Open reduction and internal fixation obtains favorable clinical and radiographic outcomes for pediatric mandibular condylar fractures

PURPOSE

Surgery with open reduction internal fixation (ORIF) for pediatric mandibular condylar fractures (MCF) is controversial. This study aims to evaluate the clinical and radiographic outcomes of the children with MCF treated surgically with ORIF.

METHODS

This retrospective study included 9 children diagnosed with MCF and treated surgically with ORIF. Imaging examinations were performed preoperatively and postoperatively. Patients underwent follow-up clinical observations and objective measurements for over 5 years.

RESULTS

All children recovered well in facial features, facial nerve functions, occlusions, joint movements, maximal incisal opening, and midline deviation postoperatively. The temporomandibular joint (TMJ) pain and click were found in 2 of 9 (22.2%) cases 1 year after surgery and disappeared 2 years later. Mandibular retrusion was always observed in a child (11.1%) postoperatively. The condylar surface appeared unsmooth in panoramic radiographs of 2 (22.2%) cases. Objective measurements showed that a patent (11.1%) had an opening deflection and a limited laterotrusion at the return visits. SNB angles of all cases were within the normal range 5 years after the operation.

CONCLUSION

Surgery with ORIF is a relatively safe and effective method for pediatric MCF. The future growth of the mandibular condyle and the long-term TMJ function are lightly influenced in patients postoperatively.

Thumb lengthening using a three-dimensional half-ring distraction frame

The purpose of this study was to evaluate the use of a three-dimensional half-ring distraction frame for thumb phalangeal lengthening. From February 2009 to March 2015, 23 patients (23 thumbs) with thumb loss were treated with a half-ring distraction frame. Active movements of the metacarpophalangeal (MCP) joint were measured with a goniometer. These measurements were compared with the opposite hand. Differences were considered statistically significant at p<0.05. Clinical outcome was assessed based on the modified Mayo score. Bone union and good alignment were achieved in all patients. The mean distraction time was 44 days (range, 35-62 days). The mean time to union was 20 days (range, 49-86 days). The mean palmar and radial abduction of the thumb was 60° (range, 53°-65°) and 63° (range, 58°-70°), respectively; on the uninjured side, these measurements were 62° (range, 56°-65°) and 64° (range, 60°-73°), respectively (p>0.05). The mean extension-flexion arc of the MCP joint was 46° (range, 40°-50°); the measurement on the uninjured side was 48° (40°-54°) (p>0.05). The mean follow-up period was 51 months (4.25 years) (range, 48-65 months). The mean modified Mayo Score was 138 (range, 113-145). There were 19 excellent, 3 good, and 1 fair results. The half-ring distraction frame is a viable alternative for thumb lengthening as it provides stable, three-dimensional fixation, resulting in good hand function.

A method for determining surface tension, viscosity, and elasticity of gels via ultrasonic levitation of gel drops

A method for obtaining the elasticity, surface tension, and viscosity of ultrasonically levitated gel drops is presented. The drops examined were made of agarose, a hydrogel. In contrast to previous studies where fluid properties are obtained using ultrasonic levitation of a liquid drop, herein the material studied was a gel which has a significant elasticity. The work presented herein is significant in that gels are of growing importance in biomedical applications and exhibit behaviors partially determined by their elasticities and surface tensions. Obtaining surface tension for these substances is important but challenging since measuring this quantity using the standard Wilhelmy plate or DuNuoy ring methods is not possible due to breakage of the gel. The experiments were conducted on agarose gels having elasticities ranging from 12.2 to 200.3 Pa. A method is described for obtaining elasticity, surface tension, and viscosity, and the method is experimentally demonstrated for surface tension and viscosity. For the range of elasticities explored, the measured surface tension ranged from 0.1 to 0.3 N/m, and the viscosity ranged from 0.0084 to 0.0204 Pa s. The measurements of surface tension are, to the authors' knowledge, the first obtained of a gel using ultrasonic levitation.

Breastfeeding is associated with reduced risk of multiple sclerosis in males, predominantly among HLA-DRB1*15:01 carriers

BACKGROUND

Breastfeeding as an infant appears protective against later development of some autoimmune diseases, but research into its influence on multiple sclerosis (MS) risk has yielded inconclusive results.

