Periodontal phenotype modification in orthodontic patients.

OBJECTIVE: The purpose of this study was to assess the feasibility of phenotype modification in orthodontic patients using combined bone and soft tissue grafting substitutes. CLINICAL CONSIDERATION: The surgical procedure was conducted on 18 patients (3 males, 15 females). Periodontal phenotype modification was conducted using demineralized freeze-dried bone allograft and a xenogeneic collagen matrix. The following parameters were recorded for each tooth at baseline and 12-month follow-up: O'Leary plaque index (PI), probing depth (PD), bleeding on probing (BOP), gingival thickness (GT), keratinized tissue width (KTW), gingival recession (GR), and vestibular depth (VD). The results showed a statistically significant increase in GT (2.02 ± 0.39 mm), KTW (1.11 ± 0.82 mm), and VD (0.18 ± 1.16 mm) (p < 0.05). GR was also significantly decreased (1.02 ± 0.99 mm) (p < 0.05). CONCLUSION: Within the limitation of this study, the proposed approach enhanced the periodontal condition in orthodontic patients. However, further studies with a larger sample size are needed to ensure long-term stability. CLINICAL SIGNIFICANCE: Hard and soft tissue conditions have paramount importance for long-term periodontal stability. Phenotype modification in orthodontic patients can diminish the probability of adverse consequences and result in optimal esthetic outcomes. The proposed technique using combined bone and soft tissue substitutes indicated promising results and could be recommended in orthodontic patients with thin periodontal phenotypes.

Mutations Increasing Cofactor Affinity, Improve Stability and Activity of a Baeyer-Villiger Monooxygenase.

The typically low thermodynamic and kinetic stability of enzymes is a bottleneck for their application in industrial synthesis. Baeyer-Villiger monooxygenases, which oxidize ketones to lactones using aerial oxygen, among other activities, suffer particularly from these instabilities. Previous efforts in protein engineering have increased thermodynamic stability but at the price of decreased activity. Here, we solved this trade-off by introducing mutations in a cyclohexanone monooxygenase from Acinetobacter sp., guided by a combination of rational and structure-guided consensus approaches. We developed variants with improved activity (1.5- to 2.5-fold) and increased thermodynamic (+5 °C T m) and kinetic stability (8-fold). Our analysis revealed a crucial position in the cofactor binding domain, responsible for an 11-fold increase in affinity to the flavin cofactor, and explained using MD simulations. This gain in affinity was compatible with other mutations. While our study focused on a particular model enzyme, previous studies indicate that these findings are plausibly applicable to other BVMOs, and possibly to other flavin-dependent monooxygenases. These new design principles can inform the development of industrially robust, flavin-dependent biocatalysts for various oxidations.

Lingual Foramen of the Mandible on Cone-Beam Computed Tomography Scans: A Study of Anatomical Variations in an Iranian Population.

Objectives: Lingual foramen (LF) is an important landmark of the mandible, which should be considered in presurgical assessment. The purpose of this study was to assess the anatomical variations of the LF using cone-beam computed tomography (CBCT). Materials and Methods: The study was conducted on 200 CBCT scans of Iranian adults. The lingual foramina (LFs) were classified into two groups by their location in the mandible namely the medial LFs (MLFs) and the lateral LFs (LLFs). The frequency of both the MLFs and the LLFs and their distance from the inferior border of the mandible were evaluated. Additionally, the diameter of the MLFs and the location of the LLFs were assessed. Data were analyzed separately for males and females. Results: All 200 participants had at least one LF. Totally, 257 LFs were detected on 200 CBCT scans, including 223 MLFs (86.6%) and 34 LLFs (13.3%). The LLF was detected in 23 patients (11.5%). The prevalence of the LLF was higher in males and in the second premolar region. The diameter of the MLFs was less than 1mm in 81% of the cases, and males had a larger MLF. Conclusion: There was a significant variability in the anatomy and location of the mandibular LF in Iranian adults. CBCT is recommended for preoperative imaging to determine the exact location and size of the LFs in the mandible to prevent possible surgical complications.

