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Patel, Brijesh R., Adam Jones, and Peter JM Crawford. "A Study of the Prescription of Radiographs for Children by a Group of General Dental Practitioners in the South West of England." Primary Dental Care os13, no. 1 (2006): 20–30. http://dx.doi.org/10.1308/135576106775194012.
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Objective This study aimed to assess the familiarity of general dental practitioners (GDPs) in the South West of England with the guidelines in the first edition of the then Faculty of General Dental Practitioners (UK) ‘good practice guidelines’ publication Selection Criteria for Dental Radiography (henceforth referred to as ‘the guidelines’) by studying the prescription of radiographs for children in two case scenarios. Method A single mailshot of questionnaires containing questions relating to the guidelines and the two case scenarios was sent to 136 GDPs in the South West of England. Their recommendations for the prescription of radiographs for the children in the two scenarios were then compared with the guidelines. Results There was a 60% response rate. Of the respondents, 48% reported that they had access to the guidelines. Of those who responded to the question, 66% said that they found the guidelines easy to use. Seventy per cent of respondents reported that they preferred the concept of guidelines to that of protocols. The results from the case scenarios revealed an under-prescription of radiographs for patients presenting with developmental problems or trauma when compared to the recommendations in the guidelines. There was good correlation for the prescription of radiographs for caries but little consensus on radiographic review times. Conclusions The study highlighted (a) areas within the guidelines that require further clarification and research and (b) that in the group studied half did not have access to the guidelines.
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Majid, IrfanAdil, Syed Mukith ur Rahaman, MalligereBasavaraju Sowbhagya, FazeenaKarimalakuzhiyil Alikutty, and Hemanth Kumar. "Radiographic prescription trends in dental implant site." Journal of Dental Implants 4, no. 2 (2014): 140. http://dx.doi.org/10.4103/0974-6781.140874.
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Mauthe, Peter W., and Kenneth A. Eaton. "An Investigation into Dental Digital Radiography in Dental Practices in West Kent following the Introduction of the 2006 NHS General Dental Services Contract." Primary Dental Care os18, no. 2 (2011): 73–82. http://dx.doi.org/10.1308/135576111795162893.
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Aims The primary aims of the study were to investigate the use of digital radiography within primary dental care practices in the West Kent Primary Care Trust (PCT) area and general dental practitioners’ (GDPs) self-reported change in radiographic prescribing patterns following the introduction of the nGDS contract in 2006. Methods Data were gathered via a piloted, self-completed questionnaire, and circulated to all GDPs listed on the National Health Service (NHS) Choices website as practising in the West Kent PCT area. There were three mailings and follow-up telephone calls. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test and Pearson correlation coefficient. Results Of 223 GDPs, 168 (75%) responded. There were 163 usable questionnaires. The respondents represented 85% of the general dental practices in West Kent. Eighty (49%) respondents were using digital intra-oral radiography. Of those who used digital radiography, 44 (55%) reported that they used phosphor plate systems and 36 (45%) that they used direct digital sensors. Eighty-three (51%) had a panoramic machine in their practice, 46 of whom (55%) were using digital systems; of these, 32 (67%) were using a direct digital system. Seventy-one GDPs reported that they worked exclusively or mainly in private practice. Forty (56%) of these ‘mainly private’ GDPs reported that they used digital radiographic systems, whereas only 40 (44%) of the 89 ‘mainly NHS’ GDPs reported using digital radiographic systems. On average, mainly private GDPs made the transition to a digital radiographic system six months before mainly NHS GDPs. Of those who provided NHS dentistry before and after April 2006, only 18 (14%) reported taking fewer radiographs and seven (6%) taking more. Conclusions In February 2010, of the West Kent GDPs who responded to the questionnaire, just under 50% used digital radiography. Mainly private GDPs were more likely to use digital radiography than their mainly NHS counterparts. A link between digital radiography and increased prescription of radiographs was not specifically apparent from this study. There was no evidence that West Kent GDPs were taking fewer radiographs than they did prior to the introduction of the new GDS contract in April 2006. Research is needed to investigate whether the uptake of digital radiography by GDPs in the rest of the country is similar to that in West Kent.
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Tyagi, Parul, Zameera Naik, and Maria Ana Karina Erica De Piedade Sequeira. "Knowledge of Appropriate Prescription of Dental Radiographs among Interns of Two Dental Institutes of Belagavi City: A Questionnaire Study." International Journal of Research Foundation of Hospital and Healthcare Administration 4, no. 2 (2016): 61–65. http://dx.doi.org/10.5005/jp-journals-10035-1061.
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ABSTRACT Aim To assess the level of knowledge of appropriate prescription of dental radiographs amongst Interns of two dental institutes of Belagavi city. Materials and methods A cross-sectional study was conducted on 120 interns of 2 dental institutes of Belagavi city. The knowledge of appropriate prescription of dental radiographs was assessed using a structured, close ended and self-designed questionnaire. Results Knowledge of appropriate prescription of dental radiographs was significantly lower in Institute 1 than Institute 2 (p=0.001*).Only a small % of 33.76 and 38.66 of interns of institutes 1,2 respectively had an above average knowledge. Thus, it is inferred that the awareness level of interns of correct prescription of radiographs is lower than expected. Conclusion The lack of awareness could be due to various factors such as a lack of previous knowledge, inadequate quality and quantity of educational courses and so on. Thus, students should receive the necessary education on correct prescription of radiographs to ensure their correct prescription, circumventing unnecessary exposure and their consequent detrimental effects. Clinical significance Radiographic examination is an important diagnostic tool used by dentists leading to an increased exposure to radiation. However, unessential exposure may lead to detrimental effects such as mutations, genetic changes and so on. One efficient way of decreasing exposure is to avoid their application when not indicated. Thus, it is the professional duty of a dentist to have adequate and accurate knowledge of prescription of radiographs. The present study shows the necessity to optimize educational tools to increase the theoretical knowledge of students and consequently improve clinical application of the knowledge gained. How to cite this article Tyagi P, Naik Z, De Piedade Sequeira MAKE. Knowledge of Appropriate Prescription of Dental Radiographs among Interns of Two Dental Institutes of Belagavi City: A Questionnaire Study. Int J Res Foundation Hosp Healthc Adm 2016;4(2):61-65.
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Sakakura, CE, JAND Morais, LCM Loffredo, and G. Scaf. "A survey of radiographic prescription in dental implant assessment." Dentomaxillofacial Radiology 32, no. 6 (2003): 397–400. http://dx.doi.org/10.1259/dmfr/20681066.
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Mauthe, Peter W., and Kenneth A. Eaton. "An Investigation into the Bitewing Radiographic Prescribing Patterns of West Kent General Dental Practitioners." Primary Dental Care os18, no. 3 (2011): 107–14. http://dx.doi.org/10.1177/2050168411os1800304.
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Aims The primary aims of the study were to investigate the use of bitewing radiography within primary dental care and adherence to guidelines on bitewing radiography by general dental practitioners (GDPs) in the West Kent Primary Care Trust (PCT) area. Within the overall aims, the study had objectives to investigate the use of radiographic guidelines, audit and caries risk assessment, the influence of private and National Health Service (NHS) practice, and the influence of the demographic profile of the GDPs on these variables. Methods Data were gathered via a piloted self-completion questionnaire, circulated to all GDPs listed on the NHS Choices website as practising in the West Kent PCT area. Three mailings and follow-up telephone calls were used. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test. Results Of 223 GDPs, 167 responded (75%). GDPs with a high NHS commitment were significantly less likely to follow Faculty of General Dental Practice (UK) guidance on prescribing bitewing radiographs for adults ( P<0.01) and children ( P<0.05) than were mainly private GDPs. Mainly NHS GDPs were more likely ‘always/mostly’ to follow National Institute for Health and Clinical Excellence guidance (83 compared to 59) ( P<0.05) and also to risk-assess patients (83 compared to 62). Only 115 (71%) had carried out a radio graphic audit or peer review in the preceding three years. Those with postgraduate qualifications were more likely ( P<0.05) to carry out radiographic audit. Conclusions The study confirmed previous research reporting the under-use of radiography for caries detection and also the failure of some GDPs to comply with ionising radiation regulations. West Kent GDPs with a high NHS commitment were less likely to follow radiographic guidance than their private counterparts. This suggests that further efforts to disseminate information on radiographic guidelines and to educate GDPs are necessary to improve adherence with all aspects of radiography within general dental practice. Research into factors that influence GDPs’ decision-making with regards to radiographic prescription may further inform the profession as to the best methods to lead to behavioural change. The dental profession and its regulators need to make a concerted effort to educate and inform GDPs so that this behaviour is modified.
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Carvalho, Joana Christina, Heliana D. Mestrinho, Alain Guillet, and Marisa Maltz. "Radiographic Yield for Clinical Caries Diagnosis in Young Adults: Indicators for Radiographic Examination." Caries Research 54, no. 2 (2020): 154–64. http://dx.doi.org/10.1159/000505905.
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This prospective cohort study investigated the distribution pattern of carious lesions diagnosed by visual tactile and radiographic examinations, assessed the radiographic yield for clinical caries diagnosis, and estimated how accurately commonly used indicators for caries identified young adults who would benefit from radiographs at different thresholds. Overall, 576 patients aged 16–32 years seeking a first consultation were included. Patients were examined for caries and answered a validated questionnaire on sociodemographics and oral health behavior. Almost 10% of clinically sound approximal surfaces presented radiolucency in enamel/dentine. Of the clinically diagnosed noncavitated approximal and occlusal lesions, 22.5 and 17.7%, respectively, presented radiolucency reaching dentine at the radiographic examination. Noncavitated/enamel lesions detected radiographically were mainly at approximal surfaces (73.2%), while at occlusal surfaces these were negligible (0.7%). More than half of approximal dentine lesions were only detected radiographically (61.3%), while more than half of occlusal dentine lesions were only clinically diagnosed (57.1%). The hierarchical logistic regression analysis showed that patient’s caries activity, D1MFS scores ≥17, and frequent consumption of soft drinks were significantly associated with detection of approximal enamel/dentine lesions. Also, patient’s caries activity and frequent consumption of soft drinks were significantly associated with occlusal dentine caries (p ≤ 0.05). The indicator power of grouping these indicators as a predictor for the presence of radiographically detected lesions showed high sensitivity (0.84–0.91) and moderate specificity (0.64–0.73) for all surfaces and thresholds tested. In conclusion, radiographs increased significantly the number of approximal enamel/dentine and occlusal dentine lesions diagnosed. The ability to identify young adults with approximal lesions from the predictor was satisfactory. Bearing in mind that an essential contribution of bitewing radiographs to clinical examination is the detection of approximal noncavitated/enamel lesions that can be inactivated by nonoperative interventions, our results support the prescription of radiographs in young adults seeking a first consultation. Updating of current guidelines’ recommendation of radiographs is warranted.
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Collins, Laura, Anastasiya Orishko, and Gregor Knepil. "A clinical audit evaluating compliance with correct radiographic prescription for localisation of impacted canines." British Journal of Oral and Maxillofacial Surgery 56, no. 10 (2018): e6. http://dx.doi.org/10.1016/j.bjoms.2018.10.022.
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Rocca, Alessandro, Carlotta Biagi, Sara Scarpini, et al. "Passive Immunoprophylaxis against Respiratory Syncytial Virus in Children: Where Are We Now?" International Journal of Molecular Sciences 22, no. 7 (2021): 3703. http://dx.doi.org/10.3390/ijms22073703.
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Respiratory syncytial virus (RSV) represents the main cause of acute respiratory tract infections in children worldwide and is the leading cause of hospitalization in infants. RSV infection is a self-limiting condition and does not require antibiotics. However hospitalized infants with clinical bronchiolitis often receive antibiotics for fear of bacteria coinfection, especially when chest radiography is performed due to similar radiographic appearance of infiltrate and atelectasis. This may lead to unnecessary antibiotic prescription, additional cost, and increased risk of development of resistance. Despite the considerable burden of RSV bronchiolitis, to date, only symptomatic treatment is available, and there are no commercially available vaccines. The only licensed passive immunoprophylaxis is palivizumab. The high cost of this monoclonal antibody (mAb) has led to limiting its prescription only for high-risk children: infants with chronic lung disease, congenital heart disease, neuromuscular disorders, immunodeficiencies, and extreme preterm birth. Nevertheless, it has been shown that the majority of hospitalized RSV-infected children do not fully meet the criteria for immune prophylaxis. While waiting for an effective vaccine, passive immune prophylaxis in children is mandatory. There are a growing number of RSV passive immunization candidates under development intended for RSV prevention in all infants. In this review, we describe the state-of-the-art of palivizumab’s usage and summarize the clinical and preclinical trials regarding the development of mAbs with a better cost-effectiveness ratio.
