25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

Magnetic resonance tumor regression grade (MR-TRG) to assess pathological complete response following neoadjuvant radiochemotherapy in locally advanced rectal cancer

This study aims to evaluate the feasibility of a magnetic resonance (MR) automatic method for quantitative assessment of the percentage of fibrosis developed within locally advanced rectal cancers (LARC) after neoadjuvant radiochemotherapy (RCT). A total of 65 patients were enrolled in the study and MR studies were performed on 3.0 Tesla scanner; patients were followed-up for 30 months. The percentage of fibrosis was quantified on T2-weighted images, using automatic K-Means clustering algorithm. According to the percentage of fibrosis, an optimal cut-off point for separating patients into favorable and unfavorable pathologic response groups was identified by ROC analysis and tumor regression grade (MR-TRG) classes were determined and compared to histopathologic TRG. An optimal cut-off point of 81% of fibrosis was identified to differentiate between favorable and unfavorable pathologic response groups resulting in a sensitivity of 78.26% and a specificity of 97.62% for the identification of complete responders (CRs). Interobserver agreement was good (0.85). The agreement between P-TRG and MR-TRG was excellent (0.923). Significant differences in terms of overall survival (OS) and disease free survival (DFS) were found between favorable and unfavorable pathologic response groups. The automatic quantification of fibrosis determined by MR is feasible and reproducible

Age estimation based on pulp–tooth volume ratio of anterior teeth in cone-beam computed tomographic images in a selected population: A cross-sectional study

The present study aimed to investigate the correlation between chronological age and pulp– tooth volume ratio in anterior teeth using cone beam computed tomographic (CBCT) images and provide equations for age estimation based on pulp–tooth volume ratio. In this cross-sectional study, CBCT images of 312 anterior teeth of the maxilla and mandible were examineαd. The chronological age and the sex of the patients were recorded. Tooth volume and pulp volume of the anterior teeth were measured using Mimics software, and then tooth–pulp volume ratio was calculated. Statistical analysis of data was performed using chi-square test, independent T-test, Pearson’s correlation, and linear regression (α = 0.05). Finally, equations were made based on the results of the regression analysis for age estimation in general and for males and females. The age of the subjects ranged between 16 and 69 years (mean 40.6 ± 12.74). The pulp–tooth volume ratio of the maxillary teeth was generally higher than the mandibular teeth. A significant inverse relationship between age and pulp–tooth volume ratio was observed for all anterior teeth. (p < 0.05). The strongest correlation between age and pulp–tooth volume ratio was reported for mandibular central incisor (r = −0.58, p < 0.001) and the weakest was for mandibular lateral incisor (r = −0.36, p = 0.012). Age estimation was most accurate among females using the maxillary central incisors (p < 0.001) and among males using the mandibular central incisors and maxillary canines (p = 0.003). Pulp–tooth volume ratio of mandibular central incisors, maxillary lateral incisors, and maxillary canines in males and maxillary and mandibular central incisors, maxillary lateral incisors, and maxillary and mandibular canines in females can be used for age estimation

Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR): A critical overview on the most promising applications of molecular scissors in oral medicine

The scientific community is continuously working to translate the novel biomedical techniques into effective medical treatments. CRISPR-Cas9 system (Clustered Regularly Interspaced Short Palindromic Repeats-9), commonly known as the “molecular scissor”, represents a recently developed biotechnology able to improve the quality and the efficacy of traditional treatments, related to several human diseases, such as chronic diseases, neurodegenerative pathologies and, interestingly, oral diseases. Of course, dental medicine has notably increased the use of biotechnologies to ensure modern and conservative approaches: in this landscape, the use of CRISPR-Cas9 system may speed and personalize the traditional therapies, ensuring a good predictability of clinical results. The aim of this critical overview is to provide evidence on CRISPR efficacy, taking into specific account its applications in oral medicine

Radiogenomics in clear cell renal cell carcinoma: correlations between advanced CT imaging (texture analysis) and microRNAs expression

