Do phosphatase of regenerating liver‑3, matrix metalloproteinases‑2, matrix metalloproteinases‑9, and epidermal growth factor receptor‑1 predict response to therapy and survival in glioblastoma multiforme.

Context: Poor survival of the glioblastoma multiforme (GBM) has been attributed in part to the invasive nature of the lesion making complete surgical removal near impossible. Phosphatase of regenerating liver‑3 (PRL‑3), matrix metalloproteinases‑2 and ‑9 (MMP‑2 and MMP‑9), and epidermal growth factor receptor (EGFR‑1) play a role in invasive nature of tumor cells. Aims: This study was conducted to evaluate PRL‑3, MMP‑2, MMP‑9, and EGFR‑1 (markers) expression in cases to GBM and to correlate their expression with therapy response and survival. Settings and Design: GBM cases (n = 62) underwent surgery followed by radiation (n = 34) and chemoradiation (n = 28). Using WHO Response Evaluation Criteria in Solid Tumors criteria response to therapy was assessed at 3 months and cases followed up for survival. Subjects and Methods: Expression of markers was assessed by immunohistochemistry as a percentage of positive tumor cells in hot spots. Statistical Analysis Used: Kaplan–Meier, ANOVA, Chi‑square test, univariate, and multivariate Cox‑regression analysis was done. Results: Response to therapy was evident in 54.8% cases of responders with the mean survival of 494.03 ± 201.13 days and 45.2% cases of non responders (278.32 ± 121.66 days) with P = 0.001. Mean survival for the patient’s opted chemoradiation was 457.43 ± 222.48 days which was approximately 3 months greater than those who opted radiation alone (P = 0.029). We found PRL‑3 overexpression was an independent, significant, poor prognostic factor for survival by multivariate analysis (P = 0.044). Cases negative for MMP’s and EGFR showed increased survival, but the difference was insignificant. Conclusion: PRL‑3 expression appears to be related to an adverse disease outcome.

The Use of Dentascan to Diagnose and Treat Mandibular Premolar with Multiple Canals.

Introduction: For successful endodontic therapy it is vital to have thorough knowledge of morphology of the root canal system and its variations besides proficient aseptic intraoperative condition. Mandibular second premolars are usually single rooted tooth with single root canal system. The incidence of the number of roots and the number of canals varies greatly in the literature. Methods and Results: This case report describes an unusual case of mandibular second premolar with two roots and five root canals. This was confirmed by radiographs, dentascan and dental operating microscope (DOM), and was successfully treated using K files system, guttapercha and AH plus sealer in lateral condensation manner. Conclusion: The clinical significance of this case report is that the precise awareness about the aberrant morphologies of the root canal system can only be appreciated when advanced radiographic techniques, magnification and illumination are used to treat such type of cases.

Platelet Rich Fibrin and Nanocry stalline Hydroxyapatite with Collagen Combination in Treatment of Periapical Lesion: A Novel Clinical Approach.

Aims: To use platelet rich fibrin (PRF), which is an autologous platelet concentrate, along with nanocrystalline hydroxyapatite with collagen for treatment of periapical lesion and negotiation of calcified canal of adjacent tooth. Case Presentation: A 19-year-old female reported to the Department of Conservative Dentistry and Endodontics with chief complaint of pain in maxillary right central incisor. Past dental history revealed trauma which she sustained 10 yrs back in the same region. On intraoral examination, there was a draining sinus, in relation to the apex of 11. Also discolouration and crown fracture was found in relation to 11. Periapical radiograph revealed a large diffused periapical radiolucency in relation to 11 and 12, open apex of 11 and calcified root canal in relation to 12. Technique Used in the Study: A periapical surgery under local anaesthesia was planned in the region of maxillary right anterior region in relation to tooth no 11 and 12. Before surgery calcified canal of tooth no 12 was negotiated. PRF and nanocrystalline hydroxyapatite with collagen combination were placed in bony cavity. Follow up of the case was done for period of 6 months. Discussion: In present case combination of nanocrystalline hydroxyapatite with collagen and PRF is used, as it helps in faster bone regeneration. Graft material is osteoconductive and collagen network provides a better scaffold for clot formation and bone regeneration. Conclusion: The combination of PRF and nanocrystalline hydroxyapatite with collagen has been demonstrated to be an effective approach to induce faster periapical healing in present case with large periapical lesion.