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Bastin, K. T., M. P. Mehta, and J. Miles. "An Analysis of Postradiosurgery Histopathology with Dose, Time, and Radiographic Correlation and Implications for Dose Prescription." Journal of Radiosurgery 1, no. 3 (1998): 201–11. http://dx.doi.org/10.1023/b:jora.0000015195.83775.fc.
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Kumar, Deepak, Eiphrangdaka L. Suchiang, and Gautam Pal. "Effects of Homoeopathic Single and Minimum Dose on Non-Radiographic Axial Spondyloarthritis—BASDAI Assessment." Homœopathic Links 33, no. 01 (2020): 041–52. http://dx.doi.org/10.1055/s-0040-1705142.
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AbstractEarly cases of ankylosing spondylitis do not have the typical presentation of radiographic sacroiliitis but present as non-radiographic axial spondyloarthritis (nr-axSpA) where both are varieties of axSpA. Homoeopathic prescription based on totality of symptoms offers a promising relief to nr-axSpA where peripheral joints are also affected. Here, a 27-year-old male patient presented with bilateral heel pain, pain in low back, pain on base of right toes, pain in neck with stiffness for 1 year had refractive response to conventional medication. Diagnosis was confirmed by Assessment of SpondyloArthritis International Society diagnostic criteria for axSpA. Single medicine and minimum dose of Silicea showed its effectiveness on the symptoms' improvement and Bath Ankylosing Spondylitis Disease Activity Index score whereby score of 8.8 (active disease) before treatment changed to 1.2 (inactive or mild disease) after treatment. Various other parameters were assessed accordingly before and after treatment. This case report encourages further exploring the beneficial effects of homoeopathic treatment in clinical condition like axSpA utilising validated scale.
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Zhao, Sizheng Steven, Joerg Ermann, Chang Xu, et al. "Comparison of comorbidities and treatment between ankylosing spondylitis and non-radiographic axial spondyloarthritis in the United States." Rheumatology 58, no. 11 (2019): 2025–30. http://dx.doi.org/10.1093/rheumatology/kez171.
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Abstract Objectives This study aimed to compare comorbidities and biologic DMARD (bDMARD) use between AS and non-radiographic axial SpA (nr-axSpA) patients, using a large cohort of patients from routine clinical practice in the United States. Methods We performed a cross-sectional study using electronic medical records from two academic hospitals in the United States. Data were extracted using automated searches (⩾3 ICD codes combined with text searches) and supplemented with manual chart review. Patients were categorized into AS or nr-axSpA according to classification criteria. Disease features, comorbidities (from a list of 39 chronic conditions) and history of bDMARD prescription were compared using descriptive statistics. Results Among 965 patients identified, 775 (80%) were classified as having axSpA. The cohort was predominantly male (74%) with a mean age of 52.5 years (s.d. 16.8). AS patients were significantly older (54 vs 46 years), more frequently male (77% vs 64%) and had higher serum inflammatory markers than those with nr-axSpA (median CRP 3.4 vs 2.2 mg/dl). Half of all patients had at least one comorbidity. The mean number of comorbidities was 1.5 (s.d. 2.2) and similar between AS and nr-axSpA groups. A history of bDMARD-use was seen in 55% of patients with no difference between groups. The most commonly prescribed bDMARDs were adalimumab (31%) and etanercept (29%). Ever-prescriptions of individual bDMARDs were similar between AS and nr-axSpA. Conclusion Despite age differences, nr-axSpA patients had similar comorbidity burdens as those with AS. Both groups received comparable bDMARD treatment in this United States clinic-based cohort.
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Mohammadi, Alireza M., Jason L. Schroeder, Lilyana Angelov, et al. "Impact of the radiosurgery prescription dose on the local control of small (2 cm or smaller) brain metastases." Journal of Neurosurgery 126, no. 3 (2017): 735–43. http://dx.doi.org/10.3171/2016.3.jns153014.
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OBJECTIVE The impact of the stereotactic radiosurgery (SRS) prescription dose (PD) on local progression and radiation necrosis for small (≤ 2 cm) brain metastases was evaluated. METHODS An institutional review board–approved retrospective review was performed on 896 patients with brain metastases ≤ 2 cm (3034 tumors) who were treated with 1229 SRS procedures between 2000 and 2012. Local progression and/or radiation necrosis were the primary end points. Each tumor was followed from the date of radiosurgery until one of the end points was reached or the last MRI follow-up. Various criteria were used to differentiate tumor progression and radiation necrosis, including the evaluation of serial MRIs, cerebral blood volume on perfusion MR, FDG-PET scans, and, in some cases, surgical pathology. The median radiographic follow-up per lesion was 6.2 months. RESULTS The median patient age was 56 years, and 56% of the patients were female. The most common primary pathology was non–small cell lung cancer (44%), followed by breast cancer (19%), renal cell carcinoma (14%), melanoma (11%), and small cell lung cancer (5%). The median tumor volume and median largest diameter were 0.16 cm3 and 0.8 cm, respectively. In total, 1018 lesions (34%) were larger than 1 cm in maximum diameter. The PD for 2410 tumors (80%) was 24 Gy, for 408 tumors (13%) it was 19 to 23 Gy, and for 216 tumors (7%) it was 15 to 18 Gy. In total, 87 patients (10%) had local progression of 104 tumors (3%), and 148 patients (17%) had at least radiographic evidence of radiation necrosis involving 199 tumors (7%; 4% were symptomatic). Univariate and multivariate analyses were performed for local progression and radiation necrosis. For local progression, tumors less than 1 cm (subhazard ratio [SHR] 2.32; p < 0.001), PD of 24 Gy (SHR 1.84; p = 0.01), and additional whole-brain radiation therapy (SHR 2.53; p = 0.001) were independently associated with better outcome. For the development of radiographic radiation necrosis, independent prognostic factors included size greater than 1 cm (SHR 2.13; p < 0.001), location in the corpus callosum (SHR 5.72; p < 0.001), and uncommon pathologies (SHR 1.65; p = 0.05). Size (SHR 4.78; p < 0.001) and location (SHR 7.62; p < 0.001)—but not uncommon pathologies—were independent prognostic factors for the subgroup with symptomatic radiation necrosis. CONCLUSIONS A PD of 24 Gy results in significantly better local control of metastases measuring < 2 cm than lower doses. In addition, tumor size is an independent prognostic factor for both local progression and radiation necrosis. Some tumor pathologies and locations may also contribute to an increased risk of radiation necrosis.
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Wulansari, Dwi Putri, and Azhari Azhari. "Biomarker of buccal mucosa cells damaged after exposure to panoramic radiography: a literature review." Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI) 5, no. 1 (2021): 27. http://dx.doi.org/10.32793/jrdi.v5i1.675.
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Objectives: This review aimed to understand the effect of exposure to panoramic radiographs on exfoliated buccal mucosal cells at the cellular level.
 Review: The dose of radiation exposure in dentistry, both intraoral and extraoral, has been regulated by The National Radiological Protection Board (NRPB). However, even though it is given in small doses, x-ray radiation due to intraoral and extraoral radiographs still has a radiobiological effect on the exposed tissue. The radiobiological effects of X-ray exposure can cause changes in biological molecules, either directly or indirectly, within hours or days. There are two classification of this radiobiological effect, called deterministic and stochastic effect. The deterministic effect occurs when the dose given exceeds the recommended dose by the NRPB, whereas the stochastic effect does not have any threshold that needs to be exceeded to give some adverse impact to the exposed tissue One method used as a predictor or biomarker of genetic damage due to exposure to physical or chemical mutagenic agents in humans is micronucleus (MN). The biomarker for the cell damaged is the change of nucleus shape and outline, called pycnosis, karyolysis, karyorrhexis.
 Conclusion: The exposed to x-ray from panoramic could induce cell and genetic damaged. Prescription for panoramic radiographic examination in patients should be as effectively as possible according to the principles of ALADA (as low as diagnostically acceptable) to avoid adverse effects on the exposed tissue.
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Miller, Jacob A., Ehsan H. Balagamwala, Lilyana Angelov, et al. "Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas." Technology in Cancer Research & Treatment 16, no. 3 (2016): 276–84. http://dx.doi.org/10.1177/1533034616643221.
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Purpose: Despite advancements in local and systemic therapy, metastasis remains common in the natural history of sarcomas. Unfortunately, such metastases are the most significant source of morbidity and mortality in this heterogeneous disease. As a classically radioresistant histology, stereotactic radiosurgery has emerged to control spinal sarcomas and provide palliation. However, there is a lack of data regarding pain relief and relapse following stereotactic radiosurgery. Methods: We queried a retrospective institutional database of patients who underwent spine stereotactic radiosurgery for primary and metastatic sarcomas. The primary outcome was pain relief following stereotactic radiosurgery. Secondary outcomes included progression of pain, radiographic failure, and development of toxicities following treatment. Results: Forty treatment sites were eligible for inclusion; the median prescription dose was 16 Gy in a single fraction. Median time to radiographic failure was 14 months. At 6 and 12 months, radiographic control was 63% and 51%, respectively. Among patients presenting with pain, median time to pain relief was 1 month. Actuarial pain relief at 6 months was 82%. Median time to pain progression was 10 months; at 12 months, actuarial pain progression was 51%. Following multivariate analysis, presence of neurologic deficit at consult (hazard ratio: 2.48, P < .01) and presence of extraspinal bone metastases (hazard ratio: 2.83, P < .01) were associated with pain relief. Greater pain at consult (hazard ratio: 1.92, P < .01), prior radiotherapy (hazard ratio: 4.65, P = .02), and greater number of irradiated vertebral levels were associated with pain progression. Conclusions: Local treatment of spinal sarcomas has remained a challenge for decades, with poor rates of local control and limited pain relief following conventional radiotherapy. In this series, pain relief was achieved in 82% of treatments at 6 months, with half of patients experiencing pain progression by 12 months. Given minimal toxicity and suboptimal pain control at 12 months, dose escalation beyond 16 Gy is warranted.
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Teyateeti, Achiraya, Christopher Graffeo, Avital Perry, Paul Brown, Bruce Pollock, and Link Michael. "RTHP-11. THE EFFECT OF PRESCRIPTION ISODOSE LINE ON LOCAL CONTROL AND RADIOGRAPHIC RESPONSE IN GAMMA KNIFE RADIOSURGERY OF VESTIBULAR SCHWANNOMA." Neuro-Oncology 21, Supplement_6 (2019): vi212. http://dx.doi.org/10.1093/neuonc/noz175.884.
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Abstract Traditionally, the 50% isodose line (IDL) is used for prescription dose when vestibular schwannomas (VS) are treated with Gamma Knife radiosurgery (GKRS). To compare the effect of IDL on treatment outcomes, propensity score-matched analysis according to age at time of GKRS and tumor volume (TV) between cohorts treated at 40%IDL and 50%IDL was performed. Patients with no history of neurofibromatosis, GKRS prescribed marginal dose of 12–14 Gy and TV ≤ 10 cc were identified. Patients were excluded if follow-up time was < 2 years. Eventually, 30 and 28 patients were included in 40%IDL and 50%IDL cohorts, respectively. Mean age and TV were not significantly different between 40%IDL and 50%IDL groups; 54.5 versus 54.0 years (p=0.891) and 2148.61 versus 2031.10 mm3 (p=0.844), respectively. Median prescription dose was 12 Gy in both groups. At median follow-up times of 111 and 72 months, the 2, 5 and 10-year local control were 100%, 96.4% and 96.4% for 40%IDL and 96.4%, 86.7%, and 86.7% for 50%IDL (p=0.243), respectively. Among 40 patients with accessible follow-up MRIs (40%IDL-n=19, 50%IDL-n=21), volume reduction at last follow-up MRIs and rate of reduction per year for 40%IDL and 50%IDL were 48.1% versus 38.3% (p=0.05) and 5.5% versus 6% (p=0.749), respectively. Of 21 patients with serviceable hearing prior to GKRS and available audiograms after GKRS (40%IDL-n=8, 50%IDL-n=13), the 2, 5 and 10-year hearing preservation rate were 100%, 83.3% and 62.5% for 40%IDL versus 76.2%, 57.1% and 11.4% for 50%IDL (p=0.017). Facial paresthesia, facial palsy and ataxia/gait disturbance requiring steroid and/or shunt were lower in 40%IDL compared to the 50%IDL; 6.7% versus 17.9% (p=0.208) and 3.3% versus 7.1% (p=0.532). To summarize, VS treated at 40%IDL have slightly better local control, although not statistically significant, compared to tumors treated at 50%IDL. However, hearing preservation and safety seem to be more favorable toward 40%IDL group.
