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1.
JCI Insight ; 4(5)2019 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-30702443

RESUMO

Molecular profiling of prostate cancer with liquid biopsies, such as circulating tumor cells (CTCs) and cell-free nucleic acid analysis, yields informative yet distinct data sets. Additional insights may be gained by simultaneously interrogating multiple liquid biopsy components to construct a more comprehensive molecular disease profile. We conducted an initial proof-of-principle study aimed at piloting this multiparametric approach. Peripheral blood samples from men with metastatic castrate-resistant prostate cancer were analyzed simultaneously for CTC enumeration, single-cell copy number variations, CTC DNA and matched cell-free DNA mutations, and plasma cell-free RNA levels of androgen receptor (AR) and AR splice variant (ARV7). In addition, liquid biopsies were compared with matched tumor profiles when available, and a second liquid biopsy was drawn and analyzed at disease progression in a subset of patients. In this manner, multiparametric liquid biopsy profiles were successfully generated for each patient and time point, demonstrating the feasibility of this approach and highlighting shared as well as unique cancer-relevant alterations. With further refinement and validation in large cohorts, multiparametric liquid biopsies can optimally integrate disparate but clinically informative data sets and maximize their utility for molecularly directed, real-time patient management.


Assuntos
Biópsia Líquida/métodos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Ácidos Nucleicos Livres/sangue , Variações do Número de Cópias de DNA , Progressão da Doença , Perfilação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Células Neoplásicas Circulantes , Neoplasias da Próstata/genética , Receptores Androgênicos/sangue , Receptores Androgênicos/genética
2.
J Mol Diagn ; 20(3): 279-288, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29471114

RESUMO

Cancer genome copy number alterations (CNAs) assist clinicians in selecting targeted therapeutics. Solid tumor CNAs are most commonly evaluated in formalin-fixed, paraffin-embedded (FFPE) tissue by fluorescence in situ hybridization. Although fluorescence in situ hybridization is a sensitive and specific assay for interrogating preselected genomic regions, it provides no information about coexisting clinically significant copy number changes. Chromosomal microarray analysis is an alternative DNA-based method for interrogating genome-wide CNAs in solid tumors. However, DNA extracted from FFPE tumor tissue produces an essential, yet problematic, sample type. The College of American Pathologists/American Society of Clinical Oncology guidelines for optimal tumor tissue handling, published in 2007 for breast cancer and in 2016 for gastroesophageal adenocarcinomas, are lacking for other solid tumors. Thus, cold ischemia times are seldom monitored in non-breast cancer and non-gastroesophageal adenocarcinomas, and all tumor biospecimens are affected by chemical fixation. Although intended to preserve specimens for long-term storage, formalin fixation causes loss of genetic information through DNA damage. Herein, we describe a reference size matching, whole-genome amplification, and fluorescent labeling method for FFPE-derived DNA designed to improve chromosomal microarray results from suboptimal nucleic acids and salvage highly degraded samples. With this technological advance, whole-genome copy number analysis of tumor DNA can be reliably performed in the clinical laboratory for a wide variety of tissue conditions and tumor types.


Assuntos
Cromossomos Humanos/genética , Variações do Número de Cópias de DNA/genética , Corantes Fluorescentes/química , Genoma Humano , Análise em Microsséries/normas , Neoplasias/genética , Inclusão em Parafina/métodos , Fixação de Tecidos/métodos , Linhagem Celular , DNA/genética , Formaldeído , Deleção de Genes , Dosagem de Genes , Humanos , PTEN Fosfo-Hidrolase/genética , Controle de Qualidade , Receptor ErbB-2/genética , Padrões de Referência
3.
Int J Periodontics Restorative Dent ; 34 Suppl 3: s71-3, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24956094

RESUMO

This case report examined crestal bone level maintenance surrounding a platform-switched implant that was retrieved due to prosthetic difficulty. The retrieved platform-switched implant threads demonstrated tight contact with the surrounding bone and demonstrated both radiographic and histologic features that were indicative of successful osseointegration. Very high bone-to-implant contact (BIC) without epithelial downgrowth to the implant thread was noted. The BIC consisted of a combination of newly formed bone and native bone. The buccal and lingual bone levels coincided with the original platform position noted at the time of the surgery, and did not appear to resorb at all. The result of the present investigation confirms the maintenance of the crestal bone level for platform-switched implants.


