Effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions: a systematic review.

In this study, we aimed to systematically review and critically appraise the available literature concerning the effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions. The 'Preferred Reporting Items for Systematic Reviews and Meta-Analysis' guidelines were followed and the study protocol was registered at the 'International Prospective Register of Systematic Reviews' (CRD42019116099). Six main databases were searched: Embase, LILACS, PubMed, Scopus, The Cochrane Library, and Web of Science. Searches were complemented with three grey literature sources: Google Scholar, ProQuest, and Open Grey. Any reduction measures, compared with preoperative status or other procedures, were considered. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Thirty-one studies were included, of which five were judged with low, 24 with moderate, and two with high risk of bias. Considering surgical approach, 20 studies assessed the decompression and 11 the marsupialisation technique. Most studies considered these techniques as preliminary treatments, followed by enucleation. From 1088 lesions found, most were odontogenic keratocysts (33.8%), followed by unicystic ameloblastomas (21.0%), dentigerous cysts (20.6%), and radicular cysts (8.4%). Large lesions and younger individuals frequently presented more favourable responses to treatment and anatomical location was not associated with lesion reduction overall. The intervention duration generally ranged between one to two years. In conclusion, marsupialisation and decompression were mostly considered as preliminary treatments, followed by enucleation. Lesion reduction was generally considered insufficient for these techniques to be used as definitive therapies, although benefits concerning the diminished invasiveness of the secondary surgery were often proposed.

Does a 6-point scale approach to post-treatment 18F-FDG PET-CT allow to improve response assessment in head and neck squamous cell carcinoma? A multicenter study.

PURPOSE: Response assessment to definitive non-surgical treatment for head and neck squamous cell carcinoma (HNSCC) is centered on the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET-CT) 12 weeks after treatment. The 5-point Hopkins score is the only qualitative system available for standardized reporting, albeit limited by suboptimal positive predictive value (PPV). The aim of our study was to explore the feasibility and assess the diagnostic accuracy of an experimental 6-point scale ("Cuneo score"). METHODS: We performed a retrospective, multicenter study on HNSCC patients who received a curatively-intended, radiation-based treatment. A centralized, independent qualitative evaluation of post-treatment FDG-PET/CT scans was undertaken by 3 experienced nuclear medicine physicians who were blinded to patients' information, clinical data, and all other imaging examinations. Response to treatment was evaluated according to Hopkins, Cuneo, and Deauville criteria. The primary endpoint of the study was to evaluate the PPV of Cuneo score in assessing locoregional control (LRC). We also correlated semi-quantitative metabolic factors as included in PERCIST and EORTC criteria with disease outcome. RESULTS: Out of a total sample of 350 patients from 11 centers, 119 subjects (oropharynx, 57.1%; HPV negative, 73.1%) had baseline and post-treatment FDG-PET/CT scans fully compliant with EANM 1.0 guidelines and were therefore included in our analysis. At a median follow-up of 42 months (range 5-98), the median locoregional control was 35 months (95% CI, 32-43), with a 74.5% 3-year rate. Cuneo score had the highest diagnostic accuracy (76.5%), with a positive predictive value for primary tumor (Tref), nodal disease (Nref), and composite TNref of 42.9%, 100%, and 50%, respectively. A Cuneo score of 5-6 (indicative of residual disease) was associated with poor overall survival at multivariate analysis (HR 6.0; 95% CI, 1.88-19.18; p = 0.002). In addition, nodal progressive disease according to PERCIST criteria was associated with worse LRC (OR for LR failure, 5.65; 95% CI, 1.26-25.46; p = 0.024) and overall survival (OR for death, 4.81; 1.07-21.53; p = 0.04). CONCLUSIONS: In the frame of a strictly blinded methodology for response assessment, the feasibility of Cuneo score was preliminarily validated. Prospective investigations are warranted to further evaluate its reproducibility and diagnostic accuracy.

[Psychosomatic sterility. Search for a hypothesis for personaity structure using Moretti's graphology method]. / Sterilità psicosomatica. Ricerca per una ipotesi di struttura di personalità con la metodologia grafologica morettiana.

Over the past three years the authors have performed a random clinical study on couples who came to the aim of identifying the possible presence, in those cases in which it was not possible to pinpoint an organic or functional etiological factor, of a relationship between personality structure and so-called "sterility sine cause" which according to the recent studies by Pancheri and Zichella on reproductive emotionality, is thought to caused by a factor of psychosomatic origin, The substantiality of the concept of reproductive emotionality, otherwise referred to as sexual instinct, was put forward in 1962 by Padre Gerolamo Moretti, a leading figure of Italian graphology. Research to date, carried out using traditional methods of clinical psychology, interview and tests, in an attempt to determine a particular personality profile, has not produced completely satisfactory results. From the literature it does not appear that graphological analysis has been applied in research of this nature. Graphology, if used by competent and appropriately trained persons, is certainly a powerful and refined diagnostic method which enables an idiographic, holistic and integrated personality profile (intelligence and temperament) tp be obtained for the subject in question. Moretti's temperament classification was used to define the personality structure of patients: assault, resistance, assignment and expectation. Research using graphological techniques has revealed that it is possible to define a personality structure within which suspected "sine cause" patients may be classified. In comparison to the control group, there was a prevalent attitude expressing a tendency to reserve, introversion, diffidence, anxiety, excessive and sometimes unmotivated concern regarding persons and things, attachment to one's own ideas, inflexibility of one's own position, scarce capacity to make oneself available, excessive attention to formal aspects. A number of practical considerations also emerged from the research: the good level of acceptance and compliance with the diagnostic instrument used and the fact that the patient in question does not necessarily have to be present. Due to the ease of obtaining an example of the patient's handwriting, graphological analysis could be outinely requested as the first approach in suspected cases of sterility due to psychosomatic causes.