Novel Dual Bicolumnar Fibula Graft Reconstruction of Distal Humerus in Pediatric Patients After Massive Bone Resection: A Report of Two Cases.

CASE: We describe 2 case studies, involving a 10-year-old girl with an aneurysmal bone cyst and a 12-year-old adolescent boy with Ewing sarcoma. The patient with Ewing sarcoma was previously managed with wide surgical excision and fibular graft reconstruction and subsequently experienced significant graft resorption, hardware failure, and fracture 24 months after operation. A revision limb salvage attempt was undertaken. In both cases, fibular strut grafts were harvested and fixed with intramedullary k-wires to recreate the medial and lateral columns of the distal humeral triangle. CONCLUSION: The technique achieved complete osseous integration, structural support, and functional restoration of the elbow in both cases, with good functional outcomes.

Removal Efficiency and Effectiveness of Four Different Fiber Posts Using Five Different Drill Systems in Multirooted Teeth.

AIM: In comparing the effectiveness and efficiency of different types of post removal systems in removing different types of fiber posts (FPs), this study aims to shed light on the success of removal by currently available drill systems. MATERIALS AND METHODS: A total of 200 maxillary first molars, were root canal treated and prepared to receive posts. The molars were divided into four groups corresponding to four different FPs: Group RX, Radix FP; Group RF, Reforpost Glass Fiber; Group HI; Hi-Rem Endodontic Post; and Group DT, D.T. Light-Post Illusion X-RO. Fiber posts were done with luting by Gradia Core (GC America, Inc.). Groups were again divided into five subgroups corresponding to the technique by which the FP was removed into as follows: Subgroup P, PD-25-1.1 Drill; subgroup G, GC FP Drill; subgroup E, EasyPost Precision Drill; subgroup R, Reaccess Carbide Double Taper Kit; and subgroup H; H-Endodontic Drill. After posts were removed, effectiveness and efficiency were documented. Data were tabulated and statistically analyzed. RESULTS: Strong significant differences regarding efficiency among groups (FP type) and subgroups (drills used) (p = 0.00) were shown by the one-way analysis of variance (ANOVA) test. Subgroup DT-G scored the longest mean removal time (20.9 minutes) while Subgroup RX-R scored the shortest mean removal time (1.4 minutes) Regarding effectiveness, strong significant differences among groups (p = 0.00) and subgroups (p = 0.00) were shown by one-way ANOVA. Subgroup RF-G scored the highest scale (5.2) whereas subgroup HI-R scored the lowest mean scale (1.2). CONCLUSION: The difference was strongly significant between tested post-removal kits and between tested FPs. Re-access Carbide Double Taper Kit performed superiorly in both effectiveness and efficiency, followed by PD-25-1.1 Drill. Hi-Rem post showed the best retrieving results among other FPs. CLINICAL SIGNIFICANCE: Knowing the best technique and tools for post removal could spare the practitioner any unwanted complications during post removal. How to cite this article: Sayed M, Alahmad AM, Alhajji KS, et al. Removal Efficiency and Effectiveness of Four Different Fiber Posts Using Five Different Drill Systems in Multirooted Teeth. J Contemp Dent Pract 2024;25(1):72-78.

Using Denosumab as a Nonsurgical Management of Aneurysmal Bone Cysts in the Pelvis.

Background: Aneurysmal bone cysts (ABCs) are infrequent, benign, and locally destructive lesions that most commonly occur during the first two decades of life. They usually affect the metaphysis of the long bones, but the pelvis is involved in 8%-12% of the cases. The management of pelvic ABCs is a challenging issue due to difficulties in choosing the appropriate approach, adjacent neurovascular bundles, the risk of intraoperative bleeding with difficulty achieving good hemostasis, and the risk of injury to the hip or sacroiliac joints. Limited data exist concerning the use of denosumab as a non-surgical treatment for pelvic ABCs. Our hypothesis was that denosumab might be an effective and safe solo treatment of cases with ABCs in the pelvis. Methods: We retrospectively assessed 20 patients with ABCs in the pelvis, who were treated by denosumab as a solo agent without surgery. Patients were assessed regarding disease control, the incidence of recurrence and non-oncological complications, and functional outcome. Results: The mean follow-up period was 38.5 months. Disease control was achieved in 16 patients (80%), with no local recurrence. Tolerable drug-related complications occurred in 15% of cases. The mean Musculoskeletal Tumor Society score was 92.3%. Conclusions: Denosumab may provide a reliable option in the nonsurgical treatment of ABCs of pelvic origin with expected lower morbidity than the surgical solution and tolerable complications. Further studies on the safety profile and long-term effects of denosumab especially in skeletally immature patients are required.

