Detection of major histocompatibility complex molecules in processed allogeneic bone blocks for use in alveolar ridge reconstruction.

Detection of major histocompatibility complex molecules in processed allogeneic bone blocks for use in alveolar ridge reconstruction.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 20;:

Authors: Fretwurst T, Gad LM, Steinberg T, Schmal H, Zeiser R, Amler AK, Nelson K, Altmann B

Abstract
OBJECTIVES: Because processed allogenic bone blocks contain remnants of cells and other organic material, the present study examined the putative presence of major histocompatibility complex (MHC) molecules in protein extracts derived from processed allogeneic bone blocks.
STUDY DESIGN: Protein content and the immunogenic potential of 3 different processed allografts (Osteograft, DIZG, Berlin, Germany; Caput femoris, DIZG, Berlin, Germany; Human Spongiosa, Charité Tissue Bank, Berlin, Germany) were assessed by protein extraction and analysis of the presence of MHC class 1 and 2 molecules prior to grafting. MHC concentration was measured by using enzyme-linked immunosorbent assay.
RESULTS: Protein content in the allograft materials varied between 0.87 and 1.61 µg protein/mg. In the allograft Human Spongiosa, no MHC was detected, whereas in the allogeneic bone blocks Osteograft and Caput femoris MHC 1 (0.04-0.037 ng/mg graft material) and in Osteograft MHC class 2 molecules were detectable.
CONCLUSIONS: The results of the present study suggest that despite thorough processing, a potential antigenicity of allografts is not eliminated. MHC molecules in allografts may sensitize the immune system.

PMID: 29571656 [PubMed - as supplied by publisher]

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Rapidly expanding mixed lesion of the maxilla in a 17-month-old boy.

Rapidly expanding mixed lesion of the maxilla in a 17-month-old boy.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 14;:

Authors: Sun HB, Park CM, Elo JA

PMID: 29571655 [PubMed - as supplied by publisher]

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Dose escalation for prostate stereotactic ablative radiotherapy (SABR): Late outcomes from two prospective clinical trials

Publication date: Available online 24 March 2018
Source:Radiotherapy and Oncology
Author(s): Yasir Alayed, Patrick Cheung, Geordi Pang, Alexandre Mamedov, Laura D'Alimonte, Andrea Deabreu, Kristina Commisso, Angela Commisso, Liang Zhang, Harvey C. Quon, Hima Bindu Musunuru, Joelle Helou, D. Andrew Loblaw
PurposeOptimal prostate SABR dose-fractionation is unknown. This study compares long-term outcomes from two prospective trials.MethodsStudy1 patients had low-risk PCa and received 35 Gy/5. Study2 patients had low/intermediate-risk PCa and received 40 Gy/5. Biochemical failure (BF) was defined as nadir + 2.Results114 patients were included (study1, n = 84; study2, n = 30). Median follow-up was 9.6 years and 6.9 years. Median nPSA was 0.4 and 0.1 ng/ml. Nine patients had BF (8 in study1, 1 in study2); two were managed with ADT and four had local salvage. The BF rate was 2.5% and 12.8% at 5 and 10 years for study1 and 3.3% at 5 years for study 2. BF probability was 0% if PSA <0.4 at 4 years, and 20.5% at 10 years if PSA ≥0.4 (p = 0.02). Nine patients died, none of PCa. No patient has metastases or castrate-resistance. At 10 years, OS and CSS were 90.4% (p = 0.25) and 100%.ConclusionsDose-escalated prostate SABR was associated with lower nPSAs but no difference in BF, OS, CSS or MFS. PSA <0.4 at 4 years was a predictor of biochemical control. Half of patients with BF were successfully salvaged. Given that this is a favorable-risk cohort, longer follow-up will be needed to see if the lower nPSA translates into lower BF rates.



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Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial

Abstract

Purpose

The phenomenon of futile recanalization, defined as lack of clinical benefit despite angiographic recanalization, is an important limitation of endovascular treatment for acute ischemic stroke. We aim to characterize the occurrence and predictors of futile recanalization in the endovascular arm of the Interventional Management of Stroke (IMS) III trial.

Methods

Patients with near complete or complete recanalization (TICI grades 2b and 3) were divided according to functional outcome at 3 months into "meaningful recanalization," defined as mRS score 0–2, and "futile recanalization," mRS score 3–6. Multivariate analysis was performed to identify predictors of futile recanalization.

