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Intralabyrinthine schwannoma (ILS) is a tumor originating from the Schwann cells in the inner ear. Various surgical approaches can be used for the resection of ILS. The aim of this report is to describe a case involving a 60-year-old man who was treated successfully with a combined surgical approach. The patient underwent a combined microscopic (transmastoid labyrinthectomy) and endoscopic procedure for surgical excision of ILS involving the vestibule and the lower half of the cochlear basal turn. The combined surgical technique enabled a complete removal of the ILS without removal of the unaffected cochlea as well as the external auditory canal. Besides additional exclusion of the middle ear, blind-sac closure of the external auditory canal and cavity obliteration were avoided. No postoperative complications were observed. A combined microscopic and endoscopic approach to surgery enables removal of the ILS involving the vestibule and the lower half of the cochlear basal turn while helping to reduce surgical radicality. [ABSTRACT FROM AUTHOR]

Recent studies demonstrated that modified thrombolysis in cerebral infarction (TICI) 3 reperfusion have better functional outcomes than modified TICI 2b after mechanical thrombectomy in acute ischemic stroke with large vessel occlusion. The purpose of this study was to determine significant factors to forecast the presence of complete reperfusion after mechanical thrombectomy based on multimodal magnetic resonance imaging (MRI). We investigated 96 consecutive patients with acute large intracranial artery occlusion of anterior circulation who based on multimodal MRI. Also, we compared clinical and radiologic parameters between patients with modified TICI 3 and those with modified TICI 0-2b. Among 96 eligible subjects received mechanical thrombectomy, 39 patients (40.6%) showed complete reperfusion and 57 partial or nonreperfusion (mTICI 2b-26, mTICI 2a-9, mTICI 1-8, and mTICI 0-14) after mechanical thrombectomy. Patients with mTICI 3 had significantly smaller initial Diffusion weighted images (DWI) lesion volume (P < .01) and much shorter time interval from onset to reperfusion (P < .01) than those patients with mTICI (0-2b). In multivariate analysis, smaller initial DWI volume (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.23-2.57; P < .01) and faster reperfusion time (OR, 1.07; 95% CI 1.01-1.14; P = .015) had an independence significance for complete reperfusion after mechanical thrombectomy. In this study, the ischemic lesion volume on DWI and faster processing time are critical factor to predict the state of complete reperfusion after mechanical thrombectomy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the soft tissue changes and skeletal stability of a modification of the Le Fort I osteotomy design – the modified quadrangular Le Fort I osteotomy (MQLI). Patients who had maxillary advancement and mandibular setback surgery for skeletal class III malocclusion with a midface deficiency were included. MQLI patients ( n = 20) were compared to conventional Le Fort I osteotomy patients (LFI) ( n = 20) using cephalometric radiographs taken preoperatively (T0), immediately postoperative (T1), and at >6 months postoperative (T2). Soft tissue radiographic changes of the cheek line and perinasal areas, and skeletal movements were analyzed. The basic skeletal characteristics and amount of maxillary and mandibular surgical change were similar in the two groups (group difference, P > 0.05). There was no significant difference between the two groups in terms of maxillary and mandibular skeletal stability. The cheek profile angle increased significantly after MQLI by 3.5° ( P < 0.05), whereas LFI showed a 2.1° increase ( P > 0.05). Overall, the soft tissue cheek outline moved significantly more anteriorly in MQLI, but the difference to LFI osteotomy did not reach statistical significance. MQLI could be an efficient and stable surgical method to improve maxillary and infraorbital hypoplasia without malar advancement, especially in Asian patients. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to compare the accuracy of maxillary repositioning using the recently introduced computerized virtual model surgery (VMS) with conventional articulator model surgery (AMS). Forty-two patients who had undergone bimaxillary surgery were investigated retrospectively in this study. The patients were divided into two groups: conventional AMS (n =23) and VMS (n =19) for intermediate splint fabrication in maxillary positioning. Planned surgical movements and actual postsurgical changes of the lateral and frontal cephalometric measurements were compared. Although variations from the planned surgical movements were relatively small, both methods had statistically significant errors in some of the linear measurements. Both groups had a similar range of errors. The overall absolute mean discrepancy between the planned and actual surgical movements for the linear measurements was 1.17mm (0–3.6mm) in AMS and 0.95mm (0–3.2mm) in VMS. Of the total measurements, measurements reflecting a surgical discrepancy of more than 2mm or 2° comprised 12.0% of the cases in AMS and 7.9% in VMS. The surgical accuracy of maxillary positioning with VMS was comparable to conventional AMS. Because VMS has the definitive advantage of eliminating the complex laboratory step and shortening the laboratory time, this can be accepted as an alternative to AMS. [Copyright &y& Elsevier]

