Midpalatal implants vs headgear for orthodontic anchorage - a randomized clinical trial: Cephalometric results

OBJECTIVE: To compare the clinical effectiveness of the mid-palatal implant as a method of reinforcing anchorage during orthodontic treatment with that of conventional extra-oral anchorage. DESIGN: A prospective, randomized, clinical trial Setting: Chesterfield and North Derbyshire Royal Hospital NHS Trust and the Charles Clifford Dental Hospital, Sheffield. SUBJECTS AND METHODS: 51 orthodontic patients between the ages of 12 and 39, with a class II division 1 malocclusion and ‘absolute anchorage’ requirements were randomly allocated to either receive a mid-palatal implant or headgear to reinforce orthodontic anchorage. The main outcome of the trial was to compare the mesial movement of the molars and incisors of the two treatment groups between T1 (start) and T2 (end of anchorage reinforcement) as measured from cephalometric radiographs. RESULTS: The reproducibility of the measuring technique was acceptable. There were significant differences between the T1 and T2 measurements within the implant group for the position of the maxillary central incisor (p<0.001), position of the maxillary molar (p=0.009) and position of the mandibular molar (p<0.001). There were significant differences within the headgear group for the position of the mandibular central incisor (p<0.045), position of the maxillary molar (p=<0.001) and position of the mandibular molar (p<0.001). All the skeletal and dental points moved mesially more in the headgear group during treatment than in the implant group. These ranged from an average of 0.5mm more mesial for the mandibular permanent molar to 1.5mm more mesial for the maxillary molar and mandibular base. None of the treatment changes between the implant and headgear groups were statistically significant. CONCLUSIONS: Mid-palatal implants are an acceptable technique for reinforcing anchorage in the orthodontic patient

Midpalatal implants vs headgear for orthodontic anchorage - a randomized clinical trial: Cephalometric results

OBJECTIVE: To compare the clinical effectiveness of the mid-palatal implant as a method of reinforcing anchorage during orthodontic treatment with that of conventional extra-oral anchorage. DESIGN: A prospective, randomized, clinical trial Setting: Chesterfield and North Derbyshire Royal Hospital NHS Trust and the Charles Clifford Dental Hospital, Sheffield. SUBJECTS AND METHODS: 51 orthodontic patients between the ages of 12 and 39, with a class II division 1 malocclusion and ‘absolute anchorage’ requirements were randomly allocated to either receive a mid-palatal implant or headgear to reinforce orthodontic anchorage. The main outcome of the trial was to compare the mesial movement of the molars and incisors of the two treatment groups between T1 (start) and T2 (end of anchorage reinforcement) as measured from cephalometric radiographs. RESULTS: The reproducibility of the measuring technique was acceptable. There were significant differences between the T1 and T2 measurements within the implant group for the position of the maxillary central incisor (p<0.001), position of the maxillary molar (p=0.009) and position of the mandibular molar (p<0.001). There were significant differences within the headgear group for the position of the mandibular central incisor (p<0.045), position of the maxillary molar (p=<0.001) and position of the mandibular molar (p<0.001). All the skeletal and dental points moved mesially more in the headgear group during treatment than in the implant group. These ranged from an average of 0.5mm more mesial for the mandibular permanent molar to 1.5mm more mesial for the maxillary molar and mandibular base. None of the treatment changes between the implant and headgear groups were statistically significant. CONCLUSIONS: Mid-palatal implants are an acceptable technique for reinforcing anchorage in the orthodontic patient

Long term outcome and elasticity of a polyester mesh used for laparoscopic ventral hernia repair

