Effect of HER2/CEP17 ratio on survival in metastatic HER2-positive gastric cancer, multicenter study.

AIM: HER2-positive metastatic gastric cancer is still a highly fatal disease despite advances. We aimed to investigate the relationship between HER2/CEP17 ratio and survival in patients with HER2-positive metastatic gastric cancer. METHODS: A total of 99 patients from 8 different centers in Turkey were included in the study. Patients with HER2-positive metastatic gastric cancer and whose HER2/CEP17 ratio was examined were included in the study. Patients were divided into two groups according to HER2/CEP17 values, and survival analysis was performed. RESULTS: The median age was 64 (24-83) years. There were 74 (74.8%) male and 25 (25.2%) female patients. OS in the high HER2/CEP17 ratio group was 21.97 months (95% CI: 16.36-27.58), and in the low ratio group was 16.17 months (95% CI: 10.95-21.38) (p = 0.015). OS was 17.7 months (95% CI: 7.02-28.37) in the high HER2 gene copy number group and 10.13 months (5.55-14.71) in the group with low copy number (p = 0.03). PFS was 10.94 months (95% CI: 7.55-14.33) in the group with high HER2 gene copy number and 7.56 months (4.62-10.49) in the low copy number group (p = 0.06). CONCLUSION: Patients with both high HER2 gene amplification and high HER2/CEP17 ratio had better OS. The PFS of the group with high HER2 gene amplification was also better. To our knowledge, this is the first study in the literature showing that the HER2/CEP17 ratio affects survival in patients with metastatic gastric cancer.

Ribociclib-induced visual hallucination in a patient with metastatic breast cancer.

INTRODUCTION: Cyclin-dependent kinase (CDK) 4/6 inhibitors are widely used in combination with aromatase inhibitors or fulvestrant for the treatment of locally advanced or metastatic hormone receptor-positive (HR+), human epidermal growth factor 2-negative (HER2-) breast cancer. Hematological toxicities (e.g. neutropenia, thrombocytopenia, anemia, lymphopenia, or febrile neutropenia), infections, decreased appetite, exhaustion, headache, dizziness, cough, nausea, vomiting, diarrhea, alopecia, rash, increased alanine aminotransferase and aspartate aminotransferase levels, and QT interval prolongation are frequent side effects associated with the use of CDK 4/6 inhibitors. However, to our knowledge, no case of hallucination associated with CDK 4/6 inhibitor use has been described in the English-language literature. CASE REPORT: We report a case of a 72-year-old woman with metastatic breast cancer who developed visual hallucinations after receiving ribociclib, a CDK 4/6 inhibitor, and letrozole for 3 days. Cranial imaging and blood tests did not reveal the cause of the hallucinations. MANAGEMENT AND OUTCOME: The visual hallucinations completely resolved within 4 days after the ribociclib treatment was terminated. The patient received only letrozole for 2 weeks, and ribociclib treatment was restarted 2 weeks later. Visual hallucinations recurred on the third day of treatment, and ribociclib treatment was discontinued again. The patient recovered completely from visual hallucinations 4 days after discontinuation. Subsequently, treatment was continued with letrozole and palbociclib, another CDK 4/6 inhibitor. Hallucinations did not recur during follow-up. DISCUSSION: To our knowledge, this is the first reported case of hallucinations caused by ribociclib; notably, it shows that symptoms may develop in the early stage of treatment.

Evaluation of the adjunctive effect of platelet-rich fibrin to enamel matrix derivative in the treatment of intrabony defects. Six-month results of a randomized, split-mouth, controlled clinical study.

AIM: This study aimed to compare the results obtained with enamel matrix derivative (EMD) and EMD + platelet-rich fibrin (PRF) in the treatment of intrabony defects (IBDs) in chronic periodontitis patients. MATERIALS AND METHODS: Using a split-mouth design, 28 paired IBDs were randomly treated either with EMD or with EMD + PRF. Clinical and radiographic measurements including clinical attachment level (CAL), probing depth (PD), gingival recession (GR), defect depth (DD), defect width (DW) and defect angle (DA) were recorded at baseline (BL) and at six months following therapy. RESULTS: BL clinical and radiographic measurements were similar for EMD and EMD + PRF groups. Although postsurgical measurements revealed significant reduction for PD and CAL in both groups, no intergroup difference was detected. When EMD and EMD + PRF groups were compared, defect fill was not also statistically different. CONCLUSIONS: Both therapies resulted in significant clinical improvement in IBD treatment. Addition of PRF did not improve the clinical and radiographic outcomes.

Effect of ovarian activity on orthodontic tooth movement and gingival crevicular fluid levels of interleukin-1ß and prostaglandin E(2) in cats.