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Eleotério, Renato Barros, Andréa Pacheco Batista Borges, Kelly Cristine de Sousa Pontes, et al. "Glucosamine and chondroitin sulfate in the repair of osteochondral defects in dogs - clinical-radiographic analysis." Revista Ceres 59, no. 5 (2012): 587–96. http://dx.doi.org/10.1590/s0034-737x2012000500003.
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Among the proposed treatments to repair lesions of degenerative joint disease (DJD), chondroprotective nutraceuticals composed by glucosamine and chondroitin sulfate are a non-invasive theraphy with properties that favors the health of the cartilage. Although used in human, it is also available for veterinary use with administration in the form of nutritional supplement independent of prescription, since they have registry only in the Inspection Service, which does not require safety and efficacy testing. The lack of such tests to prove efficacy and safety of veterinary medicines required by the Ministry of Agriculture and the lack of scientific studies proving its benefits raises doubts about the efficiency of the concentrations of such active substances. In this context, the objective of this study was to evaluate the efficacy of a veterinary chondroprotective nutraceutical based on chondroitin sulfate and glucosamine in the repair of osteochondral defects in lateral femoral condyle of 48 dogs, through clinical and radiographic analysis. The animals were divided into treatment group (TG) and control group (CG), so that only the TG received the nutraceutical every 24 hours at the rate recommended by the manufacturer. The results of the four treatment times (15, 30, 60 and 90 days) showed that the chondroprotective nutraceutical, in the rate, formulation and administration at the times used, did not improve clinical signs and radiologically did not influence in the repair process of the defects, since the treated and control groups showed similar radiographic findings at the end of the treatments.
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Ibrahim, George M., Aria Fallah, and R. Loch Macdonald. "Clinical, laboratory, and radiographic predictors of the occurrence of seizures following aneurysmal subarachnoid hemorrhage." Journal of Neurosurgery 119, no. 2 (2013): 347–52. http://dx.doi.org/10.3171/2013.3.jns122097.
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Object At present, the administration of prophylactic antiepileptic medication following aneurysmal subarachnoid hemorrhage (SAH) is controversial, and the practice is heterogeneous. Here, the authors sought to inform clinical decision making by identifying factors associated with the occurrence of seizures following aneurysm rupture. Methods Exploratory analysis was performed on 413 patients enrolled in CONSCIOUS-1 (Clazosentan to Overcome Neurological Ischemia and Infarction Occurring after Subarachnoid Hemorrhage), a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm. The association among clinical, laboratory, and radiographic covariates and the occurrence of seizures following SAH were determined. Covariates with a significance level of p < 0.20 on univariate analysis were entered into a multivariate logistic regression model. Receiver operating characteristic (ROC) curve analysis was used to define optimal predictive thresholds. Results Of the 413 patients enrolled in the study, 57 (13.8%) had at least 1 seizure following SAH. On univariate analysis, a World Federation of Neurosurgical Societies grade of IV–V, a greater subarachnoid clot burden, and the presence of midline shift and subdural hematomas were associated with seizure activity. On multivariate analysis, only a subarachnoid clot burden (OR 2.76, 95% CI 1.39–5.49) and subdural hematoma (OR 5.67, 95% CI 1.56–20.57) were associated with seizures following SAH. Using ROC curve analysis, the optimal predictive cutoff for subarachnoid clot burden was determined to be 21 (of a possible 30) on the Hijdra scale (area under the curve 0.63). Conclusions A greater subarachnoid clot burden and subdural hematoma are associated with the occurrence of seizures after aneurysm rupture. These findings may help to identify patients at greatest risk for seizures and guide informed decisions regarding the prescription of prophylactic anticonvulsive therapy. Clinical trial registration no.: NCT00111085 (ClinicalTrials.gov).
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Mendel, Jameson, Ankur Patel, Toral Patel, et al. "RADI-05. FRACTIONATED TREATMENT OF BRAIN METASTASES WITH GAMMA KNIFE ICON." Neuro-Oncology Advances 1, Supplement_1 (2019): i22. http://dx.doi.org/10.1093/noajnl/vdz014.098.
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Abstract PURPOSE/OBJECTIVE(S): Stereotactic radiosurgery with Gamma Knife is a common treatment modality for patients with brain metastasis. The Gamma Knife ICON allows for immobilization with an aquaplast mask, permitting fractionated treatments. We describe one of the first experiences utilizing this technique with brain metastasis and evaluate outcomes. MATERIALS/METHODS: From June 2017 to November 2018, 29 patients with 43 separate intracranial lesions were treated with fractionated stereotactic radiotherapy using the gamma knife ICON at a single institution. Patients received between 20–30 Gy in 3–5 fractions with no margin over the course of 5 to 23 days. Local control was physician assessed. Local failure over time was modeled using cumulative incidence; lesions were censored at last radiographic follow up. RESULTS: Median tumor volume and prescription isodose was 7.7 cm3 (range 0.3–43.9) and 50% (range 40–65), respectively. Median radiographic follow-up was 7 months and median survival was 9 months. Radiation necrosis occurred in 3/3 patients treated with 27 Gy in 3 fractions, one requiring therapeutic resection. Incidence of local failure for all treated lesions was 9% at 1 year. Tumor volume &gt;7 cm3 was associated with local failure on univariate analysis (p=0.025). 100% (2/2) lesions treated with 20 Gy in 5 fractions developed local recurrence. CONCLUSION: Fractionated stereotactic radiotherapy with the Gamma Knife ICON provides excellent local control for small and large brain metastases with minimal toxicity. Tumors &gt;7 cm3 should receive at least 30 Gy in 5 fractions for optimal control. Treatment with 27 Gy in 3 fractions appears to have high rates of treatment related toxicity and should be avoided.
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Martins, Luciana Flaquer, and Julio Wilson Vigorito. "Photometric analysis applied in determining facial type." Dental Press Journal of Orthodontics 17, no. 5 (2012): 71–75. http://dx.doi.org/10.1590/s2176-94512012000500010.
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INTRODUCTION: In orthodontics, determining the facial type is a key element in the prescription of a correct diagnosis. In the early days of our specialty, observation and measurement of craniofacial structures were done directly on the face, in photographs or plaster casts. With the development of radiographic methods, cephalometric analysis replaced the direct facial analysis. Seeking to validate the analysis of facial soft tissues, this work compares two different methods used to determining the facial types, the anthropometric and the cephalometric methods. METHODS: The sample consisted of sixty-four Brazilian individuals, adults, Caucasian, of both genders, who agreed to participate in this research. All individuals had lateral cephalograms and facial frontal photographs. The facial types were determined by the Vert Index (cephalometric) and the Facial Index (photographs). RESULTS: The agreement analysis (Kappa), made for both types of analysis, found an agreement of 76.5%. CONCLUSIONS: We concluded that the Facial Index can be used as an adjunct to orthodontic diagnosis, or as an alternative method for pre-selection of a sample, avoiding that research subjects have to undergo unnecessary tests.
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Ding, Dale, Chun-Po Yen, Zhiyuan Xu, Robert M. Starke, and Jason P. Sheehan. "Radiosurgery for patients with unruptured intracranial arteriovenous malformations." Journal of Neurosurgery 118, no. 5 (2013): 958–66. http://dx.doi.org/10.3171/2013.2.jns121239.
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Object The appropriate management of unruptured intracranial arteriovenous malformations (AVMs) remains controversial. In the present study, the authors evaluate the radiographic and clinical outcomes of radiosurgery for a large cohort of patients with unruptured AVMs. Methods From a prospective database of 1204 cases of AVMs involving patients treated with radiosurgery at their institution, the authors identified 444 patients without evidence of rupture prior to radiosurgery. The patients' mean age was 36.9 years, and 50% were male. The mean AVM nidus volume was 4.2 cm3, 13.5% of the AVMs were in a deep location, and 44.4% were at least Spetzler-Martin Grade III. The median radiosurgical prescription dose was 20 Gy. Univariate and multivariate Cox regression analyses were used to determine risk factors associated with obliteration, postradiosurgery hemorrhage, radiation-induced changes, and postradiosurgery cyst formation. The mean duration of radiological and clinical follow-up was 76 months and 86 months, respectively. Results The cumulative AVM obliteration rate was 62%, and the postradiosurgery annual hemorrhage rate was 1.6%. Radiation-induced changes were symptomatic in 13.7% and permanent in 2.0% of patients. The statistically significant independent positive predictors of obliteration were no preradiosurgery embolization (p < 0.001), increased prescription dose (p < 0.001), single draining vein (p < 0.001), radiological presence of radiation-induced changes (p = 0.004), and lower Spetzler-Martin grade (p = 0.016). Increased volume and higher Pittsburgh radiosurgery-based AVM score were predictors of postradiosurgery hemorrhage in the univariate analysis only. Clinical deterioration occurred in 30 patients (6.8%), more commonly in patients with postradiosurgery hemorrhage (p = 0.018). Conclusions Radiosurgery afforded a reasonable chance of obliteration of unruptured AVMs with relatively low rates of clinical and radiological complications.
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Combe, Bernard, Nathalie Rincheval, Joelle Benessiano, et al. "Five-year Favorable Outcome of Patients with Early Rheumatoid Arthritis in the 2000s: Data from the ESPOIR Cohort." Journal of Rheumatology 40, no. 10 (2013): 1650–57. http://dx.doi.org/10.3899/jrheum.121515.
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Objective.To report the 5-year outcome of a large prospective cohort of patients with very early rheumatoid arthritis (RA), and to identify factors predictive of outcome.Methods.Patients were recruited if they had early arthritis of < 6 months’ duration, had a high probability of developing RA, and had never been prescribed disease-modifying antirheumatic drugs (DMARD) or steroids. Logistic regression analysis was used to determine factors that predict outcome.Results.We included 813 patients from December 2002 to April 2005. Age was 48.1 ± 12.6 years, delay before referral 103.1 ± 52.4 days, 28-joint Disease Activity Score (DAS28) 5.1 ± 1.3, Health Assessment Questionnaire (HAQ) 1.0 ± 0.7; 45.8% and 38.7% had rheumatoid factor or antibodies to cyclic citrullinated peptide (anti-CCP), respectively; 22% had hand or foot erosions; 78.5% fulfilled the American College of Rheumatology/European League Against Rheumatism criteria for RA at baseline and 93.8% during followup. At 5 years, 573 patients were evaluated. The outcome was mild for most patients: disease activity (median DAS28 = 2.5) and HAQ disability (median 0.3) were well controlled over time; 50.6% achieved DAS28 remission and 64.7% low disease activity. Radiographic progression was low (2.9 Sharp unit/year) and only a few patients required joint surgery. Nevertheless, some patients developed new comorbidities. During the 5 years, 82.7% of patients had received at least 1 DMARD (methotrexate, 65.9%), 18.3% a biological DMARD, and about 60% prednisone at least once. Anti-CCP was the best predictor of remaining in the cohort for 5 years, of prescription of synthetic or biologic DMARD, and of radiographic progression.Conclusion.The 5-year outcome of an early RA cohort in the 2000s was described. Anti-CCP was a robust predictor of outcome. The generally good 5-year outcome could be related to early referral and early effective treatment, key processes in the management of early RA in daily practice.
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Williams, Brian J., Chun Po Yen, Robert M. Starke, et al. "Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival." Journal of Neurosurgery 114, no. 6 (2011): 1571–77. http://dx.doi.org/10.3171/2011.1.jns091939.
