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Clinical and Experimental Dental... Feb 2023This analysis examined the clinical and histopathological characteristics of white and red oral mucosal lesions and patient lifestyle behaviors to understand how the...
OBJECTIVES
This analysis examined the clinical and histopathological characteristics of white and red oral mucosal lesions and patient lifestyle behaviors to understand how the lesions changed over 19-23 years, including among patients who developed oral and pharyngeal cancer.
MATERIALS AND METHODS
Seventy-five individuals with red and/or white oral mucosal lesions with clinical diagnoses of smokeless tobacco lesions, leukoplakia, erythroplakia, lichen planus, ulcer, and virus-associated lesions were identified in six Veterans Affairs Medical Center Dental Clinics (VAMC) from 1996 to 2001. Biopsy results and patients' sociodemographic, medical, and tobacco/alcohol use characteristics were obtained. Study dentists used standardized forms to capture information about the lesions. Study participants were re-examined at intervals through January 2002. In 2020, a retrospective review of VAMC and public records ascertained whether participants developed oral cancer or died.
RESULTS
The most common red or white oral mucosal lesions among the 75 study participants were leukoplakia (36.0%), smokeless tobacco lesions (26.7%), virus-associated lesions (18.7%), and lichen planus (16.0%). Lesions in 11% of participants with leukoplakia and one-third of participants with lichen planus persisted for 5 years or more. Dysplasia was present in four participants with leukoplakia. Seventeen percent of participants developed a new white or red oral mucosal lesion. Five patients (6.1%) developed oral or pharyngeal cancer, four among participants with leukoplakia (one with prior dysplasia) and one among participants with lichen planus. Four of the cancers developed 6-20 years after enrollment, and only one was at the original lesion site.
CONCLUSIONS
The occurrence of oral and pharyngeal cancers in some study participants with white and red oral mucosal lesions many years after enrollment reinforces the need for patients, dentists, and health care systems to have better methods to identify and assess the malignant potential of oral lesions, monitor patients over time, and intercept high-risk oral lesions before they become cancerous.
Topics: Humans; Dental Clinics; Follow-Up Studies; Leukoplakia, Oral; Lichen Planus; Pharyngeal Neoplasms; Veterans; Mouth Neoplasms; Lichen Planus, Oral; Mouth Mucosa
PubMed: 36510634
DOI: 10.1002/cre2.677 -
Journal of Immunology (Baltimore, Md. :... Dec 2019The pharyngeal organ is located at the crossroad of the respiratory and digestive tracts in vertebrate, and it is continuously challenged by varying Ags during breathing...
The pharyngeal organ is located at the crossroad of the respiratory and digestive tracts in vertebrate, and it is continuously challenged by varying Ags during breathing and feeding. In mammals, the pharyngeal mucosa (PM) is a critical first line of defense. However, the evolutionary origins and ancient roles of immune defense and microbiota homeostasis of PM are still unknown. In this study, to our knowledge, we are the first to find that diffuse MALT is present in PM of rainbow trout, an early vertebrate. Importantly, following parasitic infection, we detect that strong parasite-specific mucosal IgT and dominant proliferation of IgT B cell immune responses occurs in trout PM, providing, to our knowledge, the first demonstration of local mucosal Ig responses against pathogens in pharyngeal organ of a nonmammal species. Moreover, we show that the trout PM microbiota is prevalently coated with secretory IgT and, to a much lesser degree, by IgM and IgD, suggesting the key role of mucosal Igs in the immune exclusion of teleost pharyngeal bacteria. Overall, to our knowledge, our findings provide the first evidence that pharyngeal mucosal immunity appear earlier than tetrapods.
Topics: Animals; Biological Evolution; Homeostasis; Oncorhynchus mykiss; Pharyngitis; Respiratory Mucosa
PubMed: 31645417
DOI: 10.4049/jimmunol.1900863 -
Journal Der Deutschen Dermatologischen... Nov 2022Mucous membrane pemphigoid (MMP) is a pemphigoid disease with predominant mucous membrane involvement. It mainly affects the mucous membranes of the mouth, eyes, nose...
Mucous membrane pemphigoid (MMP) is a pemphigoid disease with predominant mucous membrane involvement. It mainly affects the mucous membranes of the mouth, eyes, nose and pharynx, but also the larynx, trachea, esophagus, genital and perianal regions. The manifestation of the disease covers a wide spectrum from gingival erythema and single oral lesions to severe tracheal strictures that obstruct breathing and conjunctival scarring with marked visual impairment and, not infrequently, blindness. In addition to a clinical picture of predominant mucosal involvement, diagnosis is based on direct immunofluorescence of a peri-lesional biopsy and serology. The main target antigen is BP180 (collagen XVII), and reactivity with laminin 332 is associated with malignancy in approximately 25 % of MMP patients. The treatment of MMP is challenging. On the one hand, due to the involvement of different mucous membranes, good interdisciplinary cooperation is required; on the other hand, due to the rarity of the disease, no randomized controlled clinical trials are available. The aim of this guideline is to present the clinical picture, including severity and scoring systems, and to give guidance for diagnosing and treating this complex disease. In MMP, interdisciplinary cooperation plays an essential role as well as the prompt diagnosis and initiation of adequate therapy in order to avoid irreversible damage to the mucous membranes with serious complications.