Purpose: A relevant challenge for the improvement of clear cell renal cell carcinoma management could derive from the identification of novel molecular biomarkers that could greatly improve the diagnosis, prognosis, and treatment choice of these neoplasms. In this study, we investigate whether quantitative parameters obtained from computed tomography texture analysis may correlate with the expression of selected oncogenic microRNAs. Methods: In a retrospective single-center study, multiphasic computed tomography examination (with arterial, portal, and urographic phases) was performed on 20 patients with clear cell renal cell carcinoma and computed tomography texture analysis parameters such as entropy, kurtosis, skewness, mean, and standard deviation of pixel distribution were measured using multiple filter settings. These quantitative data were correlated with the expression of selected microRNAs (miR-21-5p, miR-210-3p, miR-185-5p, miR-221-3p, miR-145-5p). Both the evaluations (microRNAs and computed tomography texture analysis) were performed on matched tumor and normal corticomedullar tissues of the same patients cohort. Results: In this pilot study, we evidenced that computed tomography texture analysis has robust parameters (eg, entropy, mean, standard deviation) to distinguish normal from pathological tissues. Moreover, a higher coefficient of determination between entropy and miR-21-5p expression was evidenced in tumor versus normal tissue. Interestingly, entropy and miR-21-5p show promising correlation in clear cell renal cell carcinoma opening to a radiogenomic strategy to improve clear cell renal cell carcinoma management. Conclusion: In this pilot study, a promising correlation between microRNAs and computed tomography texture analysis has been found in clear cell renal cell carcinoma. A clear cell renal cell carcinoma can benefit from noninvasive evaluation of texture parameters in adjunction to biopsy results. In particular, a promising correlation between entropy and miR-21-5p was found

Dynamic MR of the pelvic floor. Influence of alternative methods to draw the pubococcygeal line (PCL) on the grading of pelvic floor descent

Objective: To evaluate the impact of the pubococcygeal line (PCL) position on hiatal descent grading, comparing the method recommended by the official guidelines with the other two most common methods reported in literature. Methods: Female patients prospectively included performed dynamic-MR (1,5 T) in supine position. Rectum and vagina were filled with ultrasound gel. MR protocol included TSE T2 weighted sequences on axial/sagittal/coronal planes and steady-state sequences (FIESTA) on midsagittal plane during three phases (rest, strain and defecation). On each phase, the posterior point of PCL was traced in the region recommended by the official guidelines (last coccygeal joint or PCLcc) and in the other two regions: coccyx's tip (PCLtip) and sacrococcygeal joint (PCLsc). The resulting grades of pelvic floor descent (according to HMO-System) were compared. Inter-reader and intra-reader agreement were evaluated. Results: The final population consisted of 60 patients (56yy±10). No significant differences in grading were observed using PCLtip and PCLcc in all phases (p = 0.3016/0.0719/0.0719 during rest/strain/defecation). Using PCLsc, the grading was significantly overestimated compared to PCLcc in all phases (p = 0.0041/0.0001/0.0001 during rest/strain/defecation). Inter-reader and intra-reader agreement were significantly higher using PCLtip (p &lt; 0.05). Conclusions: PCLtip is a reliable and highly reproducible option to the official PCLcc to correctly grade the pelvic floor descent and could be used when the PCLcc is not clearly visible. The use of PCLsc overestimates the grading compared to the official PCLcc and should not be used to avoid wrong patients’ management

Comparison of antimicrobial and wound-healing effects of silver nanoparticle and chlorhexidine mouthwashes: an in vivo study in rabbits

The objective is to formulate a silver nanoparticle mouthwash and then evaluate its antimicrobial and wound-healing effects in rabbit animal models. Microbial samples were collected from the oral cavity of 60 rabbits. Thereafter, standardized wounds were created in the lateral border of the tongue on the right side for all rabbits. After surgery, digital photographs were obtained from the wounds with standardized settings. To characterize the silver nanoparticles used in the synthetic mouthwash, transmission electron microscopy (TEM) and digital light scattering analysis were used. The animal models were then randomly divided into 4 groups: group 1 received 9.80 wt% silver nanoparticle mouthwash; group 2 received all the ingredients of the formulated mouthwash except for silver nanoparticles; group 3 received chlorhexidine 2.0% mouthwash; and the negative control group did not receive any postoperative mouthwash. Microbial samples were collected from oral cavity of the rabbits each day for four postoperative days. Colony-forming unit (CFU) counts were compared post-operatively with the pre-operative counts. In addition, standardized digital photographs were taken each day from the wounds and the area of the wounds was compared in postoperative and pre-operative images. Data were statistically analyzed using one-way ANOVA and repeated measures variance analysis (α = 0.05). TEM revealed spherical morphology of silver nanoparticles and digital light scattering showed an average size of 5 nm and optimal distribution of the nanoparticles. CFU count significantly decreased in groups 1 and 3 (P 0.05). Silver nanoparticle mouthwash possesses favorable antibacterial and wound-healing effects. The formulated 9.80 wt% silver nanoparticle mouthwash with a particle size of 5 nm can be a promising alternative for application after oral surgical procedures

