Managing the Edentulous Dry Mouth: The Two Part Mandibular Denture

Treatment of patients suffering from xerostomia can be a challenge and more so in the completely edentulous. The difficulties encountered can be troublesome and at times may lead to complete failure of the prosthesis. Xerostomia may occur due to a number of reasons. Here is a report of an attempt at the fabrication of complete denture in one such case. The technique involves incorporation of a salivary reservoir in the denture in which a salivary substitute is added. A case report is hereby presented illustrating the technique.     

Prospective Randomized Comparison of Open versus Transperitoneal Laparoscopic Ureterolithotomy: Experience of a Single Center from Northern India

Aim

Prospective randomized study on transperitoneal laparoscopic ureterolithotomy (TPLU) versus open ureterolithotomy (OU) for treatment of large impacted ureteric stones (≥ 1.5 cm) and assessment of overall results.

Material & Methods

In a prospective study between 2010 to 2012, 30 patients underwent TPLU and 30 OU based on 1:1 randomization. The operation was indicated primarily in 44 cases or after failed shock-wave lithotripsy/ureteroscopy in 16 cases. Two groups were compared for operative time, success rate, visual pain score, analgesic requirement, hospital stay, and postoperative complications. Statistical analysis was performed with SPSS® version 16.0 using Fisher exact or Mann-Whitney U tests with p < 0.05 considered statistically significant.

Results

The difference in visual pain score (6.2 in TPLU group vs 3.1 in OU group on day 1; 4.8 vs. 2.4 on day 2) and tramadol requirements (184.32 mg in TPLU group vs. 150.87 mg in OU group on day 1; 97.34 mg vs. 65.56 mg on day 2) were statistically significant and more in OU. Hospital stay and convalescence were significantly lower in the TPLU. However, stone removal in one attempt was similar in both the groups.

Conclusion

Although successful stone removal rates are equal in both groups, TPLU is associated significantly with less postoperative pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison to OU.Key Words: Laparoscopy, Ureterolithotomy, Ureteral calculus     

VALIDITY OF AN MRI-COMPATIBLE MOTION CAPTURE SYSTEM FOR USE WITH LOWER EXTREMITY NEUROIMAGING PARADIGMS

Background:Emergent linkages between musculoskeletal injury and the nervous system have increased interest to evaluate brain activity during functional movements associated with injury risk. Functional magnetic resonance imaging (fMRI) is a sophisticated modality that can be used to study brain activity during functional sensorimotor control tasks. However, technical limitations have precluded the precise quantification of lower-extremity joint kinematics during active brain scanning. The purpose of this study was to determine the validity of a new, MRI-compatible motion tracking system relative to a traditional multi-camera 3D motion capture system for measuring lower extremity joint kinematics.Methods:Fifteen subjects (9 females, 6 males) performed knee flexion-extension and leg press movements against guided resistance while laying supine. Motion tracking data were collected simultaneously using the MRI-compatible and traditional multi-camera 3D motion systems. Participants’ sagittal and frontal plane knee angles were calculated from data acquired by both multi-camera systems. Resultant range of angular movement in both measurement planes were compared between both systems. Instrument agreement was assessed using Bland-Altman plots and intraclass correlation coefficients (ICC).Results:The system demonstrated excellent validity in the sagittal plane (ICCs>0.99) and good to excellent validity in the frontal plane (0.84 < ICCs < 0.92). Mean differences between corresponding range of angular movement measurements ranged from 0.186 ° to 0.295 °.Conclusions:The present data indicate that this new, MRI-compatible system is valid for measuring lower extremity movements when compared to the gold standard 3D motion analysis system. As there is growing interest regarding the neural substrates of lower extremity movement, particularly in relation to injury and pathology, this system can now be integrated into neuroimaging paradigms to investigate movement biomechanics and its relation to brain activity.Level of Evidence:3     

Vesicular stomatitis virus expressing interferon-β is oncolytic and promotes antitumor immune responses in a syngeneic murine model of non-small cell lung cancer

Vesicular stomatitis virus (VSV) is a potent oncolytic virus for many tumors. VSV that produces interferon-β (VSV-IFNβ) is now in early clinical testing for solid tumors. Here, the preclinical activity of VSV and VSV-IFNβ against non-small cell lung cancer (NSCLC) is reported. NSCLC cell lines were treated in vitro with VSV expressing green fluorescence protein (VSV-GFP) and VSV-IFNβ. VSV-GFP and VSV-IFNβ were active against NSCLC cells. JAK/STAT inhibition with ruxolitinib re-sensitized resistant H838 cells to VSV-IFNβ mediated oncolysis. Intratumoral injections of VSV-GFP and VSV-IFNβ reduced tumor growth and weight in H2009 nude mouse xenografts (p < 0.01). A similar trend was observed in A549 xenografts. Syngeneic LM2 lung tumors grown in flanks of A/J mice were injected with VSV-IFNβ intratumorally. Treatment of LM2 tumors with VSV-IFNβ resulted in tumor regression, prolonged survival (p < 0.0001), and cure of 30% of mice. Intratumoral injection of VSV-IFNβ resulted in decreased tumor-infiltrating regulatory T cells (T_reg) and increased CD8⁺ T cells. Tumor cell expression of PDL-1 was increased after VSV-IFNβ treatment. VSV-IFNβ has potent antitumor effects and promotes systemic antitumor immunity. These data support further clinical investigation of VSV-IFNβ for NSCLC.     