OBJECTIVE

We investigated the possible impact of breastfeeding on MS risk.

METHODS

We used two population-based case-control studies comprising 3670 cases and 6737 matched controls. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for association between MS and exposure to prolonged breastfeeding (4 months or longer) versus reduced breastfeeding (less than 4 months). A meta-analysis of case-control studies that assessed the impact of breastfeeding on MS risk among women and men was conducted.

RESULTS

Prolonged breastfeeding was associated with reduced MS risk among men (OR 0.7, 95% CI 0.5-0.9) but not among women (OR 0.9, 95% CI 0.8-1.1). Among men, a synergistic effect was observed between HLA-DRB1*15:01 carrier status and reduced breastfeeding.

CONCLUSIONS

Findings from the current study add to accumulating evidence that breastfeeding may be a modifiable protective factor for reducing the risk of MS in offspring. When possible, mothers should be supported to breastfeed their infants; however, the mechanism of a sex-specific biologic effect of breastfeeding on MS risk is unclear.

Testing conditional mean independence for functional data

We propose a new nonparametric conditional mean independence test for a response variable $Y$ and a predictor variable $X$ where either or both can be function-valued. Our test is built on a new metric, the so-called functional martingale difference divergence, which fully characterizes the conditional mean dependence of $Y$ given $X$ and extends the martingale difference divergence proposed by Shao & Zhang (2014). We define an unbiased estimator of functional martingale difference divergence by using a $\mathcal{U}$-centring approach, and we obtain its limiting null distribution under mild assumptions. Since the limiting null distribution is not pivotal, we use the wild bootstrap method to estimate the critical value and show the consistency of the bootstrap test. Our test can detect the local alternative which approaches the null at the rate of $n^{-1/2}$ with a nontrivial power, where $n$ is the sample size. Unlike the three tests developed by Kokoszka et al. (2008), Lei (2014) and Patilea et al. (2016), our test does not require a finite-dimensional projection or assume a linear model, and it does not involve any tuning parameters. Promising finite-sample performance is demonstrated via simulations, and a real-data illustration is used to compare our test with existing ones.

Elastocapillary Transition in Gel Drop Oscillations

We report experimental observations of surface oscillations in an ultrasoft agarose gel drop. Ultrasonic levitation is used to excite shape oscillations in the gel drop and we report the natural frequency of the drop as it depends upon a nondimensional elastocapillary number, which we define as the ratio of the elastocapillary length to drop size. Our experiments span a wide range of experimental parameters and we recover the appropriate scaling laws in the elastic and capillary wave limits. The crossover between these two limits is observed and agrees well with a proposed frequency relationship.

Using tongue depressors to aid cord localization during collagenase injection for Dupuytren disease

The aim of this paper was to introduce a simple and effective method to aid in isolation and stabilization of Dupuytren cords for collagenase injection. Tongue depressors were used to isolate and stabilize the cord during the injection procedure. The area to be injected was sterilely prepared. An assistant was then directed to place a tongue depressor on both sides of the cord. A total of 35 patients with Dupuytren disease were treated. Follow-up lasted two years. Post-operative Disabilities of the Arm, Shoulder and Hand (DASH) scores was 4±2. Health-related quality of life measured with the EQ-5D index was 0.89±0.4. Recurrence rates of metacarpophalangeal joint and proximal interphalangeal joint were 11% and 14% respectively, using a flexion contracture of 20° to define recurrence. Collagenase treatment using a modified injection method with the aid of tongue depressors are a safe, effective way to treat Dupuytren contractures of the fingers. The technique can isolate the cord, which improves visualization of the cord. It may allow improved accuracy with needle placement and helps to decrease the complications and recurrence.

Anti-epidermal growth factor receptor (EGFR) monoclonal antibody combined with cisplatin and 5-fluorouracil in patients with metastatic nasopharyngeal carcinoma after radical radiotherapy: a multicentre, open-label, phase II clinical trial

BACKGROUND

We conducted a single-arm phase II trial to evaluate the efficacy and adverse effects (AEs) of an anti-epidermal growth factor receptor monoclonal antibody, nimotuzumab, combined with cisplatin and 5-fluorouracil (PF) as first-line treatment in recurrent metastatic nasopharyngeal carcinoma after radical radiotherapy.

