Frameless Fractionated Gamma Knife Radiosurgery with ICON™ for Large Metastatic Brain Tumors

BACKGROUND: Recently, a new generation of gamma knife radiosurgery (GKRS) equipped with a frameless immobilization system has encouraged the use of fractionated GKRS as an increasingly favorable treatment option. We investigated the preliminary outcome of efficacy and toxicity associated with frameless fractionated gamma knife radiosurgery (FF GKRS) for the treatment of large metastatic brain tumors. METHODS: Fifteen patients with 17 lesions were treated using FF GKRS and included in this study, because of the large tumor size of more than 10 cm3. FF GKRS was performed based on a thermoplastic mask system for 3 to 5 consecutive days. RESULTS: The mean duration of clinical follow-up was 12 months (range, 4–24), and the local control rate was 100%. Tumor volume decreased in 13 lesions (76.5%), and remained stable in 4 lesions (23.5%). One patient was classified as new lesion development because of the occurrence of leptomeningeal seeding regardless of the tumor volume change. Compared with the initial volume at the time of FF GKRS, tumor volume change at the last follow-up was 62.32% ± 29.80%. Cumulative survival rate at 12 months was 93.3% ± 6.4%. One patient died during the follow-up period because of the progression of the primary disease. No patient showed radiation necrosis on the follow-up images. CONCLUSION: Daily FF GKRS by gamma knife ICON™ revealed satisfactory tumor control rate and low morbidity, despite the short follow-up period. Further prospective studies and a longer follow-up of a large cohort of patients diagnosed with brain metastases are required to elucidate the effect of FF GKRS in brain metastases.

Infiltration of white-spot-lesions and developmental enamel defects

ABSTRACT: Purpose: To provide an overview of different indications suitable for treatment with the technique of resin infiltration (Icon, DMG), such as white-spot lesions (WSL), enamel fluorosis, and molar-incisor hypomineralisation (MIH), and to propose a valid and strategy feasible in dental surgeries for screening of dental color improvement and -stability. Method: A non-systematic review of the literature was performed to characterise inhibition of lesion progression, and the esthetic effects induced by resin infiltration of decalcified enamel, enamel fluorosis, and molar-incisor hypomineralisation (MIH), using the online database Pubmed and a suitable search strategy. Database search was complemented by a hand-search of references of retrieved articles. Results: Of 34 retrieved articles, 29 were included in the review. Evidence of an assimilation of WSL color to surrounding enamel following infiltration is available on the level of RCTs, and the results were found to be stable in color with no significant changes over at least twelve months. Evidence of an esthetic improvement of fluorotic or MIH affected teeth is available on the level of case reports and case control studies. Conclusion: As a micro-invasive approach to infiltrate and seal different types of enamel lesions, with a subsequent improvement of the esthetic appearance, resin infiltration is considered to be a useful complementation of the dental therapeutic specter.

Bio-efficacy, physical integrity, community usage and washing practices of mosquito nets treated with ICON MAXX long-lasting insecticidal treatment in India

BACKGROUND New brands of potential long lasting insecticide nets (LLINs) and LLIN treatment kits require field evaluation before they are used in a vector control programme. OBJECTIVES The aim of this study was to evaluate the bio-efficacy, usage, washing practice and physical integrity of nets treated with LLIN treatment kit, ICON MAXX in a phase III field trial in Odisha state, India. METHODS A total of 300 polyester nets treated with ICON MAXX and 140 polyester nets treated conventionally with lambda-cyhalothrin CS 2.5% ITNs were distributed. The bio-efficacy was evaluated with WHO cone bioassay. The chemical analysis of netting pieces was done at the beginning, after 12 and 36 months of the trial. FINDINGS After one year of distribution of nets, the bioassay showed 100% mortality on both ITNs and ICON MAXX treated nets. At 36 months, the overall pass rate was 58.8% and the mean lambda-cyhalothrin content of LLINs was 34.5 mg ai/m2, showing a loss of 44.4% of the original concentration. CONCLUSION ICON MAXX treated LLIN was found to retain bio-efficacy causing 97% knockdown of Anopheles stephensi up to 30 months and met the WHOPES criteria. However, the desired bio-efficacy was not sustained up to 36 months.

