Chest wall mass in a 15-year-old female patient

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Methodological Aspects for Preclinical Evaluation of Gadolinium Presence in Brain Tissue: Critical Appraisal and Suggestions for Harmonization—A Joint Initiative

Gadolinium (Gd)-based contrast agents (GBCAs) are pharmaceuticals that have been approved for 30 years and used daily in millions of patients worldwide. Their clinical benefits are indisputable. Recently, unexpected long-term presence of Gd in the brain has been reported by numerous retrospective clinical studies and confirmed in preclinical models particularly after linear GBCA (L-GBCA) compared with macrocyclic GBCA (M-GBCA). Even if no clinical consequences of Gd presence in brain tissue has been demonstrated so far, in-depth investigations on potential toxicological consequences and the fate of Gd in the body remain crucial to potentially adapt the clinical use of GBCAs, as done during the nephrogenic systemic fibrosis crisis. Preclinical models are instrumental in the understanding of the mechanism of action as well as the potential safety consequences. However, such models may be associated with risks of biases, often related to the protocol design. Selection of adequate terminology is also crucial. This review of the literature intends to summarize and critically discuss the main methodological aspects for accurate design and translational character of preclinical studies. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication February 9, 2018; and accepted for publication, after revision, February 14, 2018. All authors have contributed equally to the manuscript. Correspondence to: Philippe Robert, PhD, Guerbet, Research & Innovation, BP 57400, 95943 Roissy CdG Cedex, France. E-mail: philippe.robert@guerbet-group.com. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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An ulcer on the ventral tip of tongue.

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An ulcer on the ventral tip of tongue.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 09;:

Authors: Pontes HAR, de Souza LL, Costa AMPE, da Silva AA, Gonçalves FLN, Fonseca FP, Pontes FSC

PMID: 29653816 [PubMed - as supplied by publisher]

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Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients.

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Matrix-associated chondrocyte transplantation for reconstruction of articulating surfaces in the temporomandibular joint: a pilot study covering medium- and long-term outcomes of 6 patients.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 09;:

Authors: Undt G, Jahl M, Pohl S, Marlovits S, Moser D, Yoon HH, Frank J, Lang S, Czerny C, Klima G, Gentleman E, Ewers R

Abstract
OBJECTIVE: Matrix-associated chondrocyte transplantation is routinely used in joints of the extremities but not in the temporomandibular joint (TMJ).
STUDY DESIGN: We report the first case series in 7 patients of a tissue engineering approach to regenerate severely degraded articulating surfaces in the TMJ by simultaneously completely resurfacing both the mandibular condyle and the articular eminence/glenoid fossa with a commercially available collagen sponge seeded with autologous cells stabilized within a fibrin matrix. To facilitate healing, we temporarily employed a silicone membrane to protect the engineered tissues. The indications for surgery were posttraumatic fibro-osseous ankylosis, ankylosing osteoarthritis, or late-stage osteoarthritis.
RESULTS: Six of the patients were recalled for follow-up after 3 years 6 months to 12 years 1 month. The maximum incisal opening was 18.2 ± 9.2 mm (range, 9-33 mm) before and 31.2 ± 13.6 mm (range, 12-47 mm) at the latest follow-up. Histologic specimens taken at 4 months showed beginning differentiation of fibrocytes into chondrocytes, whereas at 3 and 11 years, mature hyaline cartilage-not typical for the TMJ-was present.
CONCLUSIONS: We conclude that the reconstruction of TMJ surfaces by matrix-associated chondrocyte transplantation may become a routine method for cartilage regeneration in the TMJ in the future.

