Vein-first versus artery-first ligation procedure for lung cancer surgery: An updated review

Background The optimal sequence of pulmonary vessel interruption during lung cancer resection remains controversial. This review aimed to elucidate the association of vein-first versus artery-first ligation and survival of the patients. Methods We searched PubMed, Web of Science, Scopus, Embase, Cochrane Library and Google Scholar from their inception to September 2021 for published articles that compared vein-first (the pulmonary vein was interrupted first) and artery-first procedure (the pulmonary artery was ligated first) during lung cancer surgery. Results Finally, a total of 13 full articles were obtained. First, 7 studies with survival information were included for meta-analyses. As compared with the artery-first ligation, vein-first approach did not decrease the risk of local recurrence (risk ratio [RR] 0.92 in favour of vein-first; 95% confidence interval [CI] 0.61–1.39, p = 0.68) or distant metastasis (RR 0.92; 95% CI 0.30–2.85, p = 0.89); but it was associated with better disease-free survival (RR 0.52; 95% CI 0.37–0.73, p < 0.01) as well as 5-year overall survival (RR 0.60; 95% CI 0.41–0.86, p < 0.01). In addition, the operative time, intraoperative blood loss, total complications, and length of postoperative stay were mainly comparable between the two groups. Second, 7 studies provided the data of tumor cells indicated by different biomarkers and detection methods; and 3 of these reports showed that vein-first ligation decreased the extent of intraoperative tumor dissemination. However, a quantitative meta-analysis was not possible due to the significant heterogeneity. Conclusion Vein-first ligation in lung cancer surgery may be associated with improved survival of the patients, which might be ascribed to potentially lower risk of tumor cell dissemination. Well-designed, large-scale trials are warranted to clarify these occasional findings.

Cilostazol for secondary stroke prevention: systematic review and meta-analysis

BackgroundStroke is one of the leading causes of death worldwide. Cilostazol, an antiplatelet and phosphodiesterase 3 inhibitor, has not been clearly established for ischaemic stroke use. We aim to determine the efficacy and safety of cilostazol for secondary stroke prevention.MethodsMEDLINE, EMBASE, Cochrane Library, Web of Science and ClinicalTrials.gov were searched from inception to 25 September 2020, for randomised trials comparing the efficacy and safety of cilostazol monotherapy or dual therapy with another antiplatelet regimen or placebo, in patients with ischaemic stroke. Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess study quality. This meta-analysis was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsEighteen randomised trials comprising 11 429 participants were included in this meta-analysis. Most trials possessed low risk of bias and were of low heterogeneity. Cilostazol significantly reduced the rate of ischaemic stroke recurrence (risk ratio, RR=0.69, 95% CI 0.58 to 0.81), any stroke recurrence (RR=0.64, 95% CI 0.54 to 0.74) and major adverse cardiovascular events (RR=0.67, 95% CI 0.56 to 0.81). Cilostazol did not significantly decrease mortality (RR=0.90, 95% CI 0.64 to 1.25) or increase the rate of good functional outcome (Modified Rankin Scale score of 0–1; RR=1.07, 95% CI 0.95 to 1.19). Cilostazol demonstrated favourable safety profile, significantly reducing the risk of intracranial haemorrhage (RR=0.46, 95% CI 0.31 to 0.68) and major haemorrhagic events (RR=0.49, 95% CI 0.34 to 0.70).ConclusionsCilostazol demonstrated superior efficacy and safety profiles compared with traditional antiplatelet regimens such as aspirin and clopidogrel for secondary stroke prevention but does not appear to affect functional outcomes. Future randomised trials can be conducted outside East Asia, or compare cilostazol with a wider range of antiplatelet agents.

