Integrated Clinical and Genomic Models to Predict Optimal Cytoreduction in High Grade Serous Ovarian Cancer

Background: Advanced high grade serous (HGSC) ovarian cancer is treated with either primary surgery followed by chemotherapy or neoadjuvant chemotherapy followed by interval surgery. The decision to proceed with surgery either primarily or after chemotherapy is based on a surgeon’s clinical assessment and prediction of an optimal outcome. Optimal surgery is correlated with improved overall survival. This clinical assessment results in an optimal surgery approximately 70% of the time. We hypothesize that this prediction can be improved by using biological tumor data to predict optimal cytoreduction.Methods: With access to a large biobank of ovarian cancer tumors, we obtained genomic data on 83 patients encompassing gene expression, exon expression, long non-coding RNA, micro RNA, single nucleotide variants, copy number variation, DNA methylation, and fusion transcripts. We then used machine learning to incorporate this data with pre-operative clinical information to create predictive models which successfully predicted whether or not a patient’s cytoreductive surgery would have an optimal outcome. These models were then validated within The Cancer Genome Atlas (TCGA) HGSC database. Results: Of the 124 models created and validated, 21 performed at least equal if not better than our historical clinical rate of optimal debulking in advanced-stage HGSC as a control, 78%. Conclusions: This is the first time tumor genomic data has been used to predict surgical outcome in ovarian cancer. Prospective validation of these models could result in improving our ability to objectively predict which patients will undergo optimal cytoreduction and, therefore, improve our ovarian cancer outcomes.

Prosthodontic Rehabilitation of Hypodontia – A Team Approach

Hypodontia can have an impact on speech, aesthetics, function and psycho-social behavior of individuals afflicted by the problem. Rehabilitation of patients with hypodontia usually requires complex treatment planning, depending upon the pattern of tooth absence, amount of residual spacing, presence of malocclusion and patient compliance. It is an interdisciplinary intervention, involving prosthodontists, orthodontists, oral surgeons, speech pathologists and psychologists to achieve an optimal outcome for the patient. This case report describes the close work of a committed team from orthodontic, oral surgery and prosthodontic department of de'Montmorency College of Dentistry, Lahore, to reach final aesthetic and functional outcomes for an 18 year old girl with oligodontia. Her chief complaint was poor esthetics and absence of multiple anterior teeth with unsightly spacing between remaining teeth. Orthodontic redistribution of spaces followed by fixed full arch prosthetic rehabilitation were the goals achieved at the end of her treatment. KEYWORDS: Oligodontia, interdisciplinary team work, prosthodontic rehabilitation, fixed restorations.

Prosthodontic Rehabilitation of Bilateral Maxillary Lateral Incisors Agenesis: A Case Report with One-Year Follow-Up

Globally, non-syndromic tooth agenesis is commonly seen in clinical practice. However, its management is often complex and requires a multidisciplinary team approach for the maximal outcome. While various treatment options are possible, considerations for the treatment are not only based on the dentofacial conditions but also cultural and social background and personal preference of the patient. Thus, patientcentred care approach should always be practised for an optimal outcome. In the present case, a patient with established craniofacial growth presenting with bilateral agenesis of maxillary lateral incisors and over-retained deciduous maxillary left canine sought for aesthetic improvements. The patient did not prefer any orthodontic treatment citing a prolonged treatment duration and sub-optimal motivation as a hindrance. Thus, a prosthodontic only approach was taken by providing a conventional cantilever bridge and ceramic veneers to achieve the aims of treatment. This article discusses the possible limitation of such prosthodontic only solution in managing tooth agenesis.

Multiple urinary bladder calculi: a rare cause of irreducible uterovaginal prolapse

A case of irreducible prolapse with multiple bladder calculi in a 65-years-old multiparous, postmenopausal woman is reported. Inability to walk, constipation and urinary incontinence were her primary complaints. Routine ultrasound of the abdomen and pelvis failed to reveal multiple vesical calculi as the prolapse was lying outside the pelvis. However, targeted plain X-ray of the prolapsed mass showed multiple vesical calculi. The patient was managed with single-stage vaginal hysterectomy and laparotomy. First vaginal hysterectomy was done then prolapsed cystocele was reduced and extraperitoneal vesicolithotomy done. Currently, the patient is relieved of all symptoms. Management of an irreducible procidentia and a hard mass in the anterior compartment, as in this case, can be challenging and requires a diligent effort to confirm the diagnosis and to execute the appropriate surgical protocol to achieve optimal outcome with minimal intra- and post-operative complications.

Mouth preparation for complete dentures

The success of complete dentures is highly dependent on the anatomy of the oral cavity. Several conditions can affect the final denture fit. Disorders of the soft tissues, such as denture hyperplasia, denture stomatitis and mucosal pathology may play a role. There are also difficulties related to the shape of the bone, including excessively large undercuts/bony exostoses, tori, enlarged tuberosities and flabby ridges and other factors, such as xerostomia to be considered. The aim of this article is to help diagnose these conditions and to suggest ways of overcoming the individual problems with which patients present before starting denture construction. CPD/Clinical Relevance: The diagnosis of several oral conditions and their appropriate management may help achieve an optimal outcome when constructing complete dentures.

TP6.2.16General practitioner compliance with Scottish cancer referral guideline for Oesophago-gastric cancer

Aims The outcome of oesophago-gastric cancer is often poor. Timely referral of suspected cancer is essential for early diagnosis and optimal outcome. This study aims to audit the General Practitioners (GPs) compliance with the Scottish referral guidelines for suspected oesophago-gastric cancer. Methods A retrospective cohort study of all newly diagnosed oesophago-gastric cancers who were referred from the primary care and discussed in a single regional MDT was performed between October 2019 and September 2020. Electronic records were interrogated and symptomatology audited against the Scottish cancer referral guidelines. Results Of the 349 patients, 227 (65.0%) were referred from the primary care. 150 (66.1%) were male and the mean age was 69.5 ± 10.9 years. Mean Scottish Index of Multiple Deprivation was 5 ± 3. 149 (65.6%) had dysphagia and/or odynophagia and 181 (79.7%) were oesophageal cancers. 67 (29.5%) were T4 disease and 87 (38.3%) were metastatic at presentation. Urgency of referral was: 25 (11.0%) routine, 54 (23.7%) urgent and 148 (65.2%) Urgent Suspicion of Cancer (USOC). 192 (84.6%) patients qualified to be referred as USOC, of these 138 (71.9%) were actually referred as USOC. Of the 35 (15.4%) patients who did not qualify for the USOC referral, 10 (28.6%) patients were referred as USOC. The sensitivity was 71.9% and specificity 71.4%. Conclusions GP compliance with the adherence with the National guidelines remains a barrier in the USOC in oesophago-gastric cancer. Further GP education and awareness is required to improve their compliance.