Update of survival and cost of metastatic melanoma with new drugs: Estimations from the MelBase cohort.

PURPOSE: Since 2011, significant progress was observed in metastatic melanoma (MM), with the commercialisation of seven immunotherapies or targeted therapies, which showed significant improvement in survival. In France, in 2004, the cost of MM was estimated at €1634 per patient; this cost has not been re-estimated since. This study provided an update on survival and cost in real-life clinical practice. METHODS: Clinical and economic data (treatments, hospitalisations, radiotherapy sessions, visits, imaging and biological exams) were extracted from the prospective MelBase cohort, collecting individual data in 955 patients in 26 hospitals, from diagnosis of metastatic disease until death. Survival was estimated by the Kaplan-Meier method. Costs were calculated from the health insurance perspective using French tariffs. For live patients, survival and costs were extrapolated using a multistate model, describing the 5-year course of the disease according to patient prognostic factors and number of treatment lines. RESULTS: Since the availability of new drugs, the mean survival time of MM patients has increased to 23.6 months (95%confidence interval [CI] :21.2;26.6), with 58% of patients receiving a second line of treatment. Mean management costs increased to €269,682 (95%CI:244,196;304,916) per patient. Drugs accounted for 80% of the total cost. CONCLUSION: This study is the first that evaluated the impact of immunotherapies and targeted therapies both on survival and cost in real-life conditions. Alongside the introduction of breakthrough therapies in the first and subsequent lines, MM has been associated with a significant increase in survival but also in costs, raising the question of financial sustainability.

[A long-term 3D cast model analysis focusing bone-borne vs. tooth-borne SARME].

UNLABELLED: This retrospective study evaluated 34 patients pre- and ~20.5 months post expansion 3D scanned cast models with tooth-borne (ТВ, n1=16) and bone-borne (BB, n2=18) devices. Measurements were performed for transverse skeletal/dental maxillary widening, dental tipping and dental attachment loss. RESULTS: T-Test in long-term effects: BB: bigger, symmetric transverse widening along the dental arch; bigger attachment loss in the frontal teeth, canines, 2nd premolars. molars; bigger dental tipping in the canines and 2nd molars; ТВ: asymmetric transverse widening along the dental arch; bigger attachment loss in the 1st premolars: bigger dental tipping in the premolars and 1st molars. CONCLUSION: BB should be used whenever bigger transverse maxillary expansion is required, new distractor designs may reduce segmental inclination and initial expansion asymmetries, consequently, eliminating the related attachment loss from secondary orthodontic tooth movements for arch alignment. ТВ devices showed minor expansion with good periodontal attachment, yet attachment loss in the first premolars must be critically seen in bigger expansion distances.

Piezoosteotomy in orthognathic surgery versus conventional saw and chisel osteotomy.

INTRODUCTION: Piezoosteotomy was assessed as alternative osteotomy method in orthognathic surgery regarding handling, time requirement, nerve and vessel impairment. MATERIALS AND METHODS: In this comparative clinical experience, 90 patient's orthognathic surgery procedures were performed in typical distribution prospectively by piezoosteotomy: 34 (38%) monosegment, 47 (52%) segmented LeFortI osteotomies, 94 (52%) sagittal split osteotomies, 11 (12%) symphyseal, and 4 (2%) mandibular body osteotomies. As controls served 90 retrospective patients with conventional saw and chisel osteotomy: 58 (64%) monosegment, 27 (30%) segmented LeFortI osteotomies, 130 (72%) sagittal split, and 4 (4%) symphyseal osteotomies. RESULTS AND DISCUSSION: Piezoosteotomies were individually designed to interdigitate the jaw segments after repositioning. The pterygomaxillary suture weakened angulated tools; auxiliary chisels were required in 100% of cases for the nasal septum and lateral nasal walls, in 33% for pterygoid processes. The dorsal maxilla as the pterygoid process were easily reduced; 15% mandibular osteotomies required sawing, while the lingual dorsal osteotomy was performed by manual feedback due to limited visibility. Bloodloss decreased from average 537 +/- 208 ml vs. 772 +/- 338 ml (p = 0.0001). Operation time remained unchanged: 223 +/- 70 min vs. 238 +/- 60 min (p = 0.2) for a conventional bimaxillary procedure. Clinical courses and reossification were unobtrusive. Alveolar inferior nerve sensitivity was retained in 98% of the piezoosteotomy collective versus 84% of controls (p = 0.0001) at 3 months postoperative testing. CONCLUSION: Piezoelectric osteotomy did not prolong the operation and reduced blood loss as alveolar nerve impairment. A few patients required additional sawing or chisel. Piezoelectric screw insertion as complex osteotomies may be initiated to simplify the procedure and increase segment interdigitation after repositioning as to minimize the osteofixation time and dimensions.

In-patient versus in vitro degradation of P(L/DL)LA and PLGA.

To assess and compare degradation rates, poly(70L-lactide-co-30DL-lactide) [P(L/DL)LA] and poly(85L-lactide-co-15-glycolide) (PLGA) copolymer degradation were studied in patients (maxillofacial region) and in vitro. Five patients of a total of 20 with 85:15 PLGA osteosyntheses, and 15 of a total of 60 with 70:30 P(L/DL)LA osteosyntheses, (10 females and 10 males, 26-55 years; mean, 33 years) underwent explantations after 3, 6, 9, 12, 18, and 24 months. Identical resorbables immersed in physiological buffer solution at 37 degrees C were compared at identical intervals. P(L/DL)LA's initial average molecular weight of 45,000 decreased to 25,000 in patients (and to 21,000 in vitro) after 6 months, and to 8000 in patients after 18 months. PLGA's average molecular weight decreased from 44,600 to 22,000 after 3 months in patients and in vitro, and to 11,000 in patients and 1300 in vitro at 6 months. In-patient and in vitro glass-transition temperatures decreased from approximately 60 degrees C to 50 degrees C over 18 months. Crystallinity in explants was < or = 4% in P(L/DL)LA throughout testing, and 16% and 30% in PLGA at 6 and 12 months, respectively. Both copolymers decomposed reliably in patients: 85:15 PLGA within 12 months and 70:30 P(L/DL)LA within 24 months on average (p < 0.005), leaving only extremely small granules that powder upon finger touch. In vitro rates were significantly faster (p < 0.005). Crystallinity associated with foreign-body reactions was minor and did not inhibit decomposition.

Analgesia continua de miembro superior por bloqueo de plexo braquial en dolor crónico oncológico / Continuous analgesia of the upper limb with brachial plexus blockade in chronic cancer pain

Objetivo:Evaluar la utilizdad del bloqueo del plexo braquial en eltratamiento del dolor intenso oncológico.Método:Evaluamos en 6 pacientes con metástasis óseas delmiembro superior la efectividad de un bloqueo continuo delplexo braquial.Resultados:Todos los pacientes del estudio tuvieron una evoluciónfavorable y un incremento en la analgesia con el tratamientosin que se produjeran efectos adversos.Conclusiones:La analgesia continua del plexo braquial es un métodoefectivo para el control del dolor del miembro superior pormetástasis

Objective:To assess the effectiveness of brachial plexus blockadefor the management of severe cancer pain.Method:In six patients with upper limb bone metastases, we assessedthe effectiveness of continuous blockade of thebrachial plexus.Results:All the study patients had a favorable evolution andanalgesia increased with the treatment, without side effects.Conclusions:Continuous analgesia of the brachial plexus is an effectivemethod for the management of upper limb pain causedby metastases