSS Statistics 27 software and Microsoft Excel. Results. According to the results of our study, while in the total patient group a clear numerical advantage in survival (overall, progression-free, relapse-free and event-free survival) was observed in the combination therapy group compared to chemotherapy group (5.5, 13.2, 9.2 and 23.9 %, respectively), no preferred tactics were identified in the total patient group. However, considering a subgroup of patients with mediastinum involved in the tumor process, a statistically significant advantage of combined treatment over single-mode chemotherapy was determined for 2-year event-free survival (92.9 ± 6.9 % vs. 62.5 ± 9.9 %, respectively, p = 0.046). The risk of an adverse event is reduced by &gt;80 % (odds ratio 0.197; 95 % confidence interval 0.036–0.977) when using consolidating radiation therapy after chemotherapy.

Impact of resin infiltration in controlling proximal initial carious lesion: A randomized controlled trial

: Dental caries is a major public health concern commonly affecting all age groups. Early detection and treatment of such lesions will limit the need for invasive treatment in the future. Resin infiltration is proposed as an encouraging non-invasive approach that can be used as an option in addition to non-operative and operative approaches to treatment.: To assesses the efficacy of micro-invasive interventions (resin infiltration or sealing) for controlling caries progression on proximal surfaces.The randomized clinical trial was carried out among 30 proximal caries lesion patients. After randomization participants were equally allocated in three groups; infiltration, sealant and placebo. DMFT &amp; DMFS index and ICDAS were recorded at baseline, 3 months, 6months and 9 months. The ANOVA and chi square tests were used to determine significant differences between groups. In all tests, p-values less than 0.05 were considered significant. : There is a significant difference in the mean DMFT and DMFS value of infiltration and resin group as compared to control group p value 0.023 and 0.007 respectively. Also infiltration group had lower score as compared to resin group. Also, Infiltration group had the lowest mean ICDAS score at all time points, indicating the lowest severity of tooth decay, followed by the sealant group and then the Control group. : Our randomized controlled trial provides valuable insights into the effectiveness of resin infiltration, sealant, and placebo groups in preventing the progression of early enamel lesions. Resin infiltration was found to be the most effective method.

Prevalence and Association of Caries and Enamel Hypomineralisation/Molar-Incisor Hypomineralisation in 8- to 10-Year-Old Children from Bavaria, Germany

Introduction: The aim of this cross-sectional epidemiological study was to record caries and enamel hypomineralisation (EH), including molar-incisor hypomineralisation (MIH), and assess associations between both entities in 8- to 10-year-olds from Bavaria, Germany. Methods: A total of 5,418 children (mean age 9.8 years; 2,726 females, 2,692 males) were examined using the dmft/DMFT index with additional inclusion of initial or non-cavitated carious lesions (it/IT). EHs were recorded in the primary (eh) and permanent dentition (EH), and individuals with different EH phenotypes were determined as follows: at least one EH, at least one hypomineralised second primary molar (HSPM), at least one hypomineralised first permanent molar (MIH), and at least one hypomineralised first permanent molar and incisor (M+IH). Multiple logistic regression models were constructed to assess association between caries and EH. Results: The percentage of children without caries in the permanent dentition (DMF = 0) was 88.9%. When data regarding initial carious lesions were included (IDMF = 0), the prevalence decreased to 75.7%. The caries experience was idmf/t = 1.6 and the IDMF/T = 0.6. The mean number of carious teeth in subjects with no eh/EH was higher than that in subjects with HSPM, MIH, or M+IH. The presence of HSPM, MIH, and M+IH was associated with a significantly lower probability of caries in the permanent dentition; the corresponding adjusted odds ratios were 0.55 (95% CI: 0.41−0.75), 0.67 (95% CI: 0.56−0.81), and 0.54 (95% CI: 0.41−0.72), respectively. Conclusions: Caries and EH are prevalent conditions in 8- to 10-year-old Bavarian schoolchildren; both dental diseases were negatively associated with each other.