Investigation of a New Type†I Baeyer-Villiger Monooxygenase from Amycolatopsis thermoflava Revealed High Thermodynamic but Limited Kinetic Stability.

Baeyer-Villiger monooxygenases (BVMOs) are remarkable biocatalysts, but, due to their low stability, their application in industry is hampered. Thus, there is a high demand to expand on the diversity and increase the stability of this class of enzyme. Starting from a known thermostable BVMO sequence from Thermocrispum municipale (TmCHMO), a novel BVMO from Amycolaptosis thermoflava (BVMOFlava ), which was successfully expressed in Escherichia coli BL21(DE3), was identified. The activity and stability of the purified enzyme was investigated and the substrate profile for structurally different cyclohexanones and cyclobutanones was assigned. The enzyme showed a lower activity than that of cyclohexanone monooxygenase (CHMOAcineto ) from Acinetobacter sp., as the prototype BVMO, but indicated higher kinetic stability by showing a twofold longer half-life at 30 °C. The thermodynamic stability, as represented by the melting temperature, resulted in a Tm value of 53.1 °C for BVMOFlava , which was comparable to the Tm of TmCHMO (ΔTm =1 °C) and significantly higher than the Tm value for CHMOAcineto ((ΔTm =14.6 °C)). A strong deviation between the thermodynamic and kinetic stabilities of BVMOFlava was observed; this might have a major impact on future enzyme discovery for BVMOs and their synthetic applications.

[Solitary bone plasmocytoma: Experience from the radiotherapy department at Mohammed-V military teaching hospital in Rabat (Morocco)]. / Plasmocytome solitaire osseux : expérience du service de radiothérapie de l'hôpital militaire d'instruction Mohammed-V de Rabat (Maroc).

PURPOSE: The primary objective was to determine in our department the progression-free survival rate of patients with solitary bone plasmocytoma and secondarily to evaluate its diagnostic, therapeutic and evolutionary aspects. PATIENTS AND METHODS: This is a retrospective review of 12 patients monitored and treated in the radiotherapy department of the Mohammed-V military medical teaching hospital in Rabat for a solitary bone plasmocytoma between January 2012 and December 2018. The average age of our patients were 53.8 years old (range: 31-72 years old). Pain was the most common telltale sign. The site of the lesions was spinal in four cases, iliac in four cases, mandibular, ribal, humeral and at the level of the astragalus in one case respectively. All patients received radiotherapy. This irradiation was delivered alone in 60% of cases or associated with surgery in 40% of cases. The average dose of radiotherapy was 47.3Gy (range: 45 to 50.4Gy) and this was delivered by a modulated volumetric arc therapy technique in ten patients and conformal tridimensional radiotherapy in two patients. RESULTS: Local control, defined by stability or radiological regression, was obtained in ten patients and four patients progressed to multiple myeloma, two of whom died. The average duration of follow-up was 51 months. CONCLUSION: Radiation therapy is the standard treatment for solitary bone plasmocytoma. It ensures good local control in 90% of cases. The prognosis is affected by progression to multiple myeloma, which justifies rigorous monitoring after treatment and suggests a reflection on the exact place of chemotherapy.

Morpholine-based buffers activate aerobic photobiocatalysis via spin correlated ion pair formation.

The use of enzymes for synthetic applications is a powerful and environmentally-benign approach to increase molecular complexity. Oxidoreductases selectively introduce oxygen and hydrogen atoms into myriad substrates, catalyzing the synthesis of chemical and pharmaceutical building blocks for chemical production. However, broader application of this class of enzymes is limited by the requirements of expensive cofactors and low operational stability. Herein, we show that morpholine-based buffers, especially 3-(N-morpholino)propanesulfonic acid (MOPS), promote photoinduced flavoenzyme-catalyzed asymmetric redox transformations by regenerating the flavin cofactor via sacrificial electron donation and by increasing the operational stability of flavin-dependent oxidoreductases. The stabilization of the active forms of flavin by MOPS via formation of the spin correlated ion pair 3[flavin˙--MOPS˙+] ensemble reduces the formation of hydrogen peroxide, circumventing the oxygen dilemma under aerobic conditions detrimental to fragile enzymes.

