Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study.

OBJECTIVES: The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period. METHODS AND MATERIALS: Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits. RESULTS: There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner. CONCLUSIONS: After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.

[Axillary management in breast cancer: The French practice versus recommendations in the post-2011 era]. / Ganglion sentinelle et curage axillaire dans le cancer du sein : la pratique française face aux recommandations à l'ère post-2011.

OBJECTIVES: Today, according to St-Gallen and ASCO clinical guidelines, axillary lymph node dissection (ALND) should be avoided in patients who meet the ACOSOG Z011 criteria. In French guidelines, ALND is still recommended in case of macrometastasis in sentinel lymph node (SLN) and in case of micrometastasis without systemic treatment. We performed a survey of the French practices in the management of the axilla. MATERIAL AND METHODS: A questionnaire was sent to 454 breast surgeons between June 2014 and January 2015. Questionnaire included items about: indications of SLN biopsy, frequency of ALND in case of metastatic SLN and modality of radiotherapy in case of metastatic SLN without ALND. RESULTS: A total of 169 surgeons (37%) answer the questionnaire. Twenty-one percent of surgeons avoid ALND in case of macrometastasis. Thirty-two percent do not perform extemporaneous examination of SLN. Only 8.4% of practionners performed a SLN biopsy after neoadjuvant chemotherapy. Fourteen percent performed a SLN biopsy in case of multicentric tumors, while it is not recommended. In case of positive SLN without ALND completion, radiotherapy does not change in 34% while irradiation fields are expanded in 44%. CONCLUSIONS: Significant unconformities are observed towards national recommendations. The divergence between French and international guidelines leads to heterogeneous surgical practices.

The pro-apoptotic activity of Drosophila Rbf1 involves dE2F2-dependent downregulation of diap1 and buffy mRNA.

The retinoblastoma gene, rb, ensures at least its tumor suppressor function by inhibiting cell proliferation. Its role in apoptosis is more complex and less described than its role in cell cycle regulation. Rbf1, the Drosophila homolog of Rb, has been found to be pro-apoptotic in proliferative tissue. However, the way it induces apoptosis at the molecular level is still unknown. To decipher this mechanism, we induced rbf1 expression in wing proliferative tissue. We found that Rbf1-induced apoptosis depends on dE2F2/dDP heterodimer, whereas dE2F1 transcriptional activity is not required. Furthermore, we highlight that Rbf1 and dE2F2 downregulate two major anti-apoptotic genes in Drosophila: buffy, an anti-apoptotic member of Bcl-2 family and diap1, a gene encoding a caspase inhibitor. On the one hand, Rbf1/dE2F2 repress buffy at the transcriptional level, which contributes to cell death. On the other hand, Rbf1 and dE2F2 upregulate how expression. How is a RNA binding protein involved in diap1 mRNA degradation. By this way, Rbf1 downregulates diap1 at a post-transcriptional level. Moreover, we show that the dREAM complex has a part in these transcriptional regulations. Taken together, these data show that Rbf1, in cooperation with dE2F2 and some members of the dREAM complex, can downregulate the anti-apoptotic genes buffy and diap1, and thus promote cell death in a proliferative tissue.

Insertion kinetics of small nucleotides through single walled carbon nanotube.

We report molecular dynamic simulations showing that a DNA molecule constituted by five unique bases can be spontaneously inserted into single walled carbon nanotube (SWCNT) in normal conditions (P, T and water environment) depending on the tube radius value. The van der Waals and electrostatic interactions play a central role for the rapid insertion process. Our study shows also that the Guanine molecule inserts the fastest compared to thymine, adenine and cytosine bases, respectively. The differences of insertion time could be exploited for applications concerning for example DNA sequencing.

U-shaped free jejunal transplantation: improved technique and indications.

Reconstruction of the oropharynx and the hypopharynx is difficult due to their wide diameters. We report eight cases of circumferential pharyngolaryngectomies for epidermoid carcinomas of the hypopharynx extended to the oropharynx and classified T4. Reconstruction was performed with a U-shaped free jejunal transplantation. This specific technique consists of a side to side anastomosis between two loops of jejunum. It facilitates reconstruction at the level of the oropharynx and diminishes postoperative complications.

Efficacy of low doses of radioiodine in the treatment of autonomous thyroid nodules: importance of dose/area ratio.