Comparing the remineralization potential of undemineralized dentin powder versus chicken eggshell powder on artificially induced initial enamel carious lesions: an in-vitro investigation

BackgroundWhite spot lesions are a widespread undesirable effect, especially prevalent during fixed orthodontic treatments. The study compared the in vitro enamel remineralization potential of undemineralized dentin matrix (UDD) versus chicken eggshell powder (CESP) for artificially induced enamel lesions.Methods100 caries-free and sound maxillary premolars were randomly divided into four groups each contain 25 teeth: Group I (Baseline): No treatment was done to the enamel surface. Group II (Negative control ): The enamel surface of the teeth underwent demineralization using demineralizing solution to create artificial carious lesions then kept in artificial saliva. Group III (CESP treated): After demineralizing the tooth surface, the teeth have been suspended in the CESP remineralizing solution. Group IV (UDD treated): After enamel demineralization, the teeth were suspended in UDD remineralizing solution. The remineralization potential was assessed by Vickers microhardness testing, scanning electron microscopic examination (SEM), and energy dispersive X-ray (EDX).ResultsThe current study demonstrated an increase in the mean microhardness of CESP and UDD-treated groups; however, It was nearer to the baseline level in the UDD group. SEM imaging revealed greater enamel remineralization in the UDD group compared to the remaining groups. The UDD group disclosed complete coverage for the prismatic enamel compared to the CESP group, which revealed a partially remineralized enamel surface. Interestingly, the Ca/P ratio increased significantly in the CESP group compared to the negative control group. In contrast, a higher significant increase in the mean Ca/P ratios was recorded in the UDD group compared to the test groups.Conclusionbiomimetic UDD and CESP powder should be utilized to treat enamel early carious lesions. However, UDD demonstrated the most significant remineralization potential.

Evaluation of REFIX Technology on the Remineralization of Artificial Early Enamel Caries Lesion by Laser Speckle Tracking Analysis.

To assess the effectiveness of the REFIX technology in the remineralization process of initial caries simulated on bovine enamel. The assessment involved the analysis of backscatter intensity, which was determined from laser speckle images. Twenty-one bovine teeth were divided into three groups: G1 and G7 were submitted to treatment with the REFIX technology for 1 and 7 days, respectively. The control group was treated with deionized water. A significant difference in backscatter was found between the carious and sound areas in all groups (p = 0.0038, p < 0.0001, and p = 0.0002 for the control group, G1, and G7, respectively). The intergroup comparison revealed no significant difference among the groups studied. REFIX technology did not alter the optical properties of the samples of bovine teeth with simulated initial caries lesions after 1 and 7 days of treatment.

Does orthodontic treatment using fixed appliances cause initial caries lesions?

Systematic review and meta-analysis of randomized clinical trials (RCTs), non-randomized studies of intervention (NRSIs), cohort and cross-sectional studies. The systematic review was registered in advance on PROSPERO, and was conducted following the Cochrane Handbook of Systematic Reviews of Interventions and PRISMA checklist. An electronic search in three databases (PubMed, Scopus, and Embase) was conducted by two authors to evaluate studies published from 1990 until May 2023. The review question was defined in PICOS format as follows: Population (P), subjects with permanent dentition who having/had orthodontic therapy; Exposure (E), orthodontic therapy with fixed orthodontic appliance; Comparison/Control (C), no orthodontic treatment or intervention; Outcome (O), assessing incidence and/or prevalence of initial caries lesions (ICLs) at subject and teeth levels was the primary outcome, whereas evaluating the influence of demographics and treatment-related variables were secondary outcomes; studies (S), randomized clinical trials, non-randomized clinical studies, cohort and cross-sectional studies. Meta-analysis was conducted of three or more included studies had comparable findings. The following factors were calculated for each study; sample size, number of patients with ICLs, number of teeth with ICLs, number of teeth affected per patient, and number of surfaces affected. Statistical heterogeneity of effects among studies was assessed by means of the Cochran's test was used to evaluate the statistical heterogeneity of effects in the included studies. Funnel plot approach was used to assess publication bias, whereas Begg's and Egger's correlation test were used to identify asymmetry. Meta-analysis was conducted using a random effects model owing to high methodological and clinical heterogeneity. A descriptive analysis was presented when the meta-analyses appeared inappropriate. Statistical significance level was set at p < 0.05 for all statistical analyses. 21 studies were included in the qualitative synthesis (systematic review); 11 RCTs; 7 NRSIs, and 3 observation studies. Of the included studies, 19 studies were analyzed in the quantitative synthesis (meta-analysis). In regard to the prevalence rate of ICLs; 57% of patients had ICLs, with a mean of 2.24 lesions per patient and 22% of surfaces were affected. In regard to the incidence rate; 48% of patients developed new ICLs, with a mean of 2.29 new lesions per patient, and 15% of surfaces became affected. Both prevalence and incidence rates were positively associated with the duration of the orthodontic therapy (P = 0.01 and P < 0.01, respectively), illustrating an elevation in the ICLs numbers as the treatment duration (number of months) increases. There was no association between patients' age and ICLs numbers. Orthodontic therapy using fixed appliances can increase the risk of accumulating plaque and developing caries lesion. However, other risk factors may play a role in developing ICLs; thus, controlling for these factors is paramount to better evaluate the true influence of orthodontic therapy on the ICLs development. Implementing caries preventive measures during orthodontic treatment may be needed to minimize the potential risks.

