Activity of eribulin mesylate in brain metastasis from breast cancer. a stone in a pond?

Background: Brain metastases develop in approximately 10-25% of patients with metastatic breast cancer (MBC) and are associated with a very poor prognosis. Case Report: We report the case of a 40-year-old woman with MBC and associated lung, bone, liver, and brain metastases, who experienced a time to progression of several months with eribulin after whole-brain radiotherapy (WBRT), 2 lines of chemotherapy, and 1 line of hormonal therapy, maintaining a good toxicity profile. Discussion: Eribulin, in association with local treatment such as WBRT, can be well tolerated and effective in achieving a long progression-free survival and a good control of brain metastases in patients with MBC who have received multiple lines of treatment. The vascular remodeling properties of eribulin, combined with brain radiotherapy, might facilitate the passage of eribulin across the blood brain barrier, improving brain response. Conclusion: Our anecdotal experience suggests that eribulin may have a potentially beneficial effect on brain metastases while maintaining a good systemic control of the disease in patients with MBC

Impressive long-term response with pertuzumab and trastuzumab in HER2-positive breast cancer with brain metastasis

This is a case report of a 40-year-old woman who, after conservative breast cancer treatment, developed a HER2 positive solitary brain metastasis in the left temporal lobe, without extracranial disease. She underwent surgery resection followed by stereotactic radiotherapy and, because of early brain progression, she was submitted to the first line therapy with pertuzumab, trastuzumab and weekly paclitaxel. After six months of treatment, a brain magnetic resonance imaging revealed a complete disappearance of brain recurrence, which persisted for more than 24 months

Multidisciplinary Approach to Fused Maxillary central Incisors: a Case Report

Introduction: The fusion of permanent teeth is a development anomaly of dental hard tissue. It may require a hard multidisciplinary approach with orthodontics, endodontics, surgery and prosthetics to solve aesthetic and functional problems. Case presentation: A 20-year-old Caucasian man presented to our Department to solve a dental anomaly of his upper central incisors. An oral investigation revealed the fusion of his maxillary central incisors and dyschromia of right central incisor. Vitality pulp tests were negative for lateral upper incisors and left central incisor. Radiographic examinations showed a fused tooth with two separate pulp chambers, two distinct roots and two separate root canals. There were also periapical lesions of central incisors and right lateral incisor, so he underwent endodontic treatment. Six months later, OPT examination revealed persistence of the periapical radiolucency, so endodontic surgery was performed, which included exeresis of the lesion, an apicoectomy and retrograde obturation with a reinforced zinc oxide-eugenol cement (SuperEBA) Complete healing of the lesion was obtained six months postoperatively. Fused teeth crowns were separated and orthodontic appliances were put in place. When correct teeth position was achieved (after nine months), the anterior teeth were prosthetically rehabilitated. Conclusion: Many treatment options have been proposed in the literature to solve cases of dental fusion. The best treatment plan depends on the nature of the anomaly, its location, the morphology of the pulp chamber and root canal system, the subgingival extent of the separation line, and the patient compliance. Following an analysis of radiographical and clinical data, it was possible to solve our patient’s dental anomaly with a multidisciplinary approach

Smoking Cessation on Periodontal and Peri-Implant Health Status: A Systematic Review

Since smoking is considered among the main risk factors for the onset and progression of periodontitis and peri-implantitis, the present systematic review aimed to evaluate the effect of smoking cessation on clinical, radiographic, and gingival crevicular periodontal parameters around natural teeth and dental implants in ex-smokers compared to current and non-smokers. The study protocol was developed based on the PRISMA guidelines, the research question was formulated according to the PICO model, and the literature search was conducted through PubMed/MEDLINE, Cochrane library, and BioMed Central databases. From the 916 title/abstracts initially identified, seven articles were included in the present systematic review and assessed for quality through the ROBINS-I tool. Reported findings on clinical and crevicular periodontal parameters around natural teeth were contrasting when comparing ex-smokers to current and non-smokers; thus, individualized recommendations for previous smoker periodontal patients are currently lacking. No data on radiographic parameters were retrieved. Similarly, data on periodontal parameters around dental implants were not available, highlighting the need for focused investigations assessing the role of both smoking habit and cessation on peri-implant health status and responsiveness to treatment

Effectiveness of surgical procedures in the acceleration of orthodontic tooth movement: Findings from systematic reviews and meta-analyses

The current overview aimed to summarise the findings provided by systematic reviews (SRs) on the effect of surgical procedures in the acceleration of tooth movement and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs addressing the effects of surgical procedures on the acceleration of tooth movement were included. The methodological quality of the included SRs was assessed using the updated version of “A Measurement Tool to Assess Systematic Review” (AMSTAR-2). Twenty-eight (28) SRs were included. The methodological quality of the included reviews ranged between critically low (6 studies) and high (12 studies). The most common critical weakness in the included reviews was the absence of clearly a-prior established review methods and any significant deviations from the protocol. The most studied surgical procedure was corticotomy, followed by micro-osteoperforation, piezocision and periodontally accelerated osteogenic orthodontics. The majority of the included SRs supported short-term favourable effects of corticotomy on treatment time and tooth movement rate, in the short-term. However, the authors of the included SRs reported that results were based on weak quality evidence. Conflicting results arise from the existent SRs with regards to the effectiveness of piezocision and micro-osteoperforation. Few SRs summarised complications and side effects of surgical techniques, supporting absence of loss of tooth vitality, periodontal problems, or severe root resorption. The current overview of SRs highlighted the need of high quality SRs comparing different surgical approaches for tooth movement acceleration though network meta-analysis, in order to determine the most efficient instrument for orthodontic movement acceleration