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Object Stereotactic radiosurgery serves as an important primary and adjuvant treatment option for patients with many types of intracranial meningiomas. This is particularly true for patients with parasellar meningiomas. In this study, the authors evaluated the outcomes of Gamma Knife surgery (GKS) used to treat parasellar meningiomas. Methods The study is a retrospective review of the outcomes in 138 patients with meningiomas treated at the University of Virginia from 1989 to 2006; all patients had a minimum follow-up of 24 months. There were 31 men and 107 women whose mean age was 54 years (range 19–85 years). Eighty-four patients had previously undergone resection. The mean pre-GKS tumor volume was 7.5 ml (range 0.2–54.8 ml). Clinical and radiographic evaluations were performed, and factors related to favorable outcomes in each case were assessed. Results The mean follow-up duration was 84 months (median 75.5 months, range 24–216 months). In 118 patients (86%), the tumor volume was unchanged or had decreased at last follow-up. Kaplan-Meier analysis demonstrated radiographic progression-free survival at 5 and 10 years to be 95.4% and 69%, respectively. Fourteen patients (10%) developed new cranial nerve palsies following GKS. Factors associated with tumor control included younger age, a higher isodose, and smaller tumor volume. A longer follow-up duration was associated with either a decrease or increase in tumor volume. Fourteen patients (10%) experienced new or worsening cranial nerve deficits after treatment. Factors associated with this occurrence were larger pretreatment tumor volume, lower peripheral radiation dose, lower maximum dose, tumor progression, and longer follow-up. Conclusions Gamma Knife surgery offers an acceptable rate of tumor control for parasellar meningiomas and accomplishes this with a low incidence of neurological deficits. Radiological control after radiosurgery is more likely in those patients with a smaller tumor volume and a higher prescription dose.
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Heffernan, Courtney, James Barrie, Alexander Doroshenko, et al. "Prompt recognition of infectious pulmonary tuberculosis is critical to achieving elimination goals: a retrospective cohort study." BMJ Open Respiratory Research 7, no. 1 (2020): e000521. http://dx.doi.org/10.1136/bmjresp-2019-000521.
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IntroductionAll pulmonary tuberculosis (PTB) cases are presumed to be infectious to some degree. This spectrum of infectiousness is independently described by both the acid-fast bacilli smear and radiographic findings. Smear-positive patients with chest radiographic findings that are typical for adult-type PTB are believed to be most infectious.HypothesisCharacterisation of the presumed most infectious PTB case is possible by reference to readily available clinical features and laboratory results.MethodsRetrospective cohort study of adult, culture-positive PTB cases (151 smear-positive; 162 smear-negative) diagnosed between 1 January 2013 and 30 April 2017 in Canada. We describe cases according to demographic, clinical and laboratory features. We use multivariable multinomial logistic regression to estimate the relative risk ratio (RRR) with 95% CI of features associated with an outcome of smear-positive PTB, characterised by ‘typical’ chest radiograph findings.ResultsBeing Canadian-born, symptomatic, having a subacute duration of symptoms and broad-spectrum antibiotic prescriptions were all more commonly associated with smear-positive than smear-negative disease (36% vs 20%; 95% vs 63%; 88% vs 54%; and 59% vs 28%, respectively). After combining smear status and radiographic features, we show that smear-positive patients with typical chest radiographs were younger, had a longer duration of symptoms (RRR 2.41; 95% CI 1.01 to 5.74 and 2.93; 95% CI 1.20 to 7.11, respectively) and were less likely to be foreign-born, or have a moderate to high-risk factor for reactivation (RRR 0.40; 95% CI 0.17 to 0.92 and 0.18; 95% CI 0.04 to 0.71, respectively) compared with smear-negative patients with atypical chest radiograph findings.ConclusionA clear picture of the presumed most infectious PTB case emerges from available historical and laboratory information; vigilance for this presentation by front-line providers will support elimination strategies aimed at reducing transmission.
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Lee, T. H., B. S. Koo, S. Lee, et al. "FRI0282 CONVENTIONAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS THERAPY HAS NO EFFICACY IN SLOWING SPINAL RADIOGRAPHIC PROGRESSION IN ANKYLOSING SPONDYLITIS: RESULTS FROM 18-YEAR LONGITUDINAL DATA." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 728.1–729. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3116.
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Background:In the treatment of ankylosing spondylitis (AS), conventional disease-modifying antirheumatic drugs (cDMARDs) are generally recommended only in patients with peripheral arthritis. However in daily clinical practice, sulfasalazine (SSZ) and methotrexate (MTX) have still been considered on the basis of their anti-inflammatory effect when non-steroidal anti-inflammatory drugs (NSAIDs) are not available and when it is difficult to start tumor necrosis factor (TNF) inhibitors. Nonetheless there is few data about the impact of the cDMARDs on the prognosis of spinal progression.Objectives:The aim of this study was to investigate the effectiveness of SSZ and MTX on the spinal radiographic progression in patients with AS.Table 1.Association of clinical covariates and DMARD intervals with the rate of mSASSS changeVariableMultivariate analysisModel 1Model 2β (95% CI)pβ (95% CI)pOn-DMARD intervals-0.081 (-0.276 to 0.115)0.418On-SSZ intervals-0.001 (-0.211 to 0.189)0.913On-MTX intervals-0.180 (-0.439 to 0.078)0.172Sex (female)-0.449 (-0.782 to -0.117)0.008-0.440 (-0.775 to -0.105)0.010Age0.012 (-0.001 to 0.026)0.0610.012 (-0.001 to 0.025)0.076Eye involvement0.572 (0.264 to 0.880)< 0.0010.577 (0.268 to 0.886)< 0.001Peripheral joint involvement-0.508 (-0.810 to -0.206)0.001-0.513 (-0.817 to -0.210)0.001HLA-B27 positivity††NSAIDs††Glucocorticoids††ESR (log)0.176 (0.087 to 0.265)< 0.0010.178 (0.088 to 0.268)< 0.001BASDAI (square root)†††Not included in the model because the value did not show potentially significant association in univariate analysis (p > 0.1).Methods:A total of 301 patients who have been treated with cDMARDs were enrolled from 1,280 patients in a single center cohort during 18 years of follow up. For each patient, time intervals of periods were created according to the prescription records. ‘On-DMARD’ intervals were time intervals of periods with SSZ or MTX treatment and ‘off-DMARD’ intervals were time intervals of periods without both SSZ and MTX treatment. The intervals were the periods excluding the treatment periods of TNF inhibitors. Radiographic progression was evaluated by the rate of Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change, an increase or decrease of mSASSS change per year. A generalized estimating equation models with adjustment for confounding covariates were used to evaluate the efficacy of cDMARDs on the radiographic progression.Results:The number of 732 on-DMARD intervals and 1,027 off-DMARD intervals were obtained. Among the on-DMARD intervals, the proportion of intervals treated with SSZ (on-SSZ intervals), MTX (on-MTX intervals) and both of them (on-SSZ/MTX intervals) were 96.2%, 19.9% and 16.1%, respectively. In the multivariable regression analysis, there was no significant decrease in the rate of mSASSS change during cDMARDs therapy (β = -0.081, p = 0.418) (Table 1). And the mean rate of mSASSS change were 0.61 during on-DMARD intervals and 0.69 during off-DMARD intervals after adjustment of other covariates.Conclusion:Treatment with cDMARDs in AS did not show significant impact in retarding spinal progression. In patients with AS, treatment with biologics rather than cDMARDs may be more effective in slowing radiographic progression.Disclosure of Interests:None declared
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Mehta, Niraj, Michael Selch, Pin-Chieh Wang, et al. "Safety and Efficacy of Stereotactic Body Radiation Therapy in the Treatment of Pulmonary Metastases from High Grade Sarcoma." Sarcoma 2013 (October 1, 2013): 1–6. http://dx.doi.org/10.1155/2013/360214.
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Introduction. Patients with high-grade sarcoma (HGS) frequently develop metastatic disease thus limiting their long-term survival. Lung metastases (LM) have historically been treated with surgical resection (metastasectomy). A potential alternative for controlling LM could be stereotactic body radiation therapy (SBRT). We evaluated the outcomes from our institutional experience utilizing SBRT. Methods. Sixteen consecutive patients with LM from HGS were treated with SBRT between 2009 and 2011. Routine radiographic and clinical follow-up was performed. Local failure was defined as CT progression on 2 consecutive scans or growth after initial shrinkage. Radiation pneumonitis and radiation esophagitis were scored using Common Toxicity Criteria (CTC) version 3.0. Results. All 16 patients received chemotherapy, and a subset (38%) also underwent prior pulmonary metastasectomy. Median patient age was 56 (12–85), and median follow-up time was 20 months (range 3–43). A total of 25 lesions were treated and evaluable for this analysis. Most common histologies were leiomyosarcoma (28%), synovial sarcoma (20%), and osteosarcoma (16%). Median SBRT prescription dose was 54 Gy (36–54) in 3-4 fractions. At 43 months, local control was 94%. No patient experienced G2-4 radiation pneumonitis, and no patient experienced radiation esophagitis. Conclusions. Our retrospective experience suggests that SBRT for LM from HGS provides excellent local control and minimal toxicity.
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Kam, M. K., S. F. Leung, W. H. Kwan, et al. "Pattern of local failure after primary 2-dimensional radiotherapy (2DRT) in non-metastatic nasopharyngeal carcinoma patients: Predominance of within-field failure and hints on dose escalation effect." Journal of Clinical Oncology 24, no. 18_suppl (2006): 15506. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.15506.
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15506 Background: To investigate the pattern of local failure and explore any dose-response effect in locally recurred NPC patients treated by 2DRT. Methods: Based on a retrospective review on 2DRT-planned, non-metastatic NPC patients treated between 1996–99, 50 patients had local recurrence (LR). Computer tomography (CT) images at primary treatment and at LR were co-registered for each patient. The pre-treatment gross tumor volumes (GTV) and LR volumes were mapped, and 3-dimensional (3D)dosimetric reconstruction were performed. 20 patients were excluded due to insufficient data. All patients (n = 30) were treated with 2DRT (median dose 66 Gy), and 15 received additional external boost (median dose 20 Gy). The 66 Gy isodose level (IL) was taken as prescription reference. Patterns of LR were classified according to the table below. Comparisons of mean dose (D mean) between LR volume and non-recurrent GTV (GTV-LR) were performed using Wilcoxon signed ranks test. Results: The proportion of within-field (IF) failure, marginal failure, and outside-field failure for the entire cohort were 83.3% (25/30), 13.3% (4/30), and 3.3% (1/30), respectively. Elements of sub-optimal target coverage and radiographic miss were identified in 13.3% (4/30) and 16.6% (5/30) of patients, respectively. The D mean within the non-recurrent GTV was statistically higher than that in the LR volume (73.3 Gy v.s. 69.9 Gy, p = 0.037). Conclusions: Improvement in target localization or dose distribution alone can only avoid less than 20% of local failure that is attributable to radiographic miss or sub-optimal target coverage. Within-field failure was the predominant mode of local recurrence. The dose-response effect observed in this study is hypothesis-generating and forms the background for future randomized trials to verify the dose-escalation benefit using modern radiotherapy technique with high conformal capacity. [Table: see text] No significant financial relationships to disclose.
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Miller, Jacob A., Ehsan H. Balagamwala, Samuel T. Chao, et al. "Spine stereotactic radiosurgery for the treatment of multiple myeloma." Journal of Neurosurgery: Spine 26, no. 3 (2017): 282–90. http://dx.doi.org/10.3171/2016.8.spine16412.