Long-term follow up of patients with low-grade chondrosarcoma in the appendicular skeleton treated by extended curettage and liquid nitrogen.

BACKGROUND: Chondrosarcoma is the second most common sarcoma of bone, accounting for about 25% of primary bone tumors. Histological grading is the single most important determinant of local recurrence and metastases, where low-grade chondrosarcoma (grade 1: atypical cartilaginous lesion) is associated with 10 years survival rate 79-100%. There has been always a debate about the need for wide resection in managing low-grade chondrosarcoma, where several reports describe successful management with intra-lesional curettage and adjuvant therapy, minimizing the need for complex reconstructive procedures and improving the expected outcomes. HYPOTHESIS: Grade 1 chondrosarcoma of the appendicular skeleton can be successfully treated through extended curettage and liquid nitrogen with favorable oncological and functional outcomes. PATIENTS AND METHODS: We retrospectively assessed 113 patients with low grade chondrosarcoma in the appendicular skeleton, who were treated by extended curettage, adjuvant therapy using liquid nitrogen, reconstruction using polymethyl methacrylate and prophylactic fixation. Patients were assessed regarding incidence of recurrence, incidence of non-oncological complications and functional outcome. RESULTS: The mean follow up period was 110 months. In three patients (2.7%), local recurrence occurred. Five point three percent of the patients got non-oncological complications that were successfully managed. The mean MSTS score was 95%, with no evidence of distant metastases or disease related mortality. CONCLUSION: Grade 1 chondrosarcoma in the appendicular skeleton can be effectively treated using extended curettage, liquid nitrogen as adjuvant and cement as filler. Prophylactic fixation is required to avoid pathological fractures. When done properly, excellent functional outcome is expected. LEVEL OF EVIDENCE: IV, Case series (retrospective comparative study).

Assessment of fibular regeneration after graft harvesting in patients with benign bone tumors: A retrospective study comparing different age groups.

INTRODUCTION: Using non-vascularized fibula as autogenous graft has gained much success in reconstruction after tumor resection owing to its simplicity. Donor-site morbidity related to fibula deficiency includes valgus ankle, chronic pain and stress fractures of the ipsilateral tibia. HYPOTHESIS: Growth potential before skeletal maturity is the most important factor promoting fibular regeneration after non- vascularized harvesting, and its decline with skeletal maturity causes failure of fibular regeneration. PATIENTS AND METHODS: This is a retrospective study of the patients with benign bone tumors who required bone defect reconstruction by non-vascularized fibular graft utilizing a periosteal preserving technique. The study entailed 118 patients below the age of 12, 100 age 12-18, and 80 above the age of 18. RESULTS: In children below 12, regeneration was complete in 95%, incomplete in 4.2% and partial in 0.8% of the cases. In adolescents, regeneration was complete in 72%, incomplete in 15% and partial in 13% of the cases. After skeletal maturity, no regeneration occurred in 92.5%of the patients, while partial regeneration occurred in 7.5% of the cases. Valgus ankle occurred in 2.8% of the cases before skeletal maturity, and none in older patients. DISCUSSION: Complete regeneration after non-vascularized fibula graft harvesting is the rule in pediatric patients and to a lesser extent in adolescent group. This is usually associated by near normal regaining of the regenerate strength and function. Non-regeneration dominates in older age group. The length of the harvested segment has no impact on the regeneration or the remodeling process. LEVEL OF EVIDENCE: IV; case series, retrospective comparative study.

Influence of dietary supplementation of clove and rosemary essential oils or their combination on growth performance, immunity status, and blood antioxidant of growing rabbits.

This study aimed to assess the dietary effects of rosemary and clove essential oils separately and in combination on the growth performance; immunological, hematological, and physiological responses; and antioxidant status of growing rabbits. One hundred forty-four of 42-day-old growing V-line rabbits (both sexes with initial live body weights of 765 ± 6 g) were randomly allocated into four treatment groups of 36 rabbits each. Each group was further sub-divided into 12 replicates of 3 rabbits in a completely randomized design. The 1st group was fed a basal diet free of additives and served as the control group, the 2nd and 3rd groups were fed basal diets supplemented with rosemary and clove essential oils, respectively, at doses of 400 mg/kg diet. The 4th group received a basal diet supplemented with a combination of clove and rosemary essential oils at doses of 200 mg/kg diet each. The results showed that the different supplementations did not influence rabbit performance or immunological traits. Opposite to performance or immunological traits, differences in red blood cells and hemoglobin value among all dietary treatments were improved (P < 0.05). Dietary essential oil supplementation with clove, rosemary oil, or a mixed of both increased (P < 0.05) blood concentrations of catalase, superoxide dismutase, and glutathione peroxidase by 47, 42, and 7%; 56, 35, and 36%; and 40, 39, and 37%, respectively, in supplemented rabbits versus control rabbits. In conclusion, clove and/or rosemary essential oils can potentially be used in rabbit diets to improve antioxidant status without change in rabbit's growth performance or immunological parameters.