PMID: 29653815 [PubMed - as supplied by publisher]

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Methodological Aspects for Preclinical Evaluation of Gadolinium Presence in Brain Tissue: Critical Appraisal and Suggestions for Harmonization—A Joint Initiative

Gadolinium (Gd)-based contrast agents (GBCAs) are pharmaceuticals that have been approved for 30 years and used daily in millions of patients worldwide. Their clinical benefits are indisputable. Recently, unexpected long-term presence of Gd in the brain has been reported by numerous retrospective clinical studies and confirmed in preclinical models particularly after linear GBCA (L-GBCA) compared with macrocyclic GBCA (M-GBCA). Even if no clinical consequences of Gd presence in brain tissue has been demonstrated so far, in-depth investigations on potential toxicological consequences and the fate of Gd in the body remain crucial to potentially adapt the clinical use of GBCAs, as done during the nephrogenic systemic fibrosis crisis. Preclinical models are instrumental in the understanding of the mechanism of action as well as the potential safety consequences. However, such models may be associated with risks of biases, often related to the protocol design. Selection of adequate terminology is also crucial. This review of the literature intends to summarize and critically discuss the main methodological aspects for accurate design and translational character of preclinical studies. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication February 9, 2018; and accepted for publication, after revision, February 14, 2018. All authors have contributed equally to the manuscript. Correspondence to: Philippe Robert, PhD, Guerbet, Research & Innovation, BP 57400, 95943 Roissy CdG Cedex, France. E-mail: philippe.robert@guerbet-group.com. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Monte Carlo simulation of the responses of gaseous effluent monitors to radioactive isotopes.

Monte Carlo simulation of the responses of gaseous effluent monitors to radioactive isotopes.

Appl Radiat Isot. 2018 Apr 02;137:205-209

Authors: Gaheen MA, Mohamed NMA

Abstract
This paper discusses use of Monte Carlo simulations to facilitate testing and calibration of a gaseous effluent monitor (GEM). MCNP5 was used to simulate responses of the 131I and 41Ar GEM detecting units exposed to specific radioactive sources. The agreement between the MCNP5 predictions and experimental measurements is good enough to validate the MCNP5 model. It has been demonstrated that the Monte Carlo code is a powerful and useful tool to determine accurate detector responses and facilitate the calibration process of this type of the monitors.

PMID: 29655126 [PubMed - as supplied by publisher]

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A protocol for a Canadian prospective observational study of decision-making on active surveillance or surgery for low-risk papillary thyroid cancer.

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A protocol for a Canadian prospective observational study of decision-making on active surveillance or surgery for low-risk papillary thyroid cancer.

BMJ Open. 2018 Apr 12;8(4):e020298

Authors: Sawka AM, Ghai S, Tomlinson G, Rotstein L, Gilbert R, Gullane P, Pasternak J, Brown D, de Almeida J, Irish J, Chepeha D, Higgins K, Monteiro E, Jones JM, Gafni A, Goldstein DP

Abstract
INTRODUCTION: Low-risk papillary thyroid cancer (PTC) is increasingly being diagnosed throughout the world; yet the mortality risk is low compared with other malignancies. Traditional management includes thyroid surgery, sometimes followed by radioactive iodine and thyroid hormone treatment. Active surveillance (AS) has been proposed as a means to reduce overtreatment of PTC. AS involves close disease follow-up, with the intention to intervene if the disease progresses, or on patient request.
METHODS AND ANALYSIS: This is a multiphase prospective observational study. In the first phase of this study, consenting eligible adults with low-risk PTC, that is, <2 cm in maximal diameter, confined to the thyroid and not immediately adjacent to critical structures in the neck, are provided verbal and written information about PTC disease prognosis following surgery or AS. Questionnaires are administered at baseline and after the disease management decision on AS or surgery is finalised. Patients may choose either option (surgery or AS), and the primary outcome is the frequency with which either disease management option is chosen. Secondary outcomes include: rationale for the decision, role of the patient in decision-making and decision satisfaction. In the second phase of the study, consenting eligible adult patients who completed the first study phase may enrol in respective AS or surgery group follow-up studies. The following outcomes are examined 1 year after enrolment in the follow-up phase: decision regret about disease management choice (primary outcome), psychological distress, disease-specific quality of life, fear of disease progression, body image satisfaction, disease progression, crossover to surgery in the AS group, new chronic thyroid hormone use and healthcare resource utilisation.
ETHICS AND DISSEMINATION: The University Health Network Research Ethics Board approved this study (ID 15-8942). The results will be published in an open access journal.
TRIAL REGISTRATION NUMBER: NCT03271892; Pre-results.

