Treatment Concepts Research Articles

Exploring pedagogues’ understanding and detection of vulnerability in Danish early childhood education and care

Abstract The conceptualisation of vulnerability among Danish pedagogues in the context of early childhood education and care (ECEC) is framed by both Danish legislation (Dagtilbudsloven, 2020) and key pedagogical concepts such as well-being, learning, development and formation (Ministry of Children and Education, 2020). Employing a phenomenological approach, this study investigated how pedagogues perceive vulnerability through interviews conducted with 15 informants. Drawing on Abbott’s key concepts of jurisdiction, diagnosis, inference and treatment, the collected data are operationalised to discern pedagogues´ different understandings of vulnerability. The findings highlight the inherent ambiguity surrounding pedagogues’ comprehension of vulnerability, closely tied to their primary responsibilities within the ECEC setting, namely, promoting well-being, facilitating learning, fostering development and enabling formation. The implications of the study shed light on the challenges faced by pedagogues in identifying vulnerability within ECEC, which encompasses both “traditional” and “new” understandings. Pedagogues tend to focus on detecting individual factors, such as personality traits and developmental disorders, or contextual factors related to a child’s family background, without considering the institutional context as a potential source of vulnerability production. This study emphasises the importance of re-evaluating current approaches to vulnerability detection in ECEC, particularly with regard to children in vulnerable positions.

Annals for Hospitalists Inpatient Notes - Key Clinical Concepts for Diagnosis and Treatment of Alcohol-Associated Hepatitis for Hospitalists.

This brief commentary summarizes what hospital medicine physicians should know about alcohol-associated hepatitis, a severe clinical entity that develops in patients with alcohol-related liver disease.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Introduction: BTK inhibitors (BTKi) monotherapy has introduced the concept of continuous treatment in CLL/SLL until disease progression, leading to several concerns like lack of deep remission, increasing risk of toxic effects and substantial cost. Therefore, time-limited treatment strategies as first line treatment of CLL/SLL were comprehensively explored and BTKi combined with chemoimmunotherapy was one of these options which could induce durable responses in young fit patients. Methods: CLL/SLL patients who were treated with iFCR as initial therapy in the First Affiliated Hospital of Nanjing Medical University were included without any genomic restrictions. Ibrutinib (420 mg daily) was given continuously for 2 years and intravenously rituximab (375 mg/m2 in day 0 of cycle 1; 500 mg/m2 in day 0 of cycle 2–6), fludarabine (25 mg/m2, days 1–3) and cyclophosphamide (250 mg/m2, days 1–3) were administered every 28-day cycle, up to maximal 6 cycles. Patients who achieved complete remission or complete remission with incomplete recovery (CR/CRi) and bone marrow (BM) undetectable MRD (uMRD) 2 years after iFCR initiation were feasible to discontinue ibrutinib maintenance. Results: 34 previously untreated, young fit CLL/SLL patients who received iFCR regimen between January 2019 and March 2021 were included in our cohort. The median age was 55 years (IQR: 48–56). IGHV was unmutated in 21 of 34 (61.8%) patients; complex karyotype was present in 11 of 34 (32.4%) patients; TP53 mutation or del(17p) was detected in 6 of 34 (17.6%) patients. CR/CRi rate and BM uMRD rate was 35.3% (12/34) and 41.2% (14/34) after 3 cycles of iFCR and increased to 55.9% (19/34) 2 months after 6 cycles in both patients who received 3 or 4 and 6 cycles of iFCR. The best CR/CRi and BM uMRD rate were both 73.5% (25/34). With the median follow-up of 33 months (range 7–42 months), the 3-year PFS and OS rate was 80.0% and 95.5% respectively. CR/CRi rate and BM uMRD rate was comparable between patients with IGHV mutated and unmutated status without TP53 aberration, while all patients with TP53 aberration failed to achieve sustainable CR/CRi or BM uMRD. Patients who achieved MRD 10-6 negative post 3 cycles of iFCR sustained remission and discontinued ibrutinib maintenance. The most common hematological adverse events were neutropenia (25/34, 73.5%) and thrombocytopenia (24/34, 70.6%), grade 3–4 neutropenia and thrombocytopenia occurred in 67.6% (23/34) and 35.3% (12/34) patients respectively. The most common non-hematological adverse events were nausea (21/34, 61.8%), fatigue (16/34, 47.1%) and vomiting (15/34, 44.1%). Conclusion: The iFCR regimen could achieve high response rate and uMRD rate as initial treatment for young fit CLL/SLL patient without TP53 aberrations with acceptable tolerability. MRD-guided iFCR courses adjustment in patients who achieved early phase remission could achieved sustainable response and reduced toxicity. Encore Abstract - previously submitted to regional or national meetings (up to <1’000 attendees) The research was funded by: This study was supported by National Natural Science Foundation of China (Grant No. 82170166, No. 82100207, No. 82170186, No. 81970146, No. 81900167), Translational Research Grant of National Clinical Research Center for Hematology (2020ZKZB01), Six Talent Peaks Project in Jiangsu Province 2019 (Grant No. WSN-001) and Youth Talent support Project in Jiangsu Province Hospital (Grant No. YNRCQN035). Keywords: Chronic Lymphocytic Leukemia (CLL), Combination Therapies No conflicts of interests pertinent to the abstract.

