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Abstract Background In recent decades, melanoma incidence has been increasing in European countries; in 2006, there were approximately 60,000 cases leading to 13,000 deaths. Within Europe there is some geographical variation in the incidence of melanoma, with the highest rates reported in Scandinavia (15 cases per 100,000 inhabitants per year) and the lowest in the Mediterranean countries (5 to 7 cases per 100,000 inhabitants per year). Methods The present article is based on the information collected in the MELODY study (MELanoma treatment patterns and Outcomes among patients with unresectable stage III or stage IV Disease: a retrospective longitudinal survey). In that study, the medical charts of patients were reviewed to document current treatment patterns and to analyse information on patients, disease characteristics and healthcare resource utilization related to the treatment of advanced melanoma regarding patients who presented with a diagnosis of malignant melanoma (stage I to IV) at participating sites between 01 July, 2005 and 30 June, 2006. Results Summarizing, though the length of the follow-up period varies among sample patients, an amount of the yearly cost per patient can be estimated, dividing the average per patient total cost (€ 5.040) by the average follow-up duration (17.5 months) and reporting to one year; on these grounds, unresectable stage III or stage IV melanoma in Italy would cost € 3,456 per patient per year.

Abstract Background Surgery is still the standard treatment for aggressive fibromatosis (AF); however, local control remains a significant problem and the impact of R0 surgery on cumulative recurrence (CR) is objective of contradictory reports. Methods This is a single-institution study of 62 consecutive patients affected by extra-abdominal and intra-abdominal AF who received macroscopically radical surgery within a time period of 15 years. Results Definitive pathology examination confirmed an R0 situation in 49 patients and an R1 in 13 patients. Five-year CR for patients who underwent R0 vs R1 surgery was 7.1% vs 46.4% (P = 0.04) and for limbs vs other localizations 33.3% vs 9.9% (P = 0.02) respectively. In 17 patients who had intraoperative frozen section (IFS) margin evaluation R0 surgery was more common (17 of 17 vs 32 of 45, P = 0.01) and CR lower (five-year CR 0% vs 19.1%, respectively, P = 0.04). However, in multivariate analysis only limb localization showed a negative impact on CR (HR: 1.708, 95% CI 1.03 to 2.84, P = 0.04). Conclusions IFS evaluation could help the surgeon to achieve R0 surgery in AF. Non-surgical treatment, including watchful follow-up, could be indicated for patients with limb AF localization, because of their high risk of recurrence even after R0 surgery.

Abstract Background In the last few years several studies have shown that Transposable Elements (TEs) in the human genome are significantly associated with Transcription Factor Binding Sites (TFBSs) and that in several cases their expansion within the genome led to a substantial rewiring of the regulatory network. Another important feature of the regulatory network which has been thoroughly studied is the combinatorial organization of transcriptional regulation. In this paper we combine these two observations and suggest that TEs, besides rewiring the network, also played a central role in the evolution of particular patterns of combinatorial gene regulation. Results To address this issue we searched for TEs overlapping Estrogen Receptor α (ERα) binding peaks in two publicly available ChIP-seq datasets from the MCF7 cell line corresponding to different modalities of exposure to estrogen. We found a remarkable enrichment of a few specific classes of Transposons. Among these a prominent role was played by MIR (Mammalian Interspersed Repeats) transposons. These TEs underwent a dramatic expansion at the beginning of the mammalian radiation and then stabilized. We conjecture that the special affinity of ERα for the MIR class of TEs could be at the origin of the important role assumed by ERα in Mammalians. We then searched for TFBSs within the TEs overlapping ChIP-seq peaks. We found a strong enrichment of a few precise combinations of TFBS. In several cases the corresponding Transcription Factors (TFs) were known cofactors of ERα, thus supporting the idea of a co-regulatory role of TFBS within the same TE. Moreover, most of these correlations turned out to be strictly associated to specific classes of TEs thus suggesting the presence of a well-defined "transposon code" within the regulatory network. Conclusions In this work we tried to shed light into the role of Transposable Elements (TEs) in shaping the regulatory network of higher eukaryotes. To test this idea we focused on a particular transcription factor: the Estrogen Receptor α (ERα) and we found that ERα preferentially targets a well defined set of TEs and that these TEs host combinations of transcriptional regulators involving several of known co-regulators of ERα. Moreover, a significant number of these TEs turned out to be conserved between human and mouse and located in the vicinity (and thus candidate to be regulators) of important estrogen-related genes.