Vein-first versus artery-first ligation procedure for lung cancer surgery: An updated review

Background The optimal sequence of pulmonary vessel interruption during lung cancer resection remains controversial. This review aimed to elucidate the association of vein-first versus artery-first ligation and circulation tumor cells (CTCs) dissemination and survival of the patients. Methods We searched PubMed, Web of Science, Scopus, Embase, Cochrane Library and Google Scholar from their inception to October 2020 for published articles that compared vein-first (the pulmonary vein was interrupted first) and artery-first procedure (the pulmonary artery was ligated first) during lung cancer surgery. Results Finally, a total of 13 full articles were included. First, 7 of these studies with survival data were included for meta-analysis. As compared with artery-first ligation, vein-first approach did not decrease local recurrence (risk ratio [RR] 0.96 in favour of vein-first ligation; 95% confidence interval [CI] 0.77–1.19, p = 0.68) or distant metastasis (RR 0.93; 95% CI 0.34–2.54, p = 0.89), but it was associated with better 5-year overall survival of the patients (RR 0.72; 95% CI 0.52–0.99, p = 0.04). Second, 7 studies provided the data of tumor cells using different biomarkers and detection methods; thus, a quantitative meta-analysis was not possible. Among them, 3 studies showed that vein-first decreased the extent of tumor dissemination. Conclusion Vein-first ligation in lung cancer surgery is associated with improved survival of the patients and potentially decreased surgery-related tumor dissemination. Further high-quality trials are warranted.

β-Blocker use is not associated with improved clinical outcomes in women with breast cancer: a meta-analysis

Background: Evidence remains inconsistent regarding the potential influence of β-blocker (BB) use on clinical outcomes in women with breast cancer. We aimed to evaluate the association between BB and prognosis of breast cancer in an updated meta-analysis. Methods: Follow-up studies comparing the clinical outcomes of breast cancer in women with and without use of BB were included by search of PubMed, Embase, and Cochrane’s Library. A random-effect model was used to pool the results. Results: Seventeen observational studies were included. Pooled results did not support a significant association between BB use and breast cancer recurrence (risk ratio [RR] = 0.85, 95% confidence interval [CI]: 0.68–1.07, P=0.17), breast cancer related deaths (RR = 0.83, 95% CI: 0.65–1.06, P=0.14), or all-cause deaths (RR = 1.01, 95% CI: 0.91–1.11, P=0.91) in women with breast cancer. Study characteristics such as sample size, definition of BB use, follow-up durations, adjustment of menopausal status, or quality score did not significantly affect the results. Subgroup analyses showed that BB may be associated with a trend of reduced risk of all-cause deaths in women with breast cancer in prospective studies (two datasets, RR = 0.81, P=0.05), but not in retrospective studies (eight datasets, RR = 1.06, P=0.16; P for subgroup analyses = 0.02). Conclusions: Current evidence from observational studies does not support a significant association between BB use and improved prognosis in women with breast cancer.

Novel Insights into Plasmodium vivax Therapeutic Failure: CYP2D6 Activity and Time of Exposure to Malaria Modulate the Risk of Recurrence

ABSTRACT Plasmodium vivax relapse is one of the major causes of sustained global malaria transmission. Primaquine (PQ) is the only commercial drug available to prevent relapses, and its efficacy is dependent on metabolic activation by cytochrome P450 2D6 (CYP2D6). Impaired CYP2D6 function, caused by allelic polymorphisms, leads to the therapeutic failure of PQ as a radical cure for P. vivax malaria. Here, we hypothesized that the host immune response to malaria parasites modulates susceptibility to P. vivax recurrences in association with CYP2D6 activity. We performed a 10-year retrospective study by genotyping CYP2D6 polymorphisms in 261 malaria-exposed individuals from the Brazilian Amazon. The immune responses against a panel of P. vivax blood-stage antigens were evaluated by serological assays. We confirmed our previous findings, which indicated an association between impaired CYP2D6 activity and a higher risk of multiple episodes of P. vivax recurrence (risk ratio, 1.75; 95% confidence interval [CI], 1.2 to 2.6; P = 0.0035). An important finding was a reduction of 3% in the risk of recurrence (risk ratio, 0.97; 95% CI, 0.96 to 0.98; P < 0.0001) per year of malaria exposure, which was observed for individuals with both reduced and normal CYP2D6 activity. Accordingly, subjects with long-term malaria exposure and persistent antibody responses to various antigens showed fewer episodes of malaria recurrence. Our findings have direct implications for malaria control, since it was shown that nonimmune individuals who do not respond adequately to treatment due to reduced CYP2D6 activity may present a significant challenge for sustainable progress toward P. vivax malaria elimination.