Assuntos
Implantes Dentários , Osseointegração , Feminino , Humanos , Pessoa de Meia-Idade
4.
Quintessence Int ; 45(3): 203-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24570987

RESUMO

The treatment of an infected socket with a severe facial dehiscence/ fenestration defect presents a therapeutic dilemma to the dental team. Both implant-supported restoration and fixed partial denture are viable options to restore function and occlusion, each with its benefits and disadvantages. In the present case report, a multi-stage regenerative approach was selected to enable implant-supported single crown. The first phase of the treatment after extraction of the maxillary central incisor was the stabilization of the blood clot with a collagen plug. Six weeks later, the surgical site was re-entered and the socket was grafted with biphasic calcium sulfate (BCS). Six months later, a dental implant was placed and a core biopsy taken. However, the central portion of the facial defect demonstrated only partial regeneration resulting in exposure of six implant threads. Freeze-dried bone allograft (FDBA) and a collagen membrane were utilized to augment the ridge and cover the exposed threads. The histology of the bone core showed a complete resorption of the grafted material with the presence of new woven bone throughout the specimen. Clinically, complete defect regeneration and augmentation of the alveolar ridge were attained after 4 months. Thus, the clinician should consider the pros and cons of this regenerative approach along with other more conservative treatment alternatives when dealing with similar cases.


Assuntos
Incisivo/cirurgia , Deiscência da Ferida Operatória/cirurgia , Extração Dentária , Alvéolo Dental/cirurgia , Aumento do Rebordo Alveolar/métodos , Biópsia , Transplante Ósseo/métodos , Implantação Dentária Endóssea/métodos , Implantes Dentários , Feminino , Humanos , Maxila , Pessoa de Meia-Idade , Osteotomia , Retalhos Cirúrgicos , Deiscência da Ferida Operatória/patologia , Alvéolo Dental/patologia
5.
Arthroscopy ; 30(1): 6-10, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24384271

RESUMO

PURPOSE: To evaluate the incidence of associated pathologic shoulder lesions that were addressed surgically in grade 3 acromioclavicular joint (ACJ) dislocations, as well as to compare this incidence between younger and older patients and between acute and chronic cases. METHODS: In this multicenter nonrandomized retrospective study, 98 patients operated on for grade 3 ACJ dislocation underwent concomitant arthroscopic evaluation for the identification and treatment of any associated lesions. The type and treatment of associated lesions were collected in a central database and analyzed. We classified patients according to age (<45 years and ≥ 45 years) and according to the length of time between trauma and surgical treatment (≤ 30 days and ≥ 120 days), obtaining the following stratification: younger acute, older acute, younger chronic, and older chronic. RESULTS: Of the patients, 42 (42.8%) were diagnosed with at least 1 additional pathologic lesion, and 29 (29.5%) required a dedicated additional treatment. Rates of treatment on associated lesions were analyzed: younger versus older groups presented a significant difference, as did younger acute versus older acute groups; SLAP and posterior rotator cuff tear treatments represented 24 of the 35 additional surgeries (68.5%). CONCLUSIONS: The overall rate of associated pathologic lesions requiring additional surgical treatment in patients with ACJ dislocation was 29.5%. Patients aged 45 years or older had a greater risk of presenting with associated lesions that needed to be surgically addressed (odds ratio, 3.01). The overall rates of associated surgical lesions in acute versus chronic cases were not shown to be significantly different. LEVEL OF EVIDENCE: Level IV, prognostic case series.


Assuntos
Articulação Acromioclavicular/lesões , Cabeça do Úmero/lesões , Luxação do Ombro/epidemiologia , Luxação do Ombro/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Traumatismos do Braço/epidemiologia , Traumatismos do Braço/cirurgia , Artroscopia , Doença Crônica , Comorbidade , Feminino , Humanos , Cabeça do Úmero/cirurgia , Incidência , Instabilidade Articular/epidemiologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Manguito Rotador/cirurgia , Lesões do Manguito Rotador , Traumatismos dos Tendões/epidemiologia , Traumatismos dos Tendões/cirurgia , Adulto Jovem
6.
Orthopedics ; 35(9): e1353-7, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22955401