Abstract Background To report results in terms of feasibility and early toxicity of hypofractionated simultaneous integrated boost (SIB) approach with Volumetric Modulated Arc Therapy (VMAT) as adjuvant treatment after breast-conserving surgery. Methods Between September 2010 and May 2011, 50 consecutive patients presenting early-stage breast cancer were submitted to adjuvant radiotherapy with SIB-VMAT approach using RapidArc in our Institution (Istituto Clinico Humanitas ICH). Three out of 50 patients were irradiated bilaterally (53 tumours in 50 patients). All patients were enrolled in a phase I-II trial approved by the ICH ethical committee. All 50 patients enrolled in the study underwent VMAT-SIB technique to irradiate the whole breast with concomitant boost irradiation of the tumor bed. Doses to whole breast and surgical bed were 40.5 Gy and 48 Gy respectively, delivered in 15 fractions over 3 weeks. Skin toxicities were recorded during and after treatment according to RTOG acute radiation morbidity scoring criteria with a median follow-up of 12 months (range 8–16). Cosmetic outcomes were assessed as excellent/good or fair/poor. Results The median age of the population was 68 years (range 36–88). According to AJCC staging system, 38 breast lesions were classified as pT1, and 15 as pT2; 49 cases were assessed as N0 and 4 as N1. The maximum acute skin toxicity by the end of treatment was Grade 0 in 20/50 patients, Grade 1 in 32/50, Grade 2 in 0 and Grade 3 in 1/50 (one of the 3 cases of bilateral breast irradiation). No Grade 4 toxicities were observed. All Grade 1 toxicities had resolved within 3 weeks. No significant differences in cosmetic scores on baseline assessment vs. 3 months and 6 months after the treatment were observed: all patients were scored as excellent/good (50/50) compared with baseline; no fair/poor judgment was recorded. No other toxicities or local failures were recorded during follow-up. Conclusions The 3-week course of postoperative radiation using VMAT with SIB showed to be feasible and was associated with acceptable acute skin toxicity profile. Long-term follow-up data are needed to assess late toxicity and clinical outcomes.

Abstract BRAF is a serine/threonine protein kinase activating the MAP kinase/ERK-signaling pathway. About 50 % of melanomas harbors activating BRAF mutations (over 90 % V600E). BRAFV600E has been implicated in different mechanisms underlying melanomagenesis, most of which due to the deregulated activation of the downstream MEK/ERK effectors. The first selective inhibitor of mutant BRAF, vemurafenib, after highly encouraging results of the phase I and II trial, was compared to dacarbazine in a phase III trial in treatment-naïve patients (BRIM-3). The study results showed a relative reduction of 63 % in risk of death and 74 % in risk of tumor progression. Considering all trials so far completed, median overall survival reached approximately 16 months for vemurafenib compared to less than 10 months for dacarbazine treatment. Vemurafenib has been extensively tested on melanoma patients expressing the BRAFV600E mutated form; it has been demonstrated to be also effective in inhibiting melanomas carrying the V600K mutation. In 2011, both FDA and EMA therefore approved vemurafenib for metastatic melanoma carrying BRAFV600 mutations. Some findings suggest that continuation of vemurafenib treatment is potentially beneficial after local therapy in a subset of patients with disease progression (PD). Among who continued vemurafenib >30 days after local therapy of PD lesion(s), a median overall survival was not reached, with a median follow-up of 15.5 months from initiation of BRAF inhibitor therapy. For patients who did not continue treatment, median overall survival from the time of disease progression was 1.4 months. A clinical phase I/II trial is evaluating the safety, tolerability and efficacy of vemurafenib in combination with the CTLA-4 inhibitor mAb ipilimumab. In the BRIM-7 trial vemurafenib is tested in association with GDC-0973, a potent and highly selective inhibitor of MEK1/2. Preliminary data seem to indicate that an additional inhibitor of mutated BRAF, GSK2118436, might be also active on a wider range of BRAF mutations (V600E-K-D-R); actually, treatment with such a compound is under evaluation in a phase III study among stage III-IV melanoma patients positive for BRAF mutations. Overall, BRAF inhibitors were well tolerated; common adverse events are arthralgia, rash, fatigue, alopecia, keratoacanthoma or cutaneous squamous-cell carcinoma, photosensitivity, nausea, and diarrhea, with some variants between different inhibitors.

