Tailoring neo/adjuvant systemic therapy in breast cancer: "The advent of a personalized approach"-The Breast-Gynecological and Immuno-Oncology International Cancer Conference (BGICC) consensus and recommendations.

BACKGROUND: The management of early breast cancer (BC) has witnessed an uprise in the use of neoadjuvant therapy and a remarkable reshaping of the systemic therapy postneoadjuvant treatment in the last few years, with the evolution of many controversial clinical situations that require consensus. METHODS: During the 14th Breast-Gynecological and Immuno-Oncology International Cancer Conference held in Egypt in 2022, a panel of 44 BC experts from 13 countries voted on statements concerning debatable challenges in the neo/adjuvant treatment setting. The recommendations were subsequently updated based on the most recent data emerging. A modified Delphi approach was used to develop this consensus. A consensus was achieved when ≥75% of voters selected an answer. RESULTS AND CONCLUSIONS: The consensus recommendations addressed different escalation and de-escalation strategies in the setting of neoadjuvant therapy for early BC. The recommendations recapitulate the available clinical evidence and expert opinion to individualize patient management and optimize therapy outcomes. Consensus was reached in 63% of the statements (52/83), and the rationale behind each statement was clarified.

Applications of artificial intelligence in restorative dentistry: a scoping review.

OBJECTIVE: Artificial intelligence (AI) applications in restorative dentistry have remarkably increased in the past 5 years. This review outlines the applications, promises, and limitations of AI in the most performed procedures in restorative dentistry. METHOD AND MATERIALS: An electronic search was performed in four databases: MEDLINE/PubMed, Embase, Web of Science, and Scopus. The search included articles published in English language without date restriction. Two independent reviewers assessed the eligibility of the studies and performed data extraction. Any discrepancy was resolved by the consensus of a third reviewer. RESULTS: A total of 33 studies were included in this review. For AI applications in restorative dentistry, the included studies were classified into three main groups: (1) diagnosis, detection, and prediction of the disease, (2) detection and prediction of the longevity of dental restorations, and (3) teeth detection and treatments. For each study, the AI model, type of dataset, sample size, and main results (accuracy, precision, sensitivity, and specificity) were reported. CONCLUSIONS: AI systems are promising as advantageous aids for diagnosis, prediction, and treatment in dentistry, with a high degree of accuracy. Despite the AI promises, several limitations are still unresolved and must be addressed to bridge the gap between technology and clinical applications.

Clinical and radiographical evaluation of CAD-CAM crowns with and without deep margin elevation: 10-year results.

STATEMENT OF PROBLEM: Current in vitro and short-term clinical studies suggest that deep margin elevation (DME) is a suitable approach to relocate subgingival margins to a supragingival position. However, long-term clinical results are lacking. PURPOSE: The purpose of this retrospective multicenter practice-based study was to assess the long-term clinical performance and periodontal health of teeth restored with computer-aided design and computer-aided manufacturing (CAD-CAM) crowns with or without DME. MATERIAL AND METHODS: Patients who had received CAD-CAM lithium disilicate (LD) crowns with or without DME in 2013 were invited for a follow-up appointment. When indicated, DME had been performed using resin-based restoration. A total of 275 LD crowns had been fabricated chairside, and 151 crowns had been laboratory milled. The crowns had been cemented with 3 different adhesive and self-adhesive resin cements. Clinical and radiographical assessment of the crowns and supporting periodontal structures were performed according to the modified United States Public Health Service (USPHS) criteria. Linear mixed effect models were used to assess the effect of the follow-up time on repeated measurements (α=.05). The Kaplan-Meier survival analyses were determined. RESULTS: A total of 380 patients with 426 crowns (153 with DME and 273 without DME) were examined with a follow-up period of 10 years. Overall, 15 teeth with secondary caries, 4 with loss of vitality, 4 crown fractures, and 3 crowns with lost retention were observed. The DME profile was rated good in 74%, acceptable in 17.5%, and poor in 8.5% of crowns. The periodontal parameters of teeth with DME were not significantly different from teeth without DME (P>.05). The 10-year survival rates for the DME and without DME groups were 95.8% and 94.7%, respectively, while the 10-year success rates for the DME and without DME groups were 94.1% and 93%, respectively. CONCLUSIONS: The use of DME and lithium disilicate crowns as well as adhesive bonding is considered a safe and reliable treatment option. The integrity of periodontal tissue was not affected by the DME or by the crowns.

Effect of different impression coping and scan body designs on the accuracy of conventional versus digital implant impressions: An in vitro study.

