Clinical Follow-Up in Orofacial Clefts—Why Multidisciplinary Care Is the Key

(1) Background: Although most clinicians involved in the treatment of cleft patients agree upon the major importance of interdisciplinary cooperation and many protocols and concepts have been discussed in the literature, there is little evidence of the relevance of continuous interdisciplinary care. We aimed to objectify the type and number of therapeutic decisions resulting from an annual multidisciplinary follow-up. (2) Methods: We retrospectively analyzed the data of all 1126 patients followed up in the weekly consultation hours for cleft patients at university clinics in Leipzig for the years 2005–2020. We assessed the clinical data of every patient and specifically evaluated the treatment decisions taken at different points in time by the participating experts of different specialties. (3) Results: In total, 3470 consultations were included in the evaluation, and in 70% of those, a therapeutic recommendation was given. Each specialty showed certain time frames with intense treatment demand, which partially overlapped. Nearly all therapy recommendations were statistically attached to a certain age (p < 0.001). (4) Conclusions: There is an exceptionally high need for the interdisciplinary assessment of patients with cleft formation. Some developmental phases are of particular importance with regard to regular follow-up and initiation of different treatment protocols. The therapy and checkup of cleft patients should be concentrated in specialized centers.

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Continuous Multidisciplinary Care for Patients With Orofacial Clefts—Should the Follow-up Interval Depend on the Cleft Entity?

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211035253 ◽

2021 ◽

pp. 105566562110352

Author(s):

Anna K. Sander ◽

Elisabeth Grau ◽

Anita Kloss-Brandstätter ◽

Rüdiger Zimmerer ◽

Michael Neuhaus ◽

...

Keyword(s):

Soft Palate ◽

Cleft Lip ◽

Care Center ◽

Tertiary Care ◽

Growth Period ◽

Multidisciplinary Care ◽

Treatment Needs ◽

Orofacial Clefts ◽

Treatment Demand

Objective The multidisciplinary follow-up of patients with cleft lip with or without palate (CL/P) is organized differently in specialized centers worldwide. The aim of this study was to evaluate the different treatment needs of patients with different manifestations of CL/P and to potentially adapt the frequency and timing of checkup examinations accordingly. Design We retrospectively analyzed the data of all patients attending the CL/P consultation hour at a tertiary care center between June 2005 and August 2020 ( n = 1126). We defined 3 groups of cleft entities: (1) isolated clefts of lip or lip and alveolus (CL/A), (2) isolated clefts of the hard and/or soft palate, and (3) complete clefts of lip, alveolus and palate (CLP). Timing and type of therapy recommendations given by the specialists of different disciplines were analyzed for statistical differences. Results Patients with CLP made up the largest group ( n = 537), followed by patients with cleft of the soft palate ( n = 371) and CL ± A ( n = 218). There were significant differences between the groups with regard to type and frequency of treatment recommendations. A therapy was recommended in a high proportion of examinations in all groups at all ages. Conclusion Although there are differences between cleft entities, the treatment need of patients with orofacial clefts is generally high during the growth period. Patients with CL/A showed a similarly high treatment demand and should be monitored closely. A close follow-up for patients with diagnosis of CL/P is crucial and measures should be taken to increase participation in follow-up appointments.

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Unexpected Return for Follow-up During the First Year of Multidisciplinary Care May Be Predictive of Rapid Deterioration of Renal Function

Medicine ◽

10.1097/md.0000000000001731 ◽

2015 ◽

Vol 94 (41) ◽

pp. e1731

Author(s):

Ming-Hsien Tsai ◽

Yu-Weil Fang ◽

Li Hui Wang ◽

Xiang Gin You ◽

Jyh-Gang Leu

Keyword(s):

Renal Function ◽

Multidisciplinary Care ◽

First Year ◽

Rapid Deterioration

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Enthesitis Related Arthritis: A Single Center Experience