Objective: To assess whether preoperative ultrasound (US) assessment of regional lymph nodes in patients who present with primary cutaneous melanoma provides accurate staging. Background: It has been suggested that preoperative US could avoid the need for sentinel node (SN) biopsy, but in most single-institution reports, the sensitivity of preoperative US has been low. Methods: Preoperative US data and SNB results were analyzed for patients enrolled at 20 centers participating in the screening phase of the second Multicenter Selective Lymphadenectomy Trial. Excised SNs were histopathologically assessed and considered positive if any melanoma was seen. Results: SNs were identified and removed from 2859 patients who had preoperative US evaluation. Among those patients, 548 had SN metastases. US was positive (abnormal) in 87 patients (3.0%). Among SN-positive patients, 39 (7.1%) had an abnormal US. When analyzed by lymph node basin, 3302 basins were evaluated, and 38 were true positive (1.2%). By basin, the sensitivity of US was 6.6% (95% confidence interval: 4.6–8.7) and the specificity 98.0% (95% CI: 97.5–98.5). Median cross-sectional area of all SN metastases was 0.13 mm2; in US true-positive nodes, it was 6.8 mm2. US sensitivity increased with increasing Breslow thickness of the primary melanoma (0% for ≤1 mm thickness, 11.9% for >4 mm thickness). US sensitivity was not significantly greater with higher trial center volume or with pre-US lymphoscintigraphy. Conclusion: In the MSLT-II screening phase population, SN tumor volume was usually too small to be reliably detected by US. For accurate nodal staging to guide the management of melanoma patients, US is not an effective substitute for SN biopsy. [ABSTRACT FROM AUTHOR]

Abstract Background Brochopleural fistula following lung resection is a therapeuric challenge for thoracic surgeons. Case presentation We describe a case of late bronchopleural fistula after right extrapleural pneumonectomy for malignant mesothelioma. Bronchoscopic attempts to repair it were unsuccessful. Conclusion The use of a modified Y Dumon stent associated with glue apposition on the bronchial stump allowed us to close the fistula without the need of any surgical repair.

Copyright of Acta Stomatologica Croatica is the property of Acta Stomatologica Croatica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The thickness of the soft tissues around dental implants is crucial for both the preservation of the marginal bone and esthetic profile. Many authors have showed the thickened soft tissues favor a better peri-implant bone stability; however, different thickening techniques can be used for this aim.Methods: Forty-seven patients were enrolled in this study, each one had one implant included in this analysis. According to the thickening procedure, patients were assigned into group A (porcine dermal matrix, n = 24) or B (healing abutment used as tenting screw to sustain the soft tissues, n = 23), soft tissue thickness was measured after flap elevation in a standardized way. Six months after implant placement, implants were uncovered and soft tissue thickness measured again.Results: At second stage, 6 months after implant placement, the mean vertical thickness was 3.01 ± 0.58 mm in group A and 2.25 ± 0.53 mm in group B. The difference between the two groups at 6 months was significant (P < 0.001). The mean vertical gain in group A was 1.33 ± 0.71 mm, whereas it was 0.43 ± 0.55 mm in group B. This difference was also statistically significant (P < 0.001).Conclusion: The use of a healing abutment for "tenting effect" has limited efficacy to obtain a significant increase in soft tissue thickness. The use of a porcine dermal matrix at time of implant placement is effective to thicken peri-implant tissues. [ABSTRACT FROM AUTHOR]

Mucinous carcinoma (MC) is a rare breast cancer characterized by the presence of large extracellular mucin amount. Two main subtypes can be distinguished: pure (PMC) and mixed (MMC). We conducted a retrospective MC analysis in our prospective maintained database, calculating disease-free survival (DFS) and 5-year overall survival (OS). We found a global 92.1% OS (higher in MMC group and statistically significative) and a DFS of 95.3% (higher in MMC group but not statistically significative). • Mucinous carcinoma (MC) is a rare breast cancer characterized by the presence of large extracellular mucin amount. • We conducted a literature review and conducted a retrospective analysis in our database, finding 157 cases of MC. • Our findings are consistent with those published in literature, showing fundamental differences between PMC and MMC management and outcomes. We reviewed literature and our data to find out mucinous breast cancer's overall survival (OS), disease free survival (DFS) and if there are differences between pure mucinous breast cancer and mixed mucinous breast cancer in terms of OS and DFS. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to retrospectively evaluate the radiographic and clinical results and the success rate of short implants with a laser-microgrooved collar (≤7.5 mm) placed in the posterior areas after up to 3 to 5 years of function and the possible influence of several variables-such as gender, periodontitis, smoking habit, location, implant stability at placement, and prosthetic fixation design-on implant marginal bone loss (MBL).Materials and Methods: A chart review was used for this multicenter study, which involved 5 private dental clinics. All patients had been treated with short dental implants with a laser-microgrooved collar from January 2012 to December 2015.Results: A total of 174 patients (99 male and 75 female patients; mean age, 51.6 ± 2.8 years) with 254 implants were evaluated. Seven short implants failed. The cumulative success rate was 97.2%, without a statistically significant difference between implants placed in the posterior maxilla and mandible. The mean MBL was 0.18 ± 0.7 mm at the mesial aspect and 0.19 ± 0.6 mm at the distal aspect. No statistical relationships were found between MBL and gender, periodontitis, smoking habit, location, implant stability at placement, and prosthetic fixation design.Conclusions: At the end of the 3- to 5-year follow-up period, short implants with a laser-microgrooved collar (≤7.5 mm) in the posterior areas yielded a relatively high cumulative success rate. The laser-microgrooved collar implant maintained stable marginal bone levels. No investigated variable was statistically associated with MBL. [ABSTRACT FROM AUTHOR]