RESUMO

The purpose of this study was to clinically examine the relationship between rotator cable integrity and the presence of pseudoparalysis. A retrospective review was performed of a consecutive series of arthroscopic repairs of massive rotator cuff tears performed between January 2007 and June 2009. A total of 127 massive tears were identified. Group 1 comprised 24 patients with preoperative pseudoparalysis. Group 2 comprised 97 patients (103 repairs) with active forward flexion more than 90°. In group I, no patient maintained integrity of both rotator cable attachments; 1 rotator cable attachment was disrupted in 45.8% of cases; and both rotator cable attachments were disrupted in 54.2% of cases. In group II, both rotator cable attachments were intact in 22.3% of cases; 1 rotator cable attachment was disrupted in 62.1% of cases; and both rotator cable attachments were disrupted in 15.5% of cases. The difference in the distribution of cable attachments between the 2 groups was statistically significant (P<.001). Overall, preoperative pseudoparalysis predicted a disruption of both rotator cables with 88.8% specificity, 44.8% sensitivity, and 77.8% accuracy. Pseudoparalysis requires the disruption of at least 1 rotator cable attachment. This study reinforces the concept of rotator cable integrity and the ability of patients to maintain forward flexion above shoulder level and highlights the importance of reinforcing the rotator cable attachments in the repair of massive rotator cuff tears.


Assuntos
Artroscopia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Lesões do Manguito Rotador , Manguito Rotador/fisiopatologia , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/cirurgia , Humanos , Paralisia/fisiopatologia , Paralisia/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Manguito Rotador/cirurgia , Resultado do Tratamento
7.
Arthroscopy ; 28(11): 1592-600, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22922004

RESUMO

PURPOSE: To determine and propose a systematic approach to evaluating magnetic resonance imaging (MRI) scans for subscapularis tears and compares preoperative MRI interpretations with findings of the same shoulders at arthroscopy. METHODS: The study was composed of 202 patients who underwent shoulder arthroscopy by 1 of 5 orthopaedic surgeons during a 3-month period. All patients had MRI scans performed within 6 months before arthroscopy. RESULTS: Of the 202 patients, 82 had subscapularis tendon tears confirmed at the time of arthroscopy. The orthopaedic surgeons correctly diagnosed 60 of 82 patients (73%) with subscapularis tendon tears on preoperative MRI that were subsequently identified by arthroscopy. The orthopaedic surgeons correctly diagnosed 113 of 120 patients (94%) as not having subscapularis tendon tears. This resulted in an overall sensitivity of 73%, specificity of 94%, positive predictive value of 90%, negative predictive value of 84%, and accuracy of 86%. The frequency of subscapularis tears was highest when the long head of the biceps was displaced from the groove (88%), a combined supraspinatus/infraspinatus tear existed (71%), or the long head of the biceps tendon was torn (69%). CONCLUSIONS: Preoperative MRI scans of the shoulder interpreted by orthopaedic surgeons with the described systematic approach resulted in improved accuracy in diagnosing subscapularis tendon tears compared with previous studies. A consistent finding is that larger subscapularis tendon tears are more easily detected using MRI scans whereas smaller tears are more frequently missed. LEVEL OF EVIDENCE: Level III, development of diagnostic criteria with universally applied reference (nonconsecutive patients).


Assuntos
Lacerações/diagnóstico , Imageamento por Ressonância Magnética , Lesões do Ombro , Ombro/patologia , Traumatismos dos Tendões/diagnóstico , Tendões/patologia , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Manguito Rotador/patologia , Manguito Rotador/cirurgia , Lesões do Manguito Rotador , Sensibilidade e Especificidade , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia
8.
Arthroscopy ; 27(2): 155-60, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20970299