Acta Medica ◽

10.32552/2021.actamedica.624 ◽

2021 ◽

pp. 1-6

Author(s):

Selcan Demir ◽

Müşerref Kasap Cüceoğlu ◽

Yelda Bilginer

Keyword(s):

Laboratory Data ◽

Inflammatory Back Pain ◽

Hla B27 ◽

Female Ratio ◽

Enthesitis Related Arthritis ◽

Spinal Involvement ◽

Therapeutic Decisions ◽

Number Of Patients ◽

Spinal Mri

Objective: Enthesitis-related arthritis is a subtype of juvenile idiopathic arthritis category, characterized by enthesitis, arthritis, and the risk of axial involvement. We aimed to summarize the demographics, clinical, and laboratory findings of enthesitis-related arthritis patients and to identify the distinguishing features of enthesitis-related arthritis patients with HLA B27 positive compared to the patients who were HLA B27 negative. Materials and Methods: This retrospective study included patients with Enthesitis-related arthritis who followed up between 2015 and 2018. Demographical, clinical, and laboratory data were retrospectively reviewed from the patient files and computerized medical charts. Results: A total of 72 patients diagnosed with enthesitis-related arthritis were included in the study. The male/female ratio was 2.1/1. Fifty-three (73%) of them presented with peripheral arthritis. The most commonly affected joint was knee (81.1%), followed by the ankle (43%), hips (32%), and wrist (5%). HLA B27 was positive in 36 (50%) patients. During follow-up, the number of patients who developed enthesitis-related arthritis -associated uveitis was 8 (11.1%). During follow-up, 56 patients with inflammatory back pain and/or sacroiliac tenderness underwent spinal MRI. Ten (17.8%) patients had only thoracal and/or lumbar involvement, 18 (32%) had only sacroiliitis, and 9 (16%) patients had both of them on spinal MRI. In comparison with HLA-B27-negative children, HLA-B27-positive patients were more likely to have enthesitis (16 (44.4%) vs 8 (22.2%), p=0.046), MRI proven sacroiliitis (19 (52.7%) vs 8 (22.2%), p=0.031), MRI proven spinal involvement (13 (36.1%) vs 6 (16.6%), p=0.031), and uveitis (8 (100%) vs 0(0%), p=0.014). During follow up, 65/72 (90.2 %) of them needed disease-modifying antirheumatic drugs (DMARD), and 51/72 (70.8%) needed anti-tumor necrosis factor-α (TNF-α) therapy. Conclusion: We found that patients who were HLA-B27- positive had significantly more enthesitis, MRI-proven sacroiliitis, MRI-proven spinal involvement, and acute anterior uveitis, in comparison to patients who were HLA B27 negative. It is crucial to carefully assess those patients with concern for enthesitis-related arthritis to determine the expected prognosis and make therapeutic decisions appropriately.

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Long Term Neuropsychological Outcomes of Survivors of Young Childhood Brain Tumors Treated on the Head Start II Protocol

Neuro-Oncology Practice ◽

10.1093/nop/npab028 ◽

2021 ◽

Author(s):

Cara F Levitch ◽

Benjamin Malkin ◽

Lauren Latella ◽

Whitney Guerry ◽

Sharon L Gardner ◽

...

Keyword(s):