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OBJECTIVE The objective of this study was to define symptomatic and radiographic outcomes following spine stereotactic radiosurgery (SRS) for the treatment of multiple myeloma. METHODS All patients with pathological diagnoses of myeloma undergoing spine SRS at a single institution were included. Patients with less than 1 month of follow-up were excluded. The primary outcome measure was the cumulative incidence of pain relief after spine SRS, while secondary outcomes included the cumulative incidences of radiographic failure and vertebral fracture. Pain scores before and after treatment were prospectively collected using the Brief Pain Inventory (BPI), a validated questionnaire used to assess severity and impact of pain upon daily functions. RESULTS Fifty-six treatments (in 38 patients) were eligible for inclusion. Epidural disease was present in nearly all treatment sites (77%). Moreover, preexisting vertebral fracture (63%), thecal sac compression (55%), and neural foraminal involvement (48%) were common. Many treatment sites had undergone prior local therapy, including external beam radiation therapy (EBRT; 30%), surgery (23%), and kyphoplasty (21%). At the time of consultation for SRS, the worst, current, and average BPI pain scores at these treatment sites were 6, 4, and 4, respectively. The median prescription dose was 16 Gy in a single fraction. The median clinical follow-up duration after SRS was 26 months. The 6- and 12-month cumulative incidences of radiographic failure were 6% and 9%, respectively. Among painful treatment sites, 41% achieved pain relief adjusted for narcotic usage, with a median time to relief of 1.6 months. The 6- and 12-month cumulative incidences of adjusted pain progression were 13% and 15%, respectively. After SRS, 1-month and 3-month worst, current, and average BPI scores all significantly decreased (p < 0.01). Vertebral fracture occurred following 12 treatments (21%), with an 18% cumulative incidence of fracture at 6 and 12 months. Two patients (4%) developed pain flare following spine SRS. CONCLUSIONS This study reports the largest series of myeloma lesions treated with spine SRS. A rapid and durable symptomatic response was observed, with a median time to pain relief of 1.6 months. This response was durable among 85% of patients at 12 months following treatment, with 91% local control. The efficacy and minimal toxicity of spine SRS is likely related to the delivery of ablative and conformal radiation doses to the target. SRS should be considered with doses of 14–16 Gy in a single fraction for patients with multiple myeloma and limited spinal disease, myelosuppression requiring “marrow-sparing” radiation therapy, or recurrent disease after EBRT.
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Biggioggero, M., E. G. Favalli, A. Marchesoni, and R. Caporali. "AB0671 PREVALENCE OF EXTRA-ARTICULAR MANIFESTATIONS AND IMPACT ON TARGETED DRUG PRESCRIPTION IN PATIENTS WITH SPONDYLOARTHRITIS: A RETROSPECTIVE ANALYSIS OF A REAL-LIFE COHORT." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1630.2–1631. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2472.
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Background:Extra-articular manifestations (EAMs), such as uveitis, inflammatory bowel diseases (IBD), and psoriasis (PSO) can frequently complicate the disease course of patients with spondyloarthritis (SpA), although prevalence data on this regard are still controversial. The occurrence of EAMs may influence the decision to introduce a targeted therapy and also drive the choice of the most appropriate drug.Objectives:The aim of this study is to retrospectively evaluate the prevalence of EAMs in a real-life cohort of SpA patients who were eligible to receive a targeted therapy and to investigate their impact in the choice of targeted treatment.Methods:Clinical data of SpA (axial SpA [axSpA], peripheral SpA, and psoriatic arthritis [PsA]) patients treated with a biologic or targeted synthetic Disease-Modifying Anti-Rheumatic Drug (DMARD) between December 1999 and December 2019 were extracted from a local registry. Prevalence of main SpA-related EAMs (uveitis, IBD and PSO) was calculated at the time of drug prescription, evaluating their distribution according to treatment subgroups. Comparisons between disease and treatment subgroups were made using the Fisher’s test.Results:The study included 629 patients with SpA (axSpA 26%, peripheral SpA 24%, PsA 50%), 266 [42%] women, mean age [±SD] 52 [±13.2] years, mean disease duration 7.8 [±7.9] years), receiving a total of 1106 lines of targeted treatment (I-line n=629, II-line n=258, ≥ III-line n=219) with etanercept (n=177), anti-TNF monoclonal antibodies (397 infliximab, 273 adalimumab, 38 certolizumab pegol, and 130 golimumab), secukinumab (n=46), ustekinumab (n=28), or apremilast (n=18). At the time of drug introduction, 13% of SpA patients showed at least one EAM. The prevalence of uveitis was higher in axSpA (11.8%) compared with both peripheral SpA (5.5%, p=0.01) and PsA (2.8%, p<0.0001), while IBD was more frequent in peripheral SpA (15.6%) than in axSpA (8.1%, p=0.008) and PsA (4.7%; p<0.0001). The prevalence of PSO was similar in axial and peripheral SpA (8.4 versus 6.3%, respectively; p=0.41). In the overall population, the baseline presence of at least one EAM was associated with a more frequent prescription of anti-TNF monoclonal antibodies rather than etanercept (14.4% versus 6.7%, respectively; p=0.004). Moreover, we observed a numerically, although not statistically significant, higher proportion of EAMs in patients treated with anti-TNF monoclonal antibodies rather than secukinumab (6.5%), ustekinumab (7.1%), and apremilast (5.9%).Conclusion:In our real-life cohort of SpA patients treated with targeted therapies, EAMs were highly represented at baseline, especially uveitis in axSpA and IBD in peripheral SpA. The presence of extra-articular involvement was associated with a preferential prescription of anti-TNF monoclonal antibodies rather than etanercept or drugs with different mechanisms of action.References:[1]Erol K, et al. Extra-articular manifestations and burden of disease in patients with radiographic and non-radiographic axial spondyloarthritis. Acta Reumatol Port. 2018;43(1):32-39.[2]Molto A, Sieper J. Peripheral spondyloarthritis: Concept, diagnosis and treatment. Best Pract Res Clin Rheumatol. 2018;32(3):357-368.[3]van der Heijde D, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017 Jun;76(6):978-991.Disclosure of Interests:Martina Biggioggero: None declared, Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Antonio Marchesoni Speakers bureau: Abbvie, Pfizer, UCB, Novartis, Celgene, Eli Lilly, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB
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Bennell, Kim L., Thorlene Egerton, Yong-Hao Pua, J. Haxby Abbott, Kevin Sims, and Rachelle Buchbinder. "Building the Rationale and Structure for a Complex Physical Therapy Intervention Within the Context of a Clinical Trial: A Multimodal Individualized Treatment for Patients With Hip Osteoarthritis." Physical Therapy 91, no. 10 (2011): 1525–41. http://dx.doi.org/10.2522/ptj.20100430.
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Evaluating the efficacy of complex interventions such as multimodal, impairment-based physical therapy treatments in randomized controlled trials is essential to inform practice and compare relative benefits of available treatment options. Studies of physical therapy interventions using highly standardized intervention protocols, although methodologically rigorous, do not necessarily reflect “real-world” clinical practice, and in many cases results have been disappointing. Development of a complex intervention that includes multiple treatment modalities and individualized treatment technique selection requires a systematic approach to designing all aspects of the intervention based on theory, evidence, and practical constraints. This perspective article outlines the development of the rationale and structure of a multimodal physical therapy program for painful hip osteoarthritis to be assessed in a clinical trial. The resulting intervention protocol comprises a semi-structured program of exercises and manual therapy, advice, physical activity, and optional prescription of a gait aid that is standardized, yet can be individualized according to physical assessment and radiographic findings. The program is evidence based and reflects contemporary physical therapist practice, while also being reproducible and reportable. This perspective article aims to encourage physical therapy researchers involved in evaluation of complex interventions to better document their own intervention development, as well as the outcomes, thus generating a body of knowledge about the development processes and protocols that is generalizable to the real-world complexity of providing physical therapy to individual patients.
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Murphy, Martin J., Steven Chang, Iris Gibbs, Quynh-Tu Le, David Martin, and Daniel Kim. "Image-guided radiosurgery in the treatment of spinal metastases." Neurosurgical Focus 11, no. 6 (2001): 1–7. http://dx.doi.org/10.3171/foc.2001.11.6.7.
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Object The authors describe a new method for treating metastatic spinal tumors in which noninvasive, image-guided, frameless stereotactic radiosurgery is performed. Stereotactic radiosurgery delivers a high dose of radiation in a single or limited number of fractions to a lesion while maintaining delivery of a low dose to adjacent normal structures. Methods Image-guided radiosurgery was developed by coupling an orthogonal pair of real-time x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the radiation beam to treatment sites associated with radiographic landmarks. This procedure can be conducted in an outpatient setting without the use of frame-based skeletal fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Four patients with spinal metastases underwent radiosurgery with total prescription doses of 1000 to 1600 cGy in one or two fractions. Alignment of the treatment dose with the target volume was accurate to within 1.5 mm. During the course of each treatment fraction, patient movement was less than 0.5 mm on average. Dosimetry was highly conformal, with a demonstrated ability to deliver 1600 cGy to the perimeter of an irregular target volume while keeping exposure to the cord itself below 800 cGy. Conclusions These experiences indicate that frameless radiosurgery is a viable therapeutic option for metastatic spine disease.
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Lau, Steven, Amit G. Singal, Adam Charles Yopp, Jeffrey John Meyer, Daniella Hall, and Michael Ryan Folkert. "Radiation therapy for palliation of osseous metastasis from hepatocellular carcinoma." Journal of Clinical Oncology 34, no. 26_suppl (2016): 204. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.204.
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204 Background: Osseous metastasis from hepatocellular carcinoma (HCC) is uncommon, and optimal palliative management for palliation is unclear. We present our clinical experience with palliative radiotherapy (RT) for osseous metastasis from HCC. Methods: Patients were identified using two prospectively maintained databases at our institution: all patients with HCC who developed metastases and all patients undergoing RT. Medical records were retrospectively reviewed following Institutional Review Board approval. We identified 146 patients with metastatic HCC, of which 28 patients with 38 osseous metastases were eligible for this analysis. All patients are seen in a multi-disciplinary clinic where consensus for management is developed. Most (89%) had metastasis at the time of initial tumor diagnosis, including 22 (79%) patients with osseous lesions at diagnosis. Tissue confirmation of metastasis was obtained in 22 (79%) patients. Outcomes of interest included patient-reported pain relief at time of follow-up, radiographic response at 6-12 months, and overall survival. Statistical analysis was performed with SPSS (IBM Corporation). Results: Median age at diagnosis was 61 years, and 86% (n = 24) were male. The most common site of metastasis was vertebral body (n = 26, 70%). Median time from bone metastasis diagnosis to RT was 1 month (range, 0-20). Only 1 patient received concomitant systemic therapy at the time of RT. Metastases were most commonly treated using 2D techniques (n = 26, 68%) to 30 Gy in 10 fractions (n = 18, 47%). Pain relief was complete, partial, and absent for 8 (21%), 24 (63%), and 6 (16%) metastases, respectively; no patient reported an increase in pain after treatment. Prescription BED3 > 50 Gy was associated with improved local control (P = .03). 7 (18%) radiographic local failures were observed at a median time of 5.4 months, and the 6-month local failure rate was 20.2%. Median survival was 3.4 months, with a 6-month survival rate of 39.1%. Conclusions: Mortality for patients with osseous metastasis from HCC is high, but palliative RT is associated with significant pain relief and/or disease control in many patients. This data on efficacy of palliative RT helps guide optimal management of these patients.
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Ho, Jennifer C., Dershan Luo, Nandita Guha-Thakurta, et al. "Gamma Knife Stereotactic Radiosurgery for Brain Metastases Using Only 3 Pins." Neurosurgery 78, no. 6 (2016): 877–82. http://dx.doi.org/10.1227/neu.0000000000001070.
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Abstract BACKGROUND: Removal of a pin during Gamma Knife stereotactic radiosurgery (GK-SRS) may be necessary to prevent collision and allow treatment. OBJECTIVE: To investigate outcomes after GK-SRS for treatment of brain metastases using a head frame immobilized to the skull with only 3 pins. METHODS: Between 2009 and 2014, we retrospectively reviewed the records of 1971 patients and identified 20 patients with multiple brain metastases treated with GK-SRS in which 1 anterior pin was removed immediately before treatment of a single posterior lesion. GK-SRS was also delivered to 116 other lesions in these 20 patients using the standard 4 pins during the same session, serving as an internal control for comparison. Endpoints included local control, dosimetric parameters, toxicity, and overall survival. RESULTS: The median number of lesions treated per session was 6 (range, 2-14). The lesions treated using 3 pins were located in the occipital lobe (n = 14) or the cerebellum (n = 6). Median follow-up was 12.3 months. There was 1 local failure involving a control lesion. Lesions treated using 3 pins had a lower prescription isodose line. GK-SRS of a lesion using 3 pins did not cause any clinical toxicities or increase in radiographic edema or hemorrhage. CONCLUSION: Treating posteriorly located brain metastases with GK-SRS using only 3 pins provided excellent local control and no difference in treatment toxicity, which may make it a safe and reasonable option for lesions that may otherwise be difficult to treat.