Radioiodine (131I) represents an interesting alternative to surgery in the treatment of autonomously functioning thyroid nodules (AFTN), but leads to a significant incidence of hypothyroidism when high doses are used. Over 4 years, we have treated 40 patients (hyperthyroid [Plummer's disease]: 6, single hot nodules with undetectable thyrotropin [TSH] and normal serum free thyroxine [FT4]: 34), 34 single hot nodules with undetectable thyrotropin TSH and normal serum free thyroxine [FT4] with 131I. The dose level was neither related to the concentration of FT4 nor to the iodine uptake on thyroid scintigram. Retrospectively we measured the nodule's area on the scan and calculated the dose/area ratio (DAR). Three months after treatment, 30 patients were euthyroid, 9 were still hyperthyroid, and 1 was hypothyroid. The mean DAR of the euthyroid patients was twofold higher than for the hyperthyroid subjects (1.4 +/- 0.8 vs. 0.7 +/- 0.3 mCi/cm2; p = .003) and one-half the DAR for the hypothyroid patient (2.82 mCi/cm2). Twenty of the 30 euthyroid patients had received a dose higher than 1 mCi/cm2 and 7 of 9 hyperthyroid patients had received a dose lower than 1 mCi/cm2. (chi2 = 12.9; p = .02). The initial values of T4, TSH, and dose level of patients who were euthyroid or hyperthyroid at 3 months were not different. These data suggest that the efficacy of 131I for treating AFTN depends on the DAR, rather than the initial T4 value or the 131I uptake. A DAR between 1 and 1.5 mCi/cm2 seems to be optimal and avoids hypothyroidism.

[Study of variations of osteocalcin concentrations in function of collection, assay method and its nyctohemeral rhythm]. / Etude des variations de concentrations de l'ostéocalcine en fonction du mode de prélèvement, de la méthode de dosage et de son cycle nycthéméral.

Osteocalcin or bone GLA protein (BGP) can be used as well as a peripheral marker of the action of hormones on osteoblast. In the present study, we report our clinical and biological results in three different conditions: the kits used for determination, the time and the hour of withdrawal. We used 4 different radioimmunoassay kits: two kits (Elsa-os-nat (cis), Osca-test (Henning)) detect intact osteocalcin molecules only and the two others (Elsa-osteo(cis), Ostk-PR(cis)) detect intact osteocalcin molecules and osteocalcin fragments. Time between collection and assay is important: we observed a diminution of osteocalcin level which can be due to the degradation of intact molecules, of 25% to 49% (depending on the kit used). The clinical profile was studied with circadian rhythm. We observed a variation of osteocalcin level in 30% of circadian rhythm according to the hour of collection sample. In conclusion, we have seen two differents situations at risk of wrong interpretation due to low level BGP: inadequate serum collection or single blood collection instead of circadian cycle.

[Reoperation of tumors of the parotid gland, surgical approach and consequences for the 7th cranial nerve. Apropos of 42 cases]. / Reprises chirurgicales des tumeurs de la parotide, approche technique et conséquences pour le VII. A propos de 42 cas.

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends on the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

[Reoperation of tumors of the parotid gland. Technical approach and consequences for the 7th cranial nerve. Apropos of 22 cases]. / Reprises chirurgicales des tumeurs de la parotide approche technique et conséquences pour le VII. A propos de 42 cas.

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends of the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial histological diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

[Parotid tumors of intermediate malignancy. Prognostic assessment. Review of the literature]. / Tumeurs parotidiennes à malignité intermédiaire. Appréciation pronostique. Mise au point bibliographique.

In 264 patients operated at Hôpital Boucicault for neoplasma of the parotid gland, 9 presented mucoepidermoid carcinoma and 4 had acinic cell adenocarcinoma. These latter 13 cases of intermediate malignancy tumors were assessed, although the retrospective follow-up period was insufficient to formulate an estimate on the survival rate of these patients. The authors further review the bibliographical data useful in evaluating the prognosis for such neoplasia. They stress the controversy existing around opinions concerning histology-based prognosis and recent advance on nuclear DNA. Indications for postoperative radiotherapy is discussed.

[Echography in studying the hyothyroepiglottic space. Normal image. Pathologic aspects. Histologic correlations]. / Apport de l'échographie dans l'étude de la loge hyo-thyro-épiglottique. Image normale. Aspects pathologiques. Confrontations histologiques.

Invasion of the hyothyroepiglottic (HTE) space, or pre-epiglottic space, constitutes an important element in selecting the type of therapy in cancer of the larynx (functional surgery, radiotherapy), the oropharynx and the hypopharynx. Clinical examination and standard X-ray films provide insufficient information. High frequency real time ultrasonography offers a reliable means for exploring the pre-epiglottic space, as evidenced by this study carried on 34 histologically-confirmed cases taken among 77 cases of carcinoma of the upper digestive and respiratory tracts. Advantages presented by this method over CT-scanning and MR imaging in this particular pathological are simplicity, rapidity and low cost, combined with good performance.