Abstract: The work evaluates the effect of heating rate in microwave sintering, and the effect of particle size of 316L powders in microwave and conventional sintering processes. The powders of 316L stainless steel were compacted by uniaxial press at 700MPa, and sintered at 1250°C for 1h by means of conventional sintering and microwave sintering. The sintering atmospheres were Ar/H2 95/5% for conventional sintering and Ar/H2 90/10% for microwave sintering. Mechanical properties were evaluated using tensile tests. The samples were characterized by optical microscopy and SEM. The porosity levels were determined using image analysis software. Microwave sintering yields fully recrystallized microstructure different from conventional sintering, however no difference in distribution and shape of pores was noticed. Heating rate in microwave sintering affects densification, tensile strength and elongation. Moreover, the use of fine powders improves physical and mechanical properties of the samples sintered by both methods. [Copyright &y& Elsevier]

Background In this meta-analysis, we evaluated associations between statins and recurrence-free survival (RFS) following treatment of localized prostate cancer, with attention to potential benefits among patients treated primarily with radiotherapy (RT) versus radical prostatectomy. Patients and methods We identified original studies examining the effect of statins on men who received definitive treatment of localized prostate cancer using a systematic search of the PubMed and EMBASE databases through August 2012. Our search yielded 17 eligible studies from 794 references; 13 studies with hazard ratios (HRs) for RFS were included in the formal meta-analysis. Results Overall, statins did not affect RFS (HR 0.90, 95% CI 0.74–1.08). However, in RT patients (six studies), statins were associated with a statistically significant improvement in RFS (HR 0.68; 95% CI 0.49–0.93); this benefit was not observed in radical prostatectomy patients (seven studies). Sensitivity analyses suggested that primary treatment modality may impact the effect of statins on prostate cancer recurrence. Conclusions Our meta-analysis suggests a potentially beneficial effect of statins on prostate cancer patients treated with RT but not among radical prostatectomy patients. Although limited by the lack of randomized data, these results suggest that primary treatment modality should be considered in future studies examining associations between statins and oncologic outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Since superconducting coils cause the current decay due to connection resistance and intrinsic characteristic in the persistent current mode, various current compensations should be required to maintain stable property in the superconducting magnet system. As an achievable solution, we fabricated a new prototype power supply, i.e., linear-type superconducting power supply (LTSPS) and we carried out the operating characteristics of LTSPS in the small scale magnets. In order to apply the LTPSP for real scale magnet, charging characteristics for various magnet scales should be expected. In the paper, based on the experimental results, we design a modeling of charging characteristic of LTSPS using a granular-based radial basis function neural networks (RBFNNs) realized with aid of the granular techniques. In contrast with the plethora of existing approaches, here we consider a development strategy in which a topology of the network is predominantly based upon a collection of information granules formed on a basis of available experimental data. The underlying design tool guiding the development of the granular-based RBFNN is based on two categories of methods such as K-means clustering and the fuzzy C-means (FCM) clustering method. As shown in the experimental studies, the granular-based RBFNN possesses essential properties of universal approximation. The model of charging characteristic of LTSPS constructed is concerned with a limited dataset (where the limitations are associated with high costs of acquiring data) as well as strong nonlinear characteristics of the underlying phenomenon. For modeling and evaluation of the performance of the SPS neural network, in advance we also run experiments for other publicly available data such as a well-known NASA software project data as well as synthetic nonlinear data. [Copyright &y& Elsevier]

