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In this consecutive series, 14 patients with severe intrabony defects and pathologic tooth migration were treated with guided tissue regeneration (GTR) and subsequent orthodontic therapy in an attempt to evaluate the validity of this multidisciplinary approach. Probing pocket depths (PPD), clinical attachment levels (CAL), and gingival recessions were assessed at baseline, 1 year after GTR, and at the end of orthodontic therapy. Radiographs were obtained at all time points. Esthetic parameters were recorded with the papilla presence index (PPI). Statistical analyses were carried out to compare the data at each time point. From baseline to 1 year after GTR, the mean PPD reduction was 5.57 mm, with a residual mean PPD of 2.71 mm; mean CAL gain was 5.86 mm. Both differences were statistically significant. There were no statistically significant differences between 1 year after GTR and the end of orthodontic therapy (mean PPD reduction 0.07 mm; mean CAL gain 0.43 mm). The reduction in PPI reflected the enhancement of papilla height that was observed in 9 of the 14 patients. Within the limits of this research, this study affirms the possibility of a combined orthodontic-periodontal approach that prevents damaging the regenerated periodontal apparatus and produces esthetic improvements as a result of realignments and enhancement of papilla height. [ABSTRACT FROM AUTHOR]

Background Advanced breast cancer (ABC) represents a substantial burden for patients and caregivers. In the present study, we aimed to estimate quality of life (QOL), utility, productivity loss, pain, health care resource utilization, and costs for patients with ABC, and QOL, utility, and productivity loss for their caregivers. Methods This multicentre prospective non-interventional study was conducted in Canada. Eligible participants were postmenopausal women with estrogen receptor-positive, her2-negative unresectable ABC and their caregivers. Validated questionnaires were used to measure QOL, utility, productivity loss, and pain. Patients and caregivers were classified into 4 health states typically used in oncology economic modelling: first-line progression-free (1L-PF), firstline progressive disease (1L-PD), second- or subsequent-line progression-free (≥2L-PF), and second- or subsequent-line progressive disease (≥2L-PD). Results Most patients and caregivers accepted to participate, with total recruitment of 202 patients and 78 caregivers. Compared with patients in PF, patients in PD had lower mean QOL scores (52.9 ± 29.9 for 1L-PD vs. 68.2 ± 23.2 for 1L-PF, and 54.0 ± 23.6 for ≥2L-PD vs. 66.0 ± 22.1 for ≥2L-PF), lower mean utility values (0.64 ± 0.22 for 1L-PD vs. 0.73 ± 0.20 for 1L-PF, and 0.65 ± 0.25 for ≥2L-PD vs. 0.74 ± 0.18 for ≥2L-PF), and greater productivity loss (39.4 ± 27.7 for 1L-PD vs. 27.5 ± 30.1 for 1L-PF, and 37.6 ± 29.2 for ≥2L-PD vs. 32.0 ± 29.0 for ≥2L-PF). Compared with caregivers of patients in PF, caregivers of patients in PD had lower QOL scores and utility values, and greater productivity loss. Conclusions Study results indicate that, for patients and caregivers, PD health states are associated with a deterioration of QOL and utility and a decrease in productivity in both 1L and ≥2L. [ABSTRACT FROM AUTHOR]

Background Palbociclib is a recently approved drug for use in combination with letrozole as initial endocrine-based therapy for the treatment of postmenopausal women with advanced estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2-) breast cancer. This report assesses the impact of palbociclib in combination with letrozole versus letrozole alone on patient-reported outcomes of pain. Methods Palbociclib was evaluated in an open-label, randomized, phase II study (PALOMA-1/TRIO-18) among postmenopausal women with advanced ER+/HER2- breast cancer who had not received prior systemic treatment for their advanced disease. Patients received continuous oral letrozole 2.5 mg daily alone or the same letrozole dose and schedule plus oral palbociclib 125 mg, given once daily for 3 weeks followed by 1 week off over repeated 28-day cycles. The primary study endpoint was investigator-assessed progression-free survival in the intent-to-treat population, and these results have recently been published (Finn et al., Lancet Oncol 2015;16:25-35). One of the key secondary endpoints was the evaluation of pain, as measured using the Brief Pain Inventory (BPI) patient-reported outcome tool. The BPI was administered at baseline and on day 1 of every cycle thereafter until disease progression and/or treatment discontinuation. Clinical trial registration This study is registered with ClinicalTrials.gov (NCT00721409). Results There were no statistically significant differences in Pain Severity or Pain Interference scores of the BPI between the two treatment groups for the overall population or among those with any bone disease at baseline. A limitation of the study is that results were not adjusted for the concomitant use of opioids or other medications used to control pain. Conclusions The addition of palbociclib to letrozole was associated with increased efficacy without negatively impacting pain severity or pain interference with daily activities. [ABSTRACT FROM AUTHOR]