OBJECTIVES: This in vitro study compared the accuracy of conventional versus digital impression techniques for angulated and straight implants using two different impression coping and scan body designs. METHODS: Two implant systems were used: Straumann and Dentegris. Two implants were placed for each system, straight and angulated at 15 degrees mesiodistally. Conventional impressions were made using the splinted open-tray technique using narrow impression coping (NIC) and wide impression coping (WIC). The stone casts produced from the conventional impression were digitized with a lab scanner (3Shape D2000). Digital impressions were made using four intraoral scanners (IOS): 3Shape Trios 3, Medit i700, Cerec Omnicam, and Emerald Planmeca using short scanbodies (SSB) and long scanbodies (LSB). The scanning was repeated ten times to generate the Standard Tessellation Language (STL) files. The distance and angle deviations between impression copings and scanbodies were measured in reference to the master model. RESULTS: The trueness and precision of SSB and WIC were significantly better than LSB and NIC (p<0.001). The range trueness of the platform deviation was better with SSB (37.1 to 51.9) than LSB (89.6 to 127.9 µm) and for WIC than NIC in conventional impressions (58.2 and 75.1 µm, respectively). The trueness of the angle deviation of digital scans with SSB (0.11 to 0.25 degrees) was significantly better than scans with LSB (0.31 to 0.57 degrees) and for WIC than NIC (0.21 and 0.52 degrees, respectively). The precision of the platform deviation of digital scans with SSB (12.4 to 34.5 µm) was higher than other scans and conventional impressions (42.9 to 71.4 µm). The precision of the angle deviation of Medit i700 and Trios 3 with SSB (0.17 and 0.20 degrees, respectively) was higher than other scans with SSB and conventional impressions (0.54 to 1.63 degrees). CONCLUSIONS: Digital scans with SSB were more accurate than conventional splinted open-tray impressions. The type of impression coping and scanbody significantly affected the impression accuracy. CLINICAL SIGNIFICANCE: The use of a short scanbody can increase the accuracy of digital impressions, and wide impression coping can increase the accuracy of conventional impressions, resulting in improved clinical outcomes.

Clinical evaluation of zirconia crowns cemented with two different resin cements: A retrospective study.

BACKGROUND: Self-adhesive resin cement has been used extensively with zirconia crowns. Several in vitro studies showed that adhesive resin cementation may increase zirconia crowns' retention and their fatigue resistance. OBJECTIVES: This retrospective study aimed to evaluate the clinical performance, survival and success rates and complications encountered with zirconia crowns cemented with two different self-adhesive resin cements. METHODS: A total of 112 patients who received 176 monolithic zirconia crowns were evaluated. Crowns were cemented with RelyX Unicem 2 (n = 74) and Panavia SA (n = 102) self-adhesive resin cements. Clinical assessments of the crowns and supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Intraoral photographs and periapical and bitewing radiographs were obtained for further assessment by two evaluators. Descriptive statistics, McNemar, t-test, log rank (Mantel-Cox) tests and Kaplan-Meier survival analyses were performed (a = .05). RESULTS: The 5-year survival and success rates were 100% and 96.4%, respectively. The complications encountered were recurrent caries (2.2%) and the need for endodontic treatment (0.5%). No technical complications, such as fracture or loss of retention, were observed. The type of cement and patient-related factors did not influence the survival and success rates of the crowns. CONCLUSIONS: Survival rate of zirconia crowns cemented with two different self-adhesive resin cements was 100% after 5 years.

Clinical performance of CAD-CAM crowns provided by predoctoral students at the University of Toronto.

STATEMENT OF PROBLEM: The clinical success of monolithic lithium disilicate glass-ceramic (LDGC) crowns manufactured with computer-aided design and computer-aided manufacturing (CAD-CAM) technology provided by predoctoral students has not been fully investigated. PURPOSE: The purpose of this retrospective clinical study was to evaluate the performance of laboratory-fabricated monolithic posterior LDGC CAD-CAM crowns provided by predoctoral students at the University of Toronto. Specific patient- and provider-related factors were also investigated. MATERIAL AND METHODS: A sample of posterior LDGC CAD-CAM crowns (IPS e.max) provided by predoctoral students was evaluated. Crown preparations were made according to specific criteria, and crowns were milled in an in-house laboratory by using the CEREC Bluecam system. The crowns were cemented with Rely-X Unicem (3M ESPE) and Calibra Universal (Dentsply Sirona) resin cements. Clinical assessments of the crowns and supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Intraoral photographs and periapical and bitewing radiographs were obtained for further assessment by 2 evaluators. Descriptive statistics, McNemar, t test, log rank (Mantel-Cox) tests, Pearson chi-squared tests, simple logistic regression, odds ratios, and Kaplan Meier survival analyses were performed (α=.05). RESULTS: A total of 189 patients receiving 210 crowns (108 premolar and 102 molar) were examined with a follow-up period of up to 6 years. Altogether, 28 complications were observed (12 technical, 11 biological, and 5 esthetic). No significant association was found between patient age, sex, periodontal condition, tooth type, tooth vitality, cement type, and crown longevity. However, significantly lower survival and success rates were found for mandibular crowns than for maxillary crowns (P=.029). The provider's experience had no significant effect on the clinical performance of LDGC CAD-CAM crowns. The 6-year cumulative survival rate was 93.0%, and the success rate was 86.4%. CONCLUSIONS: The ease of use of the CAD-CAM system and clinical performance of LDGC suggest that this technology should be used in the dental school setting by predoctoral students.