PMID: 29654030 [PubMed - in process]

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Controversial Issues in Thyroid Cancer Management.

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Controversial Issues in Thyroid Cancer Management.

J Nucl Med. 2018 Apr 13;:

Authors: Tuttle RM

Abstract
The lack of prospective randomized clinical trials for most management topics in differentiated thyroid cancer force us to make management recommendations based on retrospective observational data which is often incomplete, subject to selection bias, and conflicting. Therefore, it is not surprising that many aspects of thyroid cancer management remain controversial and not well defined. This review will examine the controversies surrounding three important topics in thyroid cancer management: (1) the option of thyroid lobectomy as initial therapy for thyroid cancer, (2) the proper use of preoperative neck imaging to optimize the completeness of the initial surgical procedure, and (3) the selective use RAI therapy as remnant ablation, adjuvant treatment or treatment of known persistent/recurrent disease. As thyroid cancer management moves toward a much more risk adapted approach to personalized management recommendations, clinicians and patients must balance the risks and benefits of the potential management options to arrive at a management plan that is optimized based on both patient preferences/values and the philosophy/experience of the local disease management team.

PMID: 29653980 [PubMed - as supplied by publisher]

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Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Lessons from Confronting Controversial Literature on Risks for Secondary Malignancy.

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Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Lessons from Confronting Controversial Literature on Risks for Secondary Malignancy.

J Nucl Med. 2018 Apr 13;:

Authors: Tulchinsky M, Binse I, Campennì A, Dizdarevic S, Giovanella L, Jong I, Kairemo K, Kim CK

PMID: 29653977 [PubMed - as supplied by publisher]

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Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis.

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Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 07;:

Authors: Wei H, Liu Z, Zang J, Wang X

Abstract
OBJECTIVE: There are conflicting views on the postoperative stability of surgery-first and surgery-early approaches in orthognathic surgery. We systematically reviewed the literature to compare the difference in postoperative stability between a surgery-first/early orthognathic approach (SFEA) and a conventional orthodontics-first approach (COA).
STUDY DESIGN: PubMed, Embase, and Cochrane Library were searched for studies related to the postoperative stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted mean differences with 95% confidence intervals were pooled using a random-effects model.
RESULTS: We analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifested less postoperative stability than COA group (weighted mean difference, 1.50; P < .00001), with moderate heterogeneity (I2 = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis conducted by omitting one study at a time further validated the robustness of the result.
CONCLUSIONS: Based on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postoperative stability than in the COA group. Patient screening and treatment plans should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.

PMID: 29631986 [PubMed - as supplied by publisher]

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Noninvasive diagnostic adjuncts for the evaluation of potentially premalignant oral epithelial lesions: current limitations and future directions.

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Noninvasive diagnostic adjuncts for the evaluation of potentially premalignant oral epithelial lesions: current limitations and future directions.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 09;:

Authors: Yang EC, Tan MT, Schwarz RA, Richards-Kortum RR, Gillenwater AM, Vigneswaran N

Abstract
Potentially premalignant oral epithelial lesions (PPOELs) are a group of clinically suspicious conditions, of which a small percentage will undergo malignant transformation. PPOELs are suboptimally diagnosed and managed under the current standard of care. Dysplasia is the most well-established marker to distinguish high-risk PPOELs from low-risk PPOELs, and performing a biopsy to establish dysplasia is the diagnostic gold standard. However, a biopsy is limited by morbidity, resource requirements, and the potential for underdiagnosis. Diagnostic adjuncts may help clinicians better evaluate PPOELs before definitive biopsy, but existing adjuncts, such as toluidine blue, acetowhitening, and autofluorescence imaging, have poor accuracy and are not generally recommended. Recently, in vivo microscopy technologies, such as high-resolution microendoscopy, optical coherence tomography, reflectance confocal microscopy, and multiphoton imaging, have shown promise for improving PPOEL patient care. These technologies allow clinicians to visualize many of the same microscopic features used for histopathologic assessment at the point of care.

PMID: 29631985 [PubMed - as supplied by publisher]

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