Results

Futile recanalization was observed in 61 (47%) of 130. Compared to meaningful recanalization group, the futile recanalization group had higher proportion of women (62.3 vs. 43.5%; p = 0.032), higher incidence of diabetes mellitus (29.5 vs. 8.7%; p = 0.004) and coronary artery disease (27.9 vs. 13%; p = 0.05), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (median [range] 19 [11–31] vs. 15 [8–26], p < 0.001), higher baseline serum glucose (7.6 ± 2.6 vs. 6.7 ± 1.7 mmol/L; p = 0.039), and longer onset-to-start of endovascular treatment time (265.8 ± 48.3 vs. 239.2 ± 47.7 min; p = 0.007). In multivariate analysis, NIHSS (OR 1.3; 95% CI 1.1–1.4), female gender (OR 3.0; 95% CI 1.1–8.2), and onset-to-start of endovascular treatment time (OR 1.2; 95% CI 1.1–1.3) were independent predictors of futile recanalization.

Conclusion

In IMS III, futile recanalization was common. Delay in endovascular treatment is the only modifiable risk factor. Additional strategies for non-modifiable risk factors—female gender and high NIHSS—need to be identified.

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Rates and predictors of futile recanalization in patients undergoing endovascular treatment in a multicenter clinical trial

Abstract

Purpose

The phenomenon of futile recanalization, defined as lack of clinical benefit despite angiographic recanalization, is an important limitation of endovascular treatment for acute ischemic stroke. We aim to characterize the occurrence and predictors of futile recanalization in the endovascular arm of the Interventional Management of Stroke (IMS) III trial.

Methods

Patients with near complete or complete recanalization (TICI grades 2b and 3) were divided according to functional outcome at 3 months into "meaningful recanalization," defined as mRS score 0–2, and "futile recanalization," mRS score 3–6. Multivariate analysis was performed to identify predictors of futile recanalization.

Results

Futile recanalization was observed in 61 (47%) of 130. Compared to meaningful recanalization group, the futile recanalization group had higher proportion of women (62.3 vs. 43.5%; p = 0.032), higher incidence of diabetes mellitus (29.5 vs. 8.7%; p = 0.004) and coronary artery disease (27.9 vs. 13%; p = 0.05), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (median [range] 19 [11–31] vs. 15 [8–26], p < 0.001), higher baseline serum glucose (7.6 ± 2.6 vs. 6.7 ± 1.7 mmol/L; p = 0.039), and longer onset-to-start of endovascular treatment time (265.8 ± 48.3 vs. 239.2 ± 47.7 min; p = 0.007). In multivariate analysis, NIHSS (OR 1.3; 95% CI 1.1–1.4), female gender (OR 3.0; 95% CI 1.1–8.2), and onset-to-start of endovascular treatment time (OR 1.2; 95% CI 1.1–1.3) were independent predictors of futile recanalization.

Conclusion

In IMS III, futile recanalization was common. Delay in endovascular treatment is the only modifiable risk factor. Additional strategies for non-modifiable risk factors—female gender and high NIHSS—need to be identified.

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Management update of potentially premalignant oral epithelial lesions

Publication date: Available online 23 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Michael Awadallah, Matthew Idle, Ketan Patel, Deepak Kademani
The term oral potentially malignant disorders (OPMD) previously defined at the World Health Organisation (W.H.O) workshop in 2005 has now been redefined as potentially premalignant oral epithelial lesions (PPOELs). It is important to differentiate PPOEL's which are a broad term to define a wide variety of clinical lesions from oral epithelial dysplasia which should be reserved specifically for lesions with biopsy proven foci of dysplasia. Unfortunately, the nomenclature is not consistent and many times both terms PPOEL and dysplasia are used interchangeably which adds to confusion in the literature. PPOEL's encompass lesions that include leukoplakia, erythroplakia, erythroleukoplakia, lichen planus, and submucosal fibrosis. The World Health Organization (W.H.O). definition of a histologically proven oral premalignant lesion that is associated with a significantly increased risk of malignant transformation. The primary goal of management of dysplasia includes the prevention, early detection and treatment prior to malignant transformation. The aim of this paper is to inform the clinician about management of PPOELs.



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Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms.

Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms.

AJNR Am J Neuroradiol. 2018 Mar 22;:

Authors: Ernst M, Kriston L, Groth M, Frölich AM, Fiehler J, Buhk JH

Abstract
BACKGROUND AND PURPOSE: Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions.
MATERIALS AND METHODS: Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed.
RESULTS: Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, "very certain"). Confidence was statistically significantly higher in cases that were generally rated as "worse." The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence.
CONCLUSIONS: Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist.

PMID: 29567657 [PubMed - as supplied by publisher]

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