3D in vitro modeling of the exocrine pancreatic unit using tomographic volumetric bioprinting

Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer, a leading cause of cancer-related deaths globally. Initial lesions of PDAC develop within the exocrine pancreas' functional units, with tumor progression driven by interactions between PDAC and stromal cells. Effective therapies require anatomically and functionally relevantin vitrohuman models of the pancreatic cancer microenvironment. We employed tomographic volumetric bioprinting, a novel biofabrication method, to create human fibroblast-laden constructs mimicking the tubuloacinar structures of the exocrine pancreas. Human pancreatic ductal epithelial (HPDE) cells overexpressing the KRAS oncogene (HPDE-KRAS) were seeded in the multiacinar cavity to replicate pathological tissue. HPDE cell growth and organization within the structure were assessed, demonstrating the formation of a thin epithelium covering the acini inner surfaces. Immunofluorescence assays showed significantly higher alpha smooth muscle actin (α-SMA) vs. F-actin expression in fibroblasts co-cultured with cancerous versus wild-type HPDE cells. Additionally,α-SMA expression increased over time and was higher in fibroblasts closer to HPDE cells. Elevated interleukin (IL)-6 levels were quantified in supernatants from co-cultures of stromal and HPDE-KRAS cells. These findings align with inflamed tumor-associated myofibroblast behavior, serving as relevant biomarkers to monitor early disease progression and target drug efficacy. To our knowledge, this is the first demonstration of a 3D bioprinted model of exocrine pancreas that recapitulates its true 3-dimensional microanatomy and shows tumor triggered inflammation.

Relative score of early neurological deterioration in perforator artery infarction: a retrospective study

Background and aimsCompared to small vessel occlusion (SVO) patients, branch atheromatous disease (BAD) patients are more likely to develop early neurological deterioration (END). Stroke patients with END have a poor prognosis. Initial clinical features/radiological findings are often insufficient to distinguish between BAD and SVO; therefore, they may not detect END. In this retrospective study, we investigated relative factors for END in perforator artery infarction and created a scoring system for END in these patients.MethodsWe extracted data from stroke patients with perforator artery infarction admitted to the Department of Neurology at Juntendo University between January 2016 and December 2022. We examined factors, such as the presence of SVO and BAD, leading to END. Variables with a P-value < 0.1 on univariate analysis were entered into binominal logistic regression analysis.ResultsOf the 1,420 stroke patients admitted over a 7-year period, 201 with perforator infarction were included in this study. END was found in 27 of 201 patients (13.4%). Binominal logistic regression analysis of background factors less than p < 0.1 revealed that age > 69 (P = 0.032; odds ratio [OR], 3.941; 95% confidence interval [CI], 1.126–13.769), body mass index < 23.8 (P = 0.041; OR, 3.183; 95%CI, 1.049–9.654), and pretreatment with anti-platelets (P = 0.003; OR, 5.183; 95%CI, 1.783–15.071) were significant factors. Regarding anti-platelet therapy, END was observed in 34.4% of patients administered aspirin and 35.0% administered clopidogrel. Initial infarct lesion size over 15 mm on initial MRI had a P value of 0.076 in univariate analysis and an odds ratio of 1.330 (95% CI 0.471–3.755; P = 0.590) in binomial logistic regression analysis. The length of stay and modified Rankin Scale at discharge were significantly exacerbated in the END group. Creating a scoring system with 1 point for each relevant factor (pEND score), significant correlations were obtained with ROC curves, and over 2 points produced the highest sensitivity and specificity for detecting END.ConclusionPatients with high pEND scores may require intensive care from early hospitalization. In addition, the occurrence of stroke during anti-platelet therapy suggests the need for alternative treatment.