Abstract: To realize effective modeling and secure accurate prediction abilities of models for power supply for high-field magnet (PSHFM), we develop a comprehensive design methodology of information granule-oriented radial basis function (RBF) neural networks. The proposed network comes with a collection of radial basis functions, which are structurally as well as parametrically optimized with the aid of information granulation and genetic algorithm. The structure of the information granule-oriented RBF neural networks invokes two types of clustering methods such as K-Means and fuzzy C-Means (FCM). The taxonomy of the resulting information granules relates to the format of the activation functions of the receptive fields used in RBF neural networks. The optimization of the network deals with a number of essential parameters as well as the underlying learning mechanisms (e.g., the width of the Gaussian function, the numbers of nodes in the hidden layer, and a fuzzification coefficient used in the FCM method). During the identification process, we are guided by a weighted objective function (performance index) in which a weight factor is introduced to achieve a sound balance between approximation and generalization capabilities of the resulting model. The proposed model is applied to modeling power supply for high-field magnet where the model is developed in the presence of a limited dataset (where the small size of the data is implied by high costs of acquiring data) as well as strong nonlinear characteristics of the underlying phenomenon. The obtained experimental results show that the proposed network exhibits high accuracy and generalization capabilities. [Copyright &y& Elsevier]

Abstract: This study intended to evaluate the morphological characteristics of the cranial base and maxillomandibular structures of facial asymmetry in adult patients, so as to determine whether mandibular asymmetry is a result of primary mandibular deformity or if it is influenced by cranial base deformity. Forty-two adult patients with dentofacial deformity were placed into two groups according to the deviation of the chin: Asymmetry group (n =24) and Non-asymmetry group (n =18). They were compared with three-dimensional (3D) CT reformatted images using a 3D visualization and analyzing program. The differences between the two groups, the correlation between the cranial base and maxillomandibular asymmetry were evaluated statistically. The degree of cranial base asymmetry in the Asymmetry group was not statistically different from the Non-asymmetry group. The asymmetric condyle position was found to be associated with skull base characteristics. The 3D position of the condyle and cranial base, however, was not closely related with mandibular asymmetry. The results showed that the cranial measurement variables were not the dominant factors that determined the degree of facial asymmetry. It seems that the mandibular skeletal factors itself, functional or intrinsic asymmetric growth potential, compensate or aggravate the influence of cranial asymmetry during the growth period. [Copyright &y& Elsevier]

Abstract: A Le Fort I osteotomy is widely used to correct dentofacial deformity because it is a safe and reliable surgical method. Although rare, various complications have been reported in relation to pterygomaxillary separation. Cranial nerve damage is one of the serious complications that can occur after Le Fort I osteotomy. In this report, a 19-year-old man with unilateral cleft lip and palate underwent surgery to correct maxillary hypoplasia, asymmetry and mandibular prognathism. After the Le Fort I maxillary osteotomy, the patient showed multiple cranial nerve damage; an impairment of outward movement of the eye (abducens nerve), decreased vision (optic nerve), and paraesthesia of the frontal and upper cheek area (ophthalmic and maxillary nerve). The damage to the cranial nerve was related to an unexpected sphenoid bone fracture and subsequent trauma in the cavernous sinus during the pterygomaxillary osteotomy. [Copyright &y& Elsevier]