Ecotoxicological assessment of sediments from the Port of Santos and the disposal sites of dredged material

The dredging of sediments from the Santos Channel is necessary to allow the navigation of ships operating in the Port of Santos. The disposal sites for such sediments are situated on the coastal zone, in front of the Santos Bay. The present paper aimed at evaluating the toxicity of sediments collected at the Santos Channel and at the former and current sediment disposal sites. Whole sediment tests with amphipods and elutriate assays with sea-urchin embryos were used. The samples from the Santos Channel were considered the most toxic: all the sediment samples from this area showed toxicity. Moreover, some samples from both former and new sediment disposal sites exhibited toxicity. Therefore, results showed that sediments from the studied areas present evidences of degradation; however, further studies are required to determine relationships between toxicity and contamination. Results also suggested that the disposal of dredged sediments should be re-evaluated.A dragagem dos sedimentos do Canal de Santos é necessária para permitir o trânsito de navios que operam no Porto de Santos. As áreas de disposição do material dragado estão situadas na zona costeira, em frente à Baía de Santos. Este estudo visou avaliar a qualidade dos sedimentos do Canal de Santos e das áreas de disposição atuais e antigas, utilizando testes de toxicidade de sedimento integral com anfípodos e de toxicidade de elutriatos com embriões de ouriço do mar. As amostras do Canal de Santos foram consideradas as mais tóxicas: todas as amostras dessa área foram consideradas significativamente tóxicas. Além disso, algumas amostras das áreas de disposição exibiram toxicidade. Os resultados mostraram, portanto, que os sedimentos apresentam evidências de degradação em sua qualidade, porém novos estudos devem ser conduzidos visando determinar as relações entre contaminação e toxicidade. Os resultados sugerem ainda que a disposição dos sedimentos dragados deva ser reavaliada

Should all patients with HR-positive HER2-negative metastatic breast cancer receive CDK 4/6 inhibitor as first-line based therapy? A network meta-analysis of data from the PALOMA 2, MONALEESA 2, MONALEESA 7, MONARCH 3, FALCON, SWOG and FACT trials

Background: We aim to understand whether all patients with hormonal receptor (HR)-positive (+)/human epidermal growth factor receptor-2 (HER2)-negative (−) metastatic breast cancer (MBC) should receive cyclin D-dependent kinase (CDK) 4/6 inhibitor-based therapy as a first-line approach. Methods: A network meta-analysis (NMA) using the Bayesian hierarchical arm-based model, which provides the estimates for various effect sizes, were computed. Results: First-line treatment options in HR+/HER2− MBC, including CDK 4/6 inhibitors combined with aromatase inhibitors (AIs) or fulvestrant (F), showed a significantly longer progression-free survival (PFS) in comparison with AI monotherapy, with a total of 26% progression risk reduction. In the indirect comparison across the three classes of CDK 4/6 inhibitors and F endocrine-based therapies, the first strategy resulted in longer PFS, regardless of specific CDK 4/6 inhibitor (HR: 0.68; 95% CrI: 0.53–0.87 for palbociclib + AI, HR: 0.65; 95% CrI: 0.53–0.79 for ribociclib + AI, HR: 0.63; 95% CrI: 0.47–0.86 for abemaciclib + AI) and patient’s characteristics. Longer PFS was also found in patients with bone-only and soft tissues limited disease treated with CDK 4/6 inhibitors. Conclusions: CDK 4/6 inhibitors have similar efficacy when associated with an AI in the first-line treatment of HR+ MBC, and are superior to either F or AI monotherapy, regardless of any other patients or tumor characteristics

Comparison of HER2 status in primary and paired metastatic sites of gastric carcinoma

Background: Trastuzumab has recently shown efficacy in the treatment of HER2-positive advanced gastric adenocarcinoma. Although antibody-based therapies target the metastatic disease, HER2 status is usually evaluated in the primary tumour because metastatic sites are rarely biopsied. The aim of this study was to compare HER2 status in primary and paired metastatic sites of gastric adenocarcinoma. Methods: The HER2 status was assessed by fluorescence in situ hybridisation (FISH) and immunohistochemistry (IHC) in 72 secondary lesions of gastric adenocarcinoma and in the corresponding primary tumours. Results: Concordance of FISH results, evaluable in 68 primary and matched metastatic sites, was 98.5%. Concordance of IHC results, available in 39 of the 72 paired cases, was 94.9%. Only one case showed discordance between primary tumour and metastasis, being negative by both IHC and FISH in the primary and showing HER2 overexpression and amplification in the corresponding pancreatic lymph node metastasis. Conclusion: The high concordance observed between HER2 results obtained by both IHC and FISH on primary tumours and corresponding metastases suggests that in gastric cancer HER2 status is maintained in most cases unchanged during the metastatic process. Keywords: HER2, gastric cancer, FISH, immunohistochemistr