Postoperative 68Ga-DOTATATE positron emission tomography has a low yield in incidental appendiceal neuroendocrine tumours.

Rarely, appendiceal neuroendocrine tumours (NET) are an incidental finding when an appendicectomy is undertaken for suspected appendicitis. The role of further imaging in this setting is poorly defined. Positron emission tomography (PET) using 68Ga-DOTATATE is requested to evaluate post-surgical status, however, there is little evidence to guide how it should be employed. The aims of this project are to: (i) characterize 68Ga-DOTATATE PET findings in patients with incidental appendiceal NETs and (ii) discuss how these data might inform post-surgical imaging with PET. We reviewed 47 PET scans in 30 patients, undertaken from 2009 to 2018. Scintigraphic findings, histopathological characteristics of the initial appendiceal lesion and medical records were reviewed. Most patients (n = 15) had small (<10 mm) appendiceal NETs with low grade (Ki67 < 2%) features. Eight patients had tumours between 10 and 20 mm, and seven had tumours >20 mm. Goblet cell features were identified in two patients. Three positive PET scans were reported in one patient with an index tumour measuring 40 mm and Ki67 < 2%. The remaining 29 patients had 44 negative scans. Clinical outcome data were available in 27 patients (mean follow-up time 57 months; range 6-123 months). There was no evidence of recurrent neuroendocrine disease at the time of the last follow-up. These data indicate that in most cases, post-surgical 68Ga-DOTATATE PET is negative in patients with incidentally detected appendiceal NETs. Clinical outcome data suggest that 68Ga-DOTATATE PET should be reserved for patients with large tumours (>20 mm) or those displaying goblet cell features.

Correlation and predictive value of pathological complete response and ultrasound characteristic parameters in neoadjuvant chemotherapy for breast.

Breast cancer ranks as one of the most prevalent malignant tumors among women, significantly endangering their health and lives. While radical surgery has been a pivotal method for halting disease progression, it alone is insufficient for enhancing the quality of life for patients. To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy (NAC). Employing a case-control study design, this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022. According to the Miller-Payne grading system, the pathological response, i.e. efficacy, of the NAC in the initial breast lesion after NAC was evaluated. Of these, 59 patients achieved a pathological complete response (PCR), while 119 did not (non-PCR group). Ultrasound characteristics prior to NAC were compared between these groups, and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches. In the PCR group, the incidence of posterior echo attenuation, lesion diameter ≥ 2.0 cm, and Alder blood flow grade ≥ II were significantly lower compared to the non-PCR group (P < 0.05). The area under the curve values for predicting NAC efficacy using posterior echo attenuation, lesion diameter, and Alder grade were 0.604, 0.603, and 0.583, respectively. Also, rates of pathological stage II, lymph node metastasis, vascular invasion, and positive Ki-67 expression were significantly lower in the PCR group (P < 0.05). Logistic regression analysis identified posterior echo attenuation, lesion diameter ≥ 2.0 cm, Alder blood flow grade ≥ II, pathological stage III, vascular invasion, and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients (P < 0.05). While ultrasound characteristics such as posterior echo attenuation, lesion diameter ≥ 2.0 cm, and Alder blood flow grade ≥ II exhibit limited predictive value for NAC efficacy, they are significantly associated with poor response to NAC in breast cancer patients.

