Metallic plate stabilisation of bone grafts in craniofacial surgery

The use of Champy miniplates to stabilise bone grafts in osseous defects following craniofacial and orbital osteotomies is discussed. The advantages of these methods are decrease in operating time, accurate fit of the bone graft and the fixation of the bone graft in the plane of the plate, thus placing it exactly into the correct position in relation to the osteotomy. Total stability is obtained and, in maxillary advancement, intermaxillary fixation may not be necessary. This is useful in children and at all ages adds to the postoperative safety. There may be less relapse with this rigid internal fixation. Long term follow-up will be required to determine whether this statement is true. Although the plates are expensive, it is felt that the reduction in operating time outweighs this.     

Analysis of IGG and IGG4 in HIV-1 seropositive patients and correlation with biological and genetic markers.

We have compared the levels of immunoglobulins G (IgG) and G4 (IgG4) in extreme seropositive patients from the GRIV cohort consisting of 168 patients with slow progression (SP) and 60 with rapid progression (RP) as well as in 173 healthy controls. IgG levels were significantly higher in SP patients than in RP patients (P = 0.008), both higher than in seronegative individuals. IgG4 levels were significantly lower in SP patients than in RP patients (P = 0.001), both lower than in seronegative individuals. We tried to correlate these levels with biological parameters (CD4(+) and CD8(+) cells, total lymphocytes, white blood cell counts, percentage of CD4(+) cells, and viral load) as well as with genetic markers from Th1/Th2 cytokines (IL2, IL4, IL6, IL10, IL13, and IFNgamma). IgG levels were correlated with the percentage of CD4(+) cells in SP while IgG4 levels were correlated with CD8(+) cell count in SP and with percentage of CD4(+) cells in RP patients. Among the parameters measured in SP patients at the time of inclusion in the study, the best predictor of progression towards AIDS was the viral load, the best predictor for stability was CD4(+) cell count, but overall, the best predictor for SP evolution (stability vs. progression) appeared to be the percentage of CD4(+) cells. Interestingly, correlations between the levels of IgG or IgG4 and the cytokine gene polymorphisms were found, notably in the IL10 gene.     

Fluorescence-supported lymphography and extended pelvic lymph node dissection in robot-assisted radical prostatectomy: a prospective,randomized trial

Purpose

To demonstrate the benefits of fluorescence-supported extended pelvic lymph node dissection (ePLND) compared to regular ePLND in robot-assisted radical prostatectomy.

Methods

120 patients with intermediate- or high-risk prostate cancer were prospectively randomized (1:1): in the intervention group, indocyanine green (ICG) was injected transrectally into the prostate before docking of the robot. In both groups, ePLND was performed including additional dissection of fluorescent lymph nodes (LN) in the ICG group.

Results

After drop-out of two patients, 59 patients were allocated to the control (A) and intervention group (B) with a median PSA of 8,6 ng/ml. Median console time was 159 (A) vs. 168 (B) min (p?=?0.20) with a longer time for ICG-ePLND: 43 (A) vs. 55 min (B) (p?=?0.001). 2609 LN were found with significantly more LN after ICG-supported ePLND with a median of 25 vs. 17 LN in A (p?<?0.001). Nodal metastases were detected in 6 patients in A (25 cancerous LN) vs. 9 patients in B (62 positive LN) (p?=?0.40). In seven of nine patients, ICG-ePLND identified at least one cancer-positive LN (sensitivity 78%), 27 of 62 cancerous LN were fluorescent. Symptomatic lymphocele occurred in one patient in a and in three patients in b (p?=?0.62). After a median follow-up of 22.9 months, PSA levels were similar.

Conclusions

While ICG-ePLND seems to be beneficial for a better understanding of the lymphatic drainage and a more meticulous diagnostic approach, the sensitivity is not sufficient to recommend stand-alone ICG lymph node dissection.

     

Antagonist characterization of atypical beta adrenoceptors in guinea pig ileum: blockade by alprenolol and dihydroalprenolol

The present study was undertaken to further characterize the atypical beta adrenoceptor in guinea pig ileum. Tension was developed in isolated segments of ileum using transmural electrical stimulation of enteric cholingeric nerves. The ability of isoproterenol to relax the ileum, via beta-1 adrenoceptor and atypical beta adrenoceptor agonism, was measured. Propranolol (5 x 10(-6) M) and bromoacetylaprenololmetane blocked beta-1 adrenoceptors but, at the concentrations tested, were without affinity at atypical beta adrenoceptors. (-)-Alprenolol and (-)-dihydroalprenolol, however, acted as competitive antagonists at both sites (pA2 values of 8.2 and 8.81 at beta-1 adrenoceptors and 6.47 and 6.43 at atypical beta adrenoceptors, respectively). (-)-Alprenolol also exerted agonistic activity at the atypical beta adrenoceptor. [3H](-)-Dihydroproalprenolol failed to identify beta-1 adrenoceptors or atypical beta adrenoceptors but, instead, bound to a putative lipophilic site unrelated to ileal adrenoceptors. Before this study, nadolol (pA2 = 4.7) was the only documented antagonist at the atypical beta adrenoceptor in guinea pig ileum. Thus, the present results detail two additional pharmacological probes which exhibit about a 100-fold greater affinity than nadolol for the atypical site.     