Importance of interdisciplinarity in modern oncology: results of a national intergroup survey of the Young Oncologists United (YOU).

Modern, personalized treatment concepts in oncology require an interdisciplinary and multiprofessional collaboration. In addition to its relevance in patient care, interdisciplinary collaboration is also becoming increasingly important in clinical research as well as medical education and resident training in oncology. Between November 2021 and March 2022, an online survey was conducted among German early career research groups, represented by Young Oncologists United (YOU). The aim was to identify the status and need for interdisciplinarity at clinic, educational, and research levels. A total of 294 participants completed the questionnaire in full. 90.7% of the respondents fully or predominantly agreed with the statement that interdisciplinary work plays a major role in their daily clinical work. 78.9% wished for more interdisciplinary collaboration. Of the 49.7% of participants who have never participated in an interdisciplinary research project, 80.1% said they would like to participate in such a study project in the future. Lack of time resources, too much organizational effort, and possible political conflicts between institutions were identified as factors that make practical implementation difficult. 74.1% declared their willingness to become active in an oncology early career research group. Interdisciplinary collaboration has become increasingly important in oncology. Networks that span different disciplines could help to promote interdisciplinary research projects among young scientists and improve exchange in professional practice and education with the implication of improved patient care.

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Background: In mantle cell lymphoma (MCL), time to relapse is a critical factor, and patients experiencing disease progression within 24 months from treatment start (POD24) have inferior survival. However, the cut-off at 24 months is arbitrary and potentially overly simplified. We aimed to quantify the impact of the timing of disease progression on overall survival, stratified by the most common first-line treatment concepts (Nordic-MCL, R-Bendamustin, and R-CHOP). Methods: Using the population-based Swedish lymphoma register, we identified all systemically treated MCL patients diagnosed between 2006 and 2018. We supplemented this with information on progression and relapse from medical chart reviews through 2022. Patients were categorized based on first-line treatment (Nordic MCL regimen, R-Bendamustin, R-CHOP, and others). POD was defined as a lack of response to primary therapy (progressive disease [PD]) or an initial response followed by a relapse. To assess the impact of POD timing on survival, we used an illness-death model with transition rates estimated using flexible parametric survival models to predict the five-year overall survival (OS) conditional on either being progression-free or experiencing POD as a smooth function of time since primary treatment. Results: A total of 1193 patients receiving systemic treatment were included. The median age at diagnosis was 70 years, and patients were followed for a median of 4 years (range 0–16 years, alive patients, six years). 33% of patients received R-Bendamustin (n = 387, median age 75 years), 30% received the Nordic MCL regimen (n = 351, median age 62 years), and 23% received R-CHOP (n = 276, median age 72 years). Almost half of the patients (48%, n = 571) experienced POD during follow-up. The five-year OS from treatment start was 47%, and progression-free survival was 32%. Among patients treated in the first line with either R-Bendamustin or the Nordic MCL protocol, those with a POD had substantially lower 5-year OS compared to patients who remained progression-free, also for POD occurring up to six years after primary treatment. For patients treated with R-CHOP, the impact of POD was largest if it occurred within 2–3 years after first-line therapy. Keyword: Aggressive B-cell non-Hodgkin lymphoma No conflicts of interests pertinent to the abstract.