Many recent studies related to cancer surgery have reported that sarcopenia influences mortality in surgical patients. However, few comprehensive studies have examined the associations between sarcopenia and short- and long-term surgical outcomes of metastatic cancer, especially breast cancer with brain metastasis. In the present study, we investigated the association between sarcopenia and mortality in patients who underwent gamma knife radiosurgery (GKRS) for brain metastasis with breast cancer. This retrospective study analysed 157 patients who underwent GKRS for brain metastasis with breast cancer between January 2014 and December 2018. A Cox regression analysis was carried out to evaluate the association between sarcopenia and mortality at 90 days, 180 days, 1 year, 3 years and the overall period. In the Cox regression analysis, sarcopenia was significantly associated with high 90-day mortality (adjusted hazard ratio 3.46, 95% confidence interval 1.24–9.67, P = 0.018), 180-day mortality (adjusted hazard ratio 2.67, 95% confidence interval 1.37–5.22, P = 0.004), 1-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.42–4.02, P = 0.001), 3-year mortality (adjusted hazard ratio 2.39, 95% confidence interval 1.53–3.74, P < 0.001) and overall mortality (adjusted hazard ratio 2.11, 95% confidence interval 1.37–3.26, P < 0.001). Sarcopenia could be a risk factor for short- and long-term mortality in patients undergoing GKRS for brain metastasis from breast cancer. • There are few studies on the survival rate of sarcopenia and metastatic cancer. • Sarcopenia was significantly associated with short-term (90- and 180-day) mortality. • Sarcopenia was significantly associated with long-term (1- and 3-year) mortality. • Sarcopenia may be a risk factor for survival in brain metastasis from breast cancer. [ABSTRACT FROM AUTHOR]

Abstract: A case is reported of spontaneous bone formation on the maxillary sinus floor associated with the extraction socket of a maxillary impacted tooth. An impacted maxillary second premolar of a 20-year-old male had been pushed into the maxillary sinus during surgical extraction. The tooth was removed using the sinus elevation technique. After 5 months of healing, the space between the sinus floor and the socket was filled with new bone. Later, implant surgery was successfully carried out without any sinus augmentation. Osteogenic activity of sinus mucosa and the blood clot in the extraction socket beneath the elevated sinus would have been important factors in this spontaneous bone formation. [Copyright &y& Elsevier]

Background: To investigate the clinicopathological significance of androgen receptor (AR) expression in primary breast cancers. [ABSTRACT FROM PUBLISHER]

Background: We examined the association between the metabolic syndrome and cancer mortality in Koreans. [ABSTRACT FROM PUBLISHER]

Abstract: Ni/Al laminates with bilayer thicknesses in the micrometer (∼5μm) and nanometer (∼50nm) range were subjected to exothermic reactions induced by laser-driven compression. The initial shockless compression steepened into shock in the microscaled laminates generating a pressure pulse duration of several tens of nanoseconds, which induced strain rates varying from 107 to 108 s−1. The laser energies applied, 650, 875, and 1305J, generated peak compression stresses of 30, 75, and 118GPa, respectively, at the plasma stagnated Al surface. Large differences in flow stresses and bulk compression moduli of Ni and Al introduced shear localization in the Ni/Al interfaces. The nanoscale Ni/Al laminates were fully reacted, producing NiAl with grain sizes less than 500nm. The NiAl intermetallic phases, B2 (β) phase (fcc) and martensitic phase (bcc), coexist in the NiAl nanograins. It was confirmed that the intermetallic reaction in the Ni/Al microlaminate cannot self-sustain for the short duration, laser-driven compressive loading. The intermetallics NiAl (equiaxed grains) and NiAl3 (dendrites) were identified on the plasma stagnated surface of Ni/Al microlaminates. The distribution of intermetallic phases varied according to the incident laser energies. [Copyright &y& Elsevier]