Background: Repair of a ventral hernia is increasingly being performed by a laparoscopic approach despite lack of good long term follow up data on outcomes. The aim of this study was to examine the long term performance of a polyester mesh and to assess its elastic properties in patients undergoing laparoscopic ventral hernia repair. Methods: All patients being assessed for a ventral hernia repair between August 2011 and November 2013 were placed on a prospective database. Those undergoing laparoscopic repair with a polyester mesh were seen at clinic at one month and one year, while their electronic records were assessed at 34 months (range 24–48 months) and 104 months (range 92–116 months). In addition, CT scans of the abdomen and pelvis performed for any reason on these patients during the follow up period were reviewed by a consultant gastrointestinal radiologist. Mechanical failure testing of the mesh was also performed. Results: Thirty-two of the 100 patients assessed for ventral hernia repair had a laparoscopic repair with a polyester mesh. Nineteen (59%) had CT scans performed during the follow-up period. No recurrence was recorded at 34 months, while three (9.4%) had a recurrence at 104 months. Two had central breakdown of the mesh at 81 and 90 months, while 1 presented acutely at 116 months after operation. Mesh had stretched across the defect by an average of 21% (range 5.7–40%) in nine patients. Mechanical testing showed that this mesh lost its elasticity at low forces ranging between 1.8 and 3.2 N/cm. Conclusion: This study shows that late recurrence is a problem following laparoscopic ventral hernia repair with polyester mesh. The mesh loses it elasticity at a low force. This combined with degradation of mesh seems the most likely cause of failure. This is unlikely to be a unique problem of polyester mesh and further long-term studies are required to better assess this operative approach to ventral hernia repair

Advances in Antisense Oligonucleotide Development for Target Identification, Validation, and as Novel Therapeutics

Antisense oligonucleotides (As-ODNs) are single stranded, synthetically prepared strands of deoxynucleotide sequences, usually 18–21 nucleotides in length, complementary to the mRNA sequence of the target gene. As-ODNs are able to selectively bind cognate mRNA sequences by sequence-specific hybridization. This results in cleavage or disablement of the mRNA and, thus, inhibits the expression of the target gene. The specificity of the As approach is based on the probability that, in the human genome, any sequence longer than a minimal number of nucleotides (nt), 13 for RNA and 17 for DNA, normally occurs only once. The potential applications of As-ODNs are numerous because mRNA is ubiquitous and is more accessible to manipulation than DNA. With the publication of the human genome sequence, it has become theoretically possible to inhibit mRNA of almost any gene by As-ODNs, in order to get a better understanding of gene function, investigate its role in disease pathology and to study novel therapeutic targets for the diseases caused by dysregulated gene expression. The conceptual simplicity, the availability of gene sequence information from the human genome, the inexpensive availability of synthetic oligonucleotides and the possibility of rational drug design makes As-ODNs powerful tools for target identification, validation and therapeutic intervention. In this review we discuss the latest developments in antisense oligonucleotide design, delivery, pharmacokinetics and potential side effects, as well as its uses in target identification and validation, and finally focus on the current developments of antisense oligonucleotides in therapeutic intervention in various diseases

Phase II randomised discontinuation trial of brivanib in patients with advanced solid tumours

Background: Brivanib is a selective inhibitor of vascular endothelial growth factor and fibroblast growth factor (FGF) signalling. We performed a phase II randomised discontinuation trial of brivanib in 7 tumour types (soft-tissue sarcomas [STS], ovarian cancer, breast cancer, pancreatic cancer, non-small-cell lung cancer [NSCLC], gastric/esophageal cancer and transitional cell carcinoma [TCC]). Patients and methods: During a 12-week open-label lead-in period, patients received brivanib 800 mg daily and were evaluated for FGF2 status by immunohistochemistry. Patients with stable disease at week 12 were randomised to brivanib or placebo. A study steering committee evaluated week 12 response to determine if enrolment in a tumour type would continue. The primary objective was progression-free survival (PFS) for brivanib versus placebo in patients with FGF2-positive tumours. Results: A total of 595 patients were treated, and stable disease was observed at the week 12 randomisation point in all tumour types. Closure decisions were made for breast cancer, pancreatic cancer, NSCLC, gastric cancer and TCC. Criteria for expansion were met for STS and ovarian cancer. In 53 randomised patients with STS and FGF2-positive tumours, the median PFS was 2.8 months for brivanib and 1.4 months for placebo (hazard ratio [HR]: 0.58, p = 0.08). For all randomised patients with sarcomas, the median PFS was 2.8 months (95% confidence interval [CI]: 1.4–4.0) for those treated with brivanib compared with 1.4 months (95% CI: 1.3–1.6) for placebo (HR = 0.64, 95% CI: 0.38–1.07; p = 0.09). In the 36 randomised patients with ovarian cancer and FGF2-positive tumours, the median PFS was 4.0 (95% CI: 2.6–4.2) months for brivanib and 2.0 months (95% CI: 1.2–2.7) for placebo (HR: 0.56, 95% CI: 0.26–1.22). For all randomised patients with ovarian cancer, the median PFS in those randomised to brivanib was 4.0 months (95% CI: 2.6–4.2) and was 2.0 months (95% CI: 1.2–2.7) in those randomised to placebo (HR = 0.54, 95% CI: 0.25–1.17; p = 0.11). Conclusion: Brivanib demonstrated activity in STS and ovarian cancer with an acceptable safety profile. FGF2 expression, as defined in the protocol, is not a predictive biomarker of the efficacy of brivanib

Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms

Background: Double contrast barium enema (DCBE) is the examination carried out most frequently for investigation of patients with large bowel symptoms. The aim of this study was to compare the sensitivity of DCBE and colonoscopy for the detection of colorectal cancer and neoplastic polyps greater than or equal to1 cm. Methods: All patients undergoing DCBE (1389) or colonoscopy (1081) as the primary investigation for large bowel symptoms or for cancer or polyp surveillance in the first g months of 1997 at a large teaching hospital were included in this study. At 1 and 2 years following investigation, a computerized search of appropriate diagnosis and procedure codes to detect any missed cancers or polyps was performed for all patients with a normal investigation. Results: Almost 19% of patients in both groups went on to have an additional large bowel investigation over the 2-year period. In the DCBE group, 47 patients (3.5%) had a cancer diagnosed; eight of them had been missed at the primary investigation (sensitivity 83%). In the colonoscopy group, 37 patients (3.4%) had a cancer; one of them had been missed at the primary investigation (sensitivity 97.5%). Neoplastic polyps greater than or equal to1 cm were diagnosed in 1.6% of the DCBE group and in 7.7% of the colonoscopy group, with sensitivities of 21.7% and 91.4%, respectively. Nine patients (0.6%) had a false positive diagnosis of cancer in the DCBE group; one had an iatrogenic bowel perforation following flexible sigmoidoscopy. Conclusions: Where adequate facilities and expertise exist, colonoscopy should be the investigation of choice for most patients with large bowel symptoms suggestive of neoplastic disease

Undergraduate medical education: a national survey of consultant radiologists

Objective: Rising clinical demand and changes to Radiologists’ job plans mean it is becoming ever more difficult for Radiologists to teach medical students. The aim of this study was to assess the current role of Radiologists in undergraduate medical education in Scotland. Methods: Consultant Radiologists working across all 14 Scottish Health Boards were invited by email to participate in an anonymous short online survey. The survey ran for 6 weeks from November 2019. One reminder email was sent a week before the survey closed. Results: 102 responses were recorded, representing 34% of the total whole time equivalent Radiologists in Scotland. All agreed Radiology should be taught to medical students. Over 70% (n = 73) taught medical students, most often during supporting professional activity time. 76 percent of Radiologists who did not teach expressed a desire to do so. The most common barrier to teaching was not having enough time in their job plan. Scottish Radiologists delivered a median of 10 h (IQR 0–22) a year of teaching to medical students. Thematic analysis of free comments revealed staffing/time constraints severely limiting ability to teach. Conclusion: This is the first national survey to assess the current role of Radiologists in teaching medical students. While most are teaching or want to teach, there is a large drop-off between current Scottish and previously reported UK median teaching hours. Engagement from Universities, Royal College of Radiologists and Health Boards is urgently needed to reverse this trend. Advances in knowledge: This is the first national survey into the current role of Radiologists in undergraduate medical education. There is a large drop-off between current Scottish and previously reported UK median teaching hours