METHODS

Patients who met the eligibility criteria were recruited from ten institutions (ClinicalTrials.gov; NCT01616849). A Simon optimal two-stage design was used to calculate the sample size. All patients received weekly nimotuzumab (200 mg) added to cisplatin (100 mg/m2 D1) and 5-fluorouracil (4 g/m2 continuous infusion D1-4) every 3-weekly for a maximum of six cycles. Primary end point was objective response rate (ORR). Secondary end points included disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and AEs.

RESULTS

A total of 35 patients were enrolled (13 in stage 1 and 22 in stage 2). Overall ORR and DCR were 71.4% (25/35) and 85.7% (30/35), respectively. Median PFS and OS were 7.0 (95% CI 5.8-8.2) months and 16.3 (95% CI 11.4-21.3) months, respectively. Unplanned exploratory analyses suggest that patients who received ≥2400 mg nimotuzumab and ≥4 cycles of PF had superior ORR, PFS and OS than those who did not (88.9% versus 12.5%, P < 0.001; 7.4 versus 2.7 months, P = 0.081; 17.0 versus 8.0 months, P = 0.202). Favourable subgroups included patients with lung metastasis [HROS 0.324 (95% CI 0.146-0.717), P = 0.008] and disease-free interval of >12 months [HROS 0.307 (95% CI 0.131-0.724), P = 0.004], but no difference was observed for metastatic burden. The only major grade 3/4 AE was leukopenia (62.9%).

CONCLUSION

Combination nimotuzumab-PF chemotherapy demonstrates potential efficacy, and is well tolerated as first-line chemotherapy regimen in recurrent metastatic nasopharyngeal carcinoma.

Abstract P5-04-29: Efficacy and safety of low-dose everolimus in Chinese HR-positive, HER2-negative metastatic breast cancer patients

Background: Everolimus has been testified to be effective among postmenopausal women with hormone receptor-positive human epidermal growth factor receptor-2 negative (HR+/HER2-) metastatic breast cancer (MBC). However, everolimus at dose of 10mg was accompanied by a higher incidence of mTOR-inhibitor class-effect adverse events (AEs) which usually leading to dose reduction or interruption. Additionally, some studies suggested that there was no correlation between dose intensity (5 vs. 10 mg labeled dose) and efficacy. Consequently, we conducted the present study aiming to explore the efficacy and safety of everolimus at dose of 5 mg plus endocrine therapy in Chinese population.

Methods: 68 HR+/HER2- MBC patients were included in this exploratory study who received everolimus at the dose of 5mg in Zhejiang Cancer Hospital between September 2014 and September 2017. Progression free survival(PFS) and overall survival(OS) were estimated by the Kaplan- Meier method, and the hazard ratios(HRs) and corresponding 95% confidence intervals(CIs) were estimated using the Cox proportional harzard model. Besides, objective response rate(ORR), clinical benefitrate(CBR) and safety profile were also evaluated.

Results: After a median follow up of 14 months, PFS was 5.3 months (95%CI 4.2-6.4), and OS was immature. 16(23.5%) were at the first or second-line, 52(76.5%) were at third-line or later. PFS for the first and second-line is significantly longer than that for the third-line or later (12.9 months vs. 4.6 months, P=0.009, HR=0.395, 95% CI=0.192-0.811). 11(16.2%) achieved partial response (PR), 42(61.7%) had stable disease (SD), and 15(22.1%) reported progressive disease (PD). The ORR and CBR were 16.2%, 35.2%, respectively. Most common all grade adverse events were stomatitis(26.5%), fatigue(10.0%), infection(11.8%), thrombocytopenia(5.9%), anemia(4.4%), hyperglycemia(4.4%). The most common ≥3 grade adverse events were stomatitis(4.4 %), infection(2.2%) and thrombocytopenia(1.1%).

Conclusions: The combination of low-dose everolimus and endocrine therapy was highly effective especially at the earlier line in Chinese population. And the safety profiles were similar to previous studies but the incidences were greatly lower. The combination of low-dose everolimus and endocrine therapy may become a proper option for HR+/HER2- MBC.