The vasculitides are a group of syndromes marked by inflammation and necrosis of blood vessels of various calibres, with luminal modifications and ischemia-induced changes in one or more organs supplied. They are primarily the expression of the tissue ischemia provoked by the damaged vessel. Their etiology is still uncertain, although viral infections are thought to be responsible for some forms. Periodontal tissues may be involved by the vessel-degenerative process. This article describes a case of leukocytoclastic vasculitis in a 23-year-old Caucasian male patient with severe necrotizing periodontitis: an average 4.7 mm full-mouth attachment loss measured involvement of the furcations and alveolar bone loss. It provides an illustration of how systemic diseases may predispose to necrotizing periodontal disease, in this case caused by tissue ischemia, and how clinicians can provide appropriate dental management of damaged oral tissues. [ABSTRACT FROM AUTHOR]

Abstract Introduction To evaluate acute toxicity and cosmetic outcomes of hypofractionated simultaneous integrated boost (SIB) as adjuvant treatment after breast-conserving surgery and adjuvant chemotherapy and to review the association of chemotherapy and short fractionation with boost. Materials and methods Patients presenting early-stage breast cancer were enrolled in a phase II trial. All patients received VMAT-SIB technique to the whole breast and tumor bed in 15 fractions, for a total dose of 40.5 and 48 Gy. Acute and late skin toxicities and breast pain were recorded. Cosmetic outcomes were also assessed as excellent/good or fair/poor. Results Between August 2010 and December 2015, 787 consecutive patients were treated and had at least 2 year follow-up. A subset of 175 patients underwent adjuvant chemotherapy (median age of 55 years) and was analysed. The median follow up was 39 months (range 24–80). At the end of RT treatment, skin toxicity was G1 in 51.1% of patients, G2 in 9.7%. At 2 years of follow up, it was G1 in 13.5% of patients, no cases ≥ G2; cosmetic outcome was excellent in 63.5% and good in 36.5% of the patients. No significant difference compared to the patients without systemic therapy was observed. Conclusion Hypofractionated VMAT-SIB in patients who had undergone adjuvant systemic therapy was safe and well tolerated in terms of acute and early late settings and cosmesis. Our data confirmed the results of other studies published on the association of hypofractionation and chemotherapy or concomitant boost. Highlights • Seven-hundred eighty-seven patients with early stage breast cancer with at least 2 year follow-up were included in the study. • All the patients received hypofractionated VMAT with SIB; 175 of them with associated chemotherapy. • At 2 years no ≥G2 skin toxicity; cosmesis was good/excellent in all patients; breast pain was present in 15.7% of the patients. • Early outcome was evaluated, no patients presented in-breast recurrence, 4 patients presented distant metastases. • No statistical differences were observed between patients having received or not systemic therapy. [ABSTRACT FROM AUTHOR]