Abstract Objectives: SELECTTION was a multinational, prospective observational study to assess the choice of and the time from initiation of second-line treatment to treatment discontinuation for any reason in patients with non-small cell lung cancer. Methods: Treatment cohorts were constructed based on prescribed second-line treatments that were at the discretion of the treating physicians, for 1013 patients enrolled in 11 countries. Propensity score analysis was conducted to assess whether the cohorts were comparable. Time from initiation of second-line treatment to treatment discontinuation was the primary endpoint. Reasons for treatment discontinuation, overall survival, progression-free survival and choice of second-line treatment were secondary endpoints. Results: The treatment cohorts were pemetrexed (46.2%), docetaxel (22.9%), erlotinib (20.4%) and other treatments (10.5%). Analyses of baseline data and propensity scores showed that the erlotinib cohort comprised substantially different patients compared with the pemetrexed and docetaxel cohorts: patients in the erlotinib cohort were more likely to be women, never-smokers, have adenocarcinoma and worse performance status. Therefore, comparisons of outcomes between cohorts were not appropriate. Although disease progression was the most common reason for treatment discontinuation in all cohorts, erlotinib patients tended to continue treatment after disease progression, whereas in the docetaxel and pemetrexed cohorts, discontinuation occurred soon after disease progression. Conclusions: In real-world clinical practice the profiles of patients assigned to erlotinib were distinctly different from those assigned to pemetrexed or docetaxel. The most common reason for treatment discontinuation was progressive disease, reflecting adherence to clinical recommendations. It is difficult to extrapolate these findings to the present, as both clinical practice and the approved indications for NSCLC treatments have evolved substantially. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Human Lyme arthritis caused by Borrelia burgdorferi is characterized by an inflammatory infiltrate that consists mainly of neutrophils and T cells. This study was undertaken to evaluate the role of the innate and acquired immune responses elicited by the neutrophil-activating protein A (NapA) of B burgdorferi in patients with Lyme arthritis. METHODS: Serum anti-NapA antibodies were measured in 27 patients with Lyme arthritis and 30 healthy control subjects. The cytokine profile of synovial fluid T cells specific for NapA was investigated in 5 patients with Lyme arthritis. The cytokine profile induced by NapA in neutrophils and monocytes was also investigated. RESULTS: Serum anti-NapA antibodies were found in 48% of the patients with Lyme arthritis but were undetectable in the healthy controls. T cells from the synovial fluid of patients with Lyme arthritis produced interleukin-17 (IL-17) in response to NapA. Moreover, NapA was able to induce the expression of IL-23 in neutrophils and monocytes, as well as the expression of IL-6, IL-1beta, and transforming growth factor beta (TGFbeta) in monocytes, via Toll-like receptor 2. CONCLUSION: These findings indicate that NapA of B burgdorferi is able to drive the expression of IL-6, IL-1beta, IL-23, and TGFbeta by cells of the innate immune system and to elicit a synovial fluid Th17 cell response that might play a crucial role in the pathogenesis of Lyme arthritis [ABSTRACT FROM AUTHOR]

Using a specific questionnaire, we examined subjective symptoms in a group of 17 physicians (9 males and 8 females, mean age 32.9 ± 3.71), attending a Postgraduate Medical School in Radiology and engaged in MRI for less than 1 year. Sixteen subjects (94%) reported the presence of at least one of the investigated symptoms during the period of MRI activity. The main symptoms were: unusual drowsiness/tiredness (88%), concentration problems (82%), headaches (76%), sleep disorders (47%), nausea (47%), illusion of movement (47%) and dizziness/vertigo (35%); the former two were subjectively related to MRI by the majority of the operators. These symptoms appeared (or worsened) in more than 15 min and, in the vast majority disappeared 30 min, or more, after the end of exposure. In 13 subjects (81%), the symptom (or some symptoms) appeared at least weekly. In this small group of health care workers recently exposed to MRI, the prevalence of subjective symptoms was higher than reported in other similar studies but, notably, the majority of subjects (77%) reported a regression within 4–8 weeks, suggesting some form of adaptation. [ABSTRACT FROM PUBLISHER]

Despite the theoretical advantages of uncemented short stems, postoperative thigh pain is still matter of concern and can be attributed to different causes. We report a peculiar case of a stress fracture around a short cementless stem with cervico-metaphyseal fixation in an otherwise healthy patient. We implanted a MiniHipTM stem in a 43 year-old male professional golf player for the treatment of primary osteoarthritis using a ceramic on ceramic bearing. Against medical advice, the patient started to play soccer at the 4th postoperative month and was completely asymptomatic to that extent; but at 8 months follow-up and without a history of trauma he started complaining about progressive hip pain. After ruling out infection and loosening, histological analysis from a bone biopsy confirmed the diagnosis of stress fracture. Although revision surgery was initially scheduled, pain started to decrease gradually with protected weight-bearing (crutches) and disappeared around the first postoperative year, remaining the patient asymptomatic at 2 and half years of follow-up, with radiographs depicting a healed fracture with a hypertrophic callus. We encourage surgeons to be aware of the existence of periprosthetic stress fractures as a source of thigh pain (sometimes intractable), and despite being infrequent, they should always be contemplated, providing that these cases can be managed conservatively with rest and limited weight-bearing. After this uncommon case, we suggest to align the stem in order to equally distribute loads onto the medial calcar and the lateral femoral cortical.

Complex regional pain syndrome (CRPS) constitutes an atypical cause of pain after orthopaedic procedures. To our knowledge, there is a paucity of literature reporting this syndrome after total hip arthroplasty (THR), since only two case reports have been published. We thenceforth describe the clinical outcome of three cases of type-1 CRPS developed after elective THR, two of them initially diagnosed with secondary osteoarthritis whereas the remaining one presented a sequel of a failed osteosynthesis that required conversion to THR. Remission of disease was found at an average seven months (range: 4–9). Medical treatment involved a combined therapy of pain management, bisphosphonates and intense physical therapy. One patient was additionally treated with a corticosteroid blockade of his right sympathetic lumbar ganglia. None of the patients required surgical treatment. At final follow-up, physical examinations and imaging were negative for disease.