RESUMO

PURPOSE: The purpose of this study was to determine the benefits of a modified rehabilitation protocol (incorporating early closed-chain overhead stretching) in reducing the risk of postoperative stiffness after arthroscopic rotator cuff repair. METHODS: During a 17-month period, we performed primary arthroscopic rotator cuff repairs in 152 patients. After surgery, patients with risk factors identified in the previous study (calcific tendonitis, adhesive capsulitis, PASTA [partial articular surface tendon avulsion]-type rotator cuff repair, concomitant labral repair, or single-tendon cuff repair) were enrolled in a modified rehabilitation protocol that added early overhead closed-chain passive motion exercises to our standard protocol; alternatively, patients without risk factors received a standard conservative rehabilitation program. Historical controls were used and comprised patients in the senior author's practice who all received the conservative rehabilitation protocol. The prevalence of postoperative stiffness was compared between the historical cohort and current study patients by use of Fisher exact tests. RESULTS: Among the 152 patients studied, 79 were positive for at least 1 of the specified risk factors and received the modified protocol. Postoperative stiffness developed in none of the 79 patients enrolled in the modified program. This finding represented a significant improvement (Fisher exact test, P = .004) over the historical controls, in which 18 of the 231 at-risk patients had significant postoperative stiffness develop. CONCLUSIONS: In at-risk patients (with calcific tendonitis, adhesive capsulitis, PASTA repair, concomitant labral repair, and single-tendon repair), a postoperative rehabilitation regimen that incorporates early closed-chain passive overhead motion can reduce the incidence of postoperative stiffness after arthroscopic rotator cuff repair.


Assuntos
Artroscopia/reabilitação , Terapia por Exercício/métodos , Manguito Rotador/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/efeitos adversos , Bursite/etiologia , Bursite/prevenção & controle , Calcinose/etiologia , Calcinose/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Amplitude de Movimento Articular , Fatores de Risco , Tendinopatia/etiologia , Tendinopatia/prevenção & controle , Adulto Jovem
9.
Arthroscopy ; 26(8): 1130-4, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20678713

RESUMO

We present an arthroscopic technique used to identify mid to distal subscapularis tendon disruptions. These tears can be easy to miss and require a thorough arthroscopic evaluation of the medial biceps sling and the medial side wall of the bicipital groove to detect. The arthroscopic procedure is performed with the patient in the lateral decubitus position, and the same portals used for standard subscapularis repair are used for this technique. If a high degree of clinical suspicion exists for subscapularis pathology and no tendon disruption is initially identified, an inspection of the medial biceps sling and medial side wall of the bicipital groove may show mid to distal subscapularis tendon disruptions. A 70 degrees arthroscope is essential in visualizing the medial sling, the subscapularis tendon, the biceps tendon, and the proximal 2 cm of the bicipital groove. Any disruptions or rents in the medial sling or medial side wall are suggestive of a subscapularis tear. Once a tear is identified, we proceed with a biceps tenodesis and then take down the medial sling from the lesser tuberosity to better delineate the subscapularis footprint. The subscapularis may then be repaired in standard fashion.


Assuntos
Artroscopia , Lesões do Ombro , Traumatismos dos Tendões/patologia , Humanos , Articulação do Ombro/patologia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia
10.
Clin Sports Med ; 29(2): 203-11, vii, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20226314

RESUMO

The postoperative rehabilitation program is critical for the successful arthroscopic treatment of rotator cuff injury. The authors' experience has confirmed that the best clinical results (restoration of strength, motion, and relief of pain) following rotator cuff repair are achieved after a durable repair of tendon to bone that heals in its entirety. Therefore, the senior author (SSB) has adopted a customized rehabilitation protocol to optimize postoperative range of motion while maintaining rotator cuff integrity. A customized rehabilitation program that begins closed-chained overhead stretches (table slides) early for groups at risk for developing stiffness and delays overhead stretches for the remaining patients until 6 weeks is best to avoid stiffness without potentially increasing the risk of rerupture in the early postoperative period.


Assuntos
Artroscopia , Complicações Pós-Operatórias/reabilitação , Manguito Rotador/cirurgia , Humanos , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Amplitude de Movimento Articular , Fatores de Risco , Lesões do Manguito Rotador , Resultado do Tratamento , Estados Unidos
11.
Arthroscopy ; 25(11): 1343-8, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19896057

RESUMO

We present a modified arthroscopic technique used to treat anterior shoulder instability associated with mild glenoid bone loss and a large Hill-Sachs lesion. The procedure aims to convert a bony intra-articular defect into an extra-articular defect by insetting the infraspinatus into the Hill-Sachs lesion. The arthroscopic procedure is performed with the patient in the lateral decubitus position, and the same portals used for anterior instability repair are used for this technique. The sequence of steps involves placing and passing the glenoid anchors and sutures and then waiting to tie the anterior sutures until after the humeral suture anchors have been placed. The subacromial bursa is cleared; then 2 transtendon suture anchors are placed in the Hill-Sachs lesion. Next, the previously placed Bankart repair sutures are tied, and finally, the remplissage sutures are tied in the subacromial space over the infraspinatus by use of the transtendon double-pulley technique. This technique uses the eyelets of the 2 suture anchors as pulleys and creates a double-mattress suture.


