Research Spotlight

Rodrigues, D. B., P. S. F. Campos, L. M. Wolford, J. Ignacio and J. R. Goncalves (2018). “Maxillary Interdental Osteotomies Have Low Morbidity for Alveolar Crestal Bone and Adjacent Teeth: A Cone Beam Computed Tomography-Based Study.” J Oral Maxillofac Surg 76(8): 1763-1771.

Full text of this article.

PURPOSE: Maxillary segmentation involving interdental osteotomies can have an adverse effect on the interdental crestal bone and adjacent teeth. The purpose of the present study was to evaluate the effect of interdental osteotomies on surrounding osseous and dental structures, including adjacent teeth, using cone beam computed tomography (CBCT), in patients who underwent segmental maxillary osteotomies. PATIENTS AND METHODS: The present retrospective cohort study evaluated interdental osteotomy (IDO) sites between the lateral incisors and canines in patients treated with 3-piece Le Fort I osteotomies. CBCT scans were assessed using Kodac Dental Imaging software at specific intervals: T0 (before surgery), T1 (immediately after surgery), and T2 (a minimum of 11 months after surgery). The statistical analysis using a linear regression model was adjusted to compare the variables at the different intervals. Injury to the dental structures was assessed by radiological evidence of dental damage, the requirement for endodontic treatment, or tooth loss. RESULTS: We evaluated 94 IDO sites in 47 patients in the present study. The mean inter-radicular distance at T0 was 2.5 mm. A statistically significant increase was seen in the inter-radicular distance (between T1 and T0) of 0.72 mm, with a reduction of the alveolar bone crest height (between T2 and T0) of 0.19 mm (P < .001) for the group that underwent IDO. A weak correlation was found for this increase in the inter-radicular distance, with changes in the alveolar crest bone height. The potential complications associated with interdental osteotomies such as iatrogenic damage to the tooth structure, the need for endodontic treatment, and tooth loss were not encountered in any patients. CONCLUSIONS: We found very low morbidity for the interdental alveolar crest and the integrity of teeth adjacent to interdental osteotomies for patients who underwent maxillary segmentation between the lateral incisors and canines.

Gaudino, M., M. J. Mack and D. P. Taggart (2018). “Additional arterial conduits in coronary artery bypass surgery: Finally coming of age.” J Thorac Cardiovasc Surg 156(2): 541-543.

Full text of this article.

At 50 years, CABG has entered a mature phase. It is now time to clarify the effect of procedural characteristics on clinical outcomes and to define the most appropriate strategy for each individual patient. Observational data have intrinsic biases and should only be considered hypothesis-generating. Randomized trials remain the only way to solve the conundrum of arterial grafts. International collaboration will be key to the success of this process. (Excerpt from text, p. 543; no abstract available.)

Kavinsky, C. J., M. F. Poulin and M. J. Mack (2018). “Training in Structural Heart Disease: Call to Action.” Circulation 138(3): 225-228.

Full text of this article.

Catheter-based therapies for congenital and structural heart diseases (SHDs) have come a long way since the pioneering work of Terry King in 1976 with the first percutaneous atrial septal defect closure, the first mitral balloon valvuloplasty by Kanji Inoue in 1984, and the first percutaneous valve replacements by Philipp Bonhoeffer and Alain Cribier in the early 2000s. More than 100 000 transcatheter aortic valve replacements (TAVRs) have been performed in the United States, and the yearly number of TAVR implants now exceeds that of isolated surgical aortic valve replacements. If the ongoing TAVR trials for low-risk patients demonstrate equivalence with surgery, we can expect another surge in demand for TAVR procedures. Similarly, percutaneous mitral valve repair procedures have now climbed to >15 000 in the United States.1 In addition, several percutaneous therapies for tricuspid and mitral valve repair and replacement are currently in the pipeline and will fuel continued growth in percutaneous therapies for SHD in the coming years. Recent Food and Drug Administration approvals of devices to close the left atrial appendage and patent foramen ovale further highlight this point. Furthermore, the number of adults with congenital heart disease (CHD) now exceeds the number of affected children, and many of these patients will require additional catheterization procedures. It is paradoxical that this nascent field has been devoid of formalized training paradigms. There is a clear and unmet need for defining the training requirements of physicians intending to perform SHD interventions. We need to ensure that future proceduralists will possess the appropriate cognitive and technical skill sets required to safely and effectively perform these interventions. (Excerpt from text, p. 225; no abstract available.)

