WT1 and TP53 as valuable diagnostic biomarkers for relapse after hematopoietic stem cell transplantation in acute myeloid leukemia.

BACKGROUND: Relapse following hematopoietic stem cell transplantation (HSCT) occurs relatively frequently and is a significant risk factor for mortality in patients with acute myeloid leukemia (AML). Early diagnosis is, therefore, of utmost importance and can provide valuable guidance for appropriate and timely intervention. Here, the diagnostic value of two molecular markers, Wilms tumor 1 (WT1) and tumor suppressor protein p53 (TP53), were studied. METHODS AND RESULTS: Twenty AML patients undergoing HSCT participated in this investigation. Some had relapsed following HSCT, while others were in remission. Peripheral blood (PB) and bone marrow (BM) samples were collected following relapse and remission. WT1 and TP53 messenger RNA (mRNA) expression was evaluated using reverse transcription-quantitative polymerase chain reaction (RT‒qPCR). The diagnostic value of genes was evaluated by utilizing receiver-operating characteristic (ROC) curve analysis. ROC analysis showed WT1 and TP53 as diagnostic markers for relapse after HSCT in AML patients. The mRNA expression level of WT1 was elevated in individuals who experienced relapse compared to those in a state of remission (p value < 0.01). Conversely, the expression level of TP53 mRNA was lower in individuals who had relapsed compared to those in remission (p value < 0.01). CONCLUSIONS: WT1 and TP53 possess the potential to serve as invaluable biomarkers in the identification of molecular relapse after HSCT in patients with AML. Further studies for a definitive conclusion are recommended.

Robotic hysterectomy compared with laparoscopic hysterectomy: is it still more costly to perform?

To establish the economic value of simple robotic hysterectomy vs laparoscopic hysterectomy and assess the impact of surgeon's experience. Retrospective cohort study. University-affiliated US regional healthcare system. Reproductive and post-menopausal women undergoing hysterectomy for benign indications. Robotic or laparoscopic hysterectomy. Between January 2018 and December 2019, a total of 985 simple laparoscopic and robotic hysterectomies were performed by 47 different gynecologists. Overall, the mean payment, direct cost, and profit were comparable (p value > 0.05) among simple robotic and laparoscopic hysterectomy. However, the mean operative time was significantly shorter for robotic hysterectomy compared to laparoscopic hysterectomy (106 min vs 127 min, respectively, p < 0.05). Operative time decreased as a surgeon's annual robotic case volume increased. Per-minute profitability of robotic hysterectomy increased significantly when a surgeon performed greater than 45 cases annually (p = 0.04). This effect became most pronounced when a surgeon performed 60 or more cases per year (p = 0.01). Simple robotic hysterectomy has shorter operative time compared to laparoscopic hysterectomy, with direct costs being similar. Robotic hysterectomy has higher per-minute profit compared to laparoscopic hysterectomy when a surgeon performs > 45 cases per year.

Stress distribution of esthetic posts in the restored maxillary central incisor: Three-dimensional finite-element analysis.

BACKGROUND: Glass fiber posts, along with their esthetic properties, may have a better stress distribution than cast posts, Therefore, the aim of the present study was to investigate the effect of glass fiber, casting, titanium, and zirconia posts on stress distribution in maxillary central tooth treated with different amounts of ferrule using finite-element analysis. MATERIALS AND METHODS: In this experimental study, three-dimensional models of maxillary central incisors that have undergone root canal treatment were designed. Then, the models were divided into four groups according to the type of post (Ni-Cr casting, glass fiber, titanium, and zirconia) used. Zirconia monolithic crowns were used in all the four groups. Ferrule heights were repeated at 0 and 2 mm in all models. Models were entered into COMSOL Metaphysics software. Then, the force of 100 N with the angle of 135° on the palatal surface was applied to the longitudinal axis of the tooth, and the stress distribution in the models was investigated. RESULTS: Maximum stress was observed in the middle third of posts. Stress distribution in glass fiber post was better than zirconia and casting posts. Stress accumulation in models with zirconia, titanium, and casting posts was also found in the site between the middle third and coronal third, whereas in models with glass fiber post, stress accumulation was found between the crown and the cemento-enamel junction. In models without ferrule, stress accumulation was observed in one-third of the coronal, especially in glass fiber posts. CONCLUSION: The post material and ferrule height affected stress concentration. The stress in the cervical area of the dentin was more for glass fiber post when compared to other posts. The use of glass fiber post in teeth with no ferrule results in lower stress along the post, but greater stress in the simulated tooth region.