Association Between Acute Inflammatory Cells and Mutation in ICAM-1 Gene With Injury Severity and Outcome Among Traumatic Cerebral Hemorrhagic Contusion.

BACKGROUND: Acute inflammation in the brain after trauma is mediated by acute inflammatory cells (neutrophils) that contributes to ischemic brain damage, neurological deterioration, and poor outcome. Migration of neutrophils to brain is mediated by intercellular adhesion molecule-1 (ICAM-1). The aim was to determine an association between neutrophils counts, ICAM-1 level and mutation in ICAM-1 gene with injury severity and patient's outcome. METHODS: Cross-sectional study was conducted for ninety Sudanese patients presented with traumatic cerebral hemorrhagic contusion to the National Center for Neurological Sciences, Khartoum, Sudan from December 2015 to January 2018. Non-Sudanese patients, and hemorrhagic contusion associated with other type of brain bleeding were excluded in this study. Moreover, 90 apparently healthy individuals were participated as control. RESULTS: Most patients were males (93.3%), their ages ranged from 25 to 44 years, 11.1% of the patients had severe brain injury, 22.2% had brain edema and the mortality rate was 8.9%. Circulatory levels of leukocytes, neutrophil and ICAM-1 among patients who sustained trauma were significantly elevated compared with controls (p = 0.000). The high level of leukocytes and neutrophils counts were significantly associated with ICAM-1pg/mL circulatory level. High levels of leukocytes, neutrophils, and ICAM-1 were documented in severe brain injuries, whereas. high level of ICAM-1 was observed among patients admitted with brain edema. Leukocytes and neutrophils counts were significantly associated with patient outcome. High level of ICAM-1 (304.88 pg/mL) was observed among patients with poor outcome compared to survivals (263.93 pg/mL). The highest circulatory level of ICAM-1 (280.75 pg/mL) was observed among patient having adenine-adenine (AA) mutant homozygous alleles, followed by (272 pg/mL) for guanine-guanine (GG) homozygous alleles, then (245.12 pg/mL) for guanine-adenine (GA) heterozygous alleles. CONCLUSIONS: Mutation in ICAM-1 gene and increased levels of leukocytes, neutrophils and ICAM-1 constitutes important markers for injury severity and patient's outcome.

Recurrence Rate of Chronic Subdural Hematoma after Evacuating It by Two Large Burr Holes, Irrigation, and Subgaleal Low-Pressure Suction Drainage.

BACKGROUND: There are no current standard operative steps for chronic subdural hematoma (CSDH). The aim of this study was to detect the recurrence rate after drainage of a unilateral diffuse CSDH by combining certain operative steps. MATERIALS AND METHODS: This is a descriptive, retrospective cohort study that included 47 consecutive adult patients who underwent evacuation of a unilateral diffuse CSDH by two large burr holes (≥2 cm in diameter) and irrigation of the subdural space by warm saline, followed by placement of a subgaleal Redivac drain under low-pressure suction in our university hospital from August 2012 to August 2016. There were 29 men and 18 women with a mean age of 69.1 years. RESULTS: All the operations were uneventful. All the patients had adequate drainage of their subdural hematomas, and all patients were discharged alert and oriented. No incidence of recurrence within 12 months after surgery. CONCLUSION: This study demonstrated that surgical management of a unilateral diffuse CSDH in adult patients by two large burr holes, irrigation, and a subgaleal Redivac low-pressure suction drainage was effective and associated with no recurrence.

Concurrent Paclitaxel and Radiotherapy for Node Positive Breast Cancer.