Determination of native zinc content of alpha-2-macroglobulin in normal, hyperzincemic and hypozincemic sera by sucrose density gradient centrifugation.

Fractions of human serum proteins obtained by sucrose density gradient centrifugation were analyzed for zinc content by atomic absorption spectrophotometry and colorimetry. Zinc was found in two distinct fractions: one fraction appeared at the albumin sedimenting area, and the second fraction appeared with alpha-2-macroglobulin (alpha-2-M). Approximately 30% of total serum zinc was associated with the alpha-2-M fraction. The high purity of this alpha-2-M containing fraction was reflected by the excellent correlation of results obtained from the determination of the protein content of these fractions by Bradford method and radial immunodiffusion analysis. Further evidence of the purity of alpha-2-M in these fractions was obtained by immunoelectrophoresis. Moreover, these alpha-2-M containing fractions did not have any significant amount of trace elements that could possibly interfere with zinc determination by the dithizone method.The suitability and reliability of this method for the determination of the native zinc content of serum alpha-2-M is supported by the experimental findings that this procedure does not cause exogenous zinc contamination and is not disruptive to protein-metal interaction.Our results also indicate that native alpha-2-M contains approximately 80–100 μg Zn/g protein and that the molar ratio between zinc and alpha-2-M is approximately 1.0. This ratio was also maintained in hypo- and hyper-zincemic sera obtained from patients with multiple myeloma and lymphocytic lymphoma.     

Effects of short vs. prolonged mechanical ventilation on antioxidant systems in piglet diaphragm

Objective Prolonged controlled mechanical ventilation (MV) is known to induce diaphragmatic oxidative stress that seems to be an important factor reducing force-generating capacity. To better understand the cellular mechanisms involved, this work examined the effect of short vs. prolonged MV on antioxidant defense in the diaphragm.Design and setting Prospective, randomized, controlled animal study in a university laboratory.Methods Eleven piglets (15–20 kg) were assigned to one of two groups: a long-MV group (n=6) ventilated for 3 days or a short-MV group (n=5) ventilated for 3 h. Force frequency curves of the transdiaphragmatic pressure (Pdi) were obtained in vivo by phrenic nerve pacing. Oxidative stress was evaluated by thiobarbituric reactive substance (TBARs) content and the enzymatic antioxidant activity of both superoxide dismutase (SOD) and glutathione peroxidase (GPx) in samples of diaphragm.Results Pdi decreased in the long-MV group by 30–35% over the 3 days at all frequencies compared to the short-MV group. Diaphragm TBARs content was significantly higher and SOD activity lower in long-MV animals than in short-MV animals after 72 h. GPx activity tended to be lower in diaphragms from long-MV animals, but this difference was not significant.Conclusions This study shows that 3 days of MV in piglets is associated with a decrease in antioxidant activity which could emphasize oxidative stress and both contribute to the diaphragm dysfunction caused by MVElectronic Supplementary Material Electronic supplementary material to this paper can be obtained by using the Springer Link server located at .S. Jaber and M. Sebbane contributed equally to this study.This article refers to the editorial     

<Emphasis Type="Italic">nab</Emphasis>-Paclitaxel Plus Gemcitabine Versus Gemcitabine in Patients with Metastatic Pancreatic Adenocarcinoma: Canadian Subgroup Analysis of the Phase 3 MPACT Trial

Introduction

The phase III MPACT trial in patients with metastatic pancreatic cancer (MPC) demonstrated superior efficacy of nab-paclitaxel (nab-P) plus gemcitabine (Gem) compared with Gem monotherapy, including the primary endpoint of overall survival (OS; median 8.7 vs. 6.6 months; hazard ratio [HR] 0.72; P < 0.001). A significant treatment difference favoring nab-P + Gem over Gem was observed for OS in patients treated in North America. The majority of patients were from the US (88%) with only 12% from Canada. Healthcare systems and treatment patterns are different between the 2 countries, and there is limited published information on outcomes of Canadian patients treated with first-line nab-P + Gem. This analysis evaluated efficacy and safety outcomes in Canadian patients in the MPACT trial.

Methods

Treatment-naive patients with MPC (N = 861) received either nab-P 125 mg/m² + Gem 1000 mg/m² on days 1, 8, and 15 every 4 weeks or Gem 1000 mg/m² weekly for the first 7 of 8 weeks (cycle 1) and then on days 1, 8, and 15 every 4 weeks (cycle ≥2).

Results

The MPACT trial enrolled 63 patients in Canada. Baseline characteristics were well balanced and comparable with those of the intent-to-treat population. Both OS (median 11.9 vs. 7.1 months; HR 0.76; P = 0.373) and progression-free survival (median 7.2 vs. 5.2 months; HR 0.65; P = 0.224) were numerically longer and overall response rate (27% vs. 17%; P = 0.312) was numerically higher with nab-P + Gem vs. Gem. The most common grade ≥3 adverse events with nab-P + Gem vs. Gem were neutropenia (22% vs. 10%), fatigue (34% vs. 33%), and neuropathy (25% vs. 0%).

Conclusion

This subanalysis confirmed that nab-P + Gem is an efficacious treatment option and has a manageable safety profile in patients with MPC treated in Canada.

Trial registration

ClinicalTrials.gov identifier, NCT00844649.

Funding

Celgene Corporation, Summit, NJ, USA.