Manipulating the stereoselectivity of the thermostable Baeyer-Villiger monooxygenase TmCHMO by directed evolution.

Baeyer-Villiger monooxygenases (BVMOs) and evolved mutants have been shown to be excellent biocatalysts in many stereoselective Baeyer-Villiger transformations, but industrial applications are rare which is partly due to the insufficient thermostability of BVMOs under operating conditions. In the present study, the substrate scope of the recently discovered thermally stable BVMO, TmCHMO from Thermocrispum municipale, was studied. This revealed that the wild-type (WT) enzyme catalyzes the oxidation of a variety of structurally different ketones with notable activity and enantioselectivity, including the desymmetrization of 4-methylcyclohexanone (99% ee, S). In order to induce the reversal of enantioselectivity of this reaction as well as the transformations of other substrates, directed evolution based on iterative saturation mutagenesis (ISM) was applied, leading to (R)-selectivity (94% ee) without affecting the thermostability of the biocatalyst.

Radiotherapy of nasopharyngeal cancer using Rapidarc: dosimetric study of military teaching hospital Mohamed V, Morocco.

BACKGROUND: The aim of the present study is to assess efficacy and efficiency of Volumetric-modulated arc therapy (VMAT) technique in treatment of nasopharyngeal cancer in our institution and to report toxicity related to this technique. METHODS: Between June 2013 and January 2015, thirty-two patients with non metastatic nasopharyngeal cancer were curatively treated using VMAT Rapidarc. Dose prescription was performed using two different schedules, it consisted of either simultaneous integrated boost or simultaneous modulated accelerated radiation therapy delivering 70 Gy in 35 fractions and 69.96 in 33 fractions respectively. The choice was leaved at the discretion of the treating physician. The optimization process was performed by Eclipse software version 10.0 (Varian Medical Systems), using PRO algorithm (Progressive resolutive optimisation) version 3. Data was collected from dose-volume histograms for both planning target volumes (PTV) and organs at risk (OAR). We calculated the homogeneity index and the conformity index as well as the number of monitor units MU and the treatment delivery time. We also reported acute and late toxicity related to radiation therapy. RESULTS: For the PTV high risk (HR), intermediate risk (PTV IR) and low risk (LR) the D95% was 97.21 ± 1.5, 97.5 ± 3.3 and 97.10 ± 6.86 respectively. Whereas, The D5% was 104.6 ± 2.16, 103.8 ± 2.1 and 100.89 ± 7.26. The CI for PTV HR was 0.98 ± 0.02 and the HI was 0.08 ± 0.02. The mean treatment delivery time was 2.3 ± 0.2, and the mean MU number was 527.6 ± 131.4. Grade 4 toxicity was not reported in any case. Grade 3 xerostomia was observed in only 3(9.4%) patients and no patients developed grade 3 hearing loss. CONCLUSION: Our results confirmed the abilities of VMAT to provide excellent coverage of target volumes while sparing OAR especially the nervous structures and salivary glands.

Sarcoidosis mediastínica imitando recidiva de cáncer linfático tras tratamiento antineoplásico / Mediastinal sarcoidosis mimicking lymph malignancy recurrence after anti-neoplastic therapy

El objetivo de este trabajo es concienciar sobre el desarrollo de sarcoidosis tras el tratamiento antineoplásico para evitar errores de diagnóstico con los estudios de FDG-PET/CT. Se presentan los casos de 3 mujeres tratados de cáncer de mama, cuello uterino y estómago, que desarrollaron sarcoidosis al finalizar el tratamiento antineoplásico. La utilidad del FDG-PET/CT está en la localización de órganos candidatos a biopsia diagnóstica, pero no sirve para distinguir un tumor maligno y lesiones inflamatorias o granulomatosas

