PET/CT-based radiomics of mass-forming intrahepatic cholangiocarcinoma improves prediction of pathology data and survival.

PURPOSE: Intrahepatic cholangiocarcinoma (IHC) is an aggressive disease with few reliable preoperative biomarkers. This study aims to elucidate if radiomics extracted from preoperative [18F]FDG PET/CT may grant a non-invasive biological characterization of IHC and predict outcome after complete resection of the tumor. METHODS: All patients preoperatively imaged by [18F]FDG PET/CT who underwent hepatectomy for mass-forming IHC in the period 2010-2019 were retrospectively evaluated. On PET images, manual slice-by-slice segmentation of IHC was performed (Tumor-VOI). A 5-mm margin region was semi-automatically generated around the tumor (Margin-VOI). Textural analysis was performed using the LifeX software. Analyzed outcomes included tumor grading (G3 vs. G1-2), microvascular invasion (MVI), overall survival (OS), and progression-free survival (PFS). The performances of the combined clinical-radiomic models were compared with those of standard clinical models. RESULTS: Overall, 74 patients (40 females, median age 68 years) were included. Considering tumor grading and MVI, the models combining the clinical data and radiomics of the Tumor-VOI had better performances than the clinical ones (AUC = 0.78 vs. 0.72 for grading; 0.87 vs. 0.78 for MVI). The inclusion into the models of radiomics of the Margin-VOI further improved the prediction of grading (AUC = 0.83), but not of MVI. Considering OS and PFS, the models including the preoperative clinical data and radiomics of the Tumor-VOI and Margin-VOI had better performances than the pure clinical ones (C-index = 0.81 vs. 0.76 for OS; 0.81 vs. 0.72 for PFS) and similar to the models including the pathology and postoperative data (C-index = 0.81 for OS; 0.79 for PFS). No model retained the standard SUV measures. CONCLUSION: The PET-based radiomics of IHC can predict pathology data and allow a reliable preoperative evaluation of prognosis. The radiomics of both the tumoral and peritumoral areas had clinical relevance. The combined clinical-radiomic models outperformed the pure preoperative clinical ones and achieved performances non-inferior to the postoperative models.

Virtual Biopsy for Diagnosis of Chemotherapy-Associated Liver Injuries and Steatohepatitis: A Combined Radiomic and Clinical Model in Patients with Colorectal Liver Metastases.

Non-invasive diagnosis of chemotherapy-associated liver injuries (CALI) is still an unmet need. The present study aims to elucidate the contribution of radiomics to the diagnosis of sinusoidal dilatation (SinDil), nodular regenerative hyperplasia (NRH), and non-alcoholic steatohepatitis (NASH). Patients undergoing hepatectomy for colorectal metastases after chemotherapy (January 2018-February 2020) were retrospectively analyzed. Radiomic features were extracted from a standardized volume of non-tumoral liver parenchyma outlined in the portal phase of preoperative post-chemotherapy computed tomography. Seventy-eight patients were analyzed: 25 had grade 2-3 SinDil, 27 NRH, and 14 NASH. Three radiomic fingerprints independently predicted SinDil: GLRLM_f3 (OR = 12.25), NGLDM_f1 (OR = 7.77), and GLZLM_f2 (OR = 0.53). Combining clinical, laboratory, and radiomic data, the predictive model had accuracy = 82%, sensitivity = 64%, and specificity = 91% (AUC = 0.87 vs. AUC = 0.77 of the model without radiomics). Three radiomic parameters predicted NRH: conventional_HUQ2 (OR = 0.76), GLZLM_f2 (OR = 0.05), and GLZLM_f3 (OR = 7.97). The combined clinical/laboratory/radiomic model had accuracy = 85%, sensitivity = 81%, and specificity = 86% (AUC = 0.91 vs. AUC = 0.85 without radiomics). NASH was predicted by conventional_HUQ2 (OR = 0.79) with accuracy = 91%, sensitivity = 86%, and specificity = 92% (AUC = 0.93 vs. AUC = 0.83 without radiomics). In the validation set, accuracy was 72%, 71%, and 91% for SinDil, NRH, and NASH. Radiomic analysis of liver parenchyma may provide a signature that, in combination with clinical and laboratory data, improves the diagnosis of CALI.