Levels of astrocyte‐derived glial fibrillary acidic protein (GFAP) and S100 calcium‐binding protein B (S100B) in the cerebrospinal fluid within the early stages of Alzheimer´s Disease

AbstractBackgroundThe quantitative analysis of biomarker proteins in the cerebrospinal fluid (CSF) substantiates the clinical diagnosis of Alzheimer´s disease (AD). A substantial problem in the early diagnosis of AD is that clinical symptoms as measured by neuropsychological tests appear only after massive cell loss has already occurred in the brain. However, when the disease manifests, abeta‐ and tau‐protein levels have already become static. In this study, we asked whether concentrations of the astrocyte‐derived proteins glial fibrillary acidic protein (GFAP) and S100 calcium‐binding protein B (S100B) in CSF might serve as markers of pathophysiological events and astrocyte reactivation in the course of AD. Although, there are some previously studies reporting high GFAP levels in cerebrospinal fluid of AD group, the CSF levels of GFAP and S100B in the early course of the AD have not been reported.MethodsWe measured the levels of GFAP and S100B in the CSF of healthy control subjects (n = 90), first degree relatives of AD (parent or sibling, n = 46), subjective memory decline (SCD) (n = 211), mild cognitive impairment (MCI) (n = 114) and AD (n = 65) patients in a well‐structured cohort (DELCODE Cohort), which has a larger sample size than previous studies.ResultsAfter comparing the CSF levels of GFAP in the study groups, we found that healthy controls had significantly lower GFAP levels than AD patients (p = 0.001, Figure 1) and the MCI patients (p = 0,004, Figure 1). It might prove to be a very important evidence of the role of astrogliosis in early stages. Furthermore, no significantly differences were found in levels of S100B, although S100B mean values show also gradual increasing from SCD to AD (Figure 2). As a note to the reader, we also found that there was low correlation between the levels of glial markers (GFAP und S100B) and markers of classical biomarkers (Aβ‐42, Ratio Aβ‐42/Aβ‐40, Total‐τ, Phospho‐τ‐181) of neurodegeneration in the disease course.ConclusionThis result may prove the role of early reactive astrocytes in early stages of disease. And this finding could lead to develop another treatment concepts targeting the early reactive astrocytes.

COPD - An Underestimated Disease

COPD - An Underestimated Disease Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition with a complex clinical picture. The diagnosis is not easy to make because COPD can develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in the early detection of the disease. Suspected COPD can be confirmed by special examinations in collaboration with pulmonologists. The new GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. A short- or long-acting bronchodilator (SAMA/SABA or LAMA/LABA) is recommended for group A, and a dual long-acting bronchodilator therapy (LABA+LAMA) is recommended for group B and E. In case of blood eosinophilia (≥300 cells/µl) and/or recent hospitalization for COPD exacerbation, triple therapy (LABA+LAMA+ICS) is recommended. General practitioners are important in implementing non-pharmacological measures (smoking cessation, regular exercise, vaccinations, patient selfmanagement education). However, this also underlines the high demands of the implementation of the GOLD guideline in daily practice.

The Importance of Neuropsychology in the Early Rehabilitation of Patients with Critical Illness after Acute COVID Infection

Abstract: The current literature has insufficiently examined the potential benefits of implementing early neuropsychological interventions for critically ill patients who have experienced COVID-19. To address this research gap, we conducted a descriptive analysis of clinical and neuropsychological data from N = 29 critically ill patients with COVID-19 admitted to an early neurological rehabilitation facility. Most patients had been diagnosed with critical illness polyneuropathy (CIP), and one-third exhibited additional brain damage. Upon admission, all patients exhibited severe cognitive impairments, demonstrating significant improvement following neuropsychological therapy. Nonetheless, the neurocognitive outcomes at discharge displayed a high cognitive and psychoemotional status variability. This paper presents the neuropsychological treatment concept we employed and discusses challenges encountered while treating critically ill patients with cognitive impairments.

