Infantile myofibromatosis treated by mandibulectomy and staged reconstruction with submental flap and free fibula flap: a case report

Abstract Background Infantile myofibromatosis is the most common benign fibrous tumor in infants. Three different types have been reported in the literature. The most commonly affected areas are the head, the neck and the trunk. Our patient showed a very high level of mandibular destruction resistant to all mandibular sparing treatment strategies requiring segmental mandibulectomy and complex reconstruction. Case presentation We describe a rare case of multicentric infantile myofibromatosis with mandibular bone destruction. The treatment required a succession of chemotherapy, a subtotal transoral resection and a hemi-mandibulectomy. The mandibular reconstruction was staged with initial bridging titanium plate with a submental flap, followed later by a fibula free flap. Conclusion Mandibular involvement by myofibromatosis is rare, and the extend of bone destruction and reconstruction make this case unique. To our knowledge, this is the only reported case of fibula free flap mandibular reconstruction in a patient with infantile myofibromatosis , as well as one of the youngest reported submental island flaps for any pathology. We describe the clinical presentation and management, including relevant imaging, histopathology, medical and surgical treatment as well as a review of relevant literature

CoAdapt P300 speller: optimized flashing sequences and online learning

International audienceThis paper presents a series of recent improvements made on the P300 speller paradigm in the context of the CoAdapt project. The flashing sequence is elicited by a new design called RIPRAND, in which the flashing rate of elements can be controlled independently of grid cardinality. Element-based evidence accumulation allows early-stopping of the flashes as soon as the symbol has been detected with confidence. No calibration session is nec-essary, thanks to a mixture-of-experts method which makes the initial predictions. When sufficient data can be buffered, subject-specific spatial and temporal filters are learned, with which the interface seamlessly makes its predictions, and the classifiers are adapted online. This paper, which presents results of three online sessions totalling 26 subjects, is the first to report online performance of a P300 speller with no calibration. 1 Material and Methods The P300 speller presented in this work was implemented in C++ with OpenViBE [7], and a dedicated stimulating software controlled the keyboard display. The software is opensource and part of OpenViBE release 0.18 We used a single Windows laptop to run all software components. The P300 speller keyboard was displayed on a separate LCD screen. A TMSi Refa8 amplifier, synchronized via hardware to the laptop, was used to record from 12 actively shielded electrodes. The visual stimulations consisted of briefly flashing "smiley" pictures. The P300 wave was detected via 3 channels of an xDAWN spatial filter [8], combined with a Regularized LDA classifier hereforth called RDA, which incorporates a regularisation of the common covariance matrix. The output of the classifier at each flashing time t is denote y(t). To save time, elements are always flashed in groups. Initial design of P300 speller groups involved rows and columns of a square matrix [2] or their randomizations [1]. The target element is then found at the intersection of the groups eliciting a P300 response. But repetitively flashing the same groups causes elements within the target groups to be wrongly selected, because of visual attention effects, and because of the contamination of all group elements by classification errors. Element-wise evidence accumulation avoids these two effects. A different random per-mutation can then be performed at each repetition of the flashes, effectively changing elements' group membership across repetitions. At each flash t, let the binary vector a(t) represent the set of n flashed elements within the grid of cardinality N . The score α(t) of each element (initialized to 0 at time 0) is updated with the following scheme, in which both target and non-target flashes contribute to the accumulation: α(t) = α(t − 1) + lo

Nuclear Imaging Study of the Pharmacodynamic Effects of Debio 1143, an Antagonist of Multiple Inhibitor of Apoptosis Proteins (IAPs), in a Triple-Negative Breast Cancer Model

International audienceBackground . Debio 1143, a potent orally available SMAC mimetic, targets inhibitors of apoptosis proteins (IAPs) members and is currently in clinical trials. In this study, nuclear imaging evaluated the effects of Debio 1143 on tumor cell death and metabolism in a triple-negative breast cancer (TNBC) cell line (MDA-MB-231)-based animal model. Methods . Apoptosis induced by Debio 1143 was assessed by FACS (caspase-3, annexin 5 (A5)), binding of 99m Tc-HYNIC-Annexin V, and a cell proliferation assay. 99m Tc-HYNIC-Annexin V SPECT and [ 18 F]-FDG PET were also performed in mice xenografted with MDA-MB-231 cells. Results . Debio 1143 induced early apoptosis both in vitro and in vivo 6 h after treatment. Debio 1143 inhibited tumor growth, which was associated with a decreased tumor [ 18 F]-FDG uptake when measured during treatment. Conclusions . This imaging study combining SPECT and PET showed the early proapoptotic effects of Debio 1143 resulting in a robust antitumor activity in a preclinical TNBC model. These imaging biomarkers represent valuable noninvasive tools for translational and clinical research in TNBC