Robotic-assisted laparoscopic Essure removal: a novel surgical approach.

Primary objective was to evaluate safety and feasibility of robotic-assisted Essure removal while describing the procedure. Secondary objective was to assess improvement of symptoms post-operatively. The design was retrospective cohort study. Patients included were those who underwent robotic-assisted Essure removal between June, 2015 and December, 2020 for symptomatic relief. Interventions are robotic-assisted laparoscopic removal of Essure devices. A retrospective chart review was conducted. Phone survey of pain scores and quality-of-life ratings were performed. Twenty-one women underwent robotic-assisted removal of Essure devices. Two cases were excluded from analysis due to concomitant procedures. All devices were removed intact (19/19). The mean time from placement to removal was 5.3 years. Safety and feasibility were demonstrated, mean operating time was 43.1 ± 12 min, mean length of stay (LOS) was 11 h, and no complications occurred. Mean pain scores (0-10) improved from 8.5 before surgery to 0.75 at 1 month after surgery (p < 0.005). Mean Quality-of-Life (QOL) scores (0-7) improved from 5.9 prior to surgery to 1.5 at 1 month after surgery (p < 0.005). To our knowledge, this is the first report of the use of robotic assistance for Essure removal. Robotic-assisted laparoscopic Essure removal appears safe, feasible, and potentially superior to other surgical approaches. Despite discontinuation of the device in 2018, Essure removal is likely to remain needed. Robotic-assisted laparoscopic Essure removal appears effective in treating pain and various other symptoms attributed to Essure devices.

Endodontic management of a tooth with apical overfilling and perforating external root resorption: A case report.

Successful non-surgical orthograde retreatment of a tooth with external root resorption in apical third of root and overfilling material beyond the apical barrier which was diagnosed with the help of cone beam computed tomography (CBCT), was reported. Biodentine was used as the treatment of choice for obturation of resorption area.

Robotic-assisted laparoscopic tubal anastomosis: Single institution analysis.

BACKGROUND: Tubal anastomosis has similar pregnancy rates regardless of approach. Historically, robotic anastomosis has been associated with increased cost and operative time. We sought to perform a contemporary study of these metrics. METHODS: One hundred and nine patients were identified who underwent robotic-assisted laparoscopic tubal anastomosis. Retrospective analysis of medical records was performed. Phone survey was conducted. RESULTS: The mean operative time decreased from 140.7 ± 27.0 min in 2013 to 60.0 ± 9.1 min in 2018, with significant downward trend (p < 0.001). The mean cost was $7153.46 ± $1484.41. The pregnancy rate was 59% (35/59), and tubal patency rate was 81% (42/52). Seventy-two percent of patients under 37 years became pregnant. CONCLUSIONS: There is significant improvement in operative time of robotic-assisted tubal anastomosis with surgical experience. Robotic tubal anastomosis outperformed historical metrics of laparoscopy and laparotomy with regard to operative time and cost in this series.

Oral Rehabilitation with Removable Partial Denture of a Patient with Cleidocranial Dysplasia.

This case report describes the oral rehabilitation of a patient with cleidocranial dysplasia who received a removable partial denture along with silicone-based permanent soft liner to improve esthetic and masticatory function. This patient was the candidate of neither implant nor orthodontic treatment due to medical conditions, history of mandible fracture, age, and risk of fracture after mandibular teeth extractions. Cone-beam computed tomography has made it possible to obtain comprehensive information regarding the morphology and positional relationship of impacted supernumerary teeth. Also, proper collaboration between surgeon and prosthodontist helped to achieve significant improvements in patient's self-esteem, masticatory function, and esthetic.