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Katayama, K., T. Okubo, K. Yujiro, et al. "SAT0146 INHIBITION OF RADIOGRAPHIC PROGRESSION BY IGURATINOD IN 116 JAPANESE RHEUMATOID ARTHIRITIS PATIENTS DESPITE CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS THERAPY." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1011.2–1012. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1434.
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Background:Japanese double-blind clinical practice studies of Iguratimod (IGU) for active rheumatoid arthritis (RA) patients indicated an early and sustained efficacy as a new conventional synthetic disease-modyfing anti-rheumatic drugs (csDMARDs) [1] as well as the safety of the treatment[2]. IGU also inhibit activation of NFkB and production of RANKL, indicating strong inhibiting activity against bone destruction. However, studies focused on the inhibitory effects of joint destruction by IGU has been poorly documented in clinical practice (3).Objectives:To evaluate inhibitory effect during 1 year by additional IGU therapy in 116 RA patients despite csDMARDs therapy.Methods:Inhibitory effects of joint damage were evaluated by modified total Sharp scoring (mTSS) at baseline and 1 year after IGU prescription. RA activity was measured by DAS28-ESR.Results:The subjects were 116 cases, 30 male, age 63.2 yrs, disease duration 93.7 months. MTX was used weekly (84 cases, 72.4%), and cs DMARDs were used as BUC 43 cases, SASP 13 cases, TAC 5 cases, and LEF 1 cases. bDMARDs were used even in 8 cases, and steroids were used in 3.9 mg (70 cases, 60.3 %). Complications were observed in 70 cases (60.3%). DAS28-ESR were significantly improved from 4.29 (baseline) to 3.65 (6 months), 3.68 (12 months), respectively (P<0.0001). As shown in Figure 1, joint destruction measured by mTSS was significantly suppressed from 7.74 to 0.57 at 1 year (P<0.0001). 70.6% of patients satisfied structural remission (ΔmTSS≤0.5). Clinically relevant radiographic progression (CRRP)(mTSS>3) was observed in 10 cases (8.6%), and rapid radiographic progression(RRP) (mTSS≥5) was observed in 2 cases (1.6%). Adverse events were observed in 26 cases (22.4 %).To investigate prognostic factor for CRRP, clinical data in baseline, 6, 12 months between ten patients with CRRP and 82 patients with structural remission were compared. As shown in Table 1, longer disease duration, more SJC (P<0.05), High CRP level(P<0.005) were prognostic for CRRP in IGU treated patients.Conclusion:Iguratimod suppressed not only clinical activities but also joint destruction in RA patients resistant to csDMARDs therapy.Table 1. Prognostic factor for CRRPReferences:[1]Ishiguro N, Yamamoto K, Katayama K et al. Concomitant iguratimod therapy in patients with active rheumatoid arthritis despite stable doses of methotrexate a randomized, double-blind, placebo-controlled trial. Mod Rheumatol. 2013;23(3):430-9[2]Hara M, Ishiguro N, Katayama K et al. Safety and efficacy of combination therapy of iguratimod with methotrexate for patients with active rheumatoid arthritis with an inadequate response to methotrexate: an open-level extension of a randomized, double-blind, placebo-controlled trial. Mod Rheumatol. 2014;24(3):410–8.[3]Ishikawa K, Ishikawa J.Iguratimod, a synthetic disease modifying anti-rheumatic drug inhibiting the activation of NF-jB and production of RANKL: Its efficacy, radiographic changes,safety and predictors over two years’ treatment for Japanese rheumatoid arthritis patients. Mod.Rheumatol.2019,29(3), 418–429.Disclosure of Interests:None declared
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Chan, Jason, Spencer Behr, Jonathan Pai, et al. "Stereotactic body radiotherapy for hepatocellular carcinoma in patients with poor liver function." Journal of Clinical Oncology 36, no. 4_suppl (2018): 397. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.397.
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397 Background: Stereotactic body radiation therapy (SBRT) may benefit patients with hepatocellular carcinoma (HCC) who are not candidates for other liver-directed therapies due to poor liver function (plf). However, optimal patient selection, safety, and efficacy of SBRT in plf-HCC patients are not known. We studied dosimetric, baseline liver function, and radiographic features at the time of treatment that may help identify HCC patients with liver dysfunction who would benefit most from SBRT. Methods: Medical records of plf-HCC patients with cirrhosis treated with SBRT at a single institution between 2013-2016 were reviewed. Prescription doses were tailored to liver function based on INR and total bilirubin (tBili) and uninvolved liver volume. Time to local progression was evaluated using cumulative incidence analysis (Gray’s test) and competing risks regression analysis. Local progression was defined using RECIST criteria. Overall survival was estimated using the Kaplan-Meier method and Cox proportional hazards model. Results: 26 plf-HCC patients with median baseline MELD 11 (range 1-35), tBili 1.6 (0.5-6.5), INR 1.2 (1.0-9.0), tumor size of 4.1 cm (1.7-8.5 cm), and liver volume 1251 cc (596-2322 cc) were treated with SBRT. 54% received SBRT for retreatment of the same tumor. Patients were heavily pretreated with 50%, 19%, and 8% previously receiving TACE, ethanol ablation, and RFA, respectively. With a median prescription of 30 Gy (8-50 Gy) in 5 fractions (2-5), the median liver dose was 8 Gy (3-14 Gy). Median increase in MELD 90 days post-SBRT was 1.1 (0-19), with 35% experiencing no increase and 25% increasing >2.5. Local control (LC) was 55% at 6 months with one patient bridged to liver transplant. LC was not associated with improved survival (p = 0.39) and median overall survival (MS) was 8.6 months (0.9-31.7 mo). However, longer MS was seen for patients without ascites (MS=16.5 vs. 4.1 mo, p = 0.005), tBili < 2 (MS=16.5 vs. 5.2 mo, p = 0.015) and MS was not reached in patients treated to > 30 Gy (p = 0.04) or with MELD < 11 (p = 0.02). Conclusions: In this cohort of HCC patients with poor liver function, the absence of ascites, tbili < 2, and lower MELD scores were associated with improved survival following SBRT.
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Grenier, Jacqueline Dolphine, Marcos Sergio Endo, Joana Yumi Teruya Uchimura, Elen De Souza Tolentino, and Nair Narumi Orita Pavan. "Combination of dentoalveolar traumatic injury: a case report (10-year follow-up)." Brazilian Dental Science 18, no. 4 (2015): 121. http://dx.doi.org/10.14295/bds.2015.v18i4.1141.
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<p>Tooth Injury comprises a group of clinical conditions that can have the separation or breakage of the tooth and its surrounding tissues. A case of multiple concomitant dental trauma is reported. In 2004, a female patient, 11 years old, visited the dental office a half hour after a dental trauma caused by a fall in the pool. She complained of mild discomfort in the tooth 11; in a clinical analysis, it was partially displaced from its socket and showed grade 2 mobility; in a radiographic analysis, the tooth showed an increase in the periodontal ligament space, a diagnosis of extrusive luxation. The adjacent teeth 21 and 22, presented subgingival bleeding, diagnosed with subluxation. After preparing the treatment plan, clinical approach consisted of manual reduction of the tooth 11 and non-rigid splint of affected teeth. The patient received a prescription of antibiotic and anti-inflammatory. After 15 days, the splint was removed and the teeth 11, 21 and 22 showed pulpal sensibility, maintaining the same results for 4 months. In the 4<sup>th</sup> month, tooth 11 was diagnosed with pulp necrosis, thus requiring endodontic treatment. After 10 years, teeth were asymptomatic, with a slight color change in tooth 11; the cone beam scan indicated root resorption in the apical third of the three elements and the presence of dystrophic calcification of teeth 21 and 22. In conclusion, the injured teeth remain in function with relevant follow-up period, highlighting the search for a response, upon the purpose of the study. </p>
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Sachdev, Sean, Robert L. Dodd, Steven D. Chang, et al. "Stereotactic Radiosurgery Yields Long-term Control for Benign Intradural, Extramedullary Spinal Tumors." Neurosurgery 69, no. 3 (2011): 533–39. http://dx.doi.org/10.1227/neu.0b013e318218db23.
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Abstract BACKGROUND: The role of stereotactic radiosurgery in the treatment of benign intracranial lesions is well established. Although a growing body of evidence supports its role in the treatment of malignant spinal lesions, a much less extensive dataset exists for treatment of benign spinal tumors. OBJECTIVE: To examine the safety and efficacy of stereotactic radiosurgery for treatment of benign, intradural extramedullary spinal tumors. METHODS: From 1999 to 2008, 87 patients with 103 benign intradural extramedullary spinal tumors (32 meningiomas, 24 neurofibromas, and 47 schwannomas) were treated with stereotactic radiosurgery at Stanford University Medical Center. Forty-three males and 44 females had a median age of 53 years (range, 12–86). Twenty-five patients had neurofibromatosis. Treatment was delivered in 1 to 5 sessions (median, 2) with a mean prescription dose of 19.4 Gy (range, 14-30 Gy) to an average tumor volume of 5.24 cm3 (range, 0.049-54.52 cm3). RESULTS: After a mean radiographic follow-up period of 33 months (range, 6–87), including 21 lesions followed for ≥ 48 months, 59% were stable, 40% decreased in size, and a single tumor (1%) increased in size. Clinically, 91%, 67%, and 86% of meningiomas, neurofibromas, and schwannomas, respectively, were symptomatically stable to improved at last follow-up. One patient with a meningioma developed a new, transient myelopathy at 9 months, although the tumor was smaller at last follow-up. CONCLUSION: As a viable alternative to microsurgical resection, stereotactic radiosurgery provides safe and efficacious long-term control of benign intradural, extramedullary spinal tumors with a low rate of complication.
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Muacevic, Alexander, Michael Staehler, Christian Drexler, Berndt Wowra, Maximilian Reiser, and Joerg-Christian Tonn. "Technical description, phantom accuracy, and clinical feasibility for fiducial-free frameless real-time image-guided spinal radiosurgery." Journal of Neurosurgery: Spine 5, no. 4 (2006): 303–12. http://dx.doi.org/10.3171/spi.2006.5.4.303.
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Object The authors describe the technical application of the Xsight Spine Tracking System, data pertaining to accuracy obtained during phantom testing, and the initial clinical feasibility of using this fiducial-free alignment system with the CyberKnife in spinal radiosurgery. Methods The Xsight integrates with the CyberKnife radiosurgery system to eliminate the need for implantation of radiographic markers or fiducials prior to spinal radiosurgery. It locates and tracks spinal lesions relative to spinal osseous landmarks. The authors performed 10 end-to-end tests of accuracy using an anthropomorphic head and cervical spine phantom. Xsight was also used in the treatment of 50 spinal lesions in 42 patients. Dose planning was based on 1.5-mm-thick computed tomography slices in which an inverse treatment planning technique was used. All lesions could be treated using the fiducial-free tracking procedure. Phantom tests produced an overall mean targeting error of 0.52 ± 0.22 mm. The setup time for patient alignment averaged 6 minutes (range 2–45 minutes). The treatment doses varied from 12 to 25 Gy to the median prescription isodose of 65% (40 to 70%). The tumor volume ranged between 1.3 and 152.8 cm3The mean spinal cord volume receiving greater than 8 Gy was 0.69 ± 0.35 cm3No short-term adverse events were noted during the 1- to 7-month follow-up period. Axial and radicular pain was relieved in 14 of 15 patients treated for pain. Conclusions Fiducial-free tracking is a feasible, accurate, and reliable tool for radiosurgery of the entire spine. By eliminating the need for fiducial implantation, the Xsight system offers patients noninvasive radiosurgical intervention for intra- and paraspinal tumors.
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Ding, Dale, Chun-Po Yen, Zhiyuan Xu, Robert M. Starke, and Jason P. Sheehan. "Radiosurgery for Primary Motor and Sensory Cortex Arteriovenous Malformations." Neurosurgery 73, no. 5 (2013): 816–24. http://dx.doi.org/10.1227/neu.0000000000000106.