Head Start ◽

Brain Tumors ◽

Hematopoietic Cell Transplantation ◽

Treatment Strategies ◽

Receptive Language ◽

Age At Diagnosis ◽

High Dose ◽

Treatment Protocols ◽

Significant Change

Abstract Background The Head Start treatment protocols have focused on curing young children with brain tumors while avoiding or delaying radiotherapy through using a combination of high-dose, marrow-ablative chemotherapy and autologous hematopoietic cell transplantation (AuHCT). Late effects data from treatment on the Head Start II (HS II) protocol have previously been published for short-term follow-up (STF) at a mean of 39.7 months post-diagnosis. The current study examines longer-term follow up (LTF) outcomes from the same cohort. Methods Eighteen HS II patients diagnosed with malignant brain tumors <10 years of age at diagnosis completed a neurocognitive battery and parents completed psychological questionnaires at a mean of 104.7 months post-diagnosis. Results There was no significant change in Full Scale IQ at LTF compared to baseline or STF. Similarly, most domains had no significant change from STF, including verbal IQ, performance IQ, academics, receptive language, learning/memory, visual-motor integration, and externalizing behaviors. Internalizing behaviors increased slightly at LTF. Clinically, most domains were within the average range, except for low average mathematics and receptive language. Additionally, performance did not significantly differ by age at diagnosis or time since diagnosis. Of note, children treated with high-dose methotrexate for disseminated disease or atypical teratoid/rhabdoid tumor displayed worse neurocognitive outcomes. Conclusions These results extend prior findings of relative stability in intellectual functioning for a LTF period. Ultimately, this study supports that treatment strategies for avoiding or delaying radiotherapy using high-dose, marrow-ablative chemotherapy and AuHCT may decrease the risk of neurocognitive and social-emotional declines in young pediatric brain tumor survivors.

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Surgical Intervention for Enneking Stage-III Vertebral Hemangiomas and Literature Review

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9770 ◽

2021 ◽

pp. 10

Author(s):

Monerah Annaim

Keyword(s):

Surgical Intervention ◽

Treatment Protocol ◽

Stage Iii ◽

Spinal Tumors ◽

Preoperative Embolization ◽

Comprehensive Treatment ◽

Treatment Protocols ◽

Enneking Stage ◽

Vertebral Hemangiomas

Introduction: Vertebral hemangiomas are benign, slow-growing tumors. They represent 2–3% of spinal tumors and are incidentally found. Various treatment protocols have been described for Enneking stage-III vertebral hemangiomas. However, it is still controversial and a comprehensive treatment protocol is still lacking. Methodology: A retrospective clinical review was conducted on patients diagnosed with Enneking stage-III vertebral hemangiomas at two centers in Riyadh, Saudi Arabia between 2010 and 2020. Result: A total of 11 patients with Enneking stage-III vertebral hemangiomas were included. The mean follow-up period was 47.5 ± 24.1 (9–120 months) months. All patients were symptomatic; the most common presentations were neurological deficit and/or myelopathy (n = 7). Ten patients underwent surgical intervention. Six patients had preoperative embolization, with a mean blood loss of 880.00 ± 334.46 ml. One patient refused surgery and underwent vertebroplasty and repeated sclerotherapy. All patients regained full neurological recovery during follow-up. No recurrence was reported. Conclusion: Intralesional spondylectomy showed good results in treating Enneking Stage-III vertebral hemangiomas. However, larger studies comparing treatment methods are needed to reach a gold standard approach.

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Management of Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Leukocyte- and Platelet-Rich Fibrin (L-PRF) and Photobiomodulation: A Retrospective Study

Journal of Clinical Medicine ◽

10.3390/jcm9113505 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3505

Author(s):

Gianluca Tenore ◽

Angela Zimbalatti ◽

Federica Rocchetti ◽

Francesca Graniero ◽

Domenico Gaglioti ◽

...

Keyword(s):