BACKGROUND: Concurrent chemo-radiotherapy in breast cancer (BC) may yield better local control with minimal toxicity in node positive patients. The feasibility of paclitaxel with radiotherapy was assessed for tolerability, cosmetic outcome as well as local control. METHODS: A prospective feasibility study on forty-three female breast cancer with stage II-III was conducted after definite surgery (modified radical mastectomy and breast conservative surgery). Adjuvant chemotherapy given was 4 cycles AC (Doxorubicin 60mg/m2+ cyclophosphamide 600mg/m2) followed by 4 cycles of Paclitaxel 60mg/m2 weekly for 12 weeks concurrent with 3D Conformal radiotherapy in a dose of 5Gy/20ttt/4wks to the whole breast and supraclavicular nodal region. Boost of 10Gy/5ttt was given to the tumor bed in conservative cases. Evaluation of lung function was done by carbon monoxide diffusion. Radiotherapy toxicity and breast cosmesis were assessed by the RTOG and Harvard criteria respectively. The cosmesis was assessed and scored at the beginning and end of RT and every 6 months thereafter. This was done by patient (subjective score) and physician (objective score) by comparing it with the contralateral untreated breast. RESULTS: After a median follow up of 36 months, the overall survival and disease-free survival were 95% and 92.5% respectively with no local relapse or radiation pneumonitis. There was no significant change in carbon monoxide diffusion after radiotherapy (p: 0.55). There was 15% delay in radiotherapy mainly due to acute GIII skin toxicity (10%), followed equally by mucositis and wound gap (2.5%). The volume of the irradiated breast was correlated with acute cosmetic effect (p = 0.057) but not on the late skin toxicity (p = 0.56). At the last follow up, the majority of patients declared excellent score in 62.5%, good in 20%, fair in 10% and poor in 7.5%. Subjective patient's satisfaction for the shape, color and size of the treated breast was 93%. CONCLUSION: Concurrent chemo-radiotherapy with weekly paclitaxel minimized the treatment duration with acceptable tolerance, cosmesis and good local control.

Erectile dysfunction in patients with nonalcoholic fatty liver disease.

BACKGROUND AND STUDY AIMS: There is a lack of studies on erectile dysfunction (ED) in patients diagnosed with nonalcoholic fatty liver disease (NAFLD). The present study aimed to estimate the prevalence of ED in patients with NAFLD and to determine the independent predictors of ED in these patients. PATIENTS AND METHODS: We conducted a prospective, hospital-based study of 192 consecutive male patients with NAFLD. All patients underwent clinical evaluation; abdominal ultrasonography; test for viral hepatitis markers; and estimation of liver chemistry panel, complete blood count, prothrombin time, serum lipids panel, serum testosterone, and fasting serum levels of glucose, insulin, and C-peptide. RESULTS: The mean age of the study population was 42.4±7.7years (79.1%≥40years). Of the 192 patients with NAFLD, 88 (45.8%) had ED, 28 (14.6%) had metabolic syndrome, 25 (13%) had type-2 diabetes mellitus (DM), and 131 (68.2%) had insulin resistance (IR). The mean level of serum testosterone was 3.17±2.94ng/mL, while the mean insulin resistance index was 2.9±1.7. Mild ED (38.6%) was the most frequent grade of ED. Age≥40years (odds ratio [OR] 6.4; 95% confidence interval [CI] 1.7-24.1; p- 0.006), IR (OR 5.9; 95% CI 1.7-20.6; p- 0.005), and low serum testosterone (OR 5.1; 95% CI 1.5-17.1; p- 0.009) were the predictors of ED. CONCLUSIONS: ED is a common disorder in male patients with NAFLD; both IR and low serum testosterone contribute to its development. Treatment of IR may carry a dual benefit of improving erectile function and decreasing the grade of hepatic steatosis.

Serum levels of N-terminal-pro B-type natriuretic peptide as a diagnostic marker for left ventricular dysfunction in children with end-stage renal disease on hemodialysis.

The objective of this study was to determine the diagnostic cutoff value of N-terminal-pro B-type natriuretic peptide (NT-pro BNP) as a marker of left ventricular (LV) dysfunction in children with end-stage renal disease (ESRD) on regular hemodialysis (HD). The study was carried out on thirty children with ESRD on regular HD and thirty healthy controls. Echocardiographic studies were done, including a conventional mode for ejection fraction, fractional shortening, tissue Doppler imaging, and longitudinal global strain by speckle tracking. Serum levels of NT-pro BNP were measured in venous blood samples before and about 30 min after HD by ELISA. Volume status was assessed by calculating interdialytic weight gain %. There were significant higher serum NT-pro BNP levels before HD (mean: 702.3 ± 274.3 ng/L) compared to controls (mean: 365.55 ± 76.5 ng/L) (P <0.001) and these levels decreased significantly after the HD session (mean: 625.1 ± 117.69 ng/L) (P = 0.031). Echocardiographic studies showed a significant impairment of LV function of the patients compared to controls. Patients with LV dysfunction had significant higher serum concentrations of NT-pro BNP compared to patients without dysfunction both before (P = 0.003) and after dialysis (P <0.001). Receiver operating curve demonstrated better prediction of LV dysfunction by NT-pro BNP levels after HD compared to its levels before HD (area under the curve was 0.9 and 0.73, respectively). Using a cutoff value of 630 ng/L, serum NT-pro BNP levels after dialysis were a diagnostic predictor of LV dysfunction with a sensitivity of 86.6%, specificity of 93.3%, positive predictive value of 92.8%, and negative predictive value of 87.5%. Serum NT-pro BNP levels were strongly correlated with the parameters of LV dysfunction in children with ESRD on regular HD. A postdialysis cutoff value of 630 ng/L could serve as a biochemical marker of LV dysfunction in those children regardless of chronic fluid overload.