Citation Format: Shao X, Wang X, Chen Z, Zheng Y. Efficacy and safety of low-dose everolimus in Chinese HR-positive, HER2-negative metastatic breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-04-29.

How I do it: the horizontal-bilateral unfolding method for self-gripping (Progrip™) mesh placement in laparoscopic inguinal hernia repair

BACKGROUND

The use of the self-gripping mesh (Progrip™) during laparoscopic inguinal hernia has been proved to be effective and eliminates the need of additional fixation. However, the deployment of the self-gripping mesh is challenging due to its adhesive property. The purpose of this study was to introduce and describe an easy self-gripping mesh deployment method in laparoscopic inguinal hernia repair.

METHODS

The self-gripping mesh was folded bilaterally towards the center of the mesh and placed vertically to align with the inferior epigastric artery, centered on the internal defect, then unfolded in a horizontal-bilateral unfolding method, first laterally, then medially.

RESULTS

A total of 63 inguinal hernias were repaired laparoscopicly: 40 patients by TAPP or TEP technique with self-gripping mesh, and there were no perioperative complications. The average time of mesh placement was 186 s (45-250 s). The patients only feel minimal pain (less than VAS 3) the second postoperative morning, and most of the patients were discharged the next day postoperatively; the average postoperative hospital duration was 1 day (1-2 days).

CONCLUSION

The present "horizontal-bilateral unfolding" mesh deployment method is a relative easy method to implant the self-gripping mesh during laparoscopic inguinal hernia repair.

MRI Abnormalities Predominate in the Bottom Part of the Sulcus with Type II Focal Cortical Dysplasia: A Quantitative Study

BACKGROUND AND PURPOSE

Type II focal cortical dysplasia is a common histopathological substrate in focal epilepsy. This study explored the spatial distribution of abnormal findings on MR imaging across the sulcus with type II focal cortical dysplasia using quantitative MR imaging postprocessing techniques.

MATERIALS AND METHODS

The morphometric analysis program and normalized FLAIR signal intensity analysis were applied to retrospectively analyze the MR imaging data of 58 patients with histopathologically confirmed type II focal cortical dysplasia. We divided the dysplastic sulcus into the bottom and nonbottom parts. Then spatial distribution types 1, 2, and 3 were arbitrarily defined as the abnormal findings on MR imaging (z-value > threshold) located in the bottom part, both the bottom and nonbottom parts, and the nonbottom part, respectively. For type 2, the mean z-values and standardized volumes of abnormal findings on MR imaging were compared between the bottom and nonbottom parts.

RESULTS

Abnormal findings on MR imaging were detected by quantitative techniques in 42 of 58 enrolled patients. Among these 42 patients, 38 and 26 patients showed gray-white matter junction blurring and cortical FLAIR hyperintensity, respectively, which were the 2 most common abnormal MR imaging features. Gray-white matter junction blurring manifested as types 1, 2, and 3 in 24, 13, and 1 patient, respectively, and the corresponding counts for cortical FLAIR hyperintensity were 12, 13, and 1 patient. For the 2 most common abnormal findings on MR imaging spatially manifested as type 2, higher mean z-values and larger corresponding standardized volumes of abnormalities were found in the bottom part.

CONCLUSIONS

Abnormal findings on MR imaging predominate in the bottom part of the sulcus with type II focal cortical dysplasia, which indicates that this malformation is bottom-of-sulcus-rooted.

Treatment of comminuted fractures of the base of the thumb metacarpal using a cemented bone-K-wire frame

We aimed to describe the treatment of comminuted fractures of the base of the thumb metacarpal using a cemented bone-K-wire frame. Between March 2010 and January 2016, 41 fractures of the base of the thumb were treated using a cemented bone-K-wire frame. The mean age of the patients was 34 years. The patients' history included a fall onto the hand in 7 cases, direct trauma in 31 cases, and polytrauma with an unclear mechanism of injury in 3 cases. At the final follow-up, hand grip and pinch strength were measured using a dynamometer. All measurements were compared with those of the opposite hand. The patients were assessed functionally using the Smith and Cooney score.All K-wires were left in place until the bone healed. Bone healing was achieved in all thumbs in an average of 5.2 weeks. Follow-up averaged 27 months. The mean hand pinch and grip strength was 8.7 kg ± 2.4 kg and 38.4 kg ± 5.9 kg, respectively. The mean measurements on the opposite side were 9.2 kg ± 2.5 kg and 40.2 kg ± 6.6 kg, respectively. Based on the Smith and Cooney score, we obtained an average score of 87 ± 9.3, with 25 excellent, 9 good, and 2 fair results. The cemented bone-K-wire frame is an external fixator alternative that can be used for treating comminuted intra-articular fractures of the base of the thumb metacarpal. The system is cheap, easy to apply, and provides rigid fixation, resulting in good functional recovery.