OBJECTIVE: To evaluate whether there is any correlation between ovarian activity and two potent bone-resorbing mediators (prostaglandin E(2) [PGE(2)], interleukin-1ß [IL-1ß]) secreted from the gingival crevicular fluid (GCF) during orthodontic tooth movement. MATERIALS AND METHODS: Eighteen female cats were included in this study. Animals were randomly divided into three groups (estrous, anestrous, and ovariectomized groups), each having six queens. Estrous was induced by administration of 150 IU equine chorionic gonadotropin (eCG) to queens of the estrous group. A closed-coil spring, applied with 80 g of tipping force to the canine, was attached between the maxillary canine and mini-implant. GCF was collected on days 0, 6, and 12 from each cat to examine PGE(2) and IL-1ß during orthodontic tooth movement in cats. The PGE(2) and IL-1ß levels were determined with enzyme-linked immunosorbent assay. RESULTS: There was no significant difference (P > .05) between anestrous and the ovariectomized groups in terms of tooth movement on days 6 and 12 of distalization. In contrast, tooth movement in the estrous group was lower (P < .05) than in the remaining two groups (anestrous and ovariectomized). The mean PGE(2) and IL-1ß levels of the canine teeth of the estrous groups were significantly lower than the remaining two groups on days 6 and 12 (P < .05) of coil spring applications. CONCLUSIONS: These results indicate that ovarian activity can affect orthodontic tooth movement and GCF levels of IL-1ß and PGE(2) in cats.

The relationship of orthodontic treatment need with periodontal status, dental caries, and sociodemographic factors.

The aim of this study was to determine the relationship of orthodontic malocclusion with periodontal status, dental caries, and sociodemographic status. Our study population consisted of a sample of 836 school children (384 male and 452 female, aged 11-14 years). Four experienced orthodontists and two experienced periodontists performed the clinical examinations. The Treatment Priority Index (TPI), Community Periodontal Index of Treatment Needs (CPITN), decayed, missing, filled teeth (DMFT) scores, and a questionnaire that surveyed socio-demographic status of students were used. Spearman's rank correlation coefficients were used to measure the association between variables. TPI scores showed that 36.4% of the students had normal occlusion, while 41.2% had slight, 15.7% had definite, 4% had severe, and 2.7% had very severe malocclusion. TPI values did not show any significant differences between pupils in different age, gender, socioeconomic status groups, and CPITN scores, whereas there was a significant relationship between TPI and DMFT scores. The orthodontic treatment need was not significantly correlated with CPITN or socio-demographic status; however, the correlation coefficient showed a significant relationship between TPI and DMFT scores.

Effects of boric acid on experimental periodontitis and alveolar bone loss in rats.

OBJECTIVE: The goal of the present study was to evaluate the histopathologic and morphometric effects of systemic boric acid in a rat periodontitis model. DESIGN: Twenty-four Wistar rats were divided into three groups of eight animals each: non-ligated (NL), ligature only (LO), and ligature and treated with boric acid (BA) (3mg/kg per day for 11 days). A 4/0 silk suture was placed in a subgingival position around the mandibular first molars; after 11 days the rats were sacrificed, and changes in alveolar bone levels were measured clinically and tissues were histopathologically examined to assess the differences amongst the study groups. RESULTS: The ratio of presence of inflammatory cell infiltration (ICI) and osteoclast number in the LO group was significantly higher than that of the NL and BA groups (p<0.05). The ratio of presence of osteoblastic activity in the LO group was significantly lower than that of the NL and BA groups (p<0.05). Alveolar bone loss was also significantly higher in the LO group compared to the BA and NL groups (p<005). CONCLUSIONS: This study has demonstrated that systemic administration of boric acid reduced periodontal inflammation and alveolar bone loss in periodontal disease in rats.

Periodontal healing of marginal flap versus paramarginal flap in palatally impacted canine surgery: a prospective study.

PURPOSE: The aim of the present study was to compare the influence of 2 mucoperiosteal flaps, marginal and paramarginal, on the periodontal healing of adjacent maxillary teeth after extraction of palatally impacted canines. PATIENTS AND METHODS: Marginal (15 patients) and paramarginal (16 patients) techniques were used to remove palatally impacted canines. The periodontal examination of the adjacent teeth included evaluation of the plaque index, gingival index, probing depth, and clinical crown length preoperatively and at the first, third, and sixth months postoperatively using an individual acrylic stent. RESULTS: No significant differences between the marginal and paramarginal flaps were found with respect to plaque index, gingival index, labial and palatal probing depth, and labial and palatal clinical crown length at all follow-up points. CONCLUSION: The results of our study have shown that the paramarginal flap design is a good alternative to the marginal flap design.