Revisiting epidermal growth factor receptor in glioblastoma multiforme: Does it play a role in response to therapy.

Background and Aim: Glioblastoma multiforme (GBM) are the most aggressive class of cancer of central nervous system with hallmark characteristics that include rampant proliferation, necrosis, and endothelial proliferation. Epidermal growth factor receptor (EGFR) has been implicated as the primary contributor to glioblastoma initiation and succession. The present study was designed to evaluate EGFR protein expression in GBM as predictor of response to therapy and survival. Materials and Methods: Epidermal growth factor receptor was assessed by immunohistochemistry as a percentage of positive tumor cells in hot spots (10 high-power fields). The study group comprised of 35 cases of GBM. All cases underwent surgical resection and subsequently underwent radiotherapy (n = 17) or radiotherapy with adjuvant temozolomide chemotherapy (n = 18). Immediate response to therapy was assessed at 3 months using World Health Organization response evaluation criteria in solid tumors criteria and cases followed up for survival. Results: Twenty-four cases (68.6%) expressed EGFR while 11/35 (31.4%) cases were negative. Response to therapy was evident in 21/35 cases (60.0%) and 14/35 were (40.0%) nonresponders. Mean EGFR protein expression in responders was 37.23 ± 33.70 and in nonresponders was 59.5 ± 39.46 (P = 0.542). The percentage of responders which were EGFR negative was 72.7% and while response in EGFR positive cases was observed in 54.2%. Mean survival in EGFR positive and negative GBM was 394.37 ± 189.11 and 420.54 ± 191.23 days, respectively. Conclusion: The EGFR negative cases appear to respond better to therapy, however, the difference is not statistically significant (P = 0.298). Further, EGFR protein expression does not play a definitive role in predicting survival. This is an original study evaluating EGFR in terms of therapeutic response.

A comparative evaluation of smear layer removal using two rotary instrument systems with ethylenediaminetetraacetic acid in different states: A SEM study.

Aim: The aim of the study was to evaluate the ability of 17% ethylenediaminetetraacetic acid (EDTA) solution and 19% EDTA gel to remove debris, and smear layer produced during root canal preparation with two NiTi files systems, Mtwo and Protaper. Materials and Methods: Twenty freshly extracted human anterior teeth with single root canal were collected. The crowns were sectioned at the cemento-enamel junction, and working length was measured. These samples were randomly divided into four groups of five samples each. In each group, 2ml of 3 % sodium hypochlorite solution was used with first instrument. The groupings were as follows. Group 1: 2 ml of 17% EDTA solution and 2 ml of 3% NaOCl were used alternatively each time a new file was employed. This group was prepared with Mtwo rotary files. Group 2: The samples in this group was prepared with Mtwo rotary files. EDTA gel (19%) was used and the samples were irrigated with 2 ml of 3% NaOCl. NaOCl and EDTA gel were used alternatively. Group 3: Five samples were prepared with Protaper file. Irrigation regime was the same as in Group 1. Group 4: Five samples were prepared with Protaper files and irrigation regime was the same as in Group 2. SEM study was done and the collected data were submitted for statistical analysis. Results: There was no statistically significant difference with the varied instruments used (Mtwo and Protaper files), and 17% EDTA solution and 19% EDTA gel. Conclusion: Both the NITI instruments produced a similar dentin surface on root canal wall when used with EDTA gel and EDTA solution.

Terminal myelocystocele.

Terminal myelocystocele is an unusual form of occult spinal dysraphism. It consists of a cystic dilatation of a low-lying terminal cord herniated posteriorly through a skin covered lumbosacral spina bifida. This condition is often associated with OEIS complex i.e. opmphalocele, exstrophy of the bladder, imperforate anus and spinal abnormality. We studied 4 cases of terminal myelocystocele. They revealed no preoperative neurological deficit. None of these had associated OEIS complex. One of the cyst was unique due to presence of copious amount of pus in its cavity. All four cases underwent successful repair and surgery remained uneventful in all of them. No child showed neurological deterioration during the follow-up.