Management of post-orthodontic white-spot-lesions: clinical handling of the resin infiltration technique (Icon®, DMG) / Manejo de lesiones de manchas blancas post-ortodoncia: manejo clínico de la técnica de infiltración de resina (Icon, DMG)

To treat initial caries lesions using the technique of resin infiltration for a restoration of natural enamel appearance. Case report of a 19 year old female who presented with moderate post-orthodontic white-spot lesions (WSLs) at the upper central and lateral incisors following two years of active treatment with a fixed orthodontic appliance, and requested an aesthetic improvement of decalcified enamel surfaces. The technique of resin infiltration (Icon®, DMG, Hamburg, Germany) is presented as a means for not only inhibiting lesion progression, but also for an adequate rehabilitation of dentofacial esthetics. Practical tips and cues for clinical handling of the infiltration technique are provided. Resin infiltration augments the therapeutic spectrum for orthodontist as well as pediatric or general dentists in that enamel areas affected by post-orthodontic WSLs can be restored to their original appearance.

El objetivo fue mostrar el tratamiento de lesiones de caries iniciales usando la técnica de infiltración de resina para una restauración de la apariencia natural del esmalte. Reporte de caso de una joven de 19 años de edad, de sexo femenino que presentó lesiones moderadas de manchas blancas (WSLs) en los incisivos centrales y laterales superiores, luego del tratamiento de ortodoncia con aparatos fijos por dos años, y solicitó una mejoría estética de las superficies descalcificadas del esmalte. La técnica de infiltración de resina (Icon®, DMG, Hamburgo, Alemania) se presenta como un medio efectivo, no sólo para inhibir la progresión de la lesión, sino también para una rehabilitación adecuada de la estética dentofacial. Se proporcionan además consejos prácticos y claves para el manejo clínico de la técnica de infiltración. La infiltración de resina aumenta el espectro terapéutico del ortodoncista, así como de odontopediatras y odontólogos generales en las áreas del esmalte afectadas con WSLs post-ortodoncia y que pueden ser restauradas a su apariencia original.

Estudio de la microdureza de dientes permanentes con fluorosis incipiente, tratados con resina infiltrante / Micro-hardness of permanent teeth with incipient fluorosis treated with infiltrant resin / Estudo da microdureza de dentes permanentes com fluorose incipiente tratados com resina infiltrante

Objetivo: Evaluar la microdureza del esmalte afectado con fluorosis sometido a tratamiento con resina infiltrante, compa-rándolo con dientes sanos y dientes con fluorosis incipiente. Materiales y métodos: La muestra estuvo constituida por 15 dientes permanentes humanos recolectados del Banco de Dientes de la Facultad de Odontología de la Universidad Central del Ecuador. Para la selección de los dientes se tuvieron en consideración los criterios diagnósticos de fluorosis dental según Thylstrup y Ferjeskov (1978), teniendo 5 dientes con score 0 y 10 dientes con fluorosis incipiente (score 1-3). Todos los dientes considerados en el estudio no presentaron lesiones de caries, grietas ni fracturas. La muestra fue dividida en 3 grupos, G1: dientes sanos (control negativo), G2: dientes con fluorosis incipiente y G3: dientes con fluorosis incipiente tratado con resina infiltrante Icon®. A cada grupo (n=5) se le realizó una profilaxis y posteriormente al G3 se le aplicó la resina infiltrante. La microdureza knoop fue obtenida mediante tres indentaciones con microdurometro (Wilson Tukon Microhardness Tester). Los datos fueron analizados a través del método de Rho de Spearman con significancia de 5%. Resultados: La media de la microdureza knoop de los grupos y sus desviaciones estándar fueron de: G1=284,8 ± 56,2 G2=325,7 ± 95,1 G3=226,2 ± 67,4. no se encontraron diferencias estadísticamente significativas entre los grupos estudia-dos (p>0,05). Conclusión: La microdureza del esmalte afectado por fluorosis incipiente sometida a tratamiento con resina infiltrante, esmalte de dientes sanos y esmalte de dientes con fluorosis incipiente no mostró diferencia estadística.