Phosphorylation of interleukin (IL)-24 is required for mediating its anti-cancer activity

Interleukin (IL)-24 is a tumor suppressor/cytokine gene that undergoes post-translational modifications (PTMs). Glycosylation and ubiquitination are important for IL-24 protein stabilization and degradation respectively. Little is known about IL-24 protein phosphorylation and its role in IL-24-mediated anti-tumor activities. In this study we conducted molecular studies to determine whether IL-24 phosphorylation is important for IL-24-mediated anti-cancer activity.Human H1299 lung tumor cell line that was stably transfected with a doxycycline (DOX)-inducible (Tet-on) plasmid vector carrying the cDNA of IL-24-wild-type (IL-24^wt) or IL-24 with all five phosphorylation sites replaced (IL-24^mt) was used in the present study. Inhibition of tumor cell proliferation, cell migration and invasion, and induction of G2/M cell cycle arrest was observed in DOX-induced IL-24^wt-expressing cells but not in IL-24^mt-expressing cells. Secretion of IL-24^mt protein was greatly reduced compared to IL-24^wt protein. Further, IL-24^wt and IL-24^mt proteins markedly differed in their subcellular organelle localization. IL-24^wt but not IL-24^mt inhibited the AKT/mTOR signaling pathway. SiRNA-mediated AKT knockdown and overexpression of myristolyated AKT protein confirmed that IL-24^wt but not IL-24^mt mediated its anti-cancer activity by inhibiting the AKT signaling pathway.Our results demonstrate that IL-24 phosphorylation is required for inhibiting the AKT/mTOR signaling pathway and exerting its anti-cancer activities.     

Fluorescence-enhanced Robotic Radical Prostatectomy Using Real-time Lymphangiography and Tissue Marking with Percutaneous Injection of Unconjugated Indocyanine Green: The Initial Clinical Experience in 50 Patients

Background

Pilot studies have demonstrated the utility of indocyanine green (ICG) sentinel lymphadenectomy for prostate cancer. Prior work has used ICG with radiocontrast agents injected at a separate procedure and relied on assistant-controlled fluorescence systems, making the technique costly and cumbersome.

Objective

To describe the initial optimization and feasibility of fluorescence-enhanced robotic radical prostatectomy (FERRP) using real-time injection of ICG for tissue marking and identification of sentinel lymphatic drainage visualized by a fully integrated surgeon-controlled system.

Design, setting, and participants

Patients with clinically localized prostate cancer at a tertiary referral center were offered FERRP. Ten patients participated in a pilot arm in which ICG dosing and injection technique were optimized. Fifty consecutive patients then underwent FERRP.

Surgical procedure

After development of the space of Retzius, 0.4 ml of a 2.5 mg/ml ICG solution were injected into each lobe of the prostate using a robotically guided percutaneous needle. After ICG was allowed to travel through the pelvic lymphatics, lymphadenectomy was performed from the endopelvic fascia to the aortic bifurcation.

Outcome measurements and statistical analysis

Parameters describing the time course of tissue fluorescence and pelvic lymphangiography were systematically recorded. Lymphatic packets containing fluorescent nodes were considered sentinel.

Results and limitations

Percutaneous, robotic-guided ICG injection proved superior to cystoscope or transrectal delivery. Tissue marking was achieved in all patients, positively identifying the prostate with uniform fluorescence relative to the obturator nerve, seminal vesicles, vas deferens, and neurovascular pedicles at a mean time of 10 min postinjection. Sentinel nodes were identified in 76% of patients at a mean time of 30 min postinjection and had 100% sensitivity, 75.4% specificity, 14.6% positive predictive value, and 100% negative predictive value for the detection of nodal metastasis.

Conclusions

FERRP is safe, feasible, and allows for reliable prostate tissue marking and identification of sentinel lymphatic drainage in the majority of patients. ICG sentinel nodes are highly sensitive but relatively nonspecific for the detection of nodal metastasis.     

Distal tibia fractures and medial plating: factors influencing re-operation

Purpose

We compared types of complications leading to re-operations in open and closed distal tibia fractures treated by locking or nonlocking medial plates.

Methods

Ninety-three patients from 2002 to 2012 who underwent open reduction and internal fixation (ORIF) and medial plating for distal extra-articular or partial articular tibia fractures were identified. Charts were retrospectively reviewed to determine the incidence of re-operation based on the type of complication that developed. Fisher’s exact and chi-square tests were performed to analyze the incidence of complications based on injury and type of plate used.

Results

Thirty-three (35.5 %) patients required re-operations: 28.6 % (n = 16) with closed injuries had complications leading to re-operations compared with 45.9 % (n = 17) of patients with open injuries (p = 0.12). Patients with closed injuries were more likely to require re-operation due to hardware pain/prominence (p = 0.03), whereas patients with open injuries were more likely to require re-operation due to nonunion (p = 0.04). There were no significant differences in infection (p = 0.66) or malunion (p = 0.99) between groups. Locking plates showed higher costs but were not associated with decreased risk of re-operation.

Conclusions

There was a high re-operation rate associated with distal tibia medial plating, with significant differences in the reason for re-operation between open versus closed groups. Complication rates were not influenced by the use of locking plates. Results of this study suggest that methods be considered to reduce re-operation based on type of fracture, such as early bone grafting or the use of alternate implants for open fractures.