Topics: Humans; Pemphigoid, Bullous; Pemphigoid, Benign Mucous Membrane; Mucous Membrane; Fluorescent Antibody Technique, Direct; Biopsy
PubMed: 36354061
DOI: 10.1111/ddg.14905 -
Tumori Apr 2023Radiotherapy (RT) against head and neck squamous cell carcinomas (HNSCC) may lead to severe toxicity in 30-40% of patients. The normal tissue complication probability...
OBJECTIVE
Radiotherapy (RT) against head and neck squamous cell carcinomas (HNSCC) may lead to severe toxicity in 30-40% of patients. The normal tissue complication probability (NTCP) models, based on dosimetric data refined the normal tissue dose/volume tolerance guidelines. In parallel, the radiation-induced nucleoshuttling (RIANS) of the Ataxia-Telangiectasia Mutated protein (pATM) is a predictive approach of individual intrinsic radiosensitivity. Here, we combined NTCP with RADIODTECT©, a blood assay derived from the RIANS model, to predict RT toxicity in HNSCC patients.
METHODS
RADIODTECT© cutoff values (i.e. 57.8 ng/mL for grade⩾2 toxicity and 46 ng/mL for grade⩾3 toxicity) have been previously assessed. Validation was performed on a prospective cohort of 36 HNSCC patients treated with postoperative RT. Toxicity was graded with the Common Terminology Criteria for Adverse Events (CTCAE) scale and two criteria were considered: grade⩾2 oral mucositis (OM2), grade⩾3 mucositis (OM3) and grade⩾2 dysphagia (DY2), grade⩾3 dysphagia (DY3). pATM quantification was assessed in lymphocytes of HNSCC patients. The discrimination power of the pATM assay was evaluated through the Area Under the Receiver Operator Characteristics Curve (AUC-ROC). Two previously described NTCP models were considered, including the dose to the oral cavity and the mean dose to the parotid glands (OM2 and OM3) and the dose to the oral cavity, to the larynx and the volume of pharyngeal constrictor muscles (DY2 and DY3).
RESULTS
Combining NTCP models with RADIODTECT© blood test improved the AUC-ROC. Considering the prediction of mucositis, AUC-ROC=0.80 was for OM2, and AUC-ROC=0.78 for OM3. Considering the prediction of acute dysphagia, AUC-ROC=0.71 for DY2 and for DY3.
CONCLUSIONS
Combining NTCP models with a radiosensitivity biomarker might significantly improve the prediction of toxicities for HNSCC patients.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; Pilot Projects; Mucositis; Head and Neck Neoplasms; Deglutition Disorders; Prospective Studies; Dysprosium; Radiotherapy Dosage; Radiation Tolerance; Biomarkers; Probability
PubMed: 35578746
DOI: 10.1177/03008916221078061 -
MBio Aug 2021Oropharyngeal candidiasis (OPC) is the most prevalent oral infection in immunocompromised patients, primarily associated with Candida albicans. Increasing evidence...
Oropharyngeal candidiasis (OPC) is the most prevalent oral infection in immunocompromised patients, primarily associated with Candida albicans. Increasing evidence points to a significant role of mucosal bacteria on the transition of C. albicans from commensal to pathogenic. In this work, we hypothesized that changes in the abundance or composition of the mucosal bacterial microbiota induced by dietary sucrose during the development of OPC can modulate C. albicans virulence. C. albicans burdens and mucosal lesions were evaluated in a mouse cortisone immunosuppression model amended with sucrose. We also analyzed the mucosal bacterial composition using 16S rRNA gene sequencing and culture methods. In immunocompetent mice, sucrose significantly increased total bacterial burdens and reduced alpha diversity, by increasing the relative abundance of mitis group streptococci. In immunocompromised mice, C. albicans infection was associated with a significantly reduced bacterial alpha diversity due to an increase in the relative abundance of enterococci. When exposed to dietary sucrose, these mice had reduced C. albicans burdens and reduced bacterial alpha diversity, associated with an increase in the relative abundance of . SparCC correlation networks showed a significant negative correlation between and in all -infected mice. Depletion of lactobacilli with antibiotic treatment partially restored C. albicans burdens in mice receiving sucrose. In coculture experiments, mouse oral Lactobacillus johnsonii isolates inhibited growth of Enterococcus faecalis isolates and C. albicans. These results support the hypothesis that the sucrose-induced attenuation of C. albicans virulence was a result of changes in the mucosal bacterial microbiome characterized by a reduction in enterococci and an increase in lactobacilli. By comparing Candida albicans virulence and the mucosal bacterial composition in a mouse oral infection model, we were able to dissect the effects of the host environment (immunosuppression), infection with C. albicans, and local modulating factors (availability of sucrose as a carbon source) on the mucosal bacterial microbiome and its role on fungal virulence. We showed that changes in endogenous microbial communities in response to sucrose can lead to attenuation of fungal disease. We also showed that Lactobacillus johnsonii may curtail virulence both by inhibiting its growth and by inhibiting the growth of potentially synergistic bacteria such as enterococci. Our results support the concept that pathogenesis should be viewed in the contexts of both a susceptible host and a mucosal bacterial microbiota conducive to virulence.