The aim of our work is to promote the awareness about the development of sarcoidosis after antineoplastic therapy in order to avoid diagnostic errors with FDG-PET/CT findings. We report the observation of three women with breast, cervix and stomach treated cancers who developed a sarcoidosis after the end of anti-neoplastic therapy. The utility of FDG-PET/CT is in pinpointing the organs candidates for diagnostic biopsy and not distinguishing between the malignancy and granulomatous or inflammatory diseases

Diagnostic, therapeutic and evolutionary characteristics of cervical cancer in Department of Radiotherapy, Mohamed V Military Hospital - Rabat in Morocco.

BACKGROUND: Cancer of uterine cervix is the second most common cause of cancer related deaths among women. The aim of this study is to report the experience of Military Hospital Mohamed V in the management of cervical cancer and their results. METHODS: All cervical cancer managed at the radiotherapy department of Military Hospital Mohamed V between January 2005 and February 2010, were included for investigation of their demographic, histological, therapeutic and follow-up characteristics. Of the 162 cases managed, 151 (93.2 %) cases were treated in our department. RESULTS: In our study the median age was 51.5 years (33-82). The median duration of symptoms before diagnosis was four [3, 7] months. The major presenting complaints were abnormal vaginal bleeding (89.8 %). Squamous cell carcinoma cervix was seen in 86.2 % (n = 137), adenocarcinoma in 11.3 % (n = 18) and adenosquamous carcinoma in 2.4 % (n = 4). One hundred seventeen (84.8 %) cases were seen at late stage. An abdominal and pelvic computed tomography (CT) scan was performed in 34.6 % (n = 56) of cases, magnetic resonance imaging (MRI) in 62.9 % (n = 102). The pelvic lymph nodes were achieved in 16.6 % of cases. Over half of patients 58.3 % (n = 88) were treated with a combination of external beam radiation therapy (EBRT) and a concurrent cisplatin based chemotherapy (40 mg /m2 weekly). With a mean of 51.6 months (2 to 109), we recorded 19 (12.6 %) pelvic relapse and 15 (9.9 %) metastases. The median time to onset was 19.4 months (2-84 months). The local control rate was 63.6 % (n = 96) and 21 (13.9 %) patients were lost to follow-up. The overall survival (OS) at 3 years and 5 years was respectively 78.3 % and 73.6 % and the relapse-free survival (RFS) was respectively 80 % and 77.2 %. CONCLUSION: Most of cervical cancer patients in Morocco are seen at late stage necessitating referral for radiotherapy, chemotherapy or palliative care. This may reflect lack of cervical screening in order to early detect and treat pre-malignant disease stage.

Mediastinal sarcoidosis mimicking lymph malignancy recurrence after anti-neoplastic therapy.

The aim of our work is to promote the awareness about the development of sarcoidosis after antineoplastic therapy in order to avoid diagnostic errors with FDG-PET/CT findings. We report the observation of three women with breast, cervix and stomach treated cancers who developed a sarcoidosis after the end of anti-neoplastic therapy. The utility of FDG-PET/CT is in pinpointing the organs candidates for diagnostic biopsy and not distinguishing between the malignancy and granulomatous or inflammatory diseases.

Incidents and complications of permanent venous central access systems: a series of 1,460 cases.

BACKGROUND: Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. METHODS: Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. RESULTS: About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication. CONCLUSION: PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.

Primary adenoid cystic carcinoma of the trachea: a report of two cases and literature review.

