Monteggia type I equivalent lesion: diaphyseal ulna and radius fractures with a posterior elbow dislocation in an adult

BACKGROUND: A rare type I Monteggia equivalent lesion with a posterior dislocation associated with a diaphyseal radius and ulna fracture in an adult is described. The probable mechanisms of injury are speculated to include flexion of the elbow and pronation of the forearm. METHODS AND RESULTS: Early reduction of the dislocation and rigid fixation of the fractures helped to achieve excellent results.     

Five-year Follow-up Study of Tooth Extraction After Nonsurgical Endodontic Treatment in a Large Population in Taiwan

Background/Purpose: Nonsurgical retreatment, apical surgery and tooth extraction are three major untoward events following nonsurgical root canal treatment (NSRCT). The purpose of this study was to assess untoward events and total tooth extraction after NSRCT in a large population of dental patients in Taiwan. Methods: A total of 1,588,217 teeth treated with NSRCT in Taiwan in 2000 were analyzed for the first untoward event and total tooth extraction over a 5-year follow-up period. Results: The first untoward event occurred in 192,488 (12.1%) teeth within the first 5 years posttreatment. Nonsurgical retreatment was performed on 69,273 (36.0%) of these teeth, 4741 (2.5%) received apical surgery, and 118,474 (61.5%) were extracted. In addition, 1,463,312 (92.1%) teeth treated with NSRCT were retained in the oral cavity, and 124,905 (7.9%), including 24,499 (19.6%) anterior teeth, 33,356 (26.7%) premolars, and 67,050 (53.7%) molars were extracted within the 5 years of follow-up. Of these 124,905 teeth, 5869 (4.7%) were extracted after nonsurgical retreatment, 562 (0.4%) after apical surgery, and 118,474 (94.9%) after the first untoward events. There were significantly more molars (54.5% vs. 43.3%) and significantly fewer anterior teeth (19.0% vs. 27.5%) extracted in private clinics than in hospitals (p < 0.001). The overall tooth extraction rate was significantly greater in hospitals (10.0%) than in private clinics (7.7%, p < 0.001). However, tooth extraction procedures were almost evenly distributed over the 5-year follow-up period, with the annual incidence being close to 20%. The overall mean tooth extraction time was significantly greater in private clinics (2.52 +/- 1.43 years) than in hospitals (2.29 +/- 1.50 years, p < 0.001). Conclusion: We conclude that tooth extraction (61.5%) is the most common of the three untoward events, and approximately 95% of tooth extractions are performed at the time of the first untoward event. NSRCT is still a valuable dental procedure in Taiwan because of the high rate (92.1%) of tooth retention after 5 years of follow-up.     

Successful treatment of gefitinib-induced acute interstitial pneumonitis with high-dose corticosteroid: a case report and literature review

Cytotoxic chemotherapy offers a modest benefit for patients with advanced non-small cell lung cancer (NSCLC), with response rates of 20–35% and median survival of 10–12 months. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), gefitinib and erlotinib are active against lung cancer. In retrospective studies, EGFR-TKI therapy among patients harboring EGFR mutations showed response rates higher than 65% and a median survival of 20–30 months. Gefitinib is well tolerated and less toxic compared to conventional cytotoxic drugs, but gefitinib-related interstitial lung disease (ILD) has been reported as a serious adverse effect. Although the mechanism remains unknown, multivariate analysis revealed male sex, history of smoking, and the coexistence of interstitial pneumonia or pre-existence of pulmonary fibrosis and poor performance status were all significant risk factors. Here, we reported a case of gefitinib pneumonitis with severe hypoxemia and impending respiratory failure who showed poor response to intermediate dose of systemic steroids but good recovery with high-dose pulse therapy.     

Wogonin triggers apoptosis in human osteosarcoma U-2 OS cells through the endoplasmic reticulum stress, mitochondrial dysfunction and caspase-3-dependent signaling pathways

Wogonin (5,7-dihydroxy-8-methoxyflavone) is a flavone constituent of Scutellaria baicalensis with various beneficial biological activities and it has been shown to have tumor therapeutic potential in vitro and in vivo. The purpose of this study was to investigate the effects of wogonin in a human osteosarcoma cell line (U-2 OS). Results showed that a dose- and time-dependent reduction occurred in cell viability after exposure to wogonin in U-2 OS cells. Increasing the levels of reactive oxygen species (ROS) and Ca2+ but decreasing the levels of mitochondrial membrane potential (?Ψm) were examined in wogonin-treated U-2 OS cells. Flow cytometric assay indicated that wogonin induced sub-G1 phase (apoptosis) and increased caspase-3 activity in examined cells. Wogonin-induced apoptosis in U-2 OS cells was also confirmed by 4',6-diamidino-2-phenylindole (DAPI) staining. Also, results from Western blotting indicated that wogonin increased the levels of Bad, Bax, cytochrome c, cleaved caspase-9, cleaved caspase-3, AIF, Endo G, Fas/CD95, caspase-8, GADD153, GRP78, ATF-6α, calpain 1, calpain 2 and caspase-4 then leading to cell apoptosis. In conclusion, wogonin induced ROS production and intracellular Ca2+, and altered the levels of anti- (Bcl-2) and pro- (Bad and Bax) apoptotic proteins. Wogonin-induced apoptosis in U-2 OS cells was through the activation of caspase-3. In conclusion, these are the first findings to show wogonin-induced cytotoxic effects through induction of apoptotic cell death and ER stress in U-2 OS cells. The potent in vitro antitumor activities suggest that wogonin could be developed for the treatment of human osteosarcoma in the future.