Background: The objective of the study was to evaluate the implications of androgen receptor (AR) in breast cancers.Patients and methods: We investigated immunohistochemical AR expression from the tissue microarrays of 931 patients between 1999 and 2005, and analyzed demographics and outcomes using uni-/multivariate analyses. Tumors with ≥10% nuclear-stained cells were considered positive for AR.Results: AR was expressed in 58.1% of patients. AR was significantly related to older age at diagnosis, smaller size, well-differentiated tumors, higher positivity of hormone receptors, non-triple-negative breast cancers (non-TNBCs), and lower proliferative index. In estrogen receptor (ER)-negative tumors, AR was distinctively associated with human epidermal growth factor receptor type 2 (HER2) overexpression. With a mean follow-up of 72.7 months, AR was positively related to survival in ER-positive but not in ER-negative tumors. In Cox’s models, AR was an independent prognostic factor for disease-free survival in ER-positive cancers. Interestingly, molecular apocrine tumors (ER negative and AR positive) with HER2 positive status showed trends of poorer outcome, but AR had no impact on survival in patients with TNBC.Conclusions: AR is significantly associated with favorable features in breast cancers and related to better outcomes in ER-positive not in ER-negative tumors. These results suggest that AR could be an additional marker for endocrine responsiveness in ER-positive cancers and a candidate for therapeutic targeting of ER-negative tumors. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Medical student education in radiation oncology traditionally takes place in-person during 3rd or 4th year of medical school. Due to the COVID-19 pandemic, onsite clerkships were placed on hold, leading to virtual medical student clerkships in radiation oncology which incorporated didactics and hands-on learning. We sought to implement this virtual medical student clerkship in radiation oncology at multiple institutions and analyze the impact and utility of this platform.Materials/methods: An IRB-approved virtual clerkship was created and implemented at 7 institutions. Students enrolled in home or away rotations. Clerkships offered general and disease subsite-specific oncology topics through recorded didactics geared towards medical students on www.radoncvirtual.com, as well as clinical vignettes, telehealth visits, chart rounds, contouring, and capstone presentations. Surveys were given pre- and post-clerkship to assess baseline comfort and knowledge. At the end of each clerkship, a course exam was given consisting of 48 questions. Clerkship directors were given a survey to assess comfort and ease of implementing the virtual clerkship. Surveys and course exams were analyzed using Wilcoxon Signed rank test and t-test, 2-sided.Results: Seventy-two (72) students enrolled at 7 institutions between 4/2020 and 2/2021. Survey response rates were 100% pre- and post-clerkship as well as from course directors. The majority of students were MS4 (57%) and MS3 (33%) with equal distribution in gender. Each institution's median number of total medical students doing an away rotation was 4 (range 3-9) and home rotation number of students 2 (range 0-36). The median length of each virtual rotation was 2.5 weeks (range: 1-4 week). 71% (n = 51) of medical students had never previously enrolled in a radiation oncology elective. Improvements in the overall knowledge of radiation oncology, as well as specific knowledge in the scope of radiation oncology, roles of radiation physicist, dosimetrist and therapist, contouring, treatment planning, and training path to the field (all P < 0.001). There was no significant difference in course final exam scores between students who had attended a radiation oncology elective before enrollment and those who had not (P = 0.27). Course directors reported spending an additional 5-10 hours per week with students. The survey revealed 100% were satisfied with content and delivery of this virtual elective, and 83% (n = 6) indicated they would utilize the material for future rotations.Conclusion: Implementation of a multi-institutional virtual radiation oncology elective was successful at improving knowledge for medical students at all levels, even those that had exposure previously. This virtual elective platform can be utilized to improve access to multiple institutions, resources, mentors, and networking opportunities. Resources in the virtual rotation platform can also be integrated into traditional educational paradigms to increase exposure in the field. [ABSTRACT FROM AUTHOR]