[Complete tumor remission after chemotherapy. What should be done?]. / Les régressions tumorales complètes après chimiothérapie. Que faire?

When confronted with complete chemotherapy-induced histological/clinical regression of a tumor, should the initial therapeutical strategy be modified? Such situations occur more and more frequently. Additional treatment must be carried out in all instances. Indeed, a correlation between complete clinical and histological regression was demonstrated in 66% of cases by histological examination of surgical specimens. It is doubtless recommended to avoid mutilating surgery and to continue chemotherapy for another year. However, whenever partial surgery had been programmed initially, the same indications and excision limits should be maintained. Combination chemical and surgical treatments yield better local results. Nonetheless, this is not always the case and the patient's tolerance to chemotherapy and background should influence the final decision. Radiotherapy then constitutes a choice alternative.

[Malignant midline granuloma, diagnostic and therapeutic problems]. / Granulome malin centro-facial, problèmes diagnostiques et thérapeutiques.

This is an analysis of 4 patients with suspicion of centro-facial granulomatosis. Diagnosis is difficult, mainly based upon clinical data, without precise histopathological presentation. The main differential diagnosis is Wegener's granulomatosis. The etiology of centrofacial granulomatosis is still unknown but multiple theories have been proposed: systemic disease, lymphoma. In one case, the initial histopathological diagnosis was undifferentiated carcinoma and the patient received chemotherapy (i.e., Adriamycin, Vincristine, Bleomycin and Steroids). A complete response was achieved. The interest of chemotherapy in the treatment of centro-facial granulomatosis is discussed.

[The Chinese flap in reconstructing the posterior pharyngolaryngeal wall, mouth cavity and in reoperation after failure of pedicled digestive transfer]. / De l'intérêt du lambeau chinois dans la reconstruction de la paroi pharyngo-laryngée postérieure, de la cavité buccale et dans la chirurgie de rattrapage après échec de transfert digestif pédiculé.

The Chinese flap has already been recommended in the context of circular pharyngolaryngectomy. The authors studied its vascularization from an anatomy-focusing project carried out on 40 dissection cases. They broaden the applications of this material to posterior reconstructive pharyngectomy, for which they specify the methods and routes of access. Other applications are proposed: this flap may represent an alternative for reconstitution of the oral cavity, or even as a second-intent surgical procedure where other technics have failed.

[Study of the hyo-thyro-epiglottic space by ultrasonography]. / Exploration de la loge hyo-thyro-épiglottique par échographie ultrasonore.

The pre-epiglottic space is located superficially at the junction of the larynx, oropharynx and hypopharynx. When it is invaded by a neighbouring cancer, the latter rises to stages 3 or 4 of the TNM classification. The space is explorable by percutaneous ultrasonic scanning of the neck. The present paper gives the first description of the normal sonographic anatomy of the pre-epiglottic space, based on 16 healthy volunteers. It also gives the first description of invasion of that space, based on 18 patients operated upon for ENT (ear, nose and throat) cancers. In 5 of these 18 patients, invasion of the pre-epiglottic space was proven at histology. There were 3 positive and no false negative results, but 3 false positive results were obtained at the beginning of the series. The accuracy of ultrasounds in this study was 83 per cent.

[Tympanic reconstruction by molded grafts. Value and results. Apropos of experience in 158 cases]. / Reconstitution tympanique par greffes moulées. Intérêt et résultats. A propos d'une expérience de 158 cas.

Use of a moulded aponeurotic graft, shapened and then made rigid by heat and formalin, is a seductive method of tympanic reconstruction because of its simplicity and availability. Indications for and results of the application of this method are analyzed based on experience of 158 cases, with sufficient follow up in 90. The principal indication for use is large perforations, when it is possible to exteriorize the whole canal and almost all the tympanic remains, while doubt exists as to its advantages for treatment of small perforations. Its essential advantage is in fact the ease with which the graft can be positioned on external surface of malleus and inside the remains of tympanic membrane. Overall anatomical results were very satisfactory (83.5%) if one includes in failures of treatment the apparent lateralizations of graft. Functional results were poorer, with rarely complete recovery of hearing and a certain number of labyrinthizations possibly due to injury to handle of malleus or even perforation of canal. Secondary degradation of favorable results may develop because of some degree of lateralization of the newly formed tympanic membrane. These could perhaps be avoided by the technical artifices proposed by other authors.