The role of nickel accumulation and epithelial cell proliferation in orthodontic treatment-induced gingival overgrowth.

The aim of this study was to investigate the role of nickel in orthodontic treatment-induced gingival hyperplasia. The nickel concentration in gingival tissues with and without overgrowth, histopathology of gingival overgrowth, and epithelial cell proliferation response to different nickel concentrations were analysed. Ten patients receiving orthodontic therapy (eight females and two males, mean age 15.4 years) were included in the study. Hyperplastic and healthy gingiva samples were collected from the same patients. The amount of nickel in the gingival tissue samples was analysed using the atomic absorption spectrometry technique. The tissues removed from hyperplastic areas during gingivectomy were also used for histological analysis. To analyse the effect of nickel on epithelial cell proliferation, four different nickel concentrations (0.5, 2, 5, and 10 microg) were incubated with keratinocyte cells for 11 days. Mann-Whitney U-test, analysis of variance, and Tukey's test were used in the statistical analyses. The results did not show any difference in nickel concentration between the study and control gingiva tissue samples, but histological analysis demonstrated an increase in epithelial thickness and a significant increase (P = 0.031, 0.02, 0.02) in epithelial cell proliferation in response to low-dose nickel concentrations, with a toxic response to a higher dose. In the limitations of this study, it is plausible that the effect of a continuing low-dose nickel release to epithelium is the initiating factor of gingival overgrowth induced by orthodontic treatment.

Smoking status and smoke-related gingival melanin pigmentation in army recruitments.

This study aimed to define the smoking status and smoke-related gingival melanin pigmentation in army recruitments and was conducted with army recruitments in Sivas. Nine hundred eight subjects were examined. The oral and dental health of those subjects was checked and recorded. The smoking status of the subjects was self-reported and recorded on questionnaires by researchers. The chi2 test and Kruskal-Wallis test were used for statistical analysis. More than one-half of the subjects (54.3%) were primary school graduates and the mean age was 20.2 +/- 0.95 years. The response rate regarding smoking was 100%. Of the respondents, 596 (65.7%) were current smokers, 12 (1.3%) were former smokers, and 300 (33.0%) were never smokers. The gingival melanin pigmentation rate was 27.5% in current smokers and 8.6% in those who never smoked (p = 0.000). Smoking five to nine cigarettes a day appeared to be sufficient to cause gingival melanin pigmentation. The proportion of smokers who had melanin pigmentation did not change after 10 cigarettes a day. A rehabilitation project on smoking prevention and smoking cessation for army recruitments is urgently needed.

Gingival hyperplasia as an early diagnostic oral manifestation in acute monocytic leukemia: a case report.

Acute Myeloblastic Leukemia (AML) is a malignant disease of bone marrow. Due to its high morbidity rate, early diagnosis and appropriate medical therapy is essential. Rapidly forming gingival hyperplasia is usually the first sign of this disease. This case report describes a 17-year-old female who presented rapid gingival overgrowth together with gingival bleeding in only two weeks time. A medical consultation was asked from hematology clinics and after a detailed medical examination Acute Monocytic Leukemia (FAB M5) was rendered. Chemotherapy was the choice of treatment. The patient responded well to chemotherapeutic induction regimen and after two months of medical therapy disease remised and gingival hyperplasia regressed. This case report shows that the gingival hyperplasia may represent an initial manifestation of an underlying systemic disease. Also, early medical therapy in acute monocytic leukemia may resolve the gingival hyperplasia that companies the disease progression.

Periodontal status of chronic renal failure patients receiving hemodialysis.

Host factors such as systemic diseases, genetic polymorphism or drug usage play a major role in the pathogenesis of periodontal disease by modifying the host response to periodontal infection or altering the susceptibility to infection by periodontal organisms. This study was designed to evaluate the clinical response of patients receiving hemodialysis to existing microbial dental plaque. Gingival Index (GI) and Plaque Index (PI) scores and probing depths (PD) were recorded for the entire dentition on 36 chronic renal failure patients receiving hemodialysis (H) and 36 systemically healthy individuals (C), matched with the patient group, based on age and extent of plaque accumulation. No statistically significant difference was observed in the clinical parameters between the two groups (PI: t=1.69 p= 0.096; GI: t=1.057 p=0.294; PD: t=0.01 p=0.99). In the present study, H patients revealed a similar response to existing bacterial plaque and their periodontal status was comparable to that of the control group. Although patients receiving hemodialysis have been suggested to present a certain degree of immunosuppression, based on the findings of the present study chronic renal failure does not seem to be an additional risk factor for more severe periodontal destruction.