Objective: To evaluate the microhardness of the enamel affected by fluorosis subjected to treatment with infiltrating resin, comparing it with sound teeth and teeth with incipient fluorosis. Materials and methods: The sample consisted of 15 permanent human teeth collected from the Teeth Bank of the Faculty of Odontology of the Central University of Ecuador. For the selection of the teeth, diagnostic criteria of dental fluorosis were considered according to Thylstrup and Ferjeskov (1978), having 5 teeth with score 0 and 10 teeth with incipient fluorosis (score 1-3). None of the teeth that were examined in the study had caries, cracks or fractures. The sample was divided into 3 groups. G1: sound teeth (negative control), G2: teeth with incipient fluorosis and G3: teeth with incipient fluorosis treated with Icon® infiltrating resin. To each group (n=5), dental prophylaxis was performed and afterwards to G3, infiltrating resin was applied. The Knoop micro-hard-ness was obtained through 3 indentations with microhardness tester (Wilson Tukon Microhardness Tester). The data were analyzed through the Spearman's Rho method with 5% significance. Results: The median of Knoop microhardness of the groups and their standard deviations were: G1=284.8 ± 56.2 G2=325.7 ± 95.1 G3=226.2 ± 67.4, no statistically significant differences were found between the examined groups (p>0.05). Conclusion: The microhardness of the enamel affected by incipient fluorosis subjected to treatment with infiltrating resin, enamel of sound teeth, and enamel of teeth with incipient fluorosis did not demonstrate statistical difference.

RESUMOObjetivo: Avaliar a microdureza do esmalte afetado com fluorose incipiente submetido ao tratamento com resina infiltrada, fazendo uma comparação com dentes higidos dentes com fluorose incipiente. Materiais e métodos: A amostra estava constituída por 15 dentes permanentes humanos coletados do Banco de Dientes de la Facultad de Odontología de la Uni-versidad Central del Ecuador (Banco de dentes da Faculdade de Odontologia da Universidade Central do Equador). Para a seleção dos dentes se considerou os critérios de diagnóstico de fluorose dental segundo Thylstrup y Ferjeskov (1978), tendo 5 dentes com pontuação de 0 e 10 dentes com fluorose incipiente (pontuação de 1 a 3). Todos os dentes considerados no estudo não apresentaram lesões de cárie, rachaduras nem fraturas. A amostragem foi dividida em 3 grupos: G1: dentes higidos (controle negativo); G2: dentes com fluorose incipiente e G3: dentes com fluorose incipiente tratados com resina infiltrante Icon®. Para cada grupo (n=5) uma profilaxia foi realizada, e posteriormente ao G3 se aplicou a resina infiltrante. A microdureza knoop foi obtida mediante três entalhes com microdurómetro (Wilson Tukon Microhardness Tester). Os dados foram analisados através do método de Rho de Spearman com um nivel de 5%. Resultados: A média da microdu-reza knoop dos grupos e seus desvios padrões foram de G1=284,8 ± 56,2; G2=325,7 ± 95,1; G3=226,2 ± 67,4, não foram estatisticamente encontradas diferenças significativas entre os grupos estudados (p>0,05). Conclusão: A microdureza do esmalte afetado com fluorose incipiente submetido ao tratamento com resina infiltrante, esmalte de dentes hígidos e de dentes com fluorose incipiente demostrou não ter diferença estatisticamente significativa.