Deep Convolutional Neural Networks for large-scale speech tasks.

Convolutional Neural Networks (CNNs) are an alternative type of neural network that can be used to reduce spectral variations and model spectral correlations which exist in signals. Since speech signals exhibit both of these properties, we hypothesize that CNNs are a more effective model for speech compared to Deep Neural Networks (DNNs). In this paper, we explore applying CNNs to large vocabulary continuous speech recognition (LVCSR) tasks. First, we determine the appropriate architecture to make CNNs effective compared to DNNs for LVCSR tasks. Specifically, we focus on how many convolutional layers are needed, what is an appropriate number of hidden units, what is the best pooling strategy. Second, investigate how to incorporate speaker-adapted features, which cannot directly be modeled by CNNs as they do not obey locality in frequency, into the CNN framework. Third, given the importance of sequence training for speech tasks, we introduce a strategy to use ReLU+dropout during Hessian-free sequence training of CNNs. Experiments on 3 LVCSR tasks indicate that a CNN with the proposed speaker-adapted and ReLU+dropout ideas allow for a 12%-14% relative improvement in WER over a strong DNN system, achieving state-of-the art results in these 3 tasks.

Incidence, etiology, and patterns of maxillofacial fractures in ain-shams university, cairo, egypt: a 4-year retrospective study.

Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our department. A retrospective cross-sectional study of all facial trauma patients admitted to our department during 2009 to 2012. Patients' data including gender, age, etiology of trauma, the pattern and demographic distribution of fractures of maxillofacial skeleton, and associated injuries were analyzed and compared with previously published data. The chi-square test was used with a p value of less than 0.05, which was considered statistically significant. There is a significant increase in maxillofacial fractures incidence in the past 2 years than former ones. There is a male predominance with highest incidence in the age group of 20 to 40 years. Road traffic accident is the most common etiological factor followed by violence. There is increase in mandibular fracture incidence compared with midface. The significant increased incidence of maxillofacial fracture due to motor car accidents and assaults in the past 2 years reflects a behavioral change within the community.

The relation between HLA-DRB1 alleles and the outcome of therapy in children with idiopathic thrombocytopenic purpura.

Idiopathic thrombocytopenic purpura (ITP) is a common hematologic disease. The pathogenesis involves formation of autoantibodies against platelet glycoproteins. The mechanism of autoimmunity might involve binding of antigenic peptides to HLA antigens. In this study, we tried to find out if a specific HLA allele might be associated with the occurrence of ITP, and whether or not this specific allele, if present, is related to the response to treatment. We investigated the frequency of HLA-DRB1 alleles in 30 Egyptian children with documented diagnosis of ITP. All patients were followed up for at least 6 months. Ten healthy children of matched age and sex served as a control group. The alleles were identified using polymerase chain reaction (PCR) sequence specific primers. The median age of the study patients with good response was 3.94 +/- 2.31 years (range 2-10 years, female to male ratio was 2.6:1 and platelet count at presentation was 17.91 +/- 9.1 X 10(9)/L (range 10-36 X10(9)/L). For patients with poor response, female to male ratio was 3.8:1 the median age and platelet count at presentation were 4.85 +/- 2.57 years (range 2-10 years) and 29.36 +/- 24.02 X 109/L (range 10-81 X 109/1L) respectively. The median duration of disease for clinically responding patients was 10.29 +/- 2.75 months (range: 6-15 months) and for non responding patients was 29.84 +/- 16.30 months (range: 6-60 months). It was found that HLA-DRB1 *14 was significantly increased in ITP patients with good response (P<0.001) while HLA-DRB1 *13 was significantly decreased in patients with good response (P=0.002, OR=0.07, CI=0.01-0.69). In conclusion, HLA-DRB1 *07 allele seems to be protective marker against ITP, HLA-DRB1 *14 allele can be used as a predictive marker for therapy in ITP patients with good response and for favourable outcome after splenectomy. Moreover, HLA-DRB1 *13 allele has an important role in resistance to therapy. Our findings indicate that genetic factors might influence the clinical course of ITP.