Central calcifying epithelial odontogenic tumour in the posterior maxilla: a case report

The calcifying epithelial odontogenic tumour (CEOT), or Pindborg tumour, is a rare, benign odontogenic tumour. CEOT is usually asymptomatic and an incidental radiological finding, often presenting as a mandibular radiolucency with flecks of calcific material. We report an unusual case of CEOT in the left posterior maxilla of a 46‐year‐old male that was associated with an unerupted tooth. The tumour in this case caused non‐specific sinus symptoms and appeared radiographically similar to an odontoma or ossifying fibroma due to its dense calcific contents. Diagnosis was confirmed histologically following surgical removal of the lesion, which showed classic CEOT histomorphology. We report this case to highlight the unusual clinico‐radiologic presentation and illustrate the diagnostic difficulties that can occur with radiolucent and/or radiopaque lesions in the jaws.     

Altered expression of the MYCN oncogene modulates MRP gene expression and response to cytotoxic drugs in neuroblastoma cells.

We have recently shown a close correlation between expression of the Multidrug Resistance-associated Protein (MRP) gene and the MYCN oncogene and provided evidence that high MRP expression is a powerful independent predictor of poor outcome in neuroblastoma (Norris et al., New Engl. J. Med., 334, 231-238, 1996). The effect of MYCN down-regulation on MRP expression and response to cytotoxic drugs was investigated in NBL-S neuroblastoma cells transfected with MYCN antisense RNA constructs. Concomitant with MYCN down-regulation, the level of MRP expression was decreased in the NBAS-4 and NBAS-5 antisense transfectants. These cells demonstrated significantly increased sensitivity to the high affinity MRP substrates vincristine, doxorubicin, sodium arsenate and potassium antimony tartrate, but not to the poor MRP substrates, taxol or cisplatin. Similarly, transfection of full-length MYCN cDNA into SH-EP neuroblastoma cells resulted in increased MRP expression and significantly increased resistance specifically to MRP substrates. The results provide evidence for the MYCN oncogene influencing cytotoxic drug response via regulation of MRP gene expression. Our data also provide a link between the malignant and chemoresistant phenotypes of this childhood malignancy.     

Comparison of arterial closure devices in antegrade and retrograde punctures.

PURPOSE: To compare the efficacy, primary failure rates, and complications for the Angio-Seal and Perclose closure devices in antegrade and retrograde common femoral artery (CFA) punctures during peripheral angioplasty procedures. METHODS: A retrospective single-center analysis was conducted between April 2002 and June 2006 of all patients who had a CFA puncture and no other intervention planned during the same admission. Patients undergoing thrombolysis were excluded. Of 215 punctures in 191 patients, 123 closures in 97 patients (82 men; mean age 69.5 +/-10.4 years, range 41-93) were eligible for analysis. Of these, 49 punctures were antegrade and 74 were retrograde. An Angio-Seal device was used in 40 closures, while 83 punctures were closed with a Perclose device. Deployment outcomes and complications were compared between devices for each puncture direction and between antegrade and retrograde punctures. RESULTS: Seventy-eight (63.4%) of the 123 closures reached the primary endpoint of complication-free progress to discharge, comprising 30 (61.2%) of the 49 antegrade closures and 48 (64.9%) of the 74 retrograde closures. There was no significant difference between the devices for the primary endpoint. Twenty-two (17.9%) attempted closures failed. Forty-one (33.3%) closures had a complication after the procedure, but none required further intervention. In antegrade closures, Angio-Seal had a significantly lower rate of primary failure (11.1% versus 38.7% for Perclose, p = 0.038). Antegrade closures had a higher rate of primary failure (p<0.01); however, this did not translate into any significant differences in postprocedural complications. No significant differences in primary failure or complication rates were found between the devices when used in retrograde punctures. CONCLUSION: Angio-Seal had a lower rate of primary failure than Perclose in antegrade puncture closures. We believe this reinforces the need for larger studies to compare closure devices in antegrade punctures.     

Chronology of the HIV-1 CRF07_BC expansion in East Asia

The HIV-1 epidemic among injecting drug users (IDU) in Taiwan is caused primarily by CRF07_BC infections. Evolutionary analyses, which utilize outgroup reference strains from northwestern China (Xinjiang), reveal that CRF07_BC was introduced into southern Taiwan in 1998-2001 and spread to central-northern Taiwan in 2001-2003, causing the largest HIV/AIDS epidemic in Taiwan. The separate introduction of CRF07_BC into Xinjiang occurred in 1992-1995. This study illustrates the temporal dynamics of CRF07_BC spread among IDU across east Asia.     

User participation in mental health nurse decision-making: a co-operative enquiry

AIM: This paper is a report of a study to encourage participants to work together to identify strategies for increasing user participation in clinical decisions and to evaluate the value of co-operative inquiry as a vehicle for supporting learning in practice. BACKGROUND: Service user participation in the clinical practice decisions of mental health nurses is considered essential for good practice. Methods need to be found which enable opportunities for shared learning, facilitate practice development and empower service users. METHOD: A co-operative inquiry design engaged all participants (n = 17) as co-researchers and involved repeated cycles of action and reflection, using multiple data collection methods. The research was conducted over a two year period in 2004-2005, with mental health nursing students collaborating with service users. FINDINGS: Factors inhibiting participation included stigmatizing and paternalistic approaches, where clinical judgments were made solely on the basis of diagnosis. Enhancing factors were a respectful culture which recognized users 'expertise' and communicated belief in individual potential. Inquiry benefits included insight into service users' perspectives, enhanced confidence in decision-making, appreciation of power issues in helping relationships and deconstruction of decision-making within a safe learning environment. CONCLUSION: Learning from novel approaches which enable nursing students to develop their reflective and reflexive ability is essential to avoid practice which disempowers and potentially harms service users' recovery. Co-operative inquiry is a valuable vehicle for developing professional practice in higher education and practice environments.     

Fludarabine,High Dose Cytarabine and Granulocyte Colony-Stimulating Factor (FLAG) as Consolidation Chemotherapy in Older Patients with Acute Myeloid Leukemia: A Retrospective Cohort Study

The study aimed to investigate the effect of consolidation treatment with fludarabine, high-dose cytarabine and granulocyte colony-stimulating factor or FLAG in older AML patients. The study included 41 eligible patients above 54 years old, who received both induction and consolidation chemotherapy for AML from 2008 to 2013. The study cohort had a minimum 24 months follow-up period. Survival analysis was carried out to assess patients’ overall survival and disease free survival based on types of consolidation regimens. The consolidation treatment with FLAG exerted a protective effect to both overall survival and disease free survival in older patients. Patients who were consolidated with FLAG regimen had a significant longer overall survival (log-rank, p = 0.0025) and disease free survival (log-rank, p = 0.0026). The median overall survival was longer (18.70 months) with the use of FLAG when compared to non-FLAG group (8.09 months). The median disease free survival was also longer (13.84 months) with use of FLAG when compared to the non-FLAG group (4.44 months). Regression analysis with Cox model yielded hazard ratio of 0.245 (p = 0.0094) in overall survival and 0.217 (p = 0.0068) in disease free survival. The use of FLAG as consolidation treatment was associated with approximately 60–80% reduction in hazard rates. The result was adjusted for age, race and gender in regression analysis. Older AML patients had longer remission and survival when consolidated with FLAG regimen after the induction chemotherapy.