Fathi, A. T., H. P. Erba, J. E. Lancet, E. M. Stein, F. Ravandi, S. Faderl, R. B. Walter, A. S. Advani, D. J. DeAngelo, T. J. Kovacsovics, A. Jillella, D. Bixby, M. Y. Levy, M. M. O’Meara, P. A. Ho, J. Voellinger and A. S. Stein (2018). “A phase 1 trial of vadastuximab talirine combined with hypomethylating agents in patients with CD33 positive AML.” Blood Jul 25. [Epub ahead of print].

Full text of this article.

Treatment of acute myeloid leukemia (AML) among the elderly is challenging due to intolerance of intensive therapy and therapy-resistant biology. Hypomethylating agents (HMAs) are commonly used, with suboptimal outcomes. Vadastuximab talirine is a CD33 directed antibody conjugated to pyrrolobenzodiazepine (PBD) dimers. Preclinically, HMA followed by vadastuximab talirine produced upregulated CD33 expression, increased DNA incorporation by PBD, and enhanced cytotoxicity. A combination cohort in a phase 1 study (NCT01902329) assessed safety, tolerability, and activity of vadastuximab talirine with HMA. Those eligible had Eastern Cooperative Oncology Group (ECOG) status 0-1, previously untreated CD33 positive AML, and declined intensive therapy. Vadastuximab talirine was administered intravenously at 10 mug/kg on last day of HMA (azacitidine or decitabine) infusion, in four week cycles. Among 53 patients treated, median age was 75 years. Patients had adverse (38%) or intermediate (62%) cytogenetic risk. Median treatment duration was 19.3 weeks. No dose limiting toxicities were reported. Majority of adverse events were due to myelosuppression, with some causing therapy delays. Thirty- and 60 day mortality rates were 2% and 8%. The composite remission rate (complete remission [CR] and CR with incomplete blood count recovery [CRi]) was 70%. Fifty one percent of remissions were minimal residual disease (MRD) negative by flow cytometry. Similarly high remission rates were observed in patients with secondary AML, aged >/=75 years, and with adverse cytogenetic risk. Median relapse free survival and overall survival were 7.7 and 11.3 months, respectively.

Garces, S., J. D. Khoury, R. Kanagal-Shamanna, A. Salem, S. A. Wang, C. Y. Ok, S. Hu, K. P. Patel, M. J. Routbort, R. Luthra, G. Tang, E. J. Schlette, C. E. Bueso-Ramos, L. J. Medeiros and S. Loghavi (2018). “Chronic lymphocytic leukemia with proliferation centers in bone marrow is associated with younger age at initial presentation, complex karyotype and TP53 disruption.” Hum Pathol Aug 4. [Epub ahead of print].

Full text of this article.

The presence of expanded proliferation centers (PCs) in lymph nodes involved by chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has been associated with adverse clinical outcomes, but the frequency and significance of PCs in bone marrow (BM) remains unclear. The study group included 36 patients with BM involvement by CLL in which PCs were present. We compared this group with 110 randomly selected BM samples involved by CLL without morphologically discernable PCs. Patients with PCs in BM were younger (median age, 53years [range,18-71] versus 58years [range, 31-82]; P=.007), more frequently experienced B-symptoms (27.8% versus 8.2%, P=.0076), more often had Rai stage IV disease (30.6% versus 17.3, P=.020), higher serum lactate dehydrogenase (P=.0037) and beta-2- microglobulin (P=.0001) levels, and lower median hemoglobin (P=.026) and platelet counts (P=.0422). TP53 alterations were more common in patients with PCs in BM (45.4% versus 18.7%; P=.0049) as was a complex karyotype (26.4% versus 9%; P=.019). There were no significant differences in the frequency of ZAP70 or CD38 positivity or IGHV mutation status. The median time to first treatment was shorter in patients with PCs in BM (7 versus 19months, P=.047) and the frequency of Richter syndrome was higher (14% versus 4%, P=.041). Patients with PCs in BM had significantly shorter overall survival compared with the control group (median 249.3 vs. undefined; P=.0241). These data suggest that identification of PCs in BM samples involved by CLL is associated with adverse prognostic features.