Immunohistochemical and electron microscopic morphometric image analysis of hepatocellular carcinoma in association of HCV infection.

Early detection of hepatocellular carcinoma (HCC) is crucial for successful therapy. The present work examined the value of ultrastructural morphometric image analysis of hepatocyte nuclei in patients with chronic hepatitis C virus (HCV) versus HCC cases with chronic HCV and the corresponding surgical tumor-free safe margins (TFMs), to highlight any early predictive signs of neoplastic cellular transformation. This work also performed an immunohistochemical assessment of cytokeratin 19 (CK19) and Ki-67-positive cells to visualize any associated proliferative activity in the examined groups. The results showed significant decrease in the hepatocyte nuclear surface areas in the HCC and TFMs versus those in the HCV cases. The hepatocyte nucleolar surface area was significantly increased in the HCC cases versus that in the HCV cases. This increase was associated with a significant increase in Ki-67-positive cells in the HCC cases compared to those in the other groups. Conversely, the mean number of CK 19-positive cells was significantly reduced in the HCC cases compared to the cell numbers in TFMs and HCV cases with severe hepatic fibrosis. Liver progenitor cells (LPCs) were discerned in the reactive ductules and canaliculo-ductular junctions that characterized TFMs. LPCs were sporadically distributed in the liver lobules and reactive bile ductules in the HCC samples. In conclusion, CK 19 represents an important marker for distinguishing between dysplastic and malignant liver nodules. Electron microscopic morphometric image analysis may be considered as adjunct factor for assessing hepatocyte malignant transformation. Wider scale studies are needed to authenticate these results.

Prognostic Value of Her2/neu Expression in Gastrointestinal Stromal Tumors: Immunohistochemical Study.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is a relatively rare type of neoplasms. In Egypt, it represents 2.5% of gastrointestinal tumors and 0.3% of all malignancies. Most of the GISTs develop in the stomach. AIM: To reveal the significance of Her2/neu immunohistochemical expression in GIST and its correlation with other histopathologic parameters and tumor relapse after regular follow-up. PATIENTS AND METHODS: This study is a retrospective and prospective cohort. It included 32 patients with GISTs, who were resectable with no distant metastasis. Immunohistochemical staining by Her2/neu was performed after complete surgical resection of the tumors with preservation of the pseudocapsule. RESULTS: In total, 53.1% of cases were men and 46.9% women. Tumors were classified into low-risk (25%), intermediate-risk (21.9%), and high-risk groups (53.1%). Her2/neu expression was negative in 56.3% of GISTs and positive in 43.7%. Its expression was significantly correlated with risk grade (P = .04), tumor size (P = .001), mitotic count (P = .00), and increased risk of relapse (P = .00). Furthermore, tumor relapse was significantly correlated with the tumor mitotic counts (P = .00). Using kappa agreement test, it showed that 4 mitotic counts/50 high-power fields (HPF) was the cutoff value with which the tumor might be associated more with relapse, with 83% sensitivity, 70% specificity, and P value of .003. CONCLUSIONS: Her2/neu might be used as an independent prognostic marker for tumor recurrence after complete resection of GIST, and the cutoff value of mitotic count that might predict tumor relapse is 4/50 HPF. However, more clinical studies with greater number of cases with fluorescent in situ hybridization integration are recommended.

Preparation and electrochemical behavior of PtRu(111) alloy single-crystal surfaces.

The electrochemical behavior of a PtRu(111) single crystal with 1:1 bulk atomic ratio is investigated for the first time by means of cyclic voltammetry and scanning tunneling microscopy (STM). The electrode surfaces are enriched with either Ru or Pt, depending on the cooling conditions after inductive heating. Analysis of the surfaces by STM shows a typical topography with smooth terraces separated by monoatomic high steps. The voltammetric characterization of PtRu(111) in acid media clearly reveals an altered electrochemical behavior of the Pt and Ru surfaces compared to Pt(111) and Ru(0001), respectively. Systematic changes are observed for hydrogen adsorption and underpotential deposition of copper as test reactions. Based on theoretical calculations in the literature, it is experimentally verified that the Pt-rich and the Ru-rich surfaces of the PtRu(111) single-crystal alloy bind adsorbates such as hydrogen significantly weaker and stronger than the pure single-crystal electrode surfaces. Such changes in surface reactivity can be crucial for electrocatalytic reactions.