The Single Midline Implant in the Edentulous Mandible-Current Status of Clinical Trials.

The single midline implant in the edentulous mandible is a treatment concept that has often been controversially discussed. Nearly 30 years ago, the first available clinical results revealed high implant survival rates and remarkable improvements in oral comfort, function, patient satisfaction and oral health-related quality of life for edentulous patients compared to the situation with no implant. However, the clinical trials were predominantly conducted with a small number of patients over a short to medium follow-up period. Today, numerous clinical investigations on the single midline implant in the edentulous mandible, which increasingly include longer-term observation periods, are available. It is the aim of this overview to present the current literature and to highlight the clinical problems. This article is a 2023 update of a review published by the authors in the German language in 2021 in the German journal Implantologie. In total, 19 prospective clinical trials with a follow-up period of 0.5-10 years were analyzed. Over this observation period, single implants with modern rough implant surfaces in the edentulous mandible reveal high implant survival rates of between 90.9 and 100% when a conventional delayed loading protocol was applied.

A new paradigm for classifying and treating HER2-positive breast cancer.

Because of the phenomenal success of treatment with monoclonal antibodies and antibody-drug conjugates targeting human epidermal growth factor receptor 2 (HER2), most patients with early-stage HER2-positive breast cancer (HER2+ BC) and some with limited metastatic diseases have been cured, and those who have not been cured have achieved significant improvements in overall survival, which has weakened the role of the TNM staging system in the prognosis of HER2+ BC today. Given that the disease is now highly curable, treatment conception, classification, and modalities should differ from those of cancer types with a poor prognosis. It is warranted to build a new paradigm for classifying and treating HER2+ BC. In our personal view, we suggest that the classification system should be based not only on traditional anatomy and cancer biology but also on available treatment regimens, their exceptional outcomes, and their toxicities. In this regard, we developed a new concise classification of HER2+ BC based on the TNM staging system, a review of the literature, research results, and our clinical experience, dividing the patients into four distinct groups: curable (lymph-node negative and small (≤3 cm) early breast cancer), do our best to cure (locally advanced or tumors >3 cm early breast cancer), hope for cure (local-regional recurrent, limited metastases, and exceptional responders), and incurable (metastatic breast cancer with poor performance status or non-exceptional responders). It will assist clinicians in developing an optimal treatment regimen at the outset, curing more HER2+ BC patients and improving their quality of life.

Stabilization Tank with Respect to Detention Time for Grey Water Treatment

Abstract: Characterization and treatment of grey water; options for (re)use. PhD thesis, Wageningen University, The Netherlands. Addressing the issues of water shortage and appropriate sanitation in Jordan, domestic grey water treatment receives growing interest. Grey water comprises the domestic wastewater flows excluding waters associated with the toilet. The topics of concern for grey water are its characteristics, treatment and potentials for use after treatment. The target of this thesis is to develop a concept for treating grey water on-site for agricultural usage, thus sustaining a recycling process of grey water in Jordan. A review was made regarding the currently available grey water treatment technologies. In addition, grey water was quantitatively and qualitatively characterized, and then grey water reuse requirements including treatment, were analyzed. Biodegradability and biodegradation rates of the grey water were investigated for selecting appropriate design and operation criteria of the treatment technology to be developed. A low-tech semi-technical scale treatment system was tested to treat grey water discharges from a dormitory at the Jordan University campus. The treatment system was evaluated on obtained removal efficiencies and conformity of the effluent to the guidelines for the use of reclaimed water for irrigation in Jordan. Finally, the objectives, approaches and the results of each chapter are summarized, and then both the results and the potential of applying decentralized sanitation and reuse (DeSaR) concepts in Jordan are discussed. Results show that storage and treatment are prerequisites for any type of grey water use. Grey water is aerobically and anaerobically biodegradable but the conversion rates are low. The core of the treatment concept consists of an integrated storage and anaerobic treatment unit, fed with a natural influent flow pattern, in a down-flow mode, up to a one day operational cycle, i.e. a variable HRT ≤ 24 hours. The second step consists of an aerobic post-treatment, mechanically aerated in a down-flow mode and a one day operational cycle, i.e. 24 hours HRT. Both units need insulation in the winter period. The final effluent, stable in winter and summer, meets the Jordanian

Targeting intestinal microecology: potential intervention strategies of traditional Chinese medicine for managing hypertension.

