Sentinel node biopsy versus elective neck dissection in early-stage oral cancer: a systematic review.

PURPOSE: To provide a summary of the evidence on the comparative effectiveness of two surgical treatment strategies, sentinel node biopsy (SNB) and elective neck dissection (END), in patients with T1-T2 oral cancer and clinically negative (cN0) neck, in terms of overall survival (OS), disease-free survival (DFS) and neck recurrence rates (NRRs). METHODS: A systematic review was performed by including studies published up to April 2019. Meta-analysis was performed to compare NRRs between SNB and END. A narrative summary of the results was generated for OS, DFS and morbidity outcomes. The certainty of evidence was assessed according to the GRADE methodology. RESULTS: No randomized studies were retrieved. Five observational studies were included in the comparative effectiveness analysis and four observational studies were included in the comparative morbidity analysis. The pooled risk ratio showed no differences in NRRs between SNB and END (10.5% vs 11.6%; pooled RR 1.09; 95% CI 0.67-1.76). No differences in OS or DFS between the two treatments were found. SNB appears to be associated with a lower rate of postoperative complications and lower shoulder dysfunction than END. Conversely, the results of the quality of life (QoL) questionnaires are not sufficient to advocate a particular strategy. CONCLUSION: Our review highlights the lack of well conducted and randomized studies comparing SNB to END, leading to poor clinical evidence. Although our findings suggest no significant differences in OS, DFS and NRR between the two strategies, the certainty of our evidence is too low to make it useful for clinical decision making.

Medium sized lactones with hypolipidaemic and antioxidant activity: synthesis and biological evaluation of promising dual-action anti-atherosclerosis drugs.

Macrocyclic lactones 1a-b have been synthesized and their potential therapeutic value evaluated. The key structural feature of these active 'chimera' compounds is the 12-membered lactone ring that brings together the well-known polysubstituted hydroquinone moiety of antioxidants and the alpha,alpha-dimethyl substituted acyl residue of gemfibrozil. Lactones 1a-b showed better activity than probucol, a classical phenolic antioxidant, in preventing the Cu++-induced oxidative modification of human LDL. The hypolipidaemic activity of the new lactones, evaluated as the inhibition of lipids biosynthesis in Hep-G2 cells, was comparable to that of gemfibrozil. These features, added to the lack of cytotoxicity, make this new class of medium sized lactones promising dual-action drugs useful as anti-atherosclerosis agents.

Effect of marrow processing on hematopoietic cell recovery in bone marrow harvests: focus on filtration.

Bone marrow processing requires a first step of filtration to remove small clots, bone fragments, fat cells and fibrin followed by centrifugation to separate mononuclear cells (MNC). These procedures cause a significant loss of cells potentially including hematopoietic stem cells (HSC). We therefore analyzed the cell recovery and phenotype of various fractions (whole marrow; filtered marrow; MNC collected after centrifugation; bone marrow fragments trapped by filtration) of bone marrow harvests (BMH) from patients with different hematological malignancies undergoing autologous bone marrow transplantation. Analysis of 25 BMH showed that the mean percentage of WBC and MNC recovered after filtration was respectively 92.28 +/- 7.42% and 92.3 +/- 9.05% of the original BMH while after centrifugation the percentage was 20.23 +/- 6.47% and 75.7 +/- 12.81%. The percentage of cells present in the tissue fragments trapped in the filters obtained from five BMH was only 3.93 +/- 1.25% (WBC) and 5.65 +/- 2.2% (MNC) of those originally present in the harvest. Phenotypic analysis performed on the same samples showed that there is no selective loss of MNC or CD34+ cells in the filtration process. Our data indicate that processing of BMH, in particular filtration of tissue fragments, does not affect the recovery of HSC.

Enkephalin binding systems in human plasma. III: Comparative protection of different peptides.

We have investigated the hydrolysis and protection from hydrolysis of several peptides by plasma enzymes and by the plasma components previously described as inhibitors of enkephalins' hydrolysis. The results shown indicate that all the peptides actually hydrolyzed are also partially protected from hydrolysis by the enkephalin-protecting substances. Protection is fairly uniform for all the peptides tested, but considerably higher in the case of leu- and met-enkephalin, suggesting a partial specificity of the protecting substances towards opioid peptides.

Mechanisms protecting plasma peptides from enzyme hydrolysis: a comparative study.

1. The role of the enkephalin-protecting plasma substances in the protection of non-opioid peptides from enzyme hydrolysis has been studied in laboratory animals and in man. 2. The results obtained indicate that all the peptides hydrolyzed by the plasma enzymes are also protected from the hydrolysis by the enkephalin-protecting substances. 3. The protection is fairly uniform in all the species and for all the peptides examined. However, in the human species the protection of leucine enkephalin is considerably higher than the average. These results are discussed in terms of a possible differential inhibition of the different plasma aminopeptidases.

In vitro interaction of opioid peptides with phospholipids. III. The role of lipid.

The binding of tritiated Leu-enkephalin to phosphatidylserine and phosphatidylcholine vesicles, both unmodified and modified by the incorporation of free fatty acid, has been studied by steric exclusion chromatography, ultraviolet difference spectroscopy and fluorescence anisotropy. The results obtained tend to confirm that both ionic and hydrophobic interactions are important in the binding phenomena. On the other hand, it seems likely that steric factors play a very limited role in the recognition of the phospholipid by the opioid peptide. Finally, these results confirm the existence of three complexes of different size, as already demonstrated. But, unlike the previously presented results, they stress the importance of the larger of the three complexes formed through binding.

Effect of different parameters on the binding of two anti-inflammatory drugs to human serum albumin.

The binding to human serum albumin of two anti-inflammatory drugs, indomethacin and indoprofen, has been studied by chromatographic and spectroscopic techniques. The results shown indicate that the binding of both drugs--but more notably of indoprofen--is very sensitive to variations of the environmental conditions. The binding is also dependent upon limited modifications in the tertiary structure of the protein. The evidences shown tend to indicate that these two phenomena are related, and that the binding is permitted under conditions of a relatively open structure of the protein molecule.

Control mechanisms of peripheral enkephalin hydrolysis in mammalian plasma.

The protection of the adrenal-released enkephalins from enzyme hydrolysis by endogenous plasma components was studied in laboratory animals and in man. The results indicate that mechanisms active in protecting leu-enkephalin from hydrolysis are present in the plasma of all species examined. The protection seems to be due to two groups of substances, possibly of peptidic nature. The amount of protection given by these substances seems to be sufficient to play a significant role in controlling the physiological levels of leu-enkephalin released into the bloodstream.

Peripheral enkephalin hydrolysis in different animal species: a comparative study.

Using column and thin layer chromatography, plasma hydrolysis of leu-enkephalin has been studied in man and several laboratory animals. The hydrolysis kinetics determined in the various species examined are considerably different. In addition, also the enzyme forms evidentiated, their molecular weight distribution and relative ratios have been found to vary greatly in the animals under test. Our data suggest that the widely different hydrolysis kinetics reported by various authors are attributable to the differences between species, rather than to differences in the analytical techniques employed.