Antibiotic Therapy ◽

Underlying Disease ◽

Osteonecrosis Of The Jaw ◽

Study Group ◽

Stage Duration ◽

Control Groups ◽

Treatment Protocols ◽

Platelet Rich Fibrin ◽

History Of

Background. The aim of this study was to compare retrospectively the effect of three different treatment protocols on the healing outcome in patients with established medication-related osteonecrosis of the jaw (MRONJ). Methods. A total of 34 MRONJ patients were recruited from the Department database and were divided according to the treatment protocols in a study group (G1) and two control groups (G2 and G3). G1 was treated with antibiotic therapy, surgery, leukocyte- and platelet-rich fibrin (L-PRF), and photobiomodulation; G2 was treated with antibiotic therapy and surgery; G3 was treated with antibiotic therapy and photobiomodulation. Various clinical variables and treatment protocols were analyzed to determine their correlation with the healing outcome at three and six months of follow-up. Results. There was a significant association between the different treatment protocols and the outcomes at both three and six months follow-up (p = 0.001 and p = 0.002, respectively). No significant association was observed between the outcomes and MRONJ localization, MRONJ stage, duration of drug treatment, gender, diabetes, corticosteroid therapy, smoking habits, underlying disease, and history of chemotherapy at both three and six months follow-up. Conclusions. Our results show that the combination of antibiotic therapy, surgery, L-PRF, and photobiomodulation may effectively contribute to MRONJ management.

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Complete responses to two different anti-PD1 agents in a metastatic melanoma patient

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155219858657 ◽

2019 ◽

Vol 26 (2) ◽

pp. 496-499 ◽

Cited By ~ 2

Author(s):

Saadettin Kilickap ◽

Deniz C Guven ◽

Oktay H Aktepe ◽

Burak Y Aktas ◽

Omer Dizdar

Keyword(s):

Metastatic Melanoma ◽

Checkpoint Inhibitors ◽

Real Life ◽

Complete Response ◽

Duration Of Treatment ◽

Treatment Protocols ◽

Real Life Data ◽

Heavily Pretreated ◽

Drug Free

In the last decade, immune checkpoint inhibitors changed the landscape of metastatic melanoma. However, the optimal duration of treatment and treatment cessation in responders is largely unknown. Herein, we represent a heavily pretreated metastatic melanoma case who had a complete response to pembrolizumab and also a complete response with nivolumab after progression during drug-free follow-up. We think that reinduction with a different anti-PD1 antibody may be used in patients with metastatic melanoma responders. Clinical trials with prespecified sequential treatment protocols and large real-life data can further delineate this subject.

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Altered NFE2 activity predisposes to leukemic transformation and myelosarcoma with AML-specific aberrations

Blood ◽

10.1182/blood-2018-09-875047 ◽

2019 ◽

Vol 133 (16) ◽

pp. 1766-1777 ◽

Cited By ~ 5

Author(s):

Jonas Samuel Jutzi ◽

Titiksha Basu ◽

Maximilian Pellmann ◽

Sandra Kaiser ◽

Doris Steinemann ◽

...

Keyword(s):

Myeloid Leukemia ◽

Myeloproliferative Neoplasms ◽

Functional Characterization ◽

Trisomy 8 ◽

Chromosome 5Q ◽

Therapeutic Decisions ◽

Prognostic Implications ◽

Clinical Algorithms

Abstract In acute myeloid leukemia (AML), acquired genetic aberrations carry prognostic implications and guide therapeutic decisions. Clinical algorithms have been improved by the incorporation of novel aberrations. Here, we report the presence and functional characterization of mutations in the transcription factor NFE2 in patients with AML and in a patient with myelosarcoma. We previously described NFE2 mutations in patients with myeloproliferative neoplasms and demonstrated that expression of mutant NFE2 in mice causes a myeloproliferative phenotype. Now, we show that, during follow-up, 34% of these mice transform to leukemia presenting with or without concomitant myelosarcomas, or develop isolated myelosarcomas. These myelosarcomas and leukemias acquired AML-specific alterations, including the murine equivalent of trisomy 8, loss of the AML commonly deleted region on chromosome 5q, and mutations in the tumor suppressor Trp53. Our data show that mutations in NFE2 predispose to the acquisition of secondary changes promoting the development of myelosarcoma and/or AML.

