Evaluation of the precision of three implant transfer impression techniques using two elastomeric impression materials

A master cast representing a completely edentulous mandible was fabricated in polyurethane resin and had four implants secured to the anterior interforaminal area. Impressions were made using six technique-material combinations. Ten definitive casts were fabricated for each technique. Linear distances between implants were measured using a traveling microscope. There was no statistically significant difference between the direct unsplinted and splinted techniques (P > .05), while the indirect technique was statistically significantly different from the other two techniques (P < .05). There was no statistically significant difference between the two impression materials.     

Change of diet, plasma lipids, lipoproteins, and fatty acids during Ramadan: a controversial association of the considered Ramadan model with atherosclerosis risk

Different Islamic populations have different alimentary habits, notably during Ramadan. The paper reports the change of diet, lipids, and lipoproteins produced during Ramadan in one Tunisian population. During Ramadan, the study subjects consumed more proteins, cholesterol, vitamin E (p<0.01), and polyunsaturated fatty acids (p<0.05). At the same time, they exhibited an increase in total cholesterol, low-density lipoprotein-cholesterol (p<0.01) and apoprotein B (p<0.05) and a decrease in the ratio of apoprotein AI to apoprotein B (p<0.01). All assayed saturated fatty acids were unaffected by Ramadan fasting while three unsaturated fatty acids (C18:1cis9, C18:2n-6, and C30:4n-6) increased significantly. A return to the habitual diet for a four-week period was not sufficient to restore the pre-fasting patterns. For the study subjects, Ramadan was clearly associated with a change of diet and biochemical profile but its effective impact on atherosclerosis risk was unclear, perhaps, because other non-alimentary changes ought to be considered too. Future studies considering the no-alimentary factors, such as sleep and physical activity, would be useful to clarify the contribution of dietary change in the observed modification of biological profile.     

Radiotherapy as a bridge to liver transplantation for hepatocellular carcinoma

About 20% of the patients with advanced hepatocellular carcinoma (HCC) who are listed for liver transplantation (LT) are eventually delisted as a result of local tumor progression. Herein, we report our experience with conformal radiotherapy (CRT) as a novel bridge to LT. From July 2006 to August 2008, CRT was delivered in five or six fractions to patients with HCC listed for LT in whom either prior local therapies had failed or those not suitable for standard local therapies because of poor liver function or anatomic issues. Radiotherapy (RT) volumes and doses were individualized to spare the uninvolved liver with the goal of stabilizing the most aggressive HCC(s) in an attempt to reduce the chance of delisting as a result of tumor progression. Ten patients with tumor diameters ranging from 25 to 108 mm were treated. Eight out of 10 tumors were beyond Milan criteria. The median age was 55 (range 36–64). Seventy percent of the patients were male subjects. The median medical MELD score was 11 (range 9–17). The median irradiated HCC volume was 79 cc (range 15–798 cc). The median RT delivered dose was 33 Gy (range 8.5–54 Gy), in one to six fractions. The median dose to the uninvolved liver was 13.3 Gy (range 1.8–16.5). Nine patients completed their CRT as planned and one patient was transplanted after the first fraction. The treatment was well tolerated: Grade 1 nausea was reported in three patients, the platelet count decreased from 154 to 98 in one patient, and there were no other complications. No treated tumors progressed during or after the treatment. Two tumors remained stable; the rest had 10–50% regression, which was sustained on follow‐up imaging. The median follow up was 14 months (range 3–20). Local tumor control was achieved in all treated tumors.Two patients were delisted as a result of cancer progression outside the treated field (one in the context of systemic metastases; yet another with progression of other untreated HCC in the liver). Three patients are still waiting for transplantation. Five patients underwent LT with no complications attributable to the CRT. Explant pathology, available for five patients, showed tumor necrosis and fibrosis with sparing of the untreated parenchyma. All transplanted patients treated with CRT are cancer‐free. CRT is a safe and efficacious local bridging therapy for patients with advanced HCC who are on the waiting list for LT. Further studies are warranted to compare the effectiveness of CRT to other local treatment regimens for HCC.     

The impact of stimulus attributes on engagement of nursing home residents with dementia

We examined the influence of stimulus attributes on the engagement of 69 nursing home residents with dementia. Specifically, we looked at work-related stimuli versus manipulative block stimuli, and whether the color, size, and material of a stimulus affect the duration and quality of engagement. Engagement was assessed using the Observational Measurement of Engagement (OME). Results revealed a clear preference for the work-related rather than manipulative block stimuli. In addition, the study participants showed a significant preference for small rather than large blocks, regardless of color or material. The effect of material and color was not statistically significant. These findings may assist nursing home caregivers who wish to provide appropriate stimuli for engaging nursing home residents with dementia.     

Natural anti-inflammatory products and leukotriene inhibitors as complementary therapy for bronchial asthma

ObjectiveTo assess the efficacy of a combination of Boswellia serrata, licorice root (Glycyrrhiza glabra) and Tumeric root (Curcuma longa) as natural leukotriene inhibitor, antiinflammatory and antioxidant products respectively in controlling bronchial asthma.Subjects and methodsThe study comprised 63 patients with bronchial asthma that are further subdivided into two groups .Group 1 receiving oral capsule (combined herb) in a soft-gelatin capsule 3 times daily for 4 weeks and group 2 receiving placebo.Plasma leukotriene C₄ (LTC₄)_, nitric oxide (NO) and malondialdehyde (MDA) levels were measured and pulmonary function was also assessed in all patients enrolled in the study.ResultsThere was a statistically significant decrease in the plasma levels of LTC₄, (MDA), and NO in target therapy group when compared with placebo group.ConclusionThe used extract contained Boswellia serrata, Curcuma longa and Glycyrrhiza has a pronounced effect in the management of bronchial asthma.     

