Maxillary distalization by a rearrangement of the Leaf Expander® screw combined with palatal miniscrews: A case report on the MaXimo Appliance

ABSTRACT Introduction: This case report describes the treatment of a crowded dental Class II malocclusion in 13 years, 2 months female patient. Maxillary distalization was achieved by a novel compliance-free appliance referred to as MaXimo, which was built by a rearrangement of the Leaf Expander® screw having palatal miniscrews as the anchorage core. Case Presentation: Pre-treatment, post-treatment and 1-year follow-up records are shown. No side effects, breakage of the appliance or loss of miniscrews was encountered. The active distalization phase lasted 14 months, while the whole treatment, including the use of multibrackets appliance, lasted 25 months. A significant spontaneous distal drifting of the premolars and canines was seen. The treatment outcomes proved to be stable at the follow-up with acceptable aesthetic and functional results. Conclusion: The MaXimo appliance proved to be efficient and of easy management, and its use may be recommended when distalization of the maxillary dentition is required. Being mostly assembled by the manufactured, the MaXimo appliance is also cheap and of easy construction

Taxanes in adjuvant chemotherapy for early breast cancer.

Adjuvant polychemotherapy improves diseasefree survival and overall survival in women with early breast cancer. A meta-analysis by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) reported that over 15 years there had been a reduction in recurrence and death in women younger than 50 years who had received adjuvant polychemotherapy [1]. A smaller but still highly significant reduction in the risk of recurrence and death was observed for women aged 50–69 years who received the same treatment. The effect of adjuvant chemotherapy on recurrence was noted mainly during the first 5 years after randomization. The magnitude of effect within this 5-year period was 2.5-times greater for women aged under 50 years compared with women aged 50–59 years. The EBCTCG meta-analysis also compared regimens that contain anthracyclines with no chemotherapy or with the oral combination of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) [1]. The most widely investigated regimens that contain anthracyclines were a combination of cyclophosphamide and 5-fluorouracil with either doxorubicin or epirubicin. The EBCTCG study found that allocation to approximately 6 months of anthracycline-based polychemotherapy reduced the yearly death rate from breast cancer by approximately 38% for women younger than 50 years of age at diagnosis and by approximately 20% for women aged 50–69 years at diagnosis

Multiple endocrine neoplasias type 2B and RET proto-oncogene

Multiple Endocrine Neoplasia type 2B (MEN 2B) is an autosomal dominant complex oncologic neurocristopathy including medullary thyroid carcinoma, pheochromocytoma, gastrointestinal disorders, marphanoid face, and mucosal multiple ganglioneuromas. Medullary thyroid carcinoma is the major cause of mortality in MEN 2B syndrome, and it often appears during the first years of life. RET proto-oncogene germline activating mutations are causative for MEN 2B. The 95% of MEN 2B patients are associated with a point mutation in exon 16 (M918/T). A second point mutation at codon 883 has been found in 2%-3% of MEN 2B cases. RET proto-oncogene is also involved in different neoplastic and not neoplastic neurocristopathies. Other RET mutations cause MEN 2A syndrome, familial medullary thyroid carcinoma, or Hirschsprung's disease. RET gene expression is also involved in Neuroblastoma. The main diagnosis standards are the acetylcholinesterase study of rectal mucosa and the molecular analysis of RET. In our protocol the rectal biopsy is, therefore, the first approach. RET mutation detection offers the possibility to diagnose MEN 2B predisposition at a pre-clinical stage in familial cases, and to perform an early total prophylactic thyroidectomy. The surgical treatment of MEN 2B is total thyroidectomy with cervical limphadenectomy of the central compartment of the neck. When possible, this intervention should be performed with prophylactic aim before 1 year of age in patients with molecular genetic diagnosis. Recent advances into the mechanisms of RET proto-oncogene signaling and pathways of RET signal transduction in the development of MEN 2 and MTC will allow new treatment possibilities

The effects of enzalutamide and abiraterone on skeletal related events and bone radiological progression free survival in castration resistant prostate cancer patients: An indirect comparison of randomized controlled trials

Two new drugs, the CYP17 inhibitor abiraterone acetate and the androgen receptor (AR) antagonist enzalutamide, have recently shown to prolong OS prior chemotherapy or in docetaxel treated mCRPC patients, using steroidal therapy or placebo as control group. Updated analyses underlined the role of these new agents on two prostate-specific endpoints as radiographic progression-free survival (rPFS) and time to first skeletal-related event (tSRE). On the basis of these reports, we made an indirect comparison between abiraterone and enzalutamide. We obtained a clinically but not significant difference favouring enzalutamide over abiraterone in terms of rPFS (HR 0.48, 95% CI 0.22â1.02). No significant difference was shown in term of tSRE (HR 0.99, 95% CI 0.83â1.17). In conclusion, abiraterone and enzalutamide have both demonstrated to significantly delay the bone progression resulting in similar improvements in bone-related endpoints in patients with mCRPC

Imatinib dose escalation versus sunitinib as a second line treatment in KIT exon 11 mutated GIST: a retrospective analysis

