Value of shoulder US compared to MRI in infants with obstetric brachial plexus paralysis

PURPOSEChildren with brachial plexus birth injury (BPBI) may eventually develop glenohumeral instability due to development of unbalanced muscular strength. Our major goal in this study is to compare the accuracy of physical examination and ultrasonography (US) in determination of glenohumeral instability in infants with BPBI compared with magnetic resonance imaging (MRI) as a gold standard, and to investigate the role and value of US as a screening modality for assessing glenohumeral instability.METHODSForty-two consecutive patients (mean age, 2.3±0.8 months) with BPBI were enrolled into this prospective study. Patients were followed up with physical examination and US with dynamic evaluation in 4–6 weeks intervals. Patients who developed glenohumeral instability based on physical examination and/or US (n=21) underwent MRI. Glenohumeral instability was defined as alpha angle >30° and percentage of posterior humeral head displacement >50%. Diagnostic accuracy of physical examination and US was calculated and quantitative parameters were compared with Wilcoxon test.RESULTSGlenohumeral instability was confirmed with MRI in 15 of 21 patients. Accuracy and sensitivity of physical examination and US were 47%, 66% and 100%, 100%, respectively in determination of glenohumeral instability. No significant difference was found for the alpha angle (p = 0.173) but the percentage of posterior humeral head displacement was statistically significant between US and MRI (p = 0.028).CONCLUSIONOur results indicate that US with dynamic evaluation is a good alternative for MRI in assessment of glenohumeral instability in infants with BPBI, since it is highly accurate and specific, and quantitative measurements used for glenohumeral instability were comparable to MRI. US can be used as a screening method to assess glenohumeral instability in infants with BPBI.

Children with brachial plexus birth injury (BPBI) may eventually develop glenohumeral instability (GI) due to development of unbalanced muscular strength. Shoulder related problems in patients with BPBI include internal rotation contracture, impaired physeal growth, and articular changes (glenoid retroversion and posterior glenoid deformation) (1, 2). Despite the fact that GI is most commonly believed to develop gradually after birth, the exact timing is not clear (3, 4). In order to prevent the development of osseous deformity, early diagnosis and intervention of GI is critical (5–7). Recent studies showed that development of GI can be detected with ultrasonography (US) as early as 3 months of age (8, 9). Clinical diagnosis of GI can be challenging and imaging modalities are important for the evaluation of stability of the joint (2). Because of the lack of ossification in the humeral head and glenoid, conventional radiographs and computerized tomography have only minor roles in the assessment of GI (10, 11). Although magnetic resonance imaging (MRI) is the current gold standard imaging modality for dysplasia in the whole age spectrum, US is also a very promising modality that can be used for this purpose. Since it is cost effective and, unlike MRI, requires no anesthesia, frequent follow-up examinations are possible with US (1, 2, 9, 12, 13). Furthermore, it is also possible to perform dynamic examination and assess the reducibility of the humeral head with US (13), which can be used as a good indicator for GI. In the literature, a variety of quantitative parameters has been used to assess the presence of GI but the alpha (α) angle and the percentage of posterior humeral head displacement (PPHHD) are the most valuable parameters for overall evaluation of the GI (2, 12, 14). Intra- and interobserver reliability of these measurements was shown to be good to excellent for US (12, 15) but there was poor agreement between US and MRI (15).The major goal of our study is to compare the accuracy of primary physical examination and US in infants with BPBI and determine whether the diagnostic success of US is comparable to MRI, the current gold standard modality. In addition, the secondary objective of this study is to assess the agreement between US and MRI measurements for detecting GI in this patient population.     

Can previously bleached teeth be bonded safely using self-etching primer systems?

OBJECTIVE: To test the null hypothesis that there is no statistical significance in (1) bond strength and (2) failure site location with bleached and unbleached enamel prepared with Transbond Plus Self-etching Primer between different time intervals. MATERIALS AND METHODS: Sixty freshly extracted human premolar teeth were randomly divided into three groups of 20 teeth each. Bleaching treatment was performed at two different time intervals (bleaching immediately before bonding and bleaching 30 days before bonding). All brackets were bonded with a self-etching primer system. The shear bond strength of these brackets was measured and recorded in MPa. Adhesive remnant index (ARI) scores were determined after the brackets failed. Data were analyzed with analysis of variance, Tukey, and chi2 tests. RESULTS: The bond strengths of group 1 (no bleaching, mean: 17.60 +/- 7.93 MPa) and group 3 (bleaching 30 days before bonding, mean: 13.95 +/- 5.23 MPa) were significantly higher (P < .05) than that of group 2 (bleaching immediately before bonding, mean: 11.45 +/- 5.25 MPa). No statistically significant differences were found between groups 1 and 3 (P > .05). ARI scores were significantly different among the three groups. In groups 1 and 2, there was a higher frequency of ARI scores of 2 to 4, indicating cohesive failures within the resin. In group 3, the failures were shown to be adhesive (resin/enamel interface) and cohesive characteristics. CONCLUSION: The use of a carbamide peroxide bleaching agent immediately before bonding significantly reduces the shear bond strength values of self-etching primer systems.     

Phase II trial of saracatinib (AZD0530), an oral SRC-inhibitor for the treatment of patients with hormone receptor-negative metastatic breast cancer

Background

SRC activation is associated with cell migration, proliferation, and metastasis. Saracatinib is an oral tyrosine kinase inhibitor (TKI) selective for SRC. We performed this trial to evaluate the efficacy and safety of saracatinib monotherapy in patients with estrogen receptor (ER)^– and progesterone receptor (PR)^– metastatic breast cancer (MBC).