Hypertension has become one of the major public health problems in the world. At present, the pathogenesis of hypertension has still not been completely elucidated. In recent years, an increasing evidence shows that intestinal microecology is closely related to hypertension, which provides a new thinking for the prevention and treatment of hypertension. Traditional Chinese medicine (TCM) has unique advantages in the treatment of hypertension. Taking intestinal microecology as the target, it is possible to interpreting the scientific connotation of TCM prevention and treatment of hypertension by updating the treatment concept of hypertension, so as to improve the therapeutic effect. In our study, the clinical evidence for TCM treatment of hypertension was systematicly summarized. And the relationship among TCM, intestinal microecology and hypertension was analyzed. In addition, the methods by which TCM regulates intestinal microecology to prevent and treat hypertension were presented, to provide new research ideas for prevention and treatment of hypertension.

Cessante Causa, Cessat Effectus : Cure is only Possible by Hering’s Law of Cure and with Annihilation of Existing Miasmatic Manifestation

Skin diseases in homoeopathy are regarded as Mother of all chronic diseases, so it is not neglected and considered as Causa prima - Hahnemann’s psoric manifestation and of high importance in homoeopathic totality, if found as a cause or existing along with main manifestation or alternating with other disease such as bronchial asthma etc. Similarly skin disease suppression by external application or even only by acute totality or sector totality selected homoeopathic medicine is considered of high important in miasmatic totality. This article deals with three cases where in one case skin eruption alternating with bronchial asthma and other case is having suppression of skin disease resulted to primary amenorrhoea. The last case is the case of an lady who had long back nose and its below area eruptions and subsequent ulcers suppressed by Nitric acid 10000CH caused the allergic conjunctivitis and skin allergies with lot of blackish discolurations and itching in whole body. The treatment methodology is adopted as per Hahnemann’s concept of treatment of chronic diseases i.e. Cessante causa, cessat effectus and Hering’s law of cure. The 1st case deals with Hering’s law of cure whereas 2nd case and 3rd case deals with Cessante causa, Cessat effectus. The three cases deals with practical part of taking acute totality and constitutional totality for total cure.

The Maritime Labour Convention 2006 in human rights context: An appraisal

The industry of shipping has been integral to human civilisation since its inception, and continue to be essential today. In fact, the vast majority of international trade, approximately 97%, is conducted through waterways. Seafarers are a vital part of this process, playing a critical role in ensuring the smooth operation of the global supply chain. Despite their importance, seafarers have historically not been granted fundamental rights. The International Labour Organisation (ILO) attempted to address this issue with a series of conventions and treaties between 1920 and 1996, but these legal instruments failed to produce the desired results. The "Maritime Labour Convention 2006" (MLC-2006) is a landmark convention that went into effect on 20th August 2013. It incorporates all previous ILO instruments and is regarded as the "fourth pillar" of the international maritime legal system, alongside SOLAS, MARPOL, STCW, and the "Seafarers' Bill of Rights." The aim of this study is to evaluate the MLC-2006 from the standpoint of human rights in order to determine whether it genuinely preserves seafarers' rights as a charter of rights because some believe it is an intentional attempt to restrict competitive advantage. Nonetheless, the MLC-2006's zero-favourable treatment concept creates a "level playing field" and a barrier to biased competition for every state in the worldwide maritime sector. In conclusion, this study evaluates the MLC-2006's impact on seafarers' rights and contributes to the on-going discussion around this important issue.