Pretreatment clinical variables associated with the response to intravitreal bevacizumab (Avastin) injection in patients with persistent diabetic macular edema

Background

The purpose of the study is to determine whether the pre-treatment clinical systemic variables and optical coherence tomography (OCT) findings are associated with the subsequent response to the intravitreal bevacizumab (IVB) in eyes with persistent diabetic macular edema (DME).

Design

Prospective, interventional non-comparative case series study.

Methods

38 Patients (45 eyes) with refractory diabetic macular edema; 16 females, 22 males with a mean aged 57.5 year. All patients had persistent DME not responded to other forms of treatments. Complete eye examination; best corrected visual acuity (BCVA) (represented as LOGMAR for adequate statistical analysis), slit-lamp exam, intraocular pressure measurement, stereoscopic biomicroscopy of the macula, and morphologic patterns of diabetic macular edema demonstrated by OCT.All patients had intravitreal injection of 0.05 mL = 1.25 mg bevacizumab (Avastin; Genentech, Inc., San Francisco, CA), and were followed up for 3 months. The pre and post-injection follow-up data were analyzed by Student-t test and Mann–Whitney test for two main outcome measures; visual acuity (LOGMAR) and central foveal thickness (CFT) changes over a period of three months, and the data included demographic factors, type, duration and the control of diabetes mellitus (HbA1C%), grade of diabetic retinopathy, renal function (serum creatinine level), serum cholesterol, blood pressure control and previous treatment by focal laser and/or intravitreal triamcinolone injection.

Results

The LOGMAR and central foveal thickness (CRT) improved in 30/45 eyes (67%) and 32/45 eyes (72%), respectively during a mean follow-up time of three months. The mean LOGMAR visual acuities were 0.64 (SD ± 0.34), 0.61 (SD ± 0.31) and 0.60 (SD ± 0.32) at pre-injection, at 1 month post-injection and at 3 months post-injection, respectively; but this mean increase in vision was statistically not significant (P value = 0.099). The mean foveal thicknesses were 444.95 μm (SD ± 127.36), 394.95 μm (SD ± 138.03) and 378.32 μm (SD ± 112.01) at pre-injection, 1 month post-injection and 3 months post-injection, respectively, this decrease in the foveal thickness was statistically significant (P value <0.001). The pre and post-injections values of the variables for diabetic duration, diabetic control (HbA1c) and OCT pattern of macular edema showed significant statistical correlations (P < 0.05) with LOGMAR only, however the values of the variables for serum creatinine and cholesterol show statistical correlation (P < 0.05) with both LOGMAR and CFT.

Conclusions

Chronicity and inadequate control of diabetes mellitus, nephropathy, hyperlipidemia and presence of vitreomacular attachment (VMA) are factors associated with poor vision progress after intravitreal bevacizumab injection.     

Phase 2 trial of preoperative irinotecan plus cisplatin and conformal radiotherapy,followed by surgery for esophageal cancer

BACKGROUND:

Esophagectomy for locally advanced esophageal cancer (LAEC) is associated with limited survival. Trimodality therapy yields a small survival advantage, with cisplatin and 5‐fluorouracil regimens most frequently studied. Newer regimens may impact these poor outcomes. This phase 2 trial assessed the feasibility and efficacy of induction chemoradiotherapy with cisplatin and irinotecan followed by esophagectomy.

METHODS:

Patients with LAEC of the thoracic esophagus or gastroesophageal junction underwent chemotherapy with preoperative irinotecan (65 mg/m²) plus cisplatin (30 mg/m²) on Weeks 1, 2, 4, 5, 7, and 8 with concurrent conformal radiotherapy (40 grays [Gy]/20 fractions during Weeks 4‐7) and external beam boost (10 Gy/5 fractions at Week 8). Esophagectomy was performed between Weeks 12 and 16. Pathologic response was the primary endpoint with follow‐up data on progression, survival, and toxicity as secondary endpoints.

RESULTS:

Fifty‐two patients were enrolled from November 2002 to October 2005. Nineteen patients had American Joint Committee on Cancer stage II, 22 had stage III, and 11 had stage IVA disease. Grade 3 to 4 toxicity (graded according to the National Cancer Institute Common Toxicity Criteria 2.0) during induction included neutropenia (36%), febrile neutropenia (8%), diarrhea (10%), and esophagitis (4%). Three patients withdrew from treatment due to toxicity. There was 1 treatment‐related death. Clinical responses included complete response in 2%, partial response in 30%, stable disease in 62%, and progressive disease in 6% of patients. Dysphagia improved/resolved in 72% of patients during induction. Forty‐three patients underwent esophagectomy and 7 (16%) achieved pathologic complete responses. Median and 3‐year overall survival for patients receiving trimodality therapy was 36 months and 51%, respectively.

CONCLUSIONS:

In LAEC, concurrent irinotecan/cisplatin and radiotherapy followed by esophagectomy is reported to be associated with dysphagia improvement in 72% of patients, a significant but manageable toxicity profile, and encouraging survival compared with historic controls. Cancer 2010. © 2010 American Cancer Society.