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Abstract BACKGROUND: Eloquent intracranial arteriovenous malformations (AVMs) located in the primary motor or somatosensory cortex (PMSC) carry a high risk of microsurgical morbidity. OBJECTIVE: To evaluate the outcomes of radiosurgery on PMSC AVMs and compare them with radiosurgery outcomes in a matched cohort of noneloquent lobar AVMs. METHODS: Between 1989 and 2009, 134 patients with PMSC AVMs underwent Gamma Knife radiosurgery with a median radiographic and clinical follow-up of 64 and 80 months, respectively. Seizure (40.3%) and hemorrhage (28.4%) were the most common presenting symptoms. Pre-radiosurgery embolization was performed in 33.6% of AVMs. Median AVM volume was 4.1 mL (range, 0.1-22.6 mL), and prescription dose was 20 Gy (range, 7-30 Gy). Cox regression analysis was performed to identify factors associated with obliteration. RESULTS: The overall obliteration rate, including magnetic resonance imaging and angiography, after radiosurgery was 63%. Obliteration was achieved in 80% of AVMs with a volume less than 3 mL compared with 55% for AVMs larger than 3 mL. No previous embolization (P = .002) and a single draining vein (P = .001) were independent predictors of obliteration on multivariate analysis. The annual post-radiosurgery hemorrhage risk was 2.5%. Radiosurgery-related morbidity was temporary and permanent in 14% and 6% of patients, respectively. Comparing PMSC AVMs with matched noneloquent lobar AVMs, the obliteration rates and clinical outcomes after radiosurgery were not statistically different. CONCLUSION: For patients harboring PMSC AVMs, radiosurgery offers a reasonable chance of obliteration with a relatively low complication rate. Eloquent location does not appear to confer the same negative prognostic value for radiosurgery that it does for microsurgery.
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Chadchavalpanichaya, Navaporn, Voraluck Prakotmongkol, Nattapong Polhan, Pitchaya Rayothee, and Sirirat Seng-Iad. "Effectiveness of the custom-mold room temperature vulcanizing silicone toe separator on hallux valgus: A prospective, randomized single-blinded controlled trial." Prosthetics and Orthotics International 42, no. 2 (2017): 163–70. http://dx.doi.org/10.1177/0309364617698518.
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Background:Silicone toe separator is considered as a conservative treatment for hallux valgus. The prefabricated toe separator does not fit all. However, effectiveness in prescription of the custom-mold toe separator is still unknown.Objectives:To investigate the effect of using a custom-mold room temperature vulcanizing silicone toe separator to decrease hallux valgus angle and hallux pain. The compliances, complications, and satisfactions of toe separator were also explored.Study design:A prospective, randomized single-blinded controlled trial.Methods:A total of 90 patients with a moderate degree of hallux valgus were enrolled in a study at the Foot Clinic, Siriraj Hospital, Thailand. Patients were randomized into two groups; the study group was prescribed a custom-mold room temperature vulcanizing silicone toe separator for 6 h per night for 12 months. Patients in both groups received proper foot care and shoes and were permitted to continue drug treatment.Results:In total, 40 patients in the study group and 39 patients in the control group completed the study. The hallux valgus angle was obtained through radiographic measurement. At month 12, both groups had significant differences in mean hallux valgus angle with a decrease of 3.3° ± 2.4° for the study group and increase of 1.9° ± 1.9° for the control group. There were statistically significant differences of hallux valgus angle between the two groups ( p < 0.05) at the end of the study. Hallux pain was decreased in the study group.Conclusion:A custom-mold room temperature vulcanizing silicone toe separator can decrease hallux valgus angle and pain with no serious complications.Clinical relevanceThe custom-mold room temperature vulcanizing silicone toe separator for treatment of hallux valgus reduces deformity and hallux pain.
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Mesinovic, Jakub, David Scott, Markus J. Seibel, et al. "Risk Factors for Incident Falls and Fractures in Older Men With and Without Type 2 Diabetes Mellitus: The Concord Health and Ageing in Men Project." Journals of Gerontology: Series A 76, no. 6 (2021): 1090–100. http://dx.doi.org/10.1093/gerona/glab062.
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Abstract Background Type 2 diabetes mellitus (T2DM) increases falls and fracture risk. Our objective was to compare incidence and risk factors for falls and fractures in community-dwelling older men with and without T2DM. Methods A total of 1705 men (471 with T2DM; 1234 without T2DM) aged ≥70 years were assessed at baseline. Men were contacted every 4 months for 6.0 ± 2.2 years to ascertain incident falls and fractures, with the latter being confirmed by radiographic reports. Hip fractures were ascertained via data linkage (follow-up: 8.8 ± 3.6 years). Risk factors for falls and fractures included physical activity and function, body composition, medications, and vision measures. Results Men with T2DM had similar fall (incident rate ratio [IRR]: 0.92 [95% confidence interval {CI}: 0.70, 1.12], n = 1246) and fracture rates (hazard ratio [HR]: 0.86 [95% CI: 0.56, 1.32], n = 1326) compared to men without T2DM after adjustment for significant risk factors. In men with T2DM, depression (IRR: 1.87 [95% CI: 1.05, 3.34], n = 333), sulphonylurea usage (IRR: 2.07 [95% CI: 1.30, 3.27]) and a greater number of prescription medications (IRR: 1.13 [95% CI: 1.03, 1.24]) were independently associated with increased fall rates, and higher total hip bone mineral density was independently associated with lower fracture rates (HR: 0.63 [95% CI: 0.47, 0.86], n = 351). Interaction terms demonstrated that better contrast sensitivity was independently associated with lower fracture rates (HR: 0.14 [95% CI: 0.02, 0.87]) in men with T2DM compared to men without T2DM. Conclusion Fall and fracture rates were similar in men with and without T2DM after adjusting for significant risk factors. Vision assessments including contrast sensitivity measures may improve fracture prediction in older men with T2DM.
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Pan, James, Allen L. Ho, Myreille D'Astous, et al. "Image-guided stereotactic radiosurgery for treatment of spinal hemangioblastoma." Neurosurgical Focus 42, no. 1 (2017): E12. http://dx.doi.org/10.3171/2016.10.focus16361.
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OBJECTIVE Stereotactic radiosurgery (SRS) has been an attractive treatment option for hemangioblastomas, especially for lesions that are surgically inaccessible and in patients with von Hippel-Lindau (VHL) disease and multiple lesions. Although there has been a multitude of studies examining the utility of SRS in intracranial hemangioblastomas, SRS has only recently been used for spinal hemangioblastomas due to technical limitations. The purpose of this study is to provide a long-term evaluation of the effectiveness of image-guided radiosurgery in halting tumor progression and providing symptomatic relief for spinal hemangioblastomas. METHODS Between 2001 and 2011, 46 spinal hemangioblastomas in 28 patients were treated using the CyberKnife image-guided radiosurgery system at the authors' institution. Fourteen of these patients also had VHL disease. The median age at treatment was 43.5 years (range 19–85 years). The mean prescription radiation dose to the tumor periphery was 21.6 Gy (range 15–35 Gy). The median tumor volume was 0.264 cm3 (range 0.025–70.9 cm3). Tumor response was evaluated on serial, contrast-enhanced CT and MR images. Clinical response was evaluated by clinical and imaging evaluation. RESULTS The mean follow-up for the cohort was 54.3 months. Radiographic follow-up was available for 19 patients with 34 tumors; 32 (94.1%) tumors were radiographically stable or displayed signs of regression. Actuarial control rates at 1, 3, and 5 years were 96.1%, 92.3%, and 92.3%, respectively. Clinical evaluation on follow-up was available for 13 patients with 16 tumors; 13 (81.2%) tumors in 10 patients had symptomatic improvement. No patient developed any complications related to radiosurgery. CONCLUSIONS Image-guided SRS is safe and effective for the primary treatment of spinal hemangioblastomas and is an attractive alternative to resection, especially for those with VHL disease.
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Emad Eldin, R. M., W. A. Reda, A. M. El-Shehaby, K. Abdel Karim, A. Nabeel, and S. Tawadros. "P03.08 Large cerebral arteriovenous malformations management with Volume-staged gamma knife radiosurgery." Neuro-Oncology 21, Supplement_3 (2019): iii26. http://dx.doi.org/10.1093/neuonc/noz126.089.
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Abstract BACKGROUND Large cerebral arteriovenous malformations (AVM) pose a management dilemma because of the limited success of any single treatment modality by itself. Surgery alone is associated with significant morbidity and mortality. Similarly, embolization alone has limited efficacy. Volume-staged gamma knife radiosurgery (VSGR) has been developed for the treatment of large AVMs, to increase the efficacy and improve safety of treatment of these lesions. The aim of the study was to assess the efficacy and safety of VSGR technique for the treatment of large cerebral AVMs. METHODS The study included patients treated by VSGR between May 2009 and July 2015. All cases had large AVMs (>10 cc). These were 29 patients. RESULTS Twenty-four patients completed radiographic follow up with 15 obliteration cases (62.5%). There was a total of 56 sessions performed. The mean AVM volume was 16 cc (10.1–29.3 cc). The mean prescription dose was 18 Gy (14–22 Gy). The mean follow up duration was 43 months (21–73 months). One patient died during follow up from unrelated cause. Two cases suffered haemorrhage during follow up. Symptomatic edema developed in 5 (17%) patients. The factors affecting obliteration were smaller total volume, higher dose/stage, non-deep location, compact AVM, AVM score less than 3, >18 Gy dose and <15 cc total volume. The factors affecting symptomatic edema were smaller total volume and shorter time between first and last sessions (p 0.012). T2 image changes were affected by SM grade 3 or more (p 0.013) and AVM score 3 or more (p 0.014). CONCLUSION VSGR provides an effective and safe treatment option for large cerebral AVMs. Smaller AVM volume is associated with higher obliteration rate.
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Crocker, Ken, Benvon Cramer, and James M. Hutchinson. "Antibiotic Availability and the Prevalence of Pediatric Pneumonia During a Physicians’ Strike." Canadian Journal of Infectious Diseases and Medical Microbiology 18, no. 3 (2007): 189–92. http://dx.doi.org/10.1155/2007/138792.
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BACKGROUND: Antibiotics are widely believed to be overpre-scribed for pediatric respiratory infections, yet there are few data available on the effect of a sudden decrease in antibiotic availability on pediatric infectious disease.OBJECTIVE: To determine whether the prevalence of radiographically diagnosed pneumonia changed over a period of decreased physician access and decreased antibiotic availability.DESIGN: A retrospective study was performed which reviewed the number of pediatric respiratory antibiotic prescriptions over a period which included a physicians’ strike. The study examined whether antibiotic availability had been affected by the strike. Pediatric chest radiograph reports were reviewed for the same period to determine whether changes in antibiotic availability had affected the prevalence of radiographically diagnosable pneumonias among children presenting to a pediatric emergency room.RESULTS: While prescriptions for antibiotics fell by a minimum estimate of 28% during the strike, there was no change in the frequency of radiographic diagnoses of pneumonia.CONCLUSIONS: Respiratory antibiotics appear to be available in the community in excess of the amount required to control pneumonia. A 28% decrease in antibiotic availability did not result in a significant increase in respiratory disease.
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Tonetto, Mateus Rodrigues, Shelon Cristina Souza Pinto, Alvaro Henrique Borges, et al. "Is there Correlation between the Root Apex Anatomy with External Root Resorption?" World Journal of Dentistry 5, no. 3 (2014): 162–65. http://dx.doi.org/10.5005/jp-journals-10015-1280.
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ABSTRACT The aim of this study was to correlate the root apex anatomies with external root resorption in patients orthodontically treated through panoramic radiography and cone beam computed tomography (CBCT) methods. Two hundred and forty dental roots were evaluated by tomographic and radiograph images from thirty patients submitted to orthodontic treatment. Orthodontic treatment with fixed appliances was developed based on the technique of straight arc (Straightwire) with Roth prescription. Dental roots anatomy were classified based on shape as: Score 0 – normal root; Score 2 – short root; Score 2 – blunt; Score 3 – bent; and Score 4 – pipette shape. Measurements of external root resorption (ERR) were performed before and after orthodontic treatment by means of CBCT and panoramic radiograph. All patients and 72% of the 173 roots presented with ERR. The frequency of root type, the normal root (score 0) was 88.75% in panoramic radiography and only 18.75% for CBCT. The frequency of ERR was high in maxillary central incisors (73%), maxillary lateral incisors (73%), mandibular central incisors (72%), mandibular lateral incisors (70%). Statistical analysis showed no correlation between the methods, type root and tooth type (p < 0.05). The CBCT had better results for identifying apical roots resorption than panoramic radiograph, but the correlation between the type of root and ERR was not confirmed. How to cite this article Gilbert TJ, Silva MB, Pinto SCS, Bhandi SH, de Musis CR, Castro I, Estrela C, Borges AH, Tonetto MR, Bandeca MC. Is there Correlation between the Root Apex Anatomy with External Root Resorption? World J Dent 2014;5(3):162-165.