Changing Concepts in Treatment of ST-Segment Elevation Myocardial

ST-Segment Elevation Myocardial (STEMI) is a lifethreatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe, reperfusion as quickly as possible- the management process is complicated and is affected by multiple factors including location, patient and practitioners’ characteristics. Indeed, treatment of acute STEMI has progressed considerably over the past 100 years, from the early stages of bed rest and development of thrombolytics and myocardial reperfusion, to today’s current strategy with a variety of mechanical and pharmacologic modalities. But the debate continues regarding optimal antithrombotic/anticoagulant and interventional strategies employed. Given the scientific and technological advantages, treatment strategies can be catered to better suit the patient and their presentation. Fibrinolytic therapy did save the lives compared to placebo, but at best restored Thrombolysis in Myocardial Infarction (TIMI) 3 Flow in 55-70% cases with increased incidence of recurrent ischaemia and infarction and intracranial haemorrhage. From Primary Angioplasty in Myocardial Infarction (PAMI) to 23 RCTs of Thrombolysis in Myocardial Infarction (TIMI) Vs Lysis showed that there is significant reduction in death (7.0% Vs 9.3%), Re-infarction (2.5% Vs 6.8%), haemorrhagic stroke (0.1% Vs 1.0%) and total stroke (1.0%) in Percutaneous Coronary Intervention (PCI) group. STEMI success has plateaued because of suboptimal salvage of myocardium and high rates of non-culprit lesion related events and reperfusion injury. Promising approaches should be further explored like hypothermia, stem cell and super-saturated oxygen therapy and PiCSO to enhance myocardial recovery and reduce infarct size. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 182

ICD patients with first appropriate ICD shock: new treatment concept is associated with better outcome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with implantable cardioverter defibrillator (ICD) receiving appropriate ICD-shocks are known to have a worse prognosis. We recently developed a new treatment concept for ICD-patients with appropriate ICD shock, the ToVAMI protocol consisting of the following three steps: Trigger optimization, Ventricular Arrhythmia treatment and Medical and Interventional prognostic heart failure treatment. This protocol was implemented into clinical practice since 9/2018. Aim of the study was to evaluate the impact of the ToVAMI protocol on the outcome of patients with first appropriate ICD shock. Methods and Results A total of 255 consecutive patients of a prospective single-centre ICD-registry who received a first appropriate ICD shock between 2012 and 8/2022 were analyzed. Patients with first ICD shock between 2012 and 8/2018 (control group, n = 175) were compared to patients with first ICD shock between 9/2018 and 6/2021 who were treated according to the ToVAMI protocol (ToVAMI group n = 80). Prospective use of the ToVAMI approach increased the rate of identified triggers (42% vs. 60%), VA therapy (34% vs. 51%), and tripled the rate of optimised heart failure treatment (Table 1). Patients treated according to the ToVAMI protocol had better survival without recurrent ICD shock (73% versus 55% at two years, p = 0.02) (Figure 1). The number of recurrent ICD shocks decreased from 48% to 25% after two years (p = 0.01), and all-cause mortality showed a trend towards lower mortality after two years (19% versus 10%, p = 0.32). In a multivariate analysis adjusting for 10 parameters, the ToVAMI approach was independently associated with a lower combined endpoint of mortality and repeated ICD shocks. Conclusion The use of ToVAMI in patients with first ICD shock is associated with a reduction of the combined endpoint of mortality and recurrence of appropriate ICD shocks.

Phytochemical Compounds Involved in the Bone Regeneration Process and Their Innovative Administration: A Systematic Review.

Bone metabolism is a complex process which is influenced by the activity of bone cells (e.g., osteocytes, osteoblasts, osteoclasts); the effect of some specific biomarkers (e.g., parathyroid hormone, vitamin D, alkaline phosphatase, osteocalcin, osteopontin, osteoprotegerin, osterix, RANKL, Runx2); and the characteristic signaling pathways (e.g., RANKL/RANK, Wnt/β, Notch, BMP, SMAD). Some phytochemical compounds-such as flavonoids, tannins, polyphenols, anthocyanins, terpenoids, polysaccharides, alkaloids and others-presented a beneficial and stimulating effect in the bone regeneration process due to the pro-estrogenic activity, the antioxidant and the anti-inflammatory effect and modulation of bone signaling pathways. Lately, nanomedicine has emerged as an innovative concept for new treatments in bone-related pathologies envisaged through the incorporation of medicinal substances in nanometric systems for oral or local administration, as well as in nanostructured scaffolds with huge potential in bone tissue engineering.