Comparison of marginal and internal fit of 3-unit zirconia frameworks fabricated with CAD-CAM technology using direct and indirect digital scans.

STATEMENT OF PROBLEM: Accurate marginal and internal fit of dental restorations are essential for their long-term success. The fit of zirconia restorations prepared using digital scan systems has not been fully evaluated. PURPOSE: The purpose of this in vitro study was to compare the marginal and internal fit of 3-unit zirconia frameworks fabricated using direct and indirect digital scans. MATERIAL AND METHODS: In a maxillary model, the left first premolar and first molar were prepared to receive 3-unit zirconia fixed dental prostheses. Conventional impressions were made using stock trays and 2-step putty/wash polyvinyl siloxane material and were scanned using laboratory scanner (Conventional Impression-Laboratory scanner [CIL] group). The impressions were then poured, and the stone casts were scanned (Dental Cast-Laboratory scanner [DCL] group). Digital scans were made using TRIOS (TRIOS Intraoral scanner [TRI] group) and CS3600 (CS3600 Intraoral scanner [CSI] group) scanners (n=10). Zirconia copings were designed and milled from presintered blocks and subsequently sintered. Marginal, mid-axial, axio-occlusal, and mid-occlusal discrepancies were measured using the silicone replica technique with stereomicroscopy at ×50 magnification. The data were analyzed using 1-way ANOVA (α=.01). RESULTS: The ANOVA revealed significant differences among the studied groups in terms of all studied characteristics (P≤.01). Marginal gap was significantly higher in the DCL group (106 ±45 µm) compared with all other groups (P≤.01). However, no significant differences were observed in marginal gap between the TRI (60 ±15 µm) and CSI (55 ±13 µm) groups (P>.01). Internal gap in the mid-occlusal and axio-occlusal regions were significantly higher in the CIL (238 ±92 µm and 227 ±95 µm) and DCL (248 ±71 µm and 216 ±68 µm) groups than those recorded in the TRI (104 ±27 µm and 126 ±31 µm) and CSI (128 ±16 µm and 147 ±28 µm) groups (P≤.01). Internal discrepancies in the mid-axial position were similar between the TRI (70 ±15 µm) and CSI (72 ±23 µm) groups (P>.01), but these values were significantly lower than those recorded in the CIL (88 ±31 µm) and DCL (85 ±30 µm) groups (P≤.01). CONCLUSIONS: Within the limitations of this study, zirconia frameworks in the TRI and CSI groups had lower marginal and internal gaps compared with those in the DCL and CIL groups. Marginal gap in all groups was within a clinically acceptable range.

Manual morcellation compared to power morcellation during robotic myomectomy.

Clinical practice has drastically changed following the 2014 U.S. Food and Drug Administration (FDA) warning statement regarding power morcellation during laparoscopic hysterectomy and myomectomy. Despite investigation into alternative tissue extraction techniques, there remain a paucity of data associated with contained manual morcellation techniques. The goal of this study was to investigate the associated perioperative outcomes of contained manual morcellation compared to power morcellation in women undergoing robotic myomectomy. Performing manual morcellation (n = 38) resulted in a 21-min decrease in mean operative time (105.4 ± 42.2 vs 126.1 ± 44.1 min, p = 0.02) compared to power morcellation (n = 62). Women were younger (33 vs 36 years, p = 0.03) in the manual morcellation group, with all other patient demographics being similar. Median specimen weight (82 vs 104 g, p = 0.13), number of fibroids removed (2 vs 1, p = 0.16), estimated blood loss (10 vs 50 mL, p = 0.25), and post-operative morphine equivalents administered (5.57 ± 4.57 vs 5.29 ± 4.39, p = 0.76) were similar. The same-day discharge rate was not significantly different between the groups (86 vs 90%, p = 0.74). Linear regression modeling identified specimen weight, number of fibroids removed, and use of power morcellation as significant contributors to surgical time. Contained manual morcellation during robotic myomectomy is associated with a significant decrease in surgical time when compared to power morcellation, with similar post-operative narcotic administration and length of stay.

