Microanchor mediated upper molar intrusion in deep posterior bite after long-term edentulousness for prosthetic reconstruction with dental implants

Introduction

Long-term edentulousness can lead to elongation of antagonistic teeth, making prosthetic rehabilitation impossible. An interdisciplinary case is presented where elongated teeth were successfully intruded by micoranchor-mediated orthodontic movement.

Discussion

To the right mandible, implants had been inserted correspondingly to the alveolar process height. However, the patient waited over 1 year for prosthetic treatment. The antagonistic maxillary teeth had elongated considerably. On the left side, elongated upper molars occluded with previously crowned and in the meantime unprovided teeth 35 and 37. On the right side, two palatal, three vestibular microanchors of 8 mm length and 1.6 mm diameter were used, on the left side, two palatal and two vestibular microanchors to intrude the teeth 14 to 17 and 26. The screwheads were connected to individually model-casted splints for bodily intrusion of the molars.

Conclusion

This case illustrates how vertical tooth movements can be ventured by the use of orthodontic microscrews before either conventional or implant-borne prosthetic rehabilitation.     

Visual attention to variation in female facial skin color distribution

Objectives  Visible skin condition of women is argued to influence human physical attraction. Recent research has shown that people are sensitive to variation in skin color distribution, and such variation affects visual perception of female facial attractiveness, healthiness, and age.
Methods  The eye gaze of 39 males and females, aged 13 to 45 years, was tracked while they viewed images of shape- and topography-standardized stimulus faces that varied only in terms of skin color distribution.
Results  The number of fixations and dwell time were significantly higher when viewing stimulus faces with the homogeneous skin color distribution of young people, compared with those of more elderly people. In accordance with recent research, facial stimuli with even skin tones were also judged to be younger and received higher attractiveness ratings. Finally, visual attention measures were negatively correlated with perceived age, but positively associated with attractiveness judgments.
Conclusions  Variation in visible skin color distribution (independent of facial form and skin surface topography) is able to selectively attract people's attention toward female faces, and this higher attention results in more positive statements about a woman's face.     

Typically atypical: histiocytoid Sweet syndrome, associated with malignancy

Sweet syndrome (acute febrile neutrophilic dermatosis) is characterized by a dramatic onset of high fever, neutrophilia and typical skin lesions. About 20 % of patients have an associated malignancy, most commonly hematologic diseases. Chronic and paucisymptomatic manifestations of Sweet syndrome may be misdiagnosed or misinterpreted as harmless, resulting in delayed diagnosis. "Atypical" manifestations are especially suspicious for associated malignancies. This is demonstrated by a 39-year old patient with chronic and afebrile disease who was referred to our clinic only after symptoms had persisted for several months. By that point, an underlying nodular lymphocyte predominant Hodgkin's lymphoma had already reached an advanced stage. Skin biopsies revealed dermal infiltrates of histiocytoid cells of myelogenous origin, supporting a diagnosis of histiocytoid Sweet syndrome. Specific cutaneous infiltrates associated with myelogenous leukemia were ruled out.     

Distribution of intraperitoneally injected diclofenac in brown trout (Salmo trutta f. fario)

The detection of low levels of pharmaceuticals in aquatic environments has lately raised concerns regarding possible adverse effects of these highly active substances on aquatic organisms. The non-steroidal anti-inflammatory drug diclofenac (DCF) is one of the pharmaceutical substances regularly detected in surface waters and has lately been demonstrated to elicit adverse effects in salmonid species at environmentally relevant concentrations. The aim of the present study was to investigate the distribution of DCF in indigenous brown trout (Salmo trutta f. fario) following intraperitoneal (i.p.) injection of a single dose of (14)C-labelled DCF. A distribution kinetic over 36 h provides information on possible accumulation of DCF in different organs as well as on DCF detoxification in trout, possibly enabling identification of sites of preferential toxicity. Approximately 57% of the total single DCF dose appeared in the bile 6 h after i.p. application. Subsequently, DCF was observed to undergo enterohepatic cycling with an amount of (14)C-activity comparable to the 6 h bile values reappearing in bile 36 h after application. Results for (14)C-activity in intestine and pylori support the observation of enterohepatic cycling with a small peak in intestine at 3 h post i.p. injection and a low peak in intestine and pylori at 6 h post i.p. injection, reflecting presence of the drug substance in bile. The highest activity in intestine was found 24 h post-injection coinciding with low levels in bile, followed by a gradual decrease of activity in intestine mirroring the re-uptake of DCF into bile. The finding of enterohepatic cycling of DCF in brown trout is suggestive of a prolonged retention of DCF in brown trout.     

Magnetic resonance imaging of the breast: Recommendations from the EUSOMA working group

The use of breast magnetic resonance imaging (MRI) is rapidly increasing. EUSOMA organised a workshop in Milan on 20–21st October 2008 to evaluate the evidence currently available on clinical value and indications for breast MRI. Twenty-three experts from the disciplines involved in breast disease management – including epidemiologists, geneticists, oncologists, radiologists, radiation oncologists, and surgeons – discussed the evidence for the use of this technology in plenary and focused sessions. This paper presents the consensus reached by this working group. General recommendations, technical requirements, methodology, and interpretation were firstly considered. For the following ten indications, an overview of the evidence, a list of recommendations, and a number of research issues were defined: staging before treatment planning; screening of high-risk women; evaluation of response to neoadjuvant chemotherapy; patients with breast augmentation or reconstruction; occult primary breast cancer; breast cancer recurrence; nipple discharge; characterisation of equivocal findings at conventional imaging; inflammatory breast cancer; and male breast. The working group strongly suggests that all breast cancer specialists cooperate for an optimal clinical use of this emerging technology and for future research, focusing on patient outcome as primary end-point.     