Concept for the Treatment of Class III Anomalies with a Skeletally Anchored Appliance Fabricated in the CAD/CAM Process-The MIRA Appliance.

Intermaxillary elastics, anchored skeletally, represent a promising concept for treatment in adolescent patients with skeletal Class III anomalies. A challenge in existing concepts is the survival rate of the miniscrews in the mandible or the invasiveness of the bone anchors. A novel concept, the mandibular interradicular anchor (MIRA) appliance, for improving skeletal anchorage in the mandible, will be presented and discussed. In a ten-year-old female patient with a moderate skeletal Class III, the novel MIRA concept, combined with maxillary protraction, was applied. This involved the use of a CAD/CAM-fabricated indirect skeletal anchorage appliance in the mandible, with interradicularly placed miniscrews distal to each canine (MIRA appliance), and a hybrid hyrax in the maxilla with paramedian placed miniscrews. The modified alt-RAMEC protocol involved an intermittent weekly activation for five weeks. Class III elastics were worn for a period of seven months. This was followed by alignment with a multi-bracket appliance. The cephalometric analysis before and after therapy shows an improvement of the Wits value (+3.8 mm), SNA (+5°), and ANB (+3°). Dentally, a transversal postdevelopment in the maxilla (+4 mm) and a labial tip of the maxillary (+3.4°) and mandibular anterior teeth (+4.7°) with gap formation is observed. The MIRA appliance represents a less invasive and esthetic alternative to the existing concepts, especially with two miniscrews in the mandible per side. In addition, MIRA can be selected for complex orthodontic tasks, such as molar uprighting and mesialization.

¿Está indicada la radioterapia o la radioquimioterapia primaria?

Radiotherapy together with surgery and systemic treatment, represent the therapeutic triad for breast cancer patients, achieving high control and survival rates. In recent years we have witnessed a (r)evolution in the conception of breast cancer treatment. The classic scheme of surgery followed by systemic treatment and radiotherapy is falling into disuse, with the preoperative administration of systemic treatment being proposed instead, seeking to maximize its effect and favoring not only more conservative surgeries but also, in selected cases, even increasing the rates of disease-free survival and overall survival. Radiotherapy, in turn, is also evolving towards a change of perspective: preoperative administration of radiotherapy can be useful in selected groups. Advances in radiobiological knowledge, together with technological improvements that are constantly being incorporated into clinical practice, favor the administration of radiotherapy in an increasingly precise and effective manner, as well as safe even in combination with drugs in the preoperative setting. In this article, we have reviewed the usefulness of preoperative radiotherapy for breast cancer patients and the possibilities of combination with other therapies.

A-252 A SINGLE CENTER SERIES OF TRACHEA RESECTIONS FOR LOCALLY ADVANCED TUMOR INFILTRATION

Abstract Background Infiltration of the cervical-visceral axis in advanced thyroid carcinoma determines the prognosis of the patients. Complete locoregional tumour resection therefore prolongs the survival even in presence of distant metastases. Results of trachea resections performed at the University Medical Center (UMC) Mainz are presented and discussed with regard to the literature. Methods Patients who underwent neck surgery along with trachea resection in a time period from January 2007 to December 2022 were retrospectively included in the study. Surgical resection strategy and operation-associated complications were documented. Overall survival and post resection survival were analysed. Results From 2007 to 2022, at the single-center UMC Mainz 36 patients (16 female, 20 male) were treated with neck surgery with trachea resections for locally advanced carcinomas. Of these, 18 underwent trachea shaving, 15 partial trachea resection and 3 circular trachea resections. Underlying histology was papillary (16/36), follicular (8/36) and poorly differentiated (4/36) thyroid carcinoma, and 8 other diagnoses. 10 patients suffered from postoperative complications (of these, 5 patients ≥ Dindo Clavien grade 4). Tumor recurrence was registered in 5 cases, whereas 19 patients remained tumour free after the operation (tumour persistence in 12 individuals). Mean overall survival from diagnosis was 75 months, mean postoperative survival was 31 months (mean postoperative follow-up period: 31 months). Conclusion Trachea resections for locally advanced tumour infiltration are feasible within highly individualised treatment concepts.