Adenoid cystic carcinoma (ACC) of the trachea is rare, it represents 1% of all respiratory tract cancers. It's generally considered as a slow-growing, with pronlonged clinical course. Most patients present with dyspnea, and the symptoms often mimic those of asthma or chronic bronchitis Surgical resection is the mainstay of treatment often combined to radiotherapy because of close surgical margins. When surgery isn't possible, most tumors respond to radiotherapy alone wich often results in long periods of remission We report two cases of primary ACC of trachea: a 49 year old male presented a distal unresectable tracheal ACC treated with chemo-radiotherapy who developed a recurrence and died 7 years after the diagnosis. And a 50 years old female with a proximal tracheal tumor treated by surgical resection and end- to- end anastomosis followed by adjuvant radiotherapy. At 10 months follow-up, our patient shows no evidence of disease with negative histological findings.

Secondary gliosarcoma after the treatment of primary glioblastoma multiforme.

CONTEXT: Gliosarcoma is a rare variant of glioblastoma multiforme containing distinct gliomatous and sarcomatous components. Gliosarcoma comprise 1.8-8% of glioblastoma multiforme and are clinically similar to them, affecting adults in the fourth and sixth decades of life, with a higher proportion found in males. The survival for patients with Gliosarcoma is equally poor as for those with glioblastoma multiforme, and there is a greater propensity for extracranial metastasis in Gliosarcoma. Clinical treatment-related experience reported in the literature is limited, and Gliosarcoma are currently treated in a similar fashion to glioblastoma multiforme, with modalities including tumor resection, postoperative radiation therapy, and chemotherapy. Gliosarcoma can arise secondarily, after conventional adjuvant treatment of high-grade glioma. The current literature on the occurrence of secondary gliosarcoma after glioblastoma multiforme is limited, with only 54 reported cases. CASE REPORT: The authors present a 48-year-old Caucasian male who had previously received postoperative combined radiation and temozolomide chemotherapy for glioblastoma multiforme. After a free disease period of 9 months the disease recurs as Gliosarcoma. The patient underwent a Total surgical excision and received chemotherapy with a basis of bevacizumab and irinotecan. The patient died from tumor progression 5 months after gliosarcoma diagnosis. CONCLUSION: The poor survival of patients with secondary gliosarcoma who had previously received combined radiation and temozolomide chemotherapy for glioblastoma multiforme may reflect a unique molecular profile of glioblastoma multiforme that eventually recurs as secondary gliosarcoma. We have to keep in mind the possibility of gliosarcomatous change in the recurrence of malignant glioma. Awareness of this pathological entity will allow more rapid diagnosis and treatment.

Radiotherapy on hidradenocarcinoma.

CONTEXT: Clear cell Hidradenocarcinoma is a rare carcinoma arising from sweat glands. It is an aggressive tumor that most metastasizes to regional lymph nodes and distant viscera; surgery with safe margins is the mainstay of treatment. CASE REPORT: We report a case of 68-year-old woman who presented with an invasive clear cell hidradenocarcinoma situated in the left parotid area which recurred 5 months after surgery, this recurrence was managed successfully by high-dose irradiation of the tumor bed (66 Gy) and regional lymphatic chains (50 Gy), after a follow-up of more than 15 months, the patient is in good local control without significant toxicity. CONCLUSION: POST OPERATIVE RADIOTHERAPY ALLOWS BETTER LOCAL CONTROL AND SHOULD BE MANDATORY WHEN HISTOLOGICAL FEATURES PREDICTIVE OF RECURRENCE ARE PRESENT: positive margins, histology poorly differentiated, perineural invasion, vascular and lymphatic invasion, lymph node involvement, and extracapsular spread.

Leiomyosarcoma of the thyroid gland.

The existence of primary thyroid sarcomas represents a contentious issue. Some authors believe that thyroid sarcomas are, in fact, anaplastic carcinomas with sarcomatous (spindle cell) features. From the standpoint of treatment and prognosis, the histogenesis of thyroid 'sarcomas' is academic, because these tumors, irrespective of the therapeutic intervention, are lethal 1. Primary thyroid leiomyosarcomas are extremely rare. Only nine isolated cases have been reported in the literature and such tumors carry a very poor prognosis [1-7] .