Diagnostic agreement between visual examination and an automated scanner system with fluorescence for detecting and classifying occlusal carious lesions in primary teeth

ObjectivesTo investigate the in vivo diagnostic agreement between visual examination (VE) using the International Caries Detection and Assessment System (ICDAS) and an automated scanner system for detecting and classifying carious lesions in primary teeth. Methods5-year-old children (n = 216) underwent VE and intraoral scanning (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark). Dental caries experience was recorded for each tooth surface using ICDAS. An automated, fluorescence-based caries scoring system was applied to eligible primary teeth occlusal surfaces on the 3D models using commercially available software. The automated system classified surfaces as sound, initial caries (ICDAS 01/02), or moderate-extensive caries (ICDAS ≥03). The diagnostic agreement was investigated using multi-level modelling and intraclass correlation coefficients. Analyses were repeated at both the initial threshold (ICDAS ≥01) and the moderate-extensive threshold (ICDAS ≥03). Results213 participants were included in the study, and 1525 primary molar occlusal surfaces were included in the analysis. The odds of detecting caries using the automated system were 46 % lower at the initial disease threshold (OR 0.54, 95 % CI 0.39–0.74) and 70 % lower at the moderate-extensive disease threshold (OR 0.30, 95 % CI 0.16–0.58) compared to VE. The intraclass correlation estimates at the initial and moderate-extensive thresholds were 0.90 (95 % CI 0.70–0.96) and 0.76 (95 % CI 0.22–0.94) respectively. ConclusionThe automated system is less likely to detect initial lesions and is more likely to underestimate lesion severity relative to visual examination using ICDAS. Clinical SignificanceClinically, using the automated tool to replace thorough visual inspection in primary teeth could result in missed opportunities to provide professional or self-care to arrest or reverse early disease. Additionally, it could misclassify moderate lesions as initial caries, potentially leading to complications associated with the delayed management of dental caries.

A 980 nm Diode Laser as an Adjunctive Therapy on the Healing of Apical Periodontitis Following Endodontic Retreatment: A Randomized Controlled Clinical Trial Study.

Introduction: Apical periodontitis is one of the common dental diseases. Microorganisms are the main reasons for these lesions; irrigations are used to remove them, but because of limited penetration, the rinsing agents may not always kill the microorganisms. Laser irradiation is effective in canal disinfection. The goal of this study was to compare the effect of calcium hydroxide (Ca(OH)2 ) and diode laser on the improvement of apical periodontitis following root canal retreatment (RCR). Methods: Twenty-four teeth of 19 patients with periapical lesions which needed RCR were divided into two groups (Ca(OH)2 and Ca(OH)2+laser irradiation [LI]). In the first session, after gutta-percha removal, cleaning, and shaping, Ca(OH)2 was used for 10 days. In the second session, in the Ca(OH)2+LI group, the irradiation utilizing a diode laser (using non-initiated 200-µm fiber, continuous wave (CW), power output of 1W) was done. The periapical radiographic healing was assessed before the retreatment and after 3-month and 6-month follow-ups by periapical index (PAI) Qrstavik. The quantitative data were analyzed (P<0.05). Results: The initial periapical lesion score was 3.75 and 3.88 in the Ca(OH)2 and Ca(OH)2+LI groups, respectively. In the Ca(OH)2 and Ca(OH)2+LI groups, 3 months after the RCR, the average periapical lesion score was 2.94 and 3.05, respectively. In the Ca(OH)2 and CA(OH)2+LI groups, 6 months after the RCR, the average periapical lesion score was 1.80 and 1.75, respectively. No significant differences were found at the 3 and 6 months between the experimental groups. Conclusion: The diode laser can reduce the periapical lesion, but there was no significant difference between CA(OH)2+LI and Ca(OH)2 at 3-month and 6-month follow-ups.

Enthesitis in IBD Patients.

Inflammatory bowel disease (IBD) is marked by chronic inflammation of the gastrointestinal tract and encompasses two major subtypes, Crohn's disease (CD) and ulcerative colitis (UC). IBD is frequently accompanied by extraintestinal manifestations (EIMs), with axial and peripheral spondyloarthritis (SpA) being the most common. Enthesitis, an inflammation of the bone insertions of capsules, ligaments, and tendons, represents an initial lesion in SpA. However, enthesitis remains an underestimated and often obscured EIM. The early detection of subclinical entheseal involvement in IBD patients using ultrasound (US) could provide an opportunity for timely intervention. US is a more feasible and affordable approach than magnetic resonance imaging (MRI). While previous meta-analyses have reported on the incidence and prevalence of SpA in IBD, specific attention to enthesitis has been lacking. Therefore, this narrative review aims to assess the current knowledge on existing IBD-SpA cohorts, focusing specifically on enthesitis.