Patients and Methods

Patients who had undergone ≤ 1 previous chemotherapy regimen for measurable ER^– and PR^– MBC received saracatinib 175 mg orally daily. The primary endpoint was disease control defined as complete response (CR) + partial response (PR) + stable disease (SD) > 6 months. Secondary endpoints included toxicity and progression-free survival (PFS). Levels of circulating tumor cells (CTCs) in response to therapy were measured over time.

Results

Nine patients were treated on study. After a median of 2 cycles (range 1-3), no patient had achieved CR, PR, or SD >6 months. The median time to treatment failure was 82 days (12-109 days).The majority (89%) of patients discontinued saracatinib because of disease progression. One patient acquired potentially treatment-related grade 4 hypoxia with interstitial infiltrates and was removed from the study. Common adverse events included fatigue, elevated liver enzymes, nausea, hyponatremia, dyspnea, cough, and adrenal insufficiency.

Conclusions

These efficacy results were not sufficiently promising to justify continued accrual to this study. Based on this series, saracatinib does not appear to have significant single-agent activity for the treatment of patients with ER⁻/PR⁻ MBC.     

Effect of acute and chronic exercise on oxidant-antioxidant equilibrium in rat hippocampus, prefrontal cortex and striatum

Although regular physical exercise is beneficial to the body, it is well known that exhaustive exercise causes oxidative stress in muscle. Recent studies suggest that regular moderate physical exercise has the beneficial effects on brain. There is a little information regarding whether or not exercise could generate oxidative stress in the brain and the findings are conflicting. The aim of this study was to investigate the effects of acute and chronic exercise on thiobarbituric acid reactive substances, as an indicator of lipid peroxidation, in the hippocampus, which has a high concentration of glucocorticoid receptors, and prefrontal cortex and striatum, which have high dopamine content. Additionally we examined antioxidant enzyme activities, superoxide dismutase and glutathione peroxidase and nitrite-nitrate levels to assess the effects of reactive oxygen and nitrogen species. In this study it was shown that acute treadmill exercise at different strengths did not cause oxidative stress in prefrontal cortex, striatum and hypocampus regions of the brain. Regular treadmill exercise performed at different strengths was shown not to cause oxidative stress in prefrontal cortex, striatum and hippocampus regions of brain. As a result, we propose that acute and chronic exercise do not cause oxidant stress in prefrontal cortex, striatum and hippocampus and chronic exercise has a favorable effect on hippocampus, possibly by decreasing superoxide radical formation.     

Effect of resin-removal methods on enamel and shear bond strength of rebonded brackets

The objective of this study is to determine (1) the effect of different resin-removal methods on shear bond strength (SBS) of rebonded brackets, (2) condition of the enamel surface, (3) time spent to remove resin remnants, and (4) the location of the bond failure. A total of 80 premolars were included in the study. Fifty of them were divided into five groups and bonded using Light Bondtrade mark sealant and Quick Curetrade mark adhesive. Ten of the samples were debonded, and the SBS of the first debonding was calculated. Forty brackets were debonded using pliers and examined by an optical microscope (16x) to determine the location of the bond failure interface, using a modified Adhesive Remnant Index (ARI). The remnant adhesives were cleaned with four methods: (1) low-speed tungsten-carbide bur (TCB), (2) high-speed TCB, (3) Sof-Lex finishing disks, and (4) microetcher. The brackets were rebonded, and a second set of SBS and ARI values were calculated and statistically evaluated. Thirty of the premolars were divided into five groups receiving the same resin-removal methods and examined by scanning electron microscope. Rebonded teeth had a greater SBS than the initial bonding, except in group 4. The rebonded SBS values were similar in groups 1-3, and only group 4 showed a statistical difference. Sof-lex discs were the most time-consuming procedures and left much adhesive remnant. The high-speed TCB was found to be the most hazardous to the enamel. The scarring of enamel after the debonding is inevitable but can be reduced.     

Anterior sacral meningocele simulating ovarian cyst

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We report a case of an anterior sacral meningocele that was mimicking an ovarian cyst.     

The effect of exercise on urinary gamma-glutamyl transferase and protein levels of volleyball players

AIM: Postexercise proteinuria and increased urinary gamma-glutamyl transferase (GGT) levels can be indicative of exercise-induced renal damage. In the literature, there exists numerous studies on exercise-induced proteinuria; but studies investigating the effects of exercise on urinary GGT levels are quite few. We aimed to evaluate the effects of exercise on renal function, expressed through the exercise-induced differences in urinary GGT, creatinine and protein levels. METHODS: The study was performed on 12 female and 12 male volleyball players of the same sports club. Urine samples collected before and 1 h after the exercise were analyzed for urinary GGT, creatinine and protein amounts. RESULTS: No statistically significant difference was observed between pre- and postexercise urinary GGT levels (U/L and U/g creatinine) of female and male volleyball players (P>0.05). A significant exercise-induced increase in urinary protein excretion was observed for the male players, while a significant exercise-induced increase in urinary creatinine excretion was observed for the female players (P<0.05). When urinary GGT levels (U/L) were compared separately for setters and spikers, it was observed that female players had no significant difference, while male spikers had a statistically significant exercise-induced increase in the urinary GGT levels (U/L) (P<0.05). CONCLUSIONS: We suggest that the insignificance of the exercise-induced increases in the urinary parameters could be due to the relatively short-course of the exercise and the timing of postexercise urine collection. A comprehensive study performed on more subjects could yield results that are more significant.