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Carney, Brian J., Erik J. Uhlmann, Maneka Puligandla, et al. "Safety of Direct-Acting Oral Anticoagulants Versus Enoxaparin in Patients with Primary and Metastatic Brain Tumors." Blood 132, Supplement 1 (2018): 2521. http://dx.doi.org/10.1182/blood-2018-99-115666.
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Abstract Introduction Venous thromboembolism (VTE) is a common complication of cancer. Patients with primary brain tumors and brain metastases are at particularly high risk, with about 20-30% suffering a VTE event. The administration of enoxaparin appears to be safe in patients with brain metastases but confers an increased risk of intracranial hemorrhage (ICH) in patients with primary brain tumors. Direct-acting oral anticoagulants (DOACs) have demonstrated efficacy in the treatment of cancer-associated thrombosis with an increased risk of hemorrhage compared to low molecular weight heparin (LMWH). There are limited data on the safety of DOACs in patients with brain tumors. As the risk of ICH associated with parenteral anticoagulants differs for primary versus secondary brain tumors, we analyzed ICH outcomes for patients with VTE receiving enoxaparin or a DOAC. Methods A retrospective cohort study was performed using a hospital-based online medical record database (CQ2) linking ICD-9 and ICD-10 codes with prescription medication records. Cases were identified based on coding for primary brain tumors or brain metastases and prescription of either a DOAC or enoxaparin. A blinded review of radiographic imaging was performed, and intracranial hemorrhages were categorized as either trace, measurable, and major. Measurable intracranial hemorrhages were those defined as greater than 1 mL in volume and major intracranial hemorrhages were defined as greater than 10 mL in volume, symptomatic (defined as focal deficit, headache, nausea, or a change in cognitive function), or required surgical intervention. Gray's test was used to compare the cumulative incidence of ICH between the groups, with death as a competing risk. Results A total of 170 patients with primary brain tumors and brain metastases were included in the study. In the primary brain tumor cohort (N=65), 18 patients received a DOAC while 47 received enoxaparin. The cumulative incidence of any ICH at 12 months was 0% in patients receiving a DOAC compared to 36.8% (95% confidence interval 22.3-51.3%) in those receiving enoxaparin (P=0.012). There were no major ICH events in the DOAC group and 8 and in the LMWH group (12-month cumulative incidence of 0% versus 18.2%, 95% CI 8.4-31.0, P=0.062). In the brain metastases cohort (N=105), 21 patients received a DOAC while 84 received enoxaparin. The DOAC and enoxaparin groups were well-matched for tumor diagnosis (non-small lung cancer 52% and 51%, respectively) including those tumor types with a high incidence of ICH (i.e. melanoma 5% and 7% and renal cell carcinoma 14% and 11%, respectively). In patients with brain metastases, DOACs did not increase the risk of any ICH relative to enoxaparin (12-month cumulative incidence 27.8% versus 52.9%, P=0.15) nor major ICH (12-month cumulative incidence 11.1% vs 17.8%, P=0.38). Conclusions DOACs can be safely administered to patients with brain tumors. In patients with primary brain tumors (i.e. glioma), DOACs appear to be safer than LMWH and should be considered for this indication. Figure. Figure. Disclosures Zwicker: Incyte: Research Funding; Parexel: Consultancy; Quercegen: Research Funding; Daiichi: Honoraria.
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Gillies, Rolland C., Carlos Quiñonez, Robert E. Wood, and Ernest W. N. Lam. "Radiograph prescription practices of dentists in Ontario, Canada." Journal of the American Dental Association 152, no. 4 (2021): 284–92. http://dx.doi.org/10.1016/j.adaj.2020.12.007.
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Wu, Jau-Ching, Wen-Cheng Huang, Hsiao-Wen Tsai, et al. "Differences between 1- and 2-level cervical arthroplasty: more heterotopic ossification in 2-level disc replacement." Journal of Neurosurgery: Spine 16, no. 6 (2012): 594–600. http://dx.doi.org/10.3171/2012.2.spine111066.
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Object The most currently accepted indication for cervical arthroplasty is 1- or 2-level degenerative disc disease (DDD) refractory to medical treatment. However, the randomized and controlled clinical trials by the US FDA investigational device exemption studies only compared cervical arthroplasty with anterior cervical discectomy and fusion for 1-level disease. Theoretically, 2-level cervical spondylosis usually implicates more advanced degeneration, whereas the 1-level DDD can be caused by merely a soft-disc herniation. This study aimed to investigate the differences between 1- and 2-level cervical arthroplasty. Methods The authors analyzed data obtained in 87 consecutive patients who underwent 1- or 2-level cervical arthroplasty with Bryan disc. The patients were divided into the 1-level and the 2-level treatment groups. Clinical outcomes were measured using the visual analog scale (VAS) for the neck and arm pain and the Neck Disability Index (NDI), with a minimum follow-up of 30 months. Radiographic outcomes were evaluated on both radiographs and CT scans. Results The study analyzed 98 levels of Bryan cervical arthroplasty in 70 patients (80.5%) who completed the evaluations in a mean follow-up period of 46.21 ± 9.85 months. There were 22 females (31.4%) and 48 males (68.6%), whose mean age was 46.57 ± 10.07 years at the time of surgery. The 1-level group had 42 patients (60.0%), while the 2-level group had 28 patients (40.0%). Patients in the 1-level group were younger than those in the 2-level group (mean 45.00 vs 48.93 years, p = 0.111 [not significant]). Proportional sex compositions and perioperative prescription of nonsteroidal antiinflammatory drugs were also similar in both groups (p = 0.227 and p = 1.000). The 2-level group had significantly greater EBL during surgery than the 1-level group (220.80 vs 111.89 ml, p = 0.024). Heterotopic ossification was identified more frequently in the 2-level group than the 1-level group (75.0% vs 40.5%, p = 0.009). Although most of the artificial discs remained mobile during the follow up, the 2-level group had fewer mobile discs (100% and 85.7%, p = 0.022) than the 1-level group. However, in both groups, the clinical outcomes measured by VAS for neck pain, VAS for arm pain, and NDI all significantly improved after surgery compared with that preoperatively, and there were no significant differences between the groups at any point of evaluation (that is, at 3, 6, 12, and 24 months after surgery). Conclusions Clinical outcomes of 1- and 2-level cervical arthroplasty were similar at 46 months after surgery, and patients in both groups had significantly improved compared with preoperative status. However, there was a significantly higher rate of heterotopic ossification formation and less mobility of the Bryan disc in patients who underwent 2-level arthroplasty. Although mobility to date has been maintained in the vast majority (94.3%) of patients, the long-term effects of heterotopic ossification warrant further investigation.
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Miller, Jacob A., Ehsan H. Balagamwala, Camille A. Berriochoa, et al. "The impact of decompression with instrumentation on local failure following spine stereotactic radiosurgery." Journal of Neurosurgery: Spine 27, no. 4 (2017): 436–43. http://dx.doi.org/10.3171/2017.3.spine161015.
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OBJECTIVESpine stereotactic radiosurgery (SRS) is a safe and effective treatment for spinal metastases. However, it is unknown whether this highly conformal radiation technique is suitable at instrumented sites given the potential for microscopic disease seeding. The authors hypothesized that spinal decompression with instrumentation is not associated with increased local failure (LF) following SRS.METHODSA 2:1 propensity-matched retrospective cohort study of patients undergoing SRS for spinal metastasis was conducted. Patients with less than 1 month of radiographic follow-up were excluded. Each SRS treatment with spinal decompression and instrumentation was propensity matched to 2 controls without decompression or instrumentation on the basis of demographic, disease-related, dosimetric, and treatment-site characteristics. Standardized differences were used to assess for balance between matched cohorts.The primary outcome was the 12-month cumulative incidence of LF, with death as a competing risk. Lesions demonstrating any in-field progression were considered LFs. Secondary outcomes of interest were post-SRS pain flare, vertebral compression fracture, instrumentation failure, and any Grade ≥ 3 toxicity. Cumulative incidences analysis was used to estimate LF in each cohort, which were compared via Gray’s test. Multivariate competing-risks regression was then used to adjust for prespecified covariates.RESULTSOf 650 candidates for the control group, 166 were propensity matched to 83 patients with instrumentation. Baseline characteristics were well balanced. The median prescription dose was 16 Gy in each cohort. The 12-month cumulative incidence of LF was not statistically significantly different between cohorts (22.8% [instrumentation] vs 15.8% [control], p = 0.25). After adjusting for the prespecified covariates in a multivariate competing-risks model, decompression with instrumentation did not contribute to a greater risk of LF (HR 1.21, 95% CI 0.74–1.98, p = 0.45). The incidences of post-SRS pain flare (11% vs 14%, p = 0.55), vertebral compression fracture (12% vs 22%, p = 0.04), and Grade ≥ 3 toxicity (1% vs 1%, p = 1.00) were not increased at instrumented sites. No instrumentation failures were observed.CONCLUSIONSIn this propensity-matched analysis, LF and toxicity were similar among cohorts, suggesting that decompression with instrumentation does not significantly impact the efficacy or safety of spine SRS. Accordingly, spinal instrumentation may not be a contraindication to SRS. Future studies comparing SRS to conventional radiotherapy at instrumented sites in matched populations are warranted.
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McNamara, Megan Ann, Daniel J. George, Krishnan Ramaswamy, et al. "Overall survival by race in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate or enzalutamide." Journal of Clinical Oncology 37, no. 7_suppl (2019): 212. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.212.
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212 Background: Prostate cancer (PC) is the most common malignancy among US men and the 2nd leading cause of cancer-related death. African Americans (AAs) have higher mortality from mCRPC than Whites (W). Despite this disparity, a small prior study suggested AAs may have better PSA response to abiraterone acetate (ABAC) than Ws, though radiographic progression did not differ. We evaluated overall survival (OS) in AA vs W chemotherapy-naïve (CN) mCRPC patients (Ps) treated with ABAC or enzalutamide (ENZ). Methods: This was a retrospective study that used the Veterans Health Administration (VHA) database. Male PC Ps (≥18 years) who had surgical or medical castration were identified from Apr 1, 2013 to Mar 31, 2018. The index date was the first prescription claim date for ABAC or ENZ following castration. Ps had no chemotherapy for 12 months pre-index date and had continuous VA health plan enrollment for ≥12 months pre- and post-index date. Ps were followed until death or disenrollment. Unadjusted and Kaplan-Meier survival analyses adjusted for demographic and clinical characteristics were used to calculate survival time, and multivariate Cox proportional hazards models assessed the relationship between race and OS. Results: This study included 2,123 W and 787 AA mCRPC Ps with mean ages of 74 and 71 years, respectively. The median follow‐up time was 570 days and 561 days for AA and W, respectively. AA were more prone to comorbid hypertension (77.1% vs 67.1%; p<.0001), type II diabetes (38.1% vs 29.3%; p<.0001), and liver damage or abnormality (8.8% vs 5.2%; p=0.0003) than W . From the unadjusted analysis, the median Kaplan-Meier estimated OS was 910 days for AAs and 784 days for Ws; AAs had better OS than Ws (HR=0.887; 95%CI [0.790-0.996]). From the adjusted analysis, the median Kaplan-Meier estimated OS was 918 days for AAs and 781 days for Ws; AAs still had better OS (HR=0.826; 95%CI [0.732-0.933]). Conclusions: This large retrospective study provides the first evidence that AA CN mCRPC Ps may have better OS with ABAC or ENZ than W Ps. Trials are needed to validate this finding and explore the mechanisms of racial disparities in outcomes with new hormonal therapies.