Capacidad de penetración de la resina infiltrativa ICON en lesiones cariosas incipientes artificiales, localizadas en diferentes zonas del esmalte en dientes extraídos por razones ortodónticas / Penetration capacity of ICON infiltrative resin in artificial incipient carious lesions, located in different areas of the enamel in teeth extracted for orthodontic reasons

La prevención viene desde los principios del siglo XX y en las últimas décadas se ha tomado conciencia de la necesidad de preservar al máximo las estructuras dentales en los procedimientos restauradores, con la aplicación de técnicas adhesivas. La presente investigación trata sobre una nueva técnica micro invasiva para la estabilización de lesiones tempranas, que es la infiltración de caries con resina Icon la cual fue colocada en diferentes zonas del esmalte vestibular. Se crearon lesiones cariosas incipientes de forma artificial en cinco piezas dentales jóvenes extraídas por razones ortodónticas, posteriormente se realizó la infiltración de éstas con resina ICON siguiendo el protocolo establecido por el fabricante. Las piezas fueron cortadas verticalmente con discos de carburundum y posteriormente sometidas al microscopio electrónico de barrido para poder ser observadas y analizar las diferencias en el coeficiente de penetración de las diferentes zonas del esmalte vestibular. En este paso se realizó la toma de 5 fotografías por pieza a diferentes resoluciones para poder ser observadas con claridad. Luego se recolectaron los datos en una guía de observación, éstos se procesaron a través del programa estadístico SPSS; realizando en un primer momento la prueba de Kolmogorv-Smirnov y luego la prueba ANOVA; obteniendo como resultado que no existen diferencias en la capacidad de penetración de la resina Icon en las diferentes zonas del esmalte por lo que la resina es igualmente efectiva en el tercio oclusal, medio y cervical. Además se pudo observar pequeñas interfases resina-esmalte lo que muestra que la resina Icon no infiltró 100% la lesión, sin embargo se cree que la efectividad de la resina se debe a que los poros de la lesión quedan completamente obturados y así detienen la difusión de nutrientes y la progresión de la caries

Prevention comes from the beginning of the 20th century, the preservation of the dental structures in the process of restoration has been taken under a highly consideration in the last decades, with the applications of adhesive techniques. This currently investigation, is about a new micro invasive technique to prevent and stabilize early injuries, which consists on the infiltration of tooth decays applying resin on different areas on the enamel. Incipient tooth decay injuries were created artificially on five youth dental pieces, these were extracted for orthodontic reasons, the implementation of the resin ICON on these samples were afterwards, following the protocol established by the manufacturer. Dental carborundum discs were used to make a vertical cut on the samples and these were subject to the Scanning Electron Microscope (SEM) afterwards for their respective observation and analyze all the differences on the ratio penetration over all the areas on the enamel. Five pictures per sample were taken on different scales and resolutions on this current step so the results could be seen and observed with more clarity. All the data and results was collected and stored on an observation guide, currently processed by the Statistic Program SPSS; the Kolmogorv-Smirnov Test was applied initially, followed by the ANOVA Test, all of this lead to state that there is no difference on the ICON Resin's penetration capacity when it is applied on different enamel areas, this concludes that the resin is equally effective applied on the occlusal third, middle and cervical. Enamel-Resin interfaces were also noticed on the samples, showing that the ICON Resin couldn't infiltrate on the injury with a 100% efficiency; however, is established and believed that the ICON Resin's effectiveness is the result of the injury's pores get clogged and with that stopping the diffusion of nutrients and the development of tooth decay.

Necesidad de tratamiento ortodóncico en escolares residentes en una comunidad rural: estudio preliminar / Orthodontic treatment need in a shoolchildren population from a rural community: a preliminary study

Los problemas de maloclusión se asocian con discriminación por apariencia, problemas oclusales, trastornos témporomandibulares, problemas de deglución, fonación, dificultad para la higiene bucal

Field evaluation of Icon®Life, a long-lasting insecticidal net (LLIN) against Anopheles culicifacies and transmission of malaria in District Gautam Budh Nagar (Uttar Pradesh), India.