Assuntos
Artroscopia/métodos , Úmero/lesões , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia , Humanos , Instabilidade Articular/cirurgia , Luxação do Ombro/fisiopatologia , Lesões do Ombro
12.
Clin Orthop Relat Res ; 466(11): 2736-44, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18752032

RESUMO

UNLABELLED: Precise pre- and postoperative anatomic measurements are necessary to plan, perform, and evaluate total knee arthroplasty (TKA). We evaluated the relationship between radiographic and navigation alignment measurements, identified sources of error in radiographic and navigated alignment assessment, and determined the differences between desired and clinically accepted alignment. Fifty-eight computer-assisted TKAs were performed and limb alignment measurements were recorded both pre- and postoperatively with standard radiographs and with an intraoperative navigation system. Intraoperative navigation produced consistent navigation-generated alignment results that were within 1 degrees of the desired alignment. The difference between preoperative radiographic and navigation measurements varied by as much as 12 degrees and the difference between postoperative radiographic and navigation measurements varied by as much as 8 degrees. This discrepancy depended on the degree of limb deformity. Postoperative radiographic measurements have inherent limitations. Navigation can generate precise, accurate, and reproducible alignment measurements. This technology can function as an effective tool for assessing pre- and postoperative limb alignment and relating intraoperative alignment measurements to clinical and functional outcomes. LEVEL OF EVIDENCE: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


Assuntos
Artrografia/métodos , Artroplastia do Joelho/métodos , Articulação do Joelho/diagnóstico por imagem , Monitorização Intraoperatória/métodos , Osteoartrite do Joelho/cirurgia , Cirurgia Assistida por Computador/métodos , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Variações Dependentes do Observador , Osteoartrite do Joelho/diagnóstico por imagem , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
14.
Orthopedics ; 29(10 Suppl): S122-4, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17407936

RESUMO

As participation in sports has increased, so have anterior cruciate ligament (ACL) reconstructions. The procedure is commonly associated with inaccurate tunnel placements, even when performed by experienced surgeons. Computer-assisted surgery may assist in eliminating inconsistent graft tunnels by increasing precision and providing navigation feedback of the surgical field. This study aimed to compare the accuracy of tunnel placements between computer-navigated and manual ACL reconstructions using radiography. Results suggest that the two methods have comparable accuracy but that the use of additional imaging techniques is recommended during tunnel placement evaluation.


Assuntos
Ligamento Cruzado Anterior/cirurgia , Artroscopia/métodos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Cirurgia Assistida por Computador/métodos , Ligamento Cruzado Anterior/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Radiografia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
15.
Clin Orthop Relat Res ; (429): 279-85, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15577499

RESUMO

A paucity of population-based data exist which describe the rapid growth of revision total knee arthroplasties, changes in patient characteristics, or the association of hospital volume with complication rates. We analyzed whether inpatient complications for 2986 revision knee arthroplasties done on patients admitted to 63 hospitals in northern Illinois from 1993-1999 were correlated with volume of revision total knee arthroplasties. Coded complication rates for hospitals with less than seven, seven to 14, or greater than 14 annual procedures were compared using logistic regression to control for clinical and demographic characteristics of patients, hospital teaching status, and the proportion of the hospitals' patients discharged to rehabilitation facilities. Revision total knee arthroplasties increased 59%, and the overall complication rate declined from 9.3% during 1993-1996 to 7.3% during 1997-1999 (p = .04). When compared with the lowest volume hospitals, medium-volume hospitals had higher complication rates, whereas the highest volume hospitals were not significantly different. The absence of volume-outcome effects may be related to the relatively high volume of primary knee arthroplasties done at almost all area hospitals, surgeon group coverage across multiple hospitals, and the small annual number of revision total knee arthroplasties done during these years.


Assuntos
Artroplastia do Joelho/efeitos adversos , Instabilidade Articular/epidemiologia , Prótese do Joelho , Complicações Pós-Operatórias/epidemiologia , Falha de Prótese , Adulto , Distribuição por Idade , Idoso , Artroplastia do Joelho/métodos , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Illinois/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Medição da Dor , Probabilidade , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Sistema de Registros , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Resultado do Tratamento
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