RNA-Seq analysis revealed genes associated with drought stress response in kabuli chickpea (Cicer arietinum L.).

Drought is the most important constraint that effects chickpea production globally. RNA-Seq has great potential to dissect the molecular mechanisms of tolerance to environmental stresses. Transcriptome profiles in roots and shoots of two contrasting Iranian kabuli chickpea genotypes (Bivanij and Hashem) were investigated under water-limited conditions at early flowering stage using RNA-Seq approach. A total of 4,572 differentially expressed genes (DEGs) were identified. Of these, 261 and 169 drought stress responsive genes were identified in the shoots and the roots, respectively, and 17 genes were common in the shoots and the roots. Gene Ontology (GO) analysis revealed several sub-categories related to the stress, including response to stress, defense response and response to stimulus in the tolerant genotype Bivanij as compared to the sensitive genotype Hashem under drought stress. In addition, several Transcription factors (TFs) were identified in major metabolic pathways such as, ABA, proline and flavonoid biosynthesis. Furthermore, a number of the DEGs were observed in "QTL-hotspot" regions which were reported earlier in chickpea. Drought tolerance dissection in the genotypes revealed that the genes and the pathways involved in shoots of Bivanij were the most important factor to make a difference between the genotypes for drought tolerance. The identified TFs in the experiment, particularly those which were up-regulated in shoots of Bivanij during drought stress, were potential candidates for enhancing tolerance to drought.

Bilateral obturator neuropathy after transobturator vaginal sling: a case report.

Transobturator tape procedure is a popular and effective minimally invasive technique to treat stress urinary incontinence. We report a case of transient obturator neuropathy caused by transobturator tape placement for stress urinary incontinence. Findings on physical examination were significant for bilateral obturator neuropathy resulting in significant motor deficit, prompting removal of the sling to avoid the potential of prolonged or permanent morbidity. There was immediate complete resolution of neuropathy with the return of motor function after surgical removal of the sling.

Synthesis of cyclopentadiene-fused chromanones via one-pot multicomponent reactions.

We have developed one-pot method for the synthesis of functionalized novel cyclopentadiene-fused chromanone scaffolds. A variety of 4-oxo-2,4-dihydrocyclopenta[c]chromene-1,2-dicarboxylates were obtained in moderate to good yields via condensation of 2-hydroxybenzaldehydes and ethyl acetoacetate with 1:1 acetylenecarboxylate-isocyanides in toluene. These reactions presumably proceed via reaction of the in situ generated 3-acetyl-2H-chromen-2-ones with acetylenecarboxylate-isocyanide zwitterionic intermediates through Michael addition/intramolecular cyclization and double [1,5] acyl shift rearrangement cascade.

Trendelenburg position in gynecologic robotic-assisted surgery.

OBJECTIVE: To estimate the necessity of routine patient positioning in steep Trendelenburg in robotic-assisted gynecologic surgery performed for benign indications. DESIGN: Descriptive study (Canadian Task Force classification II-2). SETTING: University-affiliated community hospital. PATIENTS: Twenty women undergoing robotic-assisted gynecologic surgery for benign indications. INTERVENTION: Robotic-assisted total hysterectomy, supracervical hysterectomy, myomectomy, and sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS: Demographic data and perioperative variables were recorded including age, body mass index, procedure type, console time, perioperative complications, estimated blood loss, hospital length of stay, and degree of Trendelenburg position. The degree of Trendelenburg position was measured at the end of each procedure using an electronic level. The surgeons were blinded to the degree of Trendelenburg used. All procedures were performed successfully without conversion to laparotomy. All patients were discharged to home within 24 hours. No perioperative complications were noted. The mean (SD; 95% CI) Trendelenburg position used in this cohort was 16.4 (4.1; 14.4-18.3) degrees. Patient body mass index was 28.5 (5.3; 26.1-31.1). Median console time was 87.5 (27-112) minutes. CONCLUSION: Robotic-assisted benign gynecologic surgery can be effectively performed without use of the steep Trendelenburg position. The practice of routine adherence to steep Trendelenburg positioning in benign gynecologic robotic surgery should be questioned.