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Is Pre-operative Quadriceps Strength a Predictive Factor for the Outcomes of Anterior Cruciate Ligament Reconstructions

International Journal of Sports Medicine ◽

10.1055/a-1144-3111 ◽

2020 ◽

Vol 41 (13) ◽

pp. 912-920

Author(s):

Jihong Qiu ◽

Xin He ◽

Sai-Chuen Fu ◽

Michael Tim-Yun Ong ◽

Hio Teng Leong ◽

...

Keyword(s):

Acl Reconstruction ◽

Predictive Value ◽

Cruciate Ligament ◽

Positive Association ◽

Quadriceps Strength ◽

Treatment Protocols ◽

Strength Assessment ◽

Operative Outcomes ◽

Anterior Cruciate

AbstractPersistent quadriceps weakness prevents patients from returning to sports after ACL reconstruction. Pre-operative quadriceps strength was indicated as an important factor for the outcomes of ACL reconstruction. However, the existing evidence is controversial. Therefore, this systematic review was conducted to summarize and evaluate the relationship between pre-operative quadriceps strength and the outcomes following ACL reconstruction, and to summarize the predictive value of pre-operative quadriceps strength for satisfactory post-operative outcomes. Pubmed, WOS, Embase, CINAHL and SportDiscus were searched to identify eligible studies according to PRISMA guidelines. Relevant data was extracted regarding quadriceps strength assessment methods, pre-operative quadriceps strength, participants treatment protocols, post-operative outcomes, follow-up time points and the relevant results of each individual study. Twelve cohort studies (Coleman methodology score: 62±10.4; from 44–78) with 1773 participants included. Follow-up period ranged from 3 months to 2 years. Moderate evidence supports the positive association between pre-operative quadriceps strength and post-operative quadriceps strength; weak evidence supports the positive association between pre-operative quadriceps strength and post-operative functional outcomes. By now, there is no consensus on the predictive value of pre-operative quadriceps strength for achieving satisfactory quadriceps strength after ACLR. To conclude, pre-operative quadriceps strength should be taken into consideration when predict patient recovery of ACLR.

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Combining clinical and magnetic resonance imaging markers enhances prediction of 12-year disability in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458516642314 ◽

2016 ◽

Vol 23 (1) ◽

pp. 51-61 ◽

Cited By ~ 24

Author(s):

Tomas Uher ◽

Manuela Vaneckova ◽

Lukas Sobisek ◽

Michaela Tyblova ◽

Zdenek Seidl ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Magnetic Resonance ◽

Cumulative Risk ◽

Resonance Imaging ◽

Cox Models ◽

T2 Lesions ◽

Therapeutic Decisions ◽

The Individual

Background: Disease progression and treatment efficacy vary among individuals with multiple sclerosis. Reliable predictors of individual disease outcomes are lacking. Objective: To examine the accuracy of the early prediction of 12-year disability outcomes using clinical and magnetic resonance imaging (MRI) parameters. Methods: A total of 177 patients from the original Avonex-Steroids-Azathioprine study were included. Participants underwent 3-month clinical follow-ups. Cox models were used to model the associations between clinical and MRI markers at baseline or after 12 months with sustained disability progression (SDP) over the 12-year observation period. Results: At baseline, T2 lesion number, T1 and T2 lesion volumes, corpus callosum (CC), and thalamic fraction were the best predictors of SDP (hazard ratio (HR) = 1.7–4.6; p ⩽ 0.001–0.012). At 12 months, Expanded Disability Status Scale (EDSS) and its change, number of new or enlarging T2 lesions, and CC volume % change were the best predictors of SDP over the follow-up (HR = 1.7–3.5; p ⩽ 0.001–0.017). A composite score was generated from a subset of the best predictors of SDP. Scores of ⩾4 had greater specificity (90%–100%) and were associated with greater cumulative risk of SDP (HR = 3.2–21.6; p < 0.001) compared to the individual predictors. Conclusion: The combination of established MRI and clinical indices with MRI volumetric predictors improves the prediction of SDP over long-term follow-up and may provide valuable information for therapeutic decisions.

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