Background & objectives: In the present study, Icon®Life net, a long-lasting polyethylene net, 100 denier and bursting strength of minimum 280 kpa incorporated with deltamethrin @ 65 mg/m2 was evaluated for its efficacy in reducing the density of malaria vector Anopheles culicifacies and impact on malaria prevalence in a malaria endemic area of District Gautam Budh Nagar, India. Methods: Wash resistance of Icon® Life LLIN was determined up to 20 serial washings using An. culicifacies in cone bioassays under field conditions. Efficacy of Icon®Life LLIN was determined in the field in three sets of villages in District Gautam Budh Nagar (Uttar Pradesh), India, selected randomly for the intervention with Icon®Life LLIN, untreated nets and a control without any intervention for the period of August 2008–July 2009. Entomological and malariometric indices in all the three villages were compared during pre- and post-intervention periods for one year against An. culicifacies. A survey was also conducted in the village provided with Icon® Life LLIN to assessing the perception of community regarding acceptance of these nets by the community. Results: In cone bioassays on Icon®Life LLIN with An. culicifacies, >95% knockdown within 1 h and 100% mortality after 24 h exposure were reported even after 20× serial washings under field conditions. Results of the field study revealed reduced entry rate, resting density and parity rate of An. culicifacies in the village with Icon®Life LLIN when compared to no net and untreated net villages. Number of malaria cases reported were less in the Icon®Life LLIN used villages when compared to other two villages. The community compliance and acceptance was high and no adverse health events were reported by the households using these nets. Conclusions: Icon® Life LLIN is an effective intervention for the control of An. culicifacies transmitted malaria in India. Long-term studies are indicated for the duration of effectiveness and to ascertain the epidemiological impact of the use of Icon® Life nets.

Field evaluation of lambda-cyhalothrin (ICON 10 CS) indoor residual spraying against Anopheles culicifacies in India.

Background & objectives: Field trials of lambda-cyhalothrin 10 CS (ICON 10 CS) in indoor residual spraying (IRS) with 25 mg a.i./m2 against Anopheles culicifacies was undertaken vs malathion IRS (25% WP–2 g a.i./ m2) in Tumkur district, Karnataka; vs deltamethrin IRS (2.5% WP–20 mg a.i./m2) in Dharmapuri district; and vs lambda-cyhalothrin (10 WP–25 mg a.i./m2) in Ramanathapuram district, Tamil Nadu, India. Methods: Spray operations in the experimental villages were done by the National Institute of Malaria Research (NIMR) and in the control villages by the respective State Health Department staff. Persistence of efficacy of insecticide sprayed in villages was assessed by contact bioassays against vector mosquitoes. Entomological indicators such as per structure density, parity rates of vector mosquitoes and sporozoite rates were measured in all the three study areas using standard procedures. Mass blood surveys and active fever case detections were carried out in experimental and control villages to study the impact of IRS on malaria transmission. Results: Persistence of effectiveness of ICON 10 CS was observed up to 2–3 months in all the three study areas. ICON 10 CS was found effective at par with or better than the insecticides used in the national programme in reducing the mosquito densities and in interrupting malaria transmission in the study villages. Vector density, parity rates and malaria cases considerably reduced in the ICON 10 CS-sprayed villages. Conclusion: Field trials at three sites have established that ICON 10 CS formulation was relatively more effective than malathion 25% WP, deltamethrin 2.5% WP and lambda-cyhalothrin 10% WP in some evaluation parameters like indoor resting mosquitoes, parity rates in vector mosquitoes and persistence of effectiveness. It can be used for IRS for malaria vector control with two rounds of spray at an interval of 3 months for curtailing the malaria transmission and an additional round is recommended in perennial malaria transmission areas.