We retrospectively reviewed data from 123 patients (KIT exon 11 mutated) who received sunitinib or dose-escalated imatinib as second line.All patients progressed on imatinib (400 mg/die) and received a second line treatment with imatinib (800 mg/die) or sunitinib (50 mg/die 4 weeks on/2 off or 37.5 mg/day). Deletion versus other KIT 11 mutation was recorded, correlated with clinical benefits.64% received imatinib, 36% sunitinib. KIT exon 11 mutation was available in 94 patients. With a median follow-up of 61 months, median time to progression (TTP) in patients receiving sunitinib and imatinib was 10 (95% CI 9.7-10.9) and 5 months (95% CI 3.6-6.7) respectively (P = 0.012). No difference was found in overall survival (OS) (P = 0.883). In imatinib arm, KIT exon 11 deletions was associated with a shorter TTP (7 vs 17 months; P = 0.02), with a trend in OS (54 vs 71 months P = 0.063). No difference was found in patients treated with sunitinib (P = 0.370).A second line with sunitinib was associated with an improved TTP in KIT exon 11 mutated patients progressing on imatinib 400 mg/die. Deletions in exon 11 seemed to be correlated with worse outcome in patients receiving imatinib-based second line

Differential effect of zoledronic acid on normal trabecular and cortical bone density in oncologic patients with bone metastases

AbstractPurposeTo evaluate bone density changes at the level of normal bone and bone metastases after zoledronic acid (ZA) treatment in oncologic patients.Materials and methodsWe retrospectively evaluated 72 consecutive adult patients with histologically confirmed solid tumors with at least 1 newly diagnosed bone metastatic lesion. Bone metastases were diagnosed by bone scans and confirmed with computed tomography (CT). Patients received intravenous ZA, 4mg, by 15-min infusion every 28 day through a peripheral or a central venous access and were monitored for at least 3 months and a maximum of 24 months. Bone density was determined at the level of bone metastases and at the level of normal trabecular and cortical bone using a ROI-based approach.ResultsA significant increase was demonstrated at the level of normal trabecular bone of the calvarium and the femoral neck. No significant increase of density was observed at the level of the normal cortical bone. Bone metastases showed a significant increase in CT density as compared to baseline up to 24 months after zoledronic acid.ConclusionWe have found that long term treatment with ZA increases trabecular bone density in oncologic patients whereas normal cortical bone changes are not detectable

Lack of Correlation between Liver Tests Abnormalities and Trabectedin Efficacy in the Treatment of Soft Tissue Sarcoma: A Retrospective Study

Elevation in liver transaminases is common in patients treated with the marine antitumor agent trabectedin. However, the impact of trabectedin-related transaminase elevations on treatment outcomes is unclear. This retrospective study investigated the correlation between liver tests abnormalities and treatment outcomes in patients with unresectable advanced or metastatic soft tissue sarcomas (STS) treated with trabectedin 1.5 mg/m2 once every 3 weeks at three reference centers in Italy. The effect of grade 3/4 elevations in alanine aminotransferase (ALT) or aspartate aminotransferase (AST) during the first two cycles and at any time during trabectedin treatment on progression-free survival (PFS) and overall survival (OS) were analyzed. Liver tests abnormalities during the first two cycles of chemotherapy or at any time during trabectedin treatment did not significantly affect PFS or OS. Nor were survival outcomes significantly different in the subgroups of patients with or without ALT/AST increases or with ALT/AST elevations ≥15 × the upper limit of normal (ULN) versus those with ALT/AST elevation <15 × ULN. Although liver tests abnormalities are common in patients treated with trabectedin, elevations in ALT and AST are usually transient, occur during the first two cycles of treatment, and do not appear to affect survival

Changes in bone turnover markers in patients without bone metastases receiving immune checkpoint inhibitors: An exploratory analysis

Immune checkpoint inhibitors (ICIs) has revolutionized the treatment of different advanced solid tumors, but most patients develop severe immune-related adverse events (irAEs). Although a bi-directional crosstalk between bone and immune systems is widely described, the effect of ICIs on the skeleton is poorly investigated. Here, we analyze the changes in plasma levels of type I collagen C-terminal telopeptide (CTX-I) and N-terminal propeptide of type I procollagen (PINP), reference makers of bone turnover, in patients treated with ICIs and their associ-ation with clinical outcome.A series of 44 patients affected by advanced non-small cell lung cancer or renal cell carcinoma, without bone metastases, and treated with ICIs as monotherapy were enrolled. CTX-I and PINP plasma levels were assessed at baseline and after 3 months of ICIs treatment by ELISA kits.A significant increase of CTX-I with a concomitant decreasing trend towards the reduction of PINP was observed after 3 months of treatment. Intriguingly, CTX-I increase was associated with poor prognosis in terms of treatment response and survival. These data suggest a direct relationship between ICIs treatment, increased osteoclast activity and potential fracture risk.Overall, this study reveals that ICIs may act as triggers for skeletal events, and if confirmed in larger pro-spective studies, it would identify a new class of skeletal-related irAEs

Anestesia locale computerizzata con il sistema Wand®STA®. Valutazione dell’efficacia nella terapia estrattiva dei terzi molari e della percezione dolorosa evocata in fase iniettiva

Il dolore percepito durante l’iniezione intraorale rappresenta la causa principale di ansia per molti pazienti che devono sottoporsi alle cure odontoiatriche. Lo studio presentato valuta la percezione del dolore e l’efficacia della metodica anestetica a flusso controllato con il dispositivo Wand® STA® in 50 pazienti sottoposti a terapia estrattiva di terzo molare. I pazienti riferiscono, attraverso la compilazione di questionari comprendenti la scala VAS (Scala Visuo-Analogica) e la scala MDAS (Modified Dental Anxiety Scale), una netta riduzione del dolore e dell’ansia in relazione alla metodica di erogazione (computerizzata rispetto a quella tradizionale), evidente soprattutto in soggetti con uno stato d’ansia basale maggiore. Il protocollo ha evidenziato l’efficacia di questa metodica anestetica pari al 90%, in una delle procedure di chirurgia orale più comuni e complesse in odontoiatria, che richiedono un effetto anestetico completo