Topics: Animals; Candida albicans; Candidiasis, Oral; Disease Models, Animal; Female; Lactobacillus; Mice; Mice, Inbred C57BL; Microbial Interactions; Microbiota; Mouth Mucosa; Oropharynx; RNA, Ribosomal, 16S; Sucrose; Virulence
PubMed: 34399623
DOI: 10.1128/mBio.01937-21 -
Otolaryngology--head and Neck Surgery :... Nov 2014To evaluate the preemptive analgesic effect of submucosal infiltration of ropivacaine for uvulopalatopharyngoplasty. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the preemptive analgesic effect of submucosal infiltration of ropivacaine for uvulopalatopharyngoplasty.
STUDY DESIGN
Randomized controlled trial.
SETTING
Comprehensive clinical center and academic hospital.
SUBJECTS AND METHODS
Fifty consecutive male patients scheduled for uvulopalatopharyngoplasty were divided randomly into group A and group B. In group A, 4 mL of 0.33% ropivacaine and normal saline with epinephrine was preincisionally injected under the mucosa on both sides of the tonsillar fossa, soft palate, and the lower part of palatoglossal arch, whereas the upper and middle parts of the palatoglossal arch and the upper part of the palatopharyngeal arch were infiltrated with 2 mL of the same mixture. In group B, an identical volume of normal saline with epinephrine was administered. In both groups, postoperative pain was initially controlled by intravenous morphine titration until patient-controlled analgesia with morphine could be used. Cumulative patient-controlled analgesic morphine consumption; visual analog scale scores at 4, 8, 12, 24, and 48 hours postoperatively at rest and during swallowing; and opioid-related adverse effects were recorded.
RESULTS
The visual analog score was lower at rest during the 48-hour postoperative period and during swallowing within the first 12 hours for group A versus group B (P < .05). Patients in group A required 44.1%, 38.2%, and 41.1% less morphine during the first 24 hours, 24 hours to 48 hours, and 48 hours postoperatively, respectively, and fewer patients experienced nausea, vomiting, and pruritus (P < .05).
CONCLUSION
Preemptive submucosal infiltration with 0.33% ropivacaine effectively controlled pain after uvulopalato-pharyngoplasty.
Topics: Adult; Amides; Humans; Male; Middle Aged; Mucous Membrane; Pain, Postoperative; Palate, Soft; Pharynx; Premedication; Ropivacaine; Sleep Apnea, Obstructive; Uvula
PubMed: 25113509
DOI: 10.1177/0194599814545726 -
Emerging Infectious Diseases Jan 2021Analyses of infection chains have demonstrated that severe acute respiratory syndrome coronavirus 2 is highly transmissive. However, data on postmortem stability and...
Analyses of infection chains have demonstrated that severe acute respiratory syndrome coronavirus 2 is highly transmissive. However, data on postmortem stability and infectivity are lacking. Our finding of nasopharyngeal viral RNA stability in 79 corpses showed no time-dependent decrease. Maintained infectivity is supported by virus isolation up to 35 hours postmortem.
Topics: COVID-19; Cadaver; Humans; Nasopharynx; RNA, Viral; Respiratory Mucosa; SARS-CoV-2
PubMed: 33327991
DOI: 10.3201/eid2701.203112 -
Scientific Reports Jan 2020Mucosal melanomas are primary malignant neoplasias originated from melanocytes within mucous membranes in any part of mucosal surface lining, more commonly, in the nasal...