Purpose: To introduce a novel modality that enables the measurement of forces applied during a transalveolar sinus floor elevation (tSFE) and to investigate the influence of anatomical and surgical factors on the necessitated force in sinus membrane detachment. Material and Methods: A new endosinus probe, innovated with a calibrated load cell, was used to test the forces needed to perforate ten maxillary sinuses in 5 human cadavers. The same probe was also used to detach the Schneiderian membrane from the bony floor of 21 human subjects undergoing tSFE. Results: The force needed to cause membrane perforation in the cadaver sample was on average 3.46 ± 1.04 N. The maximum force applied in vivo to a sinus membrane without perforation was 2.01 ± 0.67 N on average. Regression analysis showed that smoking (P < 0.001), as well as 3.0 mm osteotomy (P < 0.001), was significantly correlated to increased forces during membrane detachment. Conclusions: The maximum force needed to detach the membrane was found to be, on average, lower than the membrane breaking load in cadavers. Furthermore, because of smoking and a 3.0-mm osteotomy diameter demonstrating a high association with increased forces during membrane detachment, they may be considered as risk factors of membrane perforation. [ABSTRACT FROM AUTHOR]

The following contribution tackles autonomía by reflecting on the relationship between culture and space and, therefore, on the multiple actors involved in an urban project. This interaction and involvement are envisioned through the approach termed as 'cultural co-design'. The work is divided into four main sections. First, the mega-minga, an initiative based on the collaboration between citizens and institutions to produce collective urban spaces in Ecuador, is introduced. This is followed by a critical analysis of the mega-minga itself through the specific case of the Comuna de Santa Clara de San Millán, located in Quito. The deficiencies and the potentials of this collaborative practice will be illustrated by contextualizing the mega-minga historically, and relating it back to an evolving customary practice based on reciprocity. The third section of the paper looks at the intrinsic characteristics of the minga practice, explores its decolonizing qualities and the opportunity it represents to re-orient mainstream client-based and for-profit urban design practices in Ecuador. The article concludes by turning once again to the case of Santa Clara de San Millán. It envisions a scenario where autonomi'a is attainable through alternatives supporting a more equitable 'interaction' between space, culture, citizens, and institutions. [ABSTRACT FROM AUTHOR]

Objectives: Osteonecrosis of the jaw (ONJ) is a concern in patients taking anti-resorptive drugs. The aim of this study was to test the hypothesis that preoperative individualized pharmacologic control of the patient's osteometabolic profile could lead to predictable healing of the surgically treated region and minimize the incidence of complications.Study Design: This prospective study included 95 test patients (53 with osteoporosis and 42 with cancer), and 94 control patients (49 with osteoporosis and 45 with cancer) who were on anti-resorptive therapy and were candidates for ONJ treatment. Test patients underwent osteometabolic profile assessment and personalized pharmacologic supplementation before intervention. In all cases, a drug holiday was scheduled for 3 months before and at least 3 months after the intervention. Healing was assessed clinically and radiographically.Results: In the test group, after a mean follow-up of 28.2 ± 7.8 months, there was only 1 ONJ recurrence, and it was successfully resolved after the pharmacologic protocol was resumed. Five patients reported minor complications. Overall, 100% treatment success was observed. In the control group, after 28.1 ± 4.9 months follow-up, 6 fistulae, 19 abscesses, and 34 dehiscences occurred. In total, 62.8% of patients in the control group had complications or adverse events. The difference between the 2 groups was highly significant.Conclusions: Strict osteometabolic control should be a routine measure in the management of patients taking anti-resorptive drugs. [ABSTRACT FROM AUTHOR]

Copyright of Implant Dentistry is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Implant Dentistry is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the feasibility of a refined aortic flush catheter and pump system to induce emergency preservation and resuscitation before extracorporeal cardiopulmonary resuscitation in a normovolemic cardiac arrest swine model simulating near real size/weight conditions of adults. Methods In this feasibility study, 8 female Large White breed pigs weighing 70 to 80 kg underwent ventricular fibrillation cardiac arrest for 15 minutes, followed by 4°C aortic flush (150 mL/kg for the brain; 50 mL/kg for the spine) via a new hardware ensued by resuscitation with extracorporeal cardiopulmonary resuscitation. Results Brain temperature was lowered from 39.9°C (interquartile range [IQR] 39.6-40.3) to 24.0°C (IQR 20.8-28.9) in 12 minutes (IQR 11-16) with a median cooling rate of 1.3°C (IQR 0.7-1.6) per minute. A median of 776 mL (IQR 673-840) per minute with a median pump pressure of 1487 mm Hg (IQR 1324-1545) were pumped to the brain. Conclusions With the new hardware, we were able to cool the brain within a few minutes in a large pig cardiac arrest model. The exact position; the design, diameter, and length of the flush catheter; and the brain perfusion pressure seem to be critical to effectively reduce brain temperature. Redistribution of peripheral blood could lead to sterile inflammation again and might be avoided. [ABSTRACT FROM AUTHOR]

