An unusual case of vaccine-associated paralytic poliomyelitis

The present article reports a case involving an immunocompetent, previously well child who, despite two previous doses of inactivated poliovirus vaccine, developed severe flaccid paralysis consistent with polio after receiving oral polio vaccine.     

Dexamethasone exposure and asparaginase antibodies affect relapse risk in acute lymphoblastic leukemia

We have previously hypothesized that higher systemic exposure to asparaginase may cause increased exposure to dexamethasone, both critical chemotherapeutic agents for acute lymphoblastic leukemia. Whether interpatient pharmaco-kinetic differences in dexamethasone contribute to relapse risk has never been studied. The impact of plasma clearance of dexamethasone and anti-asparaginase antibody levels on risk of relapse was assessed in 410 children who were treated on a front-line clinical trial for acute lymphoblastic leukemia and were evaluable for all pharmacologic measures, using multivariate analyses, adjusting for standard clinical and biologic prognostic factors. Dexamethasone clearance (mean ± SD) was higher (P = 3 × 10(-8)) in patients whose sera was positive (17.7 ± 18.6 L/h per m(2)) versus nega-tive (10.6 ± 5.99 L/h per m(2)) for anti-asparaginase antibodies. In multivariate analyses, higher dexamethasone clearance was associated with a higher risk of any relapse (P = .01) and of central nervous system relapse (P = .014). Central nervous system relapse was also more common in patients with anti-asparaginase antibodies (P = .019). In conclusion, systemic clearance of dexamethasone is higher in patients with anti-asparaginase antibodies. Lower exposure to both drugs was associated with an increased risk of relapse.     

The impact of periodontitis on oral health‐related quality of life: a review of the evidence from observational studies

Modern population based oral health management requires a complete understanding of the impact of disease in order to provide efficient and effective oral health care and guidance. Periodontitis is an important cause of tooth loss and has been shown to be associated with a number of systemic conditions. The impact of oral conditions and disorders on quality of life has been extensively studied. However, the impact of periodontitis on quality of life has received less attention. This review summarizes the literature on the impact of periodontitis on oral health‐related quality of life (OHRQoL). Relevant publications were identified after searching the MEDLINE and EMBASE electronic databases. Screening of titles and abstracts and data extraction was conducted. Only observational studies were included in this review. Most of the reviewed studies reported a negative impact of periodontitis on OHRQoL. However, the reporting standards varied across studies. Moreover, most of the studies were conducted in developed countries.     

Piccole lesioni osteolitiche: l’utilizzo della Tomografia Computerizzata Cone Beam (TCCB) per la diagnostica prechirurgica in endodonzia

ObjectivesTo describe the use of Cone Beam Computed Tomography (CBCT) in endodontic patients when first-level diagnostic techniques (intra-oral and panoramic X-rays) are inconclusive.Materials and methodsA cone beam volumetric CT scanner was used. Using multiplanar tomographic cuts (with particular emphasis on transverse cuts), we were able to detect fine osteolytic alterations and identify their topographic features with greater precision.Results and conclusionsThe cases presented show that CBCT is being increasingly recognized as a valid diagnostic aid in the field of endodontics, particularly for pre-surgical work-ups, because the radiation exposure it involves is marginal in relation to the cost/ benefit advantages it offers.     

Opposing roles of sensory and parietal cortices in awareness in a bistable motion illusion

Motion-induced blindness (MIB) is a bistable visual phenomenon in which stationary disks surrounded by a moving pattern intermittently disappear from the viewer's awareness. We explored the cortical network that subserves the MIB phenomenon by targeting its constituent parts with disruptive transcranial magnetic stimulation (TMS), in the form of continuous theta burst stimulation (cTBS). Previous neuroimaging and TMS studies have implicated the right posterior parietal cortex (rPPC) in perceptual transitions such as binocular rivalry, while the visual area V5/MT has been suggested to play a key role in MIB. In this study, we found that cTBS applied to the rPPC lengthened the duration of disappearance in MIB, while cTBS applied to V5/MT shortened the duration of disappearance and decreased the frequency of disappearance in MIB. These results demonstrate a causal role for both the rPPC and V5/MT in MIB, and suggest that the rPPC is involved in shifting resources between competing functional areas, while V5/MT processing initiates and maintains MIB.     

Electrochemotherapy Treatment of Locally Advanced and Metastatic Soft Tissue Sarcomas: Results of a Non-Comparative Phase II Study

Aims

Our aim was to evaluate the activity, toxicity, and feasibility of electrochemotherapy (ECT) in patients with soft-tissue sarcomas (STS).

Methods

A two-stage phase II trial was conducted between October 2006 and March 2012. Patients (N = 34) with locally advanced or metastatic STS, unsuitable for standard oncological treatments and with maximum 3-cm deep tumors, received an intravenous bolus of bleomycin (15,000 IU/m²), followed by tumor electroporation according to the European Standard Operating Procedures of ECT. Outcome measures included local response according to response evaluation criteria in solid tumors (RECIST), toxicity and tumor control. Feasibility measures included the accuracy of electrode placement and the intensity of electric current flowing in tumor tissue.

Results

Median tumor size was 4.0 cm (range 2–12). Objective response, assessed on 71 target lesions, was 92.2 % (complete 32.3, 95 % CI 28–64). A total of 15 patients received up to four cycles due to incomplete response, but re-treatment did not significantly improve outcome (p = 0.205). After a median follow-up of 19.3 months, 2-year local control rate was 72.5 %. Median time to local failure (N = 11 patients) was 5.1 months. Tumor response (p = 0.041) and control (p = 0.047) correlated with histological grading. Relevant toxicity consisted of G3 skin ulceration and soft tissue necrosis (35 and 23 % of patients, respectively), although this was manageable on an outpatient basis. The accuracy of electrode placement was 47.1 %, and the adequacy of electroporative current 85.3 %.

Conclusions

ECT may represent an active and safe treatment to achieve local control in advanced STS patients with symptomatic disease. Future research challenges include the improvement of electrode placement and voltage delivery together with the containment of soft tissue toxicity.