Radiographers and COVID-19 pneumonia: diagnostic performance using CO-RADS

Introduction: A more structured role of radiographers is advisable to speed up the management of patients with suspected COVID-19. The purpose of our study was to evaluate the diagnostic performance of radiographers in the detection of COVID-19 pneumonia on chest CT using CO-RADS descriptors. Methods: CT images of patients who underwent RT-PCR and chest CT due to COVID-19 suspicion between March and July 2020 were analysed retrospectively. Six readers, including two radiologists, two highly experienced radiographers and two less experienced radiographers, independently scored each CT using the CO-RADS lexicon. ROC curves were used to investigate diagnostic accuracy, and Fleiss’κ statistics to evaluate inter-rater agreement. Results: 714 patients (419 men; 295 women; mean age: 64 years ±19SD) were evaluated. CO-RADS&gt; 3 was identified as optimal diagnostic threshold. Highly experienced radiographers achieved an average sensitivity of 58.7% (95%CI: 52.5–64.7), an average specificity of 81.8% (95%CI: 77.9–85.2), and a mean AUC of 0.72 (95%CI: 0.68–0.75). Among less experienced radiographers, an average sensitivity of 56.3% (95%CI: 50.1–62.2) and an average specificity of 81.5% (95%CI: 77.6–84.9) were observed, with a mean AUC of 0.71 (95%CI: 0.68–0.74). Consultant radiologists achieved an average sensitivity of 60.0% (95%CI: 53.7–65.8), an average specificity of 81.7% (95%CI: 77.8–85.1), and a mean AUC of 0.73 (95%CI: 0.70–0.77). Conclusion: Radiographers can adequately recognise the classic appearances of COVID-19 on CT, as described by the CO-RADS assessment scheme, in a way comparable to expert radiologists. Implications for practice: Radiographers, as the first healthcare professionals to evaluate CT images in patients with suspected SARS-CoV-2 infection, could diagnose COVID-19 pneumonia by means of a categorical reporting scheme at CT in a reliable way, hence playing a primary role in the early management of these patients

Exercise promotes angiogenesis and improves beta-adrenergic receptor signalling in the post-ischaemic failing rat heart.

We investigated whether exercise training could promote angiogenesis and improve blood perfusion and left ventricular (LV) remodelling of the post-myocardial infarction (MI) failing heart. We also explored the contribution of ameliorated beta-adrenergic receptor signalling and function on the overall improvement of cardiac contractility reserve induced by exercise.Adult Wistar male rats were randomly assigned to one of four experimental groups. Sham-operated and post-MI heart failure (HF) rats were housed under sedentary conditions or assigned to 10-weeks of a treadmill exercise protocol. At 4 weeks after MI, sedentary HF rats showed LV eccentric hypertrophy, marked increase of LV diameters associated with severely impaired fractional shortening (14 +/- 5\%), increased LV end diastolic pressure (20.9 +/- 2.6 mmHg), and pulmonary congestion. In addition, cardiac contractile responses to adrenergic stimulation were significantly blunted. In trained HF rats, exercise was able to (i) reactivate the cardiac vascular endothelial growth factor pathway with a concurrent enhancement of myocardial angiogenesis, (ii) significantly increase myocardial perfusion and coronary reserve, (iii) reduce cardiac diameters, and (iv) improve LV contractility in response to adrenergic stimulation. This latter finding was also associated with a significant improvement of cardiac beta-adrenergic receptor downregulation and desensitization.Our data indicate that exercise favourably affects angiogenesis and improves LV remodelling and contractility reserve in a rat model of severe chronic HF