Purpose: The true benefit of autologous platelet concentrates (APCs) for enhancing the healing of postextraction sites is still a matter of debate, and in recent years several clinical trials have addressed this issue. The purpose of this study was to determine the effectiveness of an APC adjunct in the preservation of fresh extraction sockets.Materials and Methods: An electronic search was performed on Medline, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. Only controlled clinical trials or randomized clinical trials were included. Selected articles underwent risk-of-bias assessment. The outcomes were complications and adverse events, discomfort and quality of life, bone healing and remodeling assessed by histologic and radiographic techniques, and soft tissue healing.Results: Thirty-three comparative studies were included. Nine articles had a parallel design and 24 had a split-mouth design. Twenty studies were considered to have a low risk of bias and 13 were considered to have a high risk. Overall, 1,193 teeth were extracted from 911 patients. Meta-analysis showed that soft tissue healing, probing depth at 3 months, and bone density at 1, 3, and 6 months were statistically better for the APC group. Qualitative analysis suggested that APCs might be associated with a decrease in swelling and trismus. However, no relevant difference among groups was found for probing depth at 1 month, incidence of alveolar osteitis, acute inflammation or infection, percentage of new bone, and indirect measurement of bone metabolism.Conclusion: APCs should be used in postextraction sites to improve clinical and radiographic outcomes such as bone density and soft tissue healing and postoperative symptoms. The actual benefit of APCs on decreasing pain in extraction sockets is still not quantifiable. [ABSTRACT FROM AUTHOR]

In transit metastases (ITM) from extremity or trunk melanomas are subcutaneous or cutaneous lymphatic deposits of melanoma cells, distant from the primary site but not reaching the draining nodal basin. Superficial ITM metastases develop in 5–10% of melanoma patients and are thought to be caused by cells spreading along lymphatics; ITM appear biologically different from distant cutaneous metastases, these probably due to a haematogenous dissemination. The diagnosis is usually clinical and by patients, but patients need to be adequately educated in the recognition of this clinical situation. Ultrasound or more sophisticated instrumental devices may be required if the disease develops more deeply in the soft tissues. According to AJCC 2009 staging classification, ITM are included in stages IIIb and IIIc, which are considered local advanced disease with quite poor 5-year survival rates and outcomes of 24–54% at 5 years. 2 Loco-regional recurrence is in fact an important risk factor for distant metastatic disease, either synchronous or metachronous. Therapy for this pattern of recurrence is less standardised then in most other clinical situations and options vary based on the volume and site of the disease. Definitive surgical resection remains the preferred therapeutic approach. However, when surgery cannot be performed with a reasonable cosmetic and functional outcome, other options must be utilized. 3–6 Treatment options are classified as local, regional or systemic. The choice of therapy depends on the number of lesions, their anatomic location, whether or not these are dermal or subcutaneous, the size and the presence or absence of extra-regional disease. [ABSTRACT FROM AUTHOR]

Background Cutaneous metastases represent a therapeutic challenge. An increasing body of experience suggests that electrochemotherapy (ECT) provides effective tumor control, although its evidence basis should be strengthened. Methods This prospective, multicenter, observational study enrolled patients with superficial metastases, who underwent ECT at 10 centers between 2008 and 2013. Outcomes included adherence to European Standard Operating Procedures of ECT (ESOPE), tumor response, local progression-free survival (LPFS), toxicity and patient-reported outcomes (PROs, EORTC QLQ-C30 plus an 8-item questionnaire). Results We enrolled 376 eligible patients. Tumor histotype distribution was as follows: melanoma, 56%; squamous cell carcinoma, 11%; Kaposi sarcoma, 11%; breast carcinoma, 8%; basal cell carcinoma, 6%; soft tissue sarcomas, 3%; others, 5%. We registered 1304 target tumors (median size 1 cm). Treatment adhered to ESOPE in 88% of patients as to the route of drug administration, and in 70% as to electrode application. The procedure was mainly performed under sedation (64.6%) and by using intravenous chemotherapy (93.4%). Tumor response rate at 60 days was 88% (complete, 50%). Small tumor size predicted complete response achievement (OR 2.24, p = 0.003), higher LPFS (HR 0.68, p = 0.004) and improved PROs (Global Health Status, p < 0.001; wound bleeding, p < 0.001; healing, p = 0.002; and aesthetics, p < 0.001). Skin toxicity (grade ≥3, 7.8%) was lower in patients with tumors <2 cm ( p ≤ 0.001 ). One-year LPFS was 73.7% (95%CI 68.4–78.3). Conclusions ECT represents a valuable skin-directed therapy across a range of malignancies. The most frequently applied treatment modality is intravenous chemotherapy under sedation. Small tumor size predicts durable tumor control, fewer side-effects and better PROs. [ABSTRACT FROM AUTHOR]