Prolapsed epiploica of the sigmoid colon after total laparoscopic hysterectomy.

Prolapsed epiploica of the sigmoid colon through the vaginal cuff is a rare finding that has never been reported after total laparoscopic hysterectomy. We encountered a case of prolapsed epiploica of the sigmoid colon in a 40-year-old female, 4 months status after total laparoscopic hysterectomy. Diagnostic laparoscopy demonstrated prolapsed epiploica of the sigmoid colon through a dehisced vaginal cuff.

Laparoscopic hysteropexy in a patient with spina bifida and ventriculoperitoneal shunt.

Laparoscopic repair of pelvic organ prolapse in patients with ventriculoperitoneal shunts has not been previously described. The optimum management of patients with ventriculoperitoneal shunts undergoing laparoscopy is uncertain. We describe the case of a 21-year-old female patient with spina bifida and ventriculoperitoneal shunt who underwent laparoscopic hysteropexy for severe pelvic organ prolapse. The implications of performing laparoscopy on patients with ventriculoperitoneal shunts are reviewed along with strategies to reduce potential intraoperative complications.

Laparoscopic-assisted vaginal hysterectomy vs laparoscopic supracervical hysterectomy for treatment of nonprolapsed uterus.

STUDY OBJECTIVE: To compare perioperative outcomes between laparoscopic-assisted vaginal hysterectomy (LAVH) and laparoscopic supracervical hysterectomy (LSH) for the nonprolapsed uterus. DESIGN: Retrospective chart analysis (Canadian Task Force classification II-2). SETTING: Three university-affiliated community hospitals. PATIENTS: Women undergoing LAVH or LSH because of benign indications without concomitant pelvic organ prolapse. INTERVENTION: Laparoscopic hysterectomy with or without adnexectomy. MEASUREMENTS AND MAIN RESULTS: Data from 265 LAVH procedures and 181 LSH procedures performed at 3 university-affiliated community hospitals were included in the analysis from January 2001 to December 2007. The cases were successive. Exclusion criteria included surgery performed to treat malignancy or pelvic organ prolapse, and procedures that were converted to laparotomy. Two hundred forty-eight LAVH procedures and 173 LSH procedures were completed successfully. There was no significant difference in mean (SD) operating time between the 2 groups (145.1 [45.6] minutes for LAVH vs 143 [51.7] minutes for LSH; p = .66). Hospital stay was significantly shorter in the LSH group (1.6 [0.6] days vs 1.2 [0.5] days; p = .001). Patients in the LAVH group had significantly larger uterine weight (147.7 [84.8] g vs 121.5 [105.5] g; p = .005). Postoperative hemoglobin change and febrile morbidity were similar between the groups, as were overall perioperative complications (19% vs 15%, respectively; p = .36) and conversion rate to laparotomy (6.9% vs 4.6%; p = .27). CONCLUSION: Compared with LAVH, LSH offers the benefits of a shorter hospital stay when performed in patients without uterine prolapse. Other perioperative outcomes studied were not significantly different between groups.

The twenty-first century role of Piver-Rutledge type III radical hysterectomy and FIGO stage IA, IB1, and IB2 cervical cancer in the era of robotic surgery: a personal perspective.

Type III radical hysterectomy reported in 1974 by Piver, Rutledge, and Smith is considered worldwide by many as the standard surgical therapy for invasive cervical carcinoma stage IB and IIA. With the increasing number of robotic surgeries being performed for early stage cervical cancer worldwide, the purpose of the paper is to present our personal perspective of the 21st century role of Piver-Rutledge type III radical hysterectomy for stage IB cervical cancer in the era of robotic surgery using the da Vinci robot.