Background Recent advances in next generation sequencing technology helped us to test multiple germline genetic mutations simultaneously. However, because of the low frequency of pathogenic/ likely pathogenic variants beyond BRCA1/2, modest risk of cancer in the carriers of moderate penetrance genes, and lack of proper preventive strategies for the carriers, clinical application of NGS multiple panel tests still has limitations. Methods In this study, we provided sequential genetic testing and counselling programs for BRCA1/2 mutation tests and multigene panels beyond BRCA, and investigated cancer worry, genetic knowledge, and attitude towards gene panels among the patients. Results As of 28 February 2019, we prospectively enrolled 149 Korean BRCA1/2 mutation-negative female breast cancer patients with high risk for hereditary breast cancer. Median age of the patients was 42.9 (range, 21.9∼74.5) years. Among the patients, we identified 15 cases with pathogenic/ likely pathogenic variants. After genetic counselling about multigene panel, patients showed slightly decreased concern about the possibility of cancer in the future (average score of pre-, 4.32±0.808 to post-, 4.07±1.017; P = 0.003) and lower influence on mood (average score of pre-, 3.31±0.669 to post-, 3.19±0.684; P = 0.005). However, there were no changes in the average score of genetic knowledge (pre-, 0.68±0.212 to post-, 0.69±0.214; P = 0.465), and the impact of cancer worries on daily activities (pre-, 3.06±0.810 to post-, 2.97±0.699; P = 0.074). In the survey on multigene panel, 143 (96.0%) patients reported that genetic testing and counseling about multigene panel were very much (55.0%) or much (40.9%) helpful for the patients and family. 63 (42.3%) patients wanted concurrent application of BRCA1/2 mutation testing and multigene testing beyond BRCA, and 71 (47.7%) patients wanted sequential application of the tests. Conclusions Multigene panel testing and genetic counselling may help to decrease cancer worry about the possibility of cancer in the future in BRCA1/2 mutation-negative patients with high risk for hereditary breast cancer. We need to find the appropriate sequence and methods for NGS multigene panel testing and counselling programs. Legal entity responsible for the study The authors. Funding National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT)(NRF-2018R1C1B6009449). Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Incorporating HER2-blockade into neoadjuvant drug regimens have led to a higher pathologic response in HER-positive breast cancer. In a view point of surgeon, a higher response to neoadjuvant treatment may offer a chance for de-escalating axillary surgery in patients with node-positive breast cancer at initial presentation. We investigated the rates of axillary lymph node dissection (ALND) and pathologic nodal response according to the types of neoadjuvant treatments including single or dual HER2 blockade in patients with clinically node-positive, HER2-postive breast cancer. Methods We retrospectively reviewed medical records from two institutions. From 2007 to 2018, patients with clinically node-positive, HER2-positive breast cancer treated with neoadjuvant chemotherapy were included. Primary outcome was the ALND rates after SLNB according to regimens. Secondary outcome was incidence of nodal pathologic complete response after axillary surgery. Results In a total, 512 patients were included for analysis. Two hundred and eighty-five patients (55.7%) were treated with chemotherapy alone, 135 (26.4%) with chemotherapy and trastuzumab, and 92 (18.0%) with chemotherapy, trastuzumab and pertuzumab. Nodal pCR rates were 45.6%, 77.8%, and 78.4% in each group (p-value < 0.0001). However, there was no difference in nodal pCR rates according to single or dual HER2-blockade (p-value = 0.778). In patients undergoing SLNB first, the ALND rates were 93.4%, 72.4%, and 71.6% in each group (p-value < 0.0001). The ALND rates were not different between two groups with single or dual HER2-blockade (p-value = 0.919). In 132 patients with more than three sentinel lymph nodes retrieved, the incidences of nodal pCR indicating the candidates for omission ALND were 44.3%, 86.2%, and 87.9% in each group (p-value < 0.0001). Conclusions For patients with node-positive, HER2-positive breast cancer, incorporating trastuzumab into neoadjuvant treatment had led to higher nodal pCR and reduced ALND. However, dual HER2-blockade with pertuzumab did not lead to increase nodal pCR and might not offer a chance of de-escalating axillary surgery compared to single HER2-blockade. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]