Background Worldwide, sentinel node biopsy (SNB) is the recommended staging procedure for stage I/II melanoma. Most melanoma guidelines recommend re-excision plus SNB as soon as possible after primary excision. To date, there is no evidence to support this timeframe. Aim To determine melanoma specific survival (MSS) for time intervals between excisional biopsy and SNB in SNB positive patients. Methods Between 1993 and 2008, 1080 patients were diagnosed with a positive SNB in nine Melanoma Group centers. We selected 1015 patients (94%) with known excisional biopsy date. Time interval was calculated from primary excision until SNB. Kaplan–Meier estimated MSS was calculated for different cutoff values. Multivariable analysis was performed to correct for known prognostic factors. Results Median age was 51 years (Inter Quartile Range (IQR) 40–62 years), 535 (53%) were men, 603 (59%) primary tumors were located on extremities. Median Breslow thickness was 3.00 mm (IQR 1.90–4.80 mm), 442 (44%) were ulcerated. Median follow-up was 36 months (IQR 20–62 months). Median time interval was 47 days (IQR 32–63 days). Median Breslow thickness was equal for both <47 days and ≥47 days interval: 3.00 mm (1.90–5.00 mm) vs 3.00 mm (1.90–4.43 mm) (p = 0.402). Sentinel node tumor burden was significantly higher in patients operated ≥47 days (p = 0.005). Univariate survival was not significantly different for median time interval. Multivariable analysis confirmed that time interval was no independent prognostic factor for MSS. Conclusions Time interval from primary melanoma excision until SNB was no prognostic factor for MSS in this SNB positive cohort. This information can be used to counsel patients. [ABSTRACT FROM AUTHOR]

Purpose: The present, randomized, controlled clinical trial compared the histologic and histomorphometric results from maxillary sinus augmentation with either biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% b-tricalcium phosphate) or autogenous bone (AB) as bonegrafting materials. Material and Methods: Ten patients received bilateral sinus elevation surgery with intraoral AB chips (control group) on one side and BCP (test group) on the contralateral side. After a healing period of 6 to 8 months, implant sites were created and trephine cores were harvested for histological and histomorphometric analysis of the grafted areas. Results: The histological examination of biopsies showed BCP particles interconnected by bridges of a vital newly formed bone. Histomorphometry demonstrated that the amount of newly formed bone in the control group (36.8%) was significantly greater than that in the BCP (28.2%) group (P = 0.0032). BCP and AB cores revealed an average of residual graft particles of 32.9% and 4.8%, respectively. The average percentage of soft tissue components was 38.9% in the BCP cores and 58.4% in the AB cores. Conclusions: Based on our findings, the amount of vital bone formation was significantly higher for AB than that for BCP. However, BCP seemed to be a biocompatible and osteoconductive material that can be used with success as a bone substitute in maxillary sinus procedures. [ABSTRACT FROM AUTHOR]

Copyright of Implant Dentistry is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study aimed at a histologic and histomorphometric analysis of the periimplant tissues and bone-titanium interface reactions in successfully osseointegrated, clinically stable, and immobile human titanium dental implants retrieved after a long loading period. Materials and Methods: In the last 30 months (2013-2015), 21 implants, retrieved from individuals for different causes after a loading period ranging from 4 to 20 years, were sent to the Implant Retrieval Center, University of Chieti-Pescara, Italy. In 4 cases, almost all the bone had been lost during the retrieval, whereas in the remaining 17 cases, mineralized bone was still present. Results: Around the majority of the implants, mature compact bone with few marrow spaces was found. The trabecular bone, constituted by a few thin bone trabeculae, was in a periimplant location around only a few implants. A high percentage of bone-implant contact (BIC) (comprised between 32 ± 4.1% and 83 ± 2.9%) was present. In almost all implants, the space within the threads was almost completely filled by compact lamellar bone or by a thin layer of bone. Close and tight contact between bone and implant surface was observed in all specimens with no gaps or connective tissue at the interface. Conclusions: All implants appeared to be well integrated in the surrounding mineralized bone, and all of them showed adequate boneto- implant contact percentages. [ABSTRACT FROM AUTHOR]