Mucosal melanomas are primary malignant neoplasias originated from melanocytes within mucous membranes in any part of mucosal surface lining, more commonly, in the nasal cavity and accessory sinuses, oral cavity, lips, pharynx, vulvar, vaginal, cervix and anorectal mucosa. Epidemiology data regarding mucosal melanomas in Brazil is scarce, hence the motivation to conduct this research paper. The χ2 test was used to compare categorical variables. Forward stepwise logistic regression method was used in the multivariate analysis to identify independent predictors of early death. A total of 801 patients were included in the analysis. Surgical resection is frequently the first approach to primary tumours (65.3%), even though the utility of lymph node surgery and radiation therapy is not well established. Advanced stage was observed in more than two thirds of patients. Early death was observed in 28.3%. MM cases with regional or distant metastases as well as those located in unusual locations had almost 4 times more risk for early death. Besides that, MM located in lips, oral cavity and pharynx and those receiving chemotherapy had 2 times more risk of early death.
Topics: Brazil; Female; Humans; Logistic Models; Male; Melanoma; Mucous Membrane; Neoplasm Metastasis; Neoplasm Staging; Survival Analysis
PubMed: 31949210
DOI: 10.1038/s41598-019-57253-6 -
Acta Paediatrica (Oslo, Norway : 1992) Jun 2021The aim of this study was to provide an update on paediatric Kingella kingae infections. (Review)
Review
AIM
The aim of this study was to provide an update on paediatric Kingella kingae infections.
METHODS
We used the PubMed database to identify studies published in English, French and Spanish up to 15 November 2020.
RESULTS
Kingella kingae colonised the oropharynx after the age of 6 months, and the mucosal surface was the portal of entry of the organism to the bloodstream and the source of child-to-child spread. Attending day care centres was associated with increased carriage rate and transmission and disease outbreaks were detected in day care facilities. Skeletal system infections were usually characterised by mild symptoms and moderately elevated inflammation markers, requiring a high clinical suspicion index. The organism was difficult to recover in cultures and molecular tests significantly improve its detection. Kingella kingae was generally susceptible to beta-lactam antibiotics, and skeletal diseases and bacteraemia responded to antimicrobial, leaving no long-term sequelae. However, patients with endocarditis frequently experienced life-threatening complications and the case fatality rate exceeded 10%.
CONCLUSION
Kingella kingae was the prime aetiology of skeletal system infections in children aged 6-48 months. Paediatricians should be aware of the peculiar features of this infection and the need to use molecular tests for diagnosis.
Topics: Bacteremia; Child; Child Day Care Centers; Humans; Infant; Kingella kingae; Neisseriaceae Infections; Oropharynx
PubMed: 33486790
DOI: 10.1111/apa.15773 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Oct 2023To study the application value of narrow-band imaging in the diagnosis of laryngopharyngeal reflux. A total of 275 patients admitted to the inpatient department or...
To study the application value of narrow-band imaging in the diagnosis of laryngopharyngeal reflux. A total of 275 patients admitted to the inpatient department or laryngoscopy room of the Otolaryngology Head and Neck Surgery Department of the First Affiliated Hospital of Harbin Medical University from September 2022 to April 2023 due to throat discomfort were selected as the research subjects. All of them completed RSI, RFS scoring scales and electronic laryngoscopy(including ordinary white light and NBI). According to the expert consensus of LPRD in 2022, RSI and RFS scoring scale were used as diagnostic criteria to divide them into LPR group and non-LPR group. Chi-square test was used to analyze the differences of positive rates of characteristic manifestations under NBI among different groups. The consistency of NBI and scale diagnostic methods was analyzed by Kappa, and RSI and RFS scoring were used as diagnostic criteria, The diagnostic efficiency of NBI method was analyzed. There were 190 people in the LPR group, 157 of whom showed characteristic performance under the NBI mode, with a positive rate of 82.6%(157/190); there were 85 people in the non-LPR group, with a positive rate of 18.8%(16/85). There was a statistically significant difference in the positive rate between the two groups(χ²=102.47, <0.05). The consistency rate between RSI, RFS and NBI was 82.2%(226/275). Kappa consistency analysis was used, and Kappa=0.605(<0.05), indicating good consistency between the two diagnostic methods. Using RSI and RFS as diagnostic criteria for LPR, the sensitivity of NBI diagnostic method was 82.6%(157/190), specificity 81.2%(69/85), positive predictive value 90.8%(157/173) and negative predictive value 67.6%(69/102). Narrow-band imaging, as a new endoscopic imaging technique, can show small changes in mucosal surface micro vessels and play an important role in the diagnosis of laryngopharyngeal reflux.
Topics: Humans; Laryngopharyngeal Reflux; Narrow Band Imaging; Laryngoscopy; Pharynx; Predictive Value of Tests
PubMed: 37828884
DOI: 10.13201/j.issn.2096-7993.2023.10.008