Risk stratification of symptomatic brain metastases by clinical and FDG PET parameters for selective use of prophylactic cranial irradiation in patients with extensive disease of small cell lung cancer

Purpose: To identify risk factors for developing symptomatic brain metastases and evaluate the impact of prophylactic cranial irradiation (PCI) on brain metastasis-free survival (BMFS) and overall survival (OS) in extensive disease small cell lung cancer (ED-SCLC). Materials and methods: Among 190 patients diagnosed with ED-SCLC who underwent FDG PET/CT and brain Magnetic Resonance Imaging (MRI) prior to treatment, 53 (27.9%) received PCI while 137 (72.1%) did not. Prognostic index predicting a high risk of symptomatic brain metastases was calculated for the group without receiving PCI (observation group, n = 137) with Cox regression model. Results: Median follow-up time was 10.6 months. Multivariate Cox regression showed that the following three factors were associated with a high risk of symptomatic brain metastases: the presence of extrathoracic metastases (p = 0.004), hypermetabolism of bone marrow or spleen on FDG PET (p < 0.001), and high neutrophil-to-lymphocyte ratio (p = 0.018). PCI significantly improved BMFS in high-risk patients (1-year rate: 94.7% vs. 62.1%, p = 0.001), but not in low-risk patients (1-year rate: 100.0% vs. 87.7%, p = 0.943). However, PCI did not improve OS in patients at high risk for symptomatic brain metastases (1-year rate: 65.2% vs. 50.0%, p = 0.123). Conclusion: Three prognostic factors (the presence of extrathoracic metastases, hypermetabolism of bone marrow or spleen on FDG PET, and high neutrophil-to-lymphocyte ratio) were associated with a high risk of symptomatic brain metastases in ED-SCLC. PCI was beneficial for patients at a high risk of symptomatic brain metastases in terms of BMFS, but not OS. Thus, selective use of PCI in ED-SCLC according to the risk stratification is recommended. (C) 2020 Elsevier B.V. All rights reserved.

Initial growth pattern of children with cleft before alveolar bone graft stage according to cleft type Unilateral cleft lip and alveolus, unilateral cleft lip and palate, and cleft palate

Objective: To test the null hypothesis that there is no significant difference in the initial growth pattern among three cleft types before alveolar bone graft (ABG) according to cleft type (unilateral cleft lip and alveolus [UCLA], unilateral cleft lip and palate [UCLP], and cleft palate [CP]). Materials and Methods: Samples consisted of the UCLA group, the UCLP group, and the CP group. Individuals were treated with the identical surgical technique by the same surgeon and had no history of orthodontic/orthopedic treatment. Lateral cephalograms taken 1 month before ABG were analyzed using 29 variables. One-way analysis of variance (ANOVA) testing and bivariate and logistic regression analyses were performed. Results: An increasing tendency for Class III relationships in the order of UCLA, UCLP, and CP was noted (ANB, AB-to-facial plane angle, AB-to-mandibular plane angle; P < .001, respectively). UCLP and CP groups demonstrated more posterior positioning of the maxilla (SNA, A-to-N-perp; P < .001, respectively) and a hyperdivergent pattern (gonial angle, SN-GoMe angle, FMA; P < .001, respectively) compared with the UCLA group. Because no differences in palatal plane angle and SN-to-occlusal plane angle were noted among the three groups, the hyperdivergent pattern in the UCLP and CP groups might be due to an innate growth pattern and eventual adaptation of the mandible to maxillary growth. UCLP and CP groups showed more Class III relationships (ANB: P < .05, P < .001, respectively) and a more hyperdivergent pattern (FMA: P < .05, P < .01, respectively) than the UCLA group. Conclusion: When the degree of cleft involvement increases from the primary palate to the secondary palate, the predominance of the Class III relationship and the hyperdivergent pattern increases also. (c) 2011 by The EH Angle Education and Research Foundation, Inc.

Associations between the risk of tooth agenesis and single-nucleotide polymorphisms of MSX1 and PAX9 genes in nonsyndromic cleft patients

Objective: To investigate the association between the risk of tooth agenesis and single-nucleotide polymorphisms (SNPs) of MSX1 and PAX9 genes in nonsyndromic cleft patients. Materials and Methods: The subjects were 126 Korean nonsyndromic cleft patients. Tooth agenesis type (TAT) was classified as none (0); cleft area (1); cleft area + other area (2); and other area (3) based on agenesis of the maxillary lateral incisor (MXLI) and another tooth within or outside the cleft area. TAT was further grouped into two subcategories (0 and 1) and four subcategories (0, 1, 2, and 3). Three SNPs of MSX1 and 10 SNPs of PAX9 were investigated using Fisher's exact test and logistic regression analysis. Results: Although the association between genotype distribution of PAX9-rs7142363 and TAT was significant (P < .05 in four subcategories#, genotypic odds ratios #GORs# of SNPs in each TAT were not meaningful. However, for MSX1-rs12532 and PAX9-rs2073247, associations between genotypic distribution and TAT were significant #P < .01 in four subcategories and P < .05 in two subcategories; P < .01 in two subcategories, respectively#. In cleft area, GORs of MXLI agenesis in genotypes GA of MSX1-rs12532 and CT of PAX9-rs2073247 were increased by 3.14-fold and 4.15-fold compared with genotype GG of MSX1-rs12532 and CC of PAX9-rs2073247, respectively #P <. 01; P < .05#. In cleft area + other area, the GOR of agenesis of MXLI and another tooth in genotype AA of MSX1-rs12532 was increased by fivefold compared with genotype GG #P < .05). Conclusion: Genetic disturbances of MSX1 and PAX9 genes are associated with tooth agenesis within and outside the cleft area.OAIID:oai:osos.snu.ac.kr:snu2013-01/102/0000004298/13SEQ:13PERF_CD:SNU2013-01EVAL_ITEM_CD:102USER_ID:0000004298ADJUST_YN:YEMP_ID:A072100DEPT_CD:852CITE_RATE:1.184FILENAME:seoyj-msx1-pax9-missing-ao-2013.pdfDEPT_NM:치의과학과SCOPUS_YN:YCONFIRM:

Repetitive single subarachnoid injections for trial administration of the intrathecal morphine pump in patients with intractable non-cancer pain -A case report-

Since the early 1980s, the implantable intrathecal drug pump (ITDP) has been used increasingly to manage chronic pain. Prior to making a decision to implant an ITDP, trial administration of the intrathecal (IT) drug should be performed to estimate the effective dose for a starting set of implantable ITDPs. There is no standard method of trial IT drug administration, though. Therefore, this paper reports 20 cases of IT morphine trial with single and repetitive injections until the appropriate dose was attained with respect to analgesia and its side effects. The trial procedure was performed with daily sequential IT injections using morphine and 0.3% mepivacaine. Twelve out of the total of 20 patients had positive responses. Thus, it is inferred that daily sequential IT morphine injections combined with a placebo injection as a trial ITDP would be useful in evaluating the effectiveness and adverse effects of IT morphine infusion with clinically insignificant side effects