Background Multidisciplinary management of oligometastatic breast cancer with local therapy could improve disease control. The aim of our study is the assessment of safety and efficacy of Stereotactic Body Radiation Therapy (SBRT) in selected subset of patients. Patients and methods Oligometastastic patients from breast cancer were treated with SBRT for 1–3 lung and liver lesions, in an observational study. Inclusion criteria were: age >18 years, ECOG 0-2, diagnosis of breast cancer, no extrapulmonary and/or extrahepatic disease, other metastatic sites stable or responding after chemotherapy were allowed, no life threatening conditions, less than 5 lung and liver lesions (with maximum diameter <5 cm), chemotherapy completed at least 3 weeks before treatment, written informed consent. Prescription dose ranged between 48 and 75 Gy in 3 or 4 consecutive fractions. Primary end-point was local control (LC). Secondary end-points were toxicity, overall survival (OS) and progression-free survival (PFS). Results From April 2010 to June 2014, 33 patients for a total number of 43 lesions were irradiated. Median follow up was 24 months (range 3–59). Actuarial LC rates were 98% at 1 year and 90% at 2 and 3 years. Complete response, partial response and progressive disease were detected in 25 (53.2%), 16 (34%), and 6 (12.8%) lesions, respectively. Median OS was 48 months. Actuarial OS rates at 1 and 2 years were 93% and 66% respectively. Median PFS was 11 months, with a PFS rate at 1 and 2 years of 48% and 27%, respectively. At univariate analysis DFI >12 months, hormonal receptor positivity, medical therapies after SBRT showed a significant impact on OS. Treatment was well tolerated, with no G3-4 toxicities. Conclusions SBRT is a safe and feasible alternative treatment of liver and lung oligometastases from breast cancer, in selected patients not amenable to surgery, with good local control and survival rate. [ABSTRACT FROM AUTHOR]

Background: Clinicians should be able to weigh the role of the main risk factors associated with early implant failure. Purpose: The aim of this meta-analysis was to assess the influence of different patient-related and implant-related risk factors on the occurrence of early implant failure. Materials and Methods: In July, 2014 the main electronic databases were searched for studies reporting on early failures. Relevant papers were selected by 2 independent authors using predefined selection criteria. Three authors independently scored the included studies for quality assessment. The estimated odds ratios of the main risk factors from the selected papers were subjected to meta-analysis. Results: Nine studies were included. A total of 18,171 implants were meta-analyzed, of which 10,921 were analyzed for smoking, 15,260 for implant diameter, 16,075 for implant length, and 16,711 for implant location (maxilla vs mandible). The main significant risk factors for early implant failures were the smoking habit (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3, 2.3), implants shorter than 10 mm (OR, 1.6; 95% CI, 1.2, 2.2) and implants placed in the maxilla (OR, 1.3; 95% CI, 1.0, 1.6). Conclusions: Clinicians should be aware of the increased risk of early failure in the presence of smokers, implants with reduced length, and implant-supported maxillary rehabilitation. [ABSTRACT FROM AUTHOR]

Copyright of Implant Dentistry is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Multiple primary melanoma (MPM), in concert with a positive family history, is a predictor of cyclin-dependent kinase (CDK) inhibitor 2A (CDKN2A) germline mutations. A rule regarding the presence of either 2 or 3 or more cancer events (melanoma and pancreatic cancer) in low or high melanoma incidence populations, respectively, has been established to select patients for genetic referral.Objective: We sought to determine the CDKN2A/CDK4/microphthalmia-associated transcription factor mutation rate among Italian patients with MPM to appropriately direct genetic counseling regardless of family history.Methods: In all, 587 patients with MPM and an equal number with single primary melanomas and control subjects were consecutively enrolled at the participating centers and tested for CDKN2A, CDK4, and microphthalmia-associated transcription factor.Results: CDKN2A germline mutations were found in 19% of patients with MPM versus 4.4% of patients with single primary melanoma. In familial MPM cases the mutation rate varied from 36.6% to 58.8%, whereas in sporadic MPM cases it varied from 8.2% to 17.6% in patients with 2 and 3 or more melanomas, respectively. The microphthalmia-associated transcription factor E318K mutation accounted for 3% of MPM cases altogether.Limitations: The study was hospital based, not population based. Rare novel susceptibility genes were not tested.Conclusion: Italian patients who developed 2 melanomas, even in situ, should be referred for genetic counseling even in the absence of family history. [ABSTRACT FROM AUTHOR]