Adjunctive systemic antimicrobials in the treatment of chronic periodontitis: A systematic review and network meta-analysis.

The aim of this systematic review and network meta-analysis was to assess the efficacy of antimicrobials adjunctive to scaling and root planing (SRP) in the treatment of chronic periodontitis. The study was conducted according to the PRISMA statement. The protocol (CRD42020178621) was registered on the International Prospective Register of Systematic Reviews (PROSPERO). The MEDLINE, EMBASE, and CENTRAL databases were searched up to March 2020; furthermore, a manual search of relevant periodontal journals was conducted. Mean differences (MD) and standard deviations were calculated for clinical attachment level (CAL) gain and probing depth (PD) reduction at 6 and 12 months. A network meta-analysis was performed to assess direct and indirect comparisons and to establish a ranking of treatments. A total of 21 randomized clinical trials (RCTs) were included in the systematic review. Network meta-analysis showed that SRP + amoxicillin (AMX) + metronidazole (MTZ), as compared to SRP, reached the highest PD reduction at 6 [MD = 0.47; 95% CI (0.3; 0.64)] and 12 months [MD = 0.51; 95% CI (0.25; 0.78)], and CAL gain at 6 [MD = 0.54; 95% CI (0.27; 0.8)] and 12 months [MD = 0.37; 95% CI (0.05; 0.69)]. Network meta-analysis indicated that AMX + MTZ adjunctive to SRP provided the best improvement in clinical parameters, followed by SRP + MTZ.

Electromyographic evaluation in children orthodontically treated for skeletal Class II malocclusion: Comparison of two treatment techniques.

OBJECTIVE: To compare the clinical efficacy of two techniques for fabricating a Bimler device by assessing the patient's surface electromyography (sEMG) activity at rest before treatment and six months after treatment. METHODS: Twenty-four patients undergoing orthodontic treatment were enrolled in the study; 12 formed the test group and wore a Bimler device fabricated with a Myoprint impression using neuromuscular orthodontic technique and 12 formed the control group and were treated by traditional orthodontic technique with a wax bite in protrusion. The "rest" sEMG of each patient was recorded prior to treatment and six months after treatment. RESULTS: The neuromuscular-designed Bimler device was more comfortable and provided better treatment results than the traditional Bimler device. CONCLUSION: This study suggests that the patient group subjected to neuromuscular orthodontic treatment had a treatment outcome with more relaxed masticatory muscles and better function versus the traditional orthodontic treatment.

Effects of intervertebral disc disorders of low back on the mandibular kinematic: kinesiographic study.

BACKGROUND: Intervertebral disc disorders are one of the most common causes of low back pain. Neuromuscular dysfunction frequently is present in patients with lumbar disc herniation.When considering joint dysfunction, it is important to remember that the spine functions as a unit. Dysfunction on one level can trigger compensatory changes in other spinal levels or in other areas of the musculoskeleton. Findings demonstrated the relationship between stomatognathic and postural systems justifying the hypothesis that muscular-skeletal impairment in one system could affect the other one. However, evidence that a lumbar intervertebral disc herniation could influence the mandibular kinematics is still lacking. Aim of this study was to analyse the effects that intervertebral disc herniation of low back could have on the mandibular kinematics. FINDINGS: Kinesiographic evaluations of the mandibular dynamics of 23 adult patients suffering L4/L5 and L5/S1 lumbosacral disc hernation were compared with a non pathological control group. A statistically significant difference of maximal mouth opening (p < .05) and of maximal mouth opening velocity (p < .03) was found comparing the study patients with the control subjects. CONCLUSION: Lumbosacral disc herniation appears to be associated with changes in the activity of mandibular kinematics both in rate and quality of movement. The study suggests the existence of connections between masticatory system and lumbar disk herniation.