Treatment of Odontogenic Keratocyst: A Case Report

Aim: Odontogenic keratocysts are aggressive lesions characterised by a high recurrence risk ratio due to dental lamina residues in mandibular and maxillary regions. Odontogenic keratocysts appear distinct from other jaw cysts. Methodology: In this report, a 35-year-old male patient was admitted to our clinic with numbness in the left mandible; the patient had also been admitted approximately 1 year previously complaining of paraesthesia, which subsequently progressed to complete numbness. During intraoral examination luxation was detected in the mandibular left second molar tooth. No carries or periodontal abnormalities were observed. In panoramic images a radiolucent lesion was detected, with regular boundaries, in the area of interest. Results: The mass was enucleated under local anaesthesia and second molar teeth were extracted. During histopathological examination the mass was determined as a keratocyst. Conclusions: In the present case, surgical treatment was performed. How to cite this article: Koparal M, Adiguzel O. Treatment of Odontogenic Keratocyst: A Case Report. Int Dent Res 2017;7:17-9. Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Treatment of Odontogenic Keratocyst: A Case Report

Aim: Odontogenic keratocysts are aggressive lesions characterised by a high recurrence risk ratio due to dental lamina residues in mandibular and maxillary regions. Odontogenic keratocysts appear distinct from other jaw cysts. Methodology: In this report, a 35-year-old male patient was admitted to our clinic with numbness in the left mandible; the patient had also been admitted approximately 1 year previously complaining of paraesthesia, which subsequently progressed to complete numbness. During intraoral examination luxation was detected in the mandibular left second molar tooth. No carries or periodontal abnormalities were observed. In panoramic images a radiolucent lesion was detected, with regular boundaries, in the area of interest. Results: The mass was enucleated under local anaesthesia and second molar teeth were extracted. During histopathological examination the mass was determined as a keratocyst. Conclusions: In the present case, surgical treatment was performed. How to cite this article: Koparal M, Adiguzel O. Treatment of Odontogenic Keratocyst: A Case Report. Int Dent Res 2016;6:13-15. Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Epidemiology and genetics of hypodontia and microdontia: A study of twin families

ABSTRACT Objective: To identify genetic and environmental factors contributing to hypodontia and microdontia by using Korean twin family data. Materials and Methods: A total of 1267 individuals (525 men and 742 women; 180 monozygotic twins [MZ] and 43 dizygotic twins [DZ] from 282 families) underwent an oral examination as part of the Healthy Twin Study in Korea. Dental anomalies classified as hypodontia or microdontia were diagnosed using radiographs and clinical examinations. In order to estimate genetic contributions to dental anomalies, we estimated the pairwise concordance rate (PCR), recurrence risk ratio (RRR), and heritability (h2). Results: The prevalence of hypodontia and microdontia was 3.55% and 3.00%, respectively. MZ had the highest PCR and RRR (13.0–15.3). The PCR and RRR values for both anomalies were much higher for DZ (5.0–11.9) than for siblings (1.4–2.6), despite the fact that DZ pairs and sibling pairs share 50% genetic identity. Further genetic analysis revealed both an additive genetic effect (0.38 when hypodontia and microdontia were pooled) and a strong “twin effect” (0.52 when hypodontia and microdontia were pooled). Conclusions: This twin-based study revealed that the formation of dental anomalies is affected by both genetic and environmental factors, and that the impact of these factors varies according to the specific dental anomaly.