Use of a bidirectional barbed suture in robot-assisted sacrocolpopexy.

Abdominal sacrocolpopexy is an effective and durable surgical procedure that is conventionally reserved for management of vaginal vault prolapse. With the availability of robotic technology in recent years, sacrocolpopexy has become more commonly performed in a minimally invasive fashion. Peritoneal closure can be a tedious and time-consuming step in robot-assisted sacrocolpopexy. We describe a novel technique utilizing a bidirectional barbed suture to re-approximate the peritoneum in robot-assisted sacrocolpopexy, making the procedure more time-efficient.

Intramyometrial injection of vasopressin in laparoscopic supracervical hysterectomy.

STUDY OBJECTIVE: To investigate the effectiveness of vasopressin in reducing blood loss in laparoscopic supracervical hysterectomy (LSH). DESIGN: Retrospective chart analysis (Canadian Task Force classification II-2). SETTING: University-affiliated teaching hospital. PATIENTS: In all, 143 women who had LSH for benign gynecologic disease. INTERVENTIONS: Laparoscopic supracervical hysterectomy. MEASUREMENTS AND MAIN RESULTS: From January 2001 through December 2006, 143 patients were identified who had consecutive, successful LSH performed by different gynecologic laparoscopists. There were no exclusion criteria. The patients were divided into 2 groups based on whether intramyometrial vasopressin injection was used intraoperatively to reduce blood loss; 77 (54%) patients received intramyometrial vasopressin injection and 66 (46%) did not. The 2 groups were compared with regard to blood loss, operating time, uterine weight, hospital stay, concomitant salpingo-oophorectomy, perioperative complications, and patient characteristics including age, gravity, parity, body mass index, surgical history, and number of cesarean deliveries. No difference existed in the first postoperative day decrease in hemoglobin between the vasopressin and control group (2.3 +/- 0.9 vs 2.1 +/- 1.2 g/dL, respectively, p = .56). No significant difference existed between the groups with respect to operating time (146.9 +/- 52.6 vs 131.9 +/- 42.8 min, p = .07) or uterine weight (145.4 +/- 121.8 vs 119.5 +/- 66.9 g, p = .14). All other parameters and patient characteristics were similar between the 2 groups except for the duration of hospital stay. Patients who received intramyometrial vasopressin injection experienced a slightly longer duration of hospital stay (1.4 +/- 0.7 vs 1.1 +/- 0.4 days, p = .02). CONCLUSION: Our study does not support the routine use of intramyometrial vasopressin injection during LSH to reduce blood loss.

Assessing the learning curve for laparoscopic supracervical hysterectomy.

OBJECTIVE: We assessed the learning curve for laparoscopic supracervical hysterectomy. METHODS: This was a prospective cohort study. We analyzed the first 60 consecutive laparoscopic supracervical hysterectomy procedures performed by a team of 2 gynecological laparoscopic surgeons between May 2001 and July 2006 to examine whether a learning curve exists as defined by a decrease in operating time and complications as the sequence increased. Based on previous reports, we defined the first 30 laparoscopic supracervical hysterectomies as "early" cases and the subsequent cases as "late" cases. RESULTS: The mean operating time for laparoscopic supracervical hysterectomy was significantly reduced from 166 minutes to 142.3 minutes (P < or = 0.05) between the early and the late cases. The mean first postoperative day drop in hemoglobin between the early and the late cases was from 2.4 gm/dL to 2.0 gm/dL (P = 0.08). Two complications occurred in the series: one delayed bowel injury in the early cases and one conversion to laparotomy due to a cystotomy in the late cases. No difference existed between the early and the late patients regarding age, parity, body mass index, uterine weight, previous abdominal surgery, or hospital stay. There was an overall linear correlation between the operating time and uterine weight (R = 0.384). CONCLUSION: There is a learning curve for laparoscopic supracervical hysterectomy. After gaining experience in performing 30 cases, the operating time is significantly reduced. The operation can be performed safely during the learning period.