The effects of ULF-TENS stimulation on gnathology: the state of the art.

AIMS: The aim of this study was to evaluate the state of the art in the current literature regarding the effect of ultra low frequency-transcutaneous electrical nerve stimulation (ULF-TENS) on patients with temporomandibular disorders (TMD). METHODOLOGY: The authors reviewed the literature through a thorough manual and electronic research on PubMed database (using the Medical Subject Headings thesaurus) and subsequent analysis of all the found papers regarding the effect of TENS on TMD patients. No randomized controlled trials on the investigated topic were found. Only eight papers regarding controlled clinical trials (CCT) were selected according to the search strategy selection criteria. RESULTS: According to the available literature and the authors' experience, ULF-TENS seems to be a valid support in the management of TMD patients, but also a 'provocative' tool, so its application should always be monitored by electromyographic and electrognathographic analysis (before and after TENS). CONCLUSIONS: Further clinical studies (mainly randomized controlled trials) on ULF-TENS application in neuromuscular gnathology are needed.

Does orthodontic treatment provide a real functional improvement? a case control study.

BACKGROUND: Electromyographic analysis of the masticatory muscles provides useful data on the behavior of these muscles during stomatognathic system functioning and allows a functional assessment of orthodontic treatments. This study was undertaken to verify if achieving an Angle Class I bite through orthodontic treatment can lead to neuromuscular balance. METHODS: This study enrolled 30 patients (20 females, 10 males, mean age: 15.78 years) with an Angle Class II, division 1 malocclusion that was orthodontically treated. A group of 30 subjects (19 females, 11 males; mean age: 16.15 years), randomly selected among subjects with an Angle Class II, division 1 malocclusion that had not been orthodontically treated served as the Control group. Both groups were subjected to electromyography to study their neuromuscular characteristics. The Shapiro-Wilk's test revealed a non normal distribution, therefore we used a Friedman two way ANOVA by ranks test to compare differences of surface electromyography values between treated and untreated subjects at closed and open eyes condition. RESULTS: A statistically significant interaction between orthodontic treatment and open eyes conditions was detected for anterior temporal muscles. A significant imbalance of the anterior temporal muscles, which is indicative of an asymmetric electromyographic pattern, was also found. CONCLUSIONS: The present data indicate that achieving a correct occlusal target does not necessarily correspond to a neuromuscular balance.

Effect of ill-fitting dentures on the swallowing duration in patients using polygraphy.

BACKGROUND: Surface electromyography (SEMG) has been widely used in the recent years to study swallowing physiology, offering a valid and reliable tool for identifying normal swallowing. The goal of our study was to assess the contribution of denture fitness in the age-related increase of swallowing duration. METHODS: Twenty denture wearers and 20 dentate individuals were analysed using SEMG and a computerised kinesiography of mandibular movement. Three spontaneous saliva swallowings were recorded for each patient with both their old and new prostheses. Three spontaneous saliva swallowings were recorded for each dentate person in two different recording sessions. RESULTS: Old prosthesis mean swallowing time was 1.84 (SD ± 0.85) seconds while the new well-fitting prostheses needed a 1.28 (SD ± 0.55) (p = 0.0009) swallowing time. The difference in swallowing time was significant (p = 0.01) between dentate subjects and individuals wearing an old prosthesis. No significant difference was found between dentate subjects and the same prosthesis wearers when a new well-fitting prosthesis was worn. CONCLUSION: Data presented in this work suggest that part of the increased duration of swallowing showed by elderly and healthy people is because of incorrect an dental prosthesis. Prolongation of swallowing duration in the elderly population could be reconsidered in the light of the quality of dental device worn by the aged population.