Extracting the surface tension of soft gels from elastocapillary wave behavior

Mechanically-excited waves appear as surface patterns on soft agarose gels. We experimentally quantify the dispersion relationship for these waves over a range of shear modulus in the transition zone where the surface energy (capillarity) is comparable to the elastic energy of the solid. Rayleigh waves and capillary-gravity waves are recovered as limiting cases. Gravitational forces appear as a pre-stress through the self-weight of the gel and are important. We show the experimental data fits well to a proposed dispersion relationship which differs from that typically used in studies of capillary to elastic wave crossover. We use this combined theoretical and experimental analysis to develop a new technique for measuring the surface tension of soft materials, which has been historically difficult to measure directly.

FAVORABLE EFFECT OF LEVOTHYROXINE ON NUTRITIONAL STATUS OF PATIENTS WITH STAGE 3-4 CHRONIC KIDNEY DISEASE

The aim of this study was to analyze the incidence of malnutrition in patients with stage 3-4 chronic kidney disease (CKD) and primary subclinical hypothyroidism and the effect of levothyroxine for improving nutritional status and delaying kidney disease.

PATIENTS AND METHODS

In the study were included 200 patients with stage 3-4 CKD: CKD3 stage group (n=100) and CKD4 stage group (n=100). These patients were further divided into: control group (non-treatment group) group a (n=65) and experiment group (treatment group) group b (n=135) according to their levothyroxine treatment. The CKD3 stage group is divided into c3 (n=35) and e3 (n=65), and CKD4 group is divided into c4 (n=30) and e4 (n=70) groups.

RESULTS

Upon treatment of subclinical hypothyroidism with levothyroxine, nutritional indicators of patients are improved, and the weight, left and right-hand grip strength, hemoglobin (HB), serum albumin are higher compared to control. After levothyroxine treatment, eGFR in the treatment group increased with each time point, while in the control group it could be seen a significant decrease. This effect was more robust in the CKD3 group than in the CKD4 group. In conclusion, levothyroxine treatment can delay the progression of kidney diseases with more efficacy in stage 3 patients.

Abstract P2-02-11: Not presented

This abstract was not presented at the symposium.

Abstract P2-05-12: Not presented

This abstract was not presented at the symposium.

Overcoming drug-resistant lung cancer by paclitaxel loaded tetrahedral DNA nanostructures

Drug-loaded tetrahedron DNA nanostructures and their cytotoxic effect on drug-resistant cells have been studied.

A combined experimental and theoretical investigation on cellular blebbing

Although accumulating evidence has demonstrated the important role of membrane blebbing in various cellular processes, the fundamental question of how the initiation/evolution of blebs are influenced by physical factors like membrane-cortex interactions and intracellular pressure remains unclear. Here, we report a combined modeling and experimental study to address this outstanding issue. Specifically, boundary integral method was used to track the motion of membrane (in 3D) during blebbing while possible rupture of the bilayer-cortex adhesion has also been taken into account. We showed that, for a given differential pressure across the cell membrane, the size of the weakened cortex must be over a critical value for blebbing to occur and the steady-state volume of a bleb is proportional to its initial growth rate, all in good agreement with recent experiments. The predicted shape evolution of blebs also matches well with our observations. Finally, a blebbing map, summarizing the essential physics involved, was obtained which exhibits three distinct regimes: no bleb formation corresponding to a low intracellular pressure or a small weakened cortex region; bleb formed with a fixed width when the disrupted cortex zone is very large; and a growing bleb resulted from progressive membrane-cortex detachment under intermediate weakened cortex size.