Evaluation of two modalities of perioperative treatment in the management of extremity and truncal soft tissue sarcomas: neoadjuvant concurrent chemoradiotherapy and sequential treatment.

PURPOSE: Patients with locally advanced grade 2-3 extremity/truncal soft tissue sarcomas (STS) are at high risk of recurrence. The objective of this study was to assess the efficacy and feasibility of neoadjuvant concurrent chemoradiotherapy (cCRT) in selected grade 2-3 patients with limb or trunk wall STS, and to compare this schedule to a sequential approach combining neoadjuvant chemotherapy and adjuvant radiotherapy. METHODS: We retrospectively included patients who underwent neoadjuvant cCRT at two comprehensive cancer centers from 1992-2016. We then compared these results to those of patients treated with preoperative chemotherapy and postoperative radiotherapy from a third comprehensive cancer center with a propensity score matched analysis. RESULTS: A total of 53 patients were treated by neoadjuvant cCRT; 58 patients could be matched with 29 patients in each treatment group after propensity score matching. Disease-free survival and overall survival at 5 years were 54.9 and 63.5%, respectively with neoadjuvant cCRT, with no significant difference when compared to the sequential treatment group. R0 resection rate was higher (90.9 vs 44.8%, p < 0.01) in the cCRT group than in the sequential treatment group during a shorter therapeutic sequence (118 vs 210.5 days, p < 0.01), with no impact on the surgical procedure or postoperative complications. CONCLUSION: cCRT is feasible with acceptable immediate and late toxicities. It could facilitate surgery by increasing the R0 resection rate and improve patient compliance by shortening the therapeutic sequence.

[Blood-injection-injury phobia: Physochophysiological and therapeutical specificities]. / La phobie du sang-injection-accident : spécificités psychophysiologiques et thérapeutiques.

INTRODUCTION: Seventy-five percent of patients with blood-injection-injury phobia (BII-phobia) report a history of fainting in response to phobic stimuli. This specificity may lead to medical conditions remaining undiagnosed and untreated, incurring considerable cost for the individual and society. The psychophysiology of BII-phobia remains poorly understood and the literature on effective treatments has been fairly sparse. Aims of the systematic review: to synthesize the psychophysiology of BII-phobia and to propose a systematic review of the literature on effectiveness of different treatments evaluated in this indication. RESULTS: Firstly, the most distinct feature of the psychophysiology of BII-phobia is its culmination in a vasovagal syncope, which has been described as biphasic. The initial phase involves a sympathetic activation as is typically expected from fear responses of the fight-flight type. The second phase is characterized by a parasympathetic activation leading to fainting, which is associated with disgust. Subjects with syncope related to BII-phobia have an underlying autonomic dysregulation predisposing them to neurally mediated syncope, even in the absence of any blood or injury stimulus. Many studies report that BII-phobic individuals have a higher level of disgust sensitivity than individuals without any phobia. Secondly, behavioral psychotherapy techniques such as exposure only, applied relaxation, applied tension, and tension only, have demonstrated efficacy with no significant difference between all these techniques. The disgust induction has not improved effectiveness of exposure. CONCLUSION: We have explained the psychophysiology of BII-phobia, the understanding of which is required to study and validate specific techniques, in order to improve the prognosis of this disorder, which is a public health issue.

Effects of surface treatment on the free surface energy of dentin.

OBJECTIVES: The purpose of this study was to evaluate the influence of six treatments on the dispersive, acid, and base components of the free surface energy of dentin. METHODS: Occlusal dentin surfaces were polished with 4000 grit abrasive paper, washed and air dried. Characteristics of the surface energy were calculated by measuring contact angles of the four following liquids:alpha-bromonaphtalene, glycerol, ethylene glycol, and water. The dentin was then treated with aqueous solutions containing: (1) oxalic acid and glycine (OX/GLY),(2) oxalic acid, glycine, and HEMA (OX/GLY/HEMA), (3) phosphoric acid (PA), (4) maleic acid (MA),(5) EDTA, or (6) NaCIO. After treatment, washing and air drying, the energy characteristics of the samples were evaluated again. RESULTS: Three kinds of wetting behavior were observed: an increase (OX/GLY/HEMA), a stabilization (PA, NaCIO) or a decrease (OX/GLY, MA, EDTA) of the wettability of the dentin surface. The calculations demonstrated that dentin surfaces are basic. SIGNIFICANCE: This study of the evolution of the surface energy components gave information on adhesion mechanisms involving hydrophilic and hydrophobic interactions. The results may be helpful in the formulation of conditioners and primers.

Bonding of luting materials for resin-bonded bridges: clinical relevance of in vitro tests.

A retrospective clinical study on 78 resin-bonded bridges placed between 1981 and 1992 was used to validate the wedge test in the assessment of the bonding of resin-based luting material. According to the correlation obtained between the findings of the in vivo and the in vitro studies, the wedge test may be considered to be predictive of the clinical performance of resin bonds. The life expectancy of resin-bonded bridges bonded with the 4 META containing material tested appears to be longer than that for bridges bonded with conventional resin cements.