Dose-intensified epirubicin versus standard-dose epirubicin/cyclophosphamide followed by CMF in breast cancer patients with 10 or more positive lymph nodes: Results of a randomised trial (GABG-IV E-93) – The German Adjuvant Breast Cancer Group

To compare dose-intensified epirubicin monotherapy with a standard sequential regimen, patients with primary breast cancer and ?10 involved axillary nodes were randomised to either four 21-day cycles of epirubicin 120 mg/m² (E120; n = 202) or four 21-day cycles of epirubicin 90 mg/m² plus cyclophosphamide 600 mg/m² (EC) followed by three 28-day cycles of cyclophosphamide, methotrexate and 5-fluorouracil (CMF; n = 209). Simultaneous hormonal treatment was applied in both arms. At 5 years’ median follow-up, the 5-year event-free survival (EFS) rates were 47.7% (95% confidence interval [CI], 40.2–55.2%) for E120 and 45.9% (38.5–53.3%) for EC-CMF. E120 was as effective as EC-CMF with regard to EFS (hazard ratio [HR] for E120 versus EC-CMF 1.04; 95% CI, 0.79–1.36; p = 0.79) and overall survival (HR 1.06; 95% CI 0.77–1.46; p = 0.72). The data demonstrate that 4 cycles of dose-intensified epirubicin monotherapy can be as effective as 7 cycles of standard sequential polychemotherapy in high-risk breast cancer patients with ?10 positive lymph nodes, despite treatment with a single agent and a shorter treatment duration.     

Continuous administration of sorafenib in combination with transarterial chemoembolization in patients with hepatocellular carcinoma: results of a phase I study

Background and Aim.

It is unknown whether sorafenib can be combined with transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma. This study assesses the safety and tolerability of a continuous regimen of sorafenib combined with TACE.

Methods.

This was an open-label phase I study testing a continuous administration of sorafenib (dose escalation from 200 mg twice daily [bid] to 400 mg bid) starting 7 days prior to TACE with doxorubicin (50 mg).

Results.

Twenty-one patients were screened and 14 received sorafenib combined with TACE. Because there were no dose-limiting toxicities in the first three patients who received sorafenib at a dose of 200 mg bid, subsequent patients received 400 mg bid. Twenty-seven procedures were performed (median, two per patient) and two local therapy–related severe adverse events occurred. The median duration of sorafenib therapy was 246 days (range, 14–547 days). Sorafenib-related adverse events of grade ≥3 were hand–foot skin reaction (n = 3), weight loss (n = 2), diarrhea (n = 1), abdominal pain (n = 1), and thrombocytopenia (n = 3). After treatment with sorafenib and TACE, there was a significant decrease in the concentration of plasma vascular endothelial growth factor (VEGF) from 93 ng/l to 67 ng/l.

Conclusions.

Continuous administration of sorafenib at a dose of 400 mg bid combined with TACE was tolerable. The adverse event profile of this regimen was comparable with that of sorafenib monotherapy with the exception of thrombocytopenia, which may be more frequent. There were no increases in the circulating VEGF levels after TACE with this combined regimen. (Swiss Association for the Study of the Liver study number 25; ClinicalTrials.gov trial identifier, {"type":"clinical-trial","attrs":{"text":"NCT00478374","term_id":"NCT00478374"}}NCT00478374).     

Wo steht die Kosten-Nutzen-Bewertung des IQWiG

Standardization of international health economic guidelines has been repeatedly requested. In this context, an international reference case was proposed, which constitutes an agreed approach for the key elements of health economic evaluation including study perspective, comparators, source of effectiveness data, role of modeling, main (economic) outcome, source of utilities, characterizing uncertainty. It is, however, questionable whether such a reference scenario can reasonably be applied across all health care systems. Our analysis pursues the question to which degree the Institute for Quality and Efficiency in Health Care’s (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) “General methods for evaluating the relation between cost and benefit” comply with the key elements of the reference case. In case of divergences, they will be described and discussed in light of the German social legislation and in consideration of current scientific evidence. In conclusion, the analysis revealed that IQWiG complied with the reference case in almost all aspects. Differences were found only with respect to the choice of main (economic) outcome and the source of utilities. These differences seem justified and well explained in the context of the German social legislation as well as in view of the weaknesses of the quality-adjusted life year (QALY) concept.     

Trend in active transportation to school among Swiss school children and its associated factors: three cross-sectional surveys 1994, 2000 and 2005

Background  

Giving the rising trend in childhood obesity in many countries including Switzerland, strategies to increase physical activity such as promoting active school travel are important. Yet, little is known about time trends of active commuting in Swiss schoolchildren and factors associated with changes in walking and biking to school.