Machine learning for prediction of schizophrenia based on identifying the primary and interaction effects of minor physical anomalies.

In the neurodevelopmental model of schizophrenia, minor physical anomalies (MPAs) are considered neurodevelopmental markers of schizophrenia. To date, there has been no research to evaluate the interaction between MPAs. Our study built and used a machine learning model to predict the risk of schizophrenia based on measurements of MPA items and to investigate the potential primary and interaction effects of MPAs. The study included 470 patients with schizophrenia and 354 healthy controls. The models used are classical statistical model, Logistic Regression (LR), and machine leaning models, Decision Tree (DT) and Random Forest (RF). We also plotted two-dimensional scatter diagrams and three-dimensional linear/quadratic discriminant analysis (LDA/QDA) graphs for comparison with the DT dendritic structure. We found that RF had the highest predictive power for schizophrenia (Full-training AUC = 0.97 and 5-fold cross-validation AUC = 0.75). We identified several primary MPAs, such as the mouth region, high palate, furrowed tongue, skull height and mouth width. Quantitative MPA analysis indicated that the higher skull height and the narrower mouth width, the higher the risk of schizophrenia. In the interaction, we further identified that skull height and mouth width, furrowed tongue and skull height, high palate and skull height, and high palate and furrowed tongue, showed significant two-item interactions with schizophrenia. A weak three-item interaction was found between high palate, skull height, and mouth width. In conclusion, we found that the two machine learning methods showed good predictive ability in assessing the risk of schizophrenia using the primary and interaction effects of MPAs.

Surgical Treatment Outcome for Familial Melkersson-Rosenthal Syndrome.

BACKGROUND Recurrent facial nerve palsy, orofacial edema, and fissured tongue are a triad of manifestations that characterize a rare disorder named Melkersson-Rosenthal syndrome. It is important to consider this syndrome when diagnosing atypical, unilateral, or bilateral facial palsies with characteristics of familial prevalence. There is no established outcome prediction for this disease and the syndrome does not have a specific duration or prospective timeline. Recurrent facial paralysis can require surgery and a multidisciplinary approach with regular follow-up. CASE REPORT We describe a 38-year-old woman presenting with a third episode of facial paralysis and discuss her pedigree chart and the treatment course chosen. After conservative treatment with oral corticosteroids, antiviral therapy, and motor physical therapy with no significant improvements, the patient underwent facial nerve decompression surgery with outstanding results. Eight months after surgery and intense postoperative physical therapy, the patient improved from grade VI to grade II palsy on the House-Brackmann Scale. The patient's older brother also presented a fissured tongue and had a history of 2 episodes of facial paralysis. The patient's son, mother, and sister also presented tongue fissuring but did not have any other clinical signs of the syndrome. CONCLUSIONS Despite being rare, Melkersson-Rosenthal syndrome is associated with a family inheritance and its diagnosis has prognostic implications. Therefore, it is of the utmost importance to have suspicion of this disorder in order to improve quality of care and target the treatment accordingly. Surgical treatment in these cases seems to be an excellent choice to treat current facial paralysis and prevent further episodes.

Soluble LPS receptor CD14 is increased in saliva of patients with geographic tongue.

OBJECTIVES: The soluble bacterial pattern recognition receptor, sCD14 augments inflammatory responses in oral cavity. The aim of the study was to investigate whether patients with geographic tongue (GT) with and without fissured tongue (FT) have impaired inflammatory regulation, manifesting as increased levels of sCD14 in the saliva. MATERIAL AND METHODS: An enzyme-linked immunosorbent assay was used to measure the amount of sCD14 in whole and parotid saliva of patients diagnosed with GT (GT whole, n = 21; GT parotid, n = 23) and control subjects (GT whole, n = 25; GT parotid, n = 18). The levels of sCD14 were also evaluated according to our previous clinical assessment of GT based on the number of lesions detected on the tongue, as 'mild' (a single lesion), 'moderate' (2-5 lesions), or 'severe' (≥6 lesions). Diagnosis of FT was established when multiple grooves or fissures were observed on the dorsal and lateral surfaces of the tongue. RESULTS: GT patients had significantly higher sCD14 levels in whole (p<.05) and parotid saliva (p<.001), compared with controls. GT patients with FT had significantly increased sCD14 levels only in parotid saliva. A gradual increase in sCD14 levels in parotid and unstimulated saliva was seen in GT patients with multiple tongue lesions compared with single lesions. CONCLUSIONS: GT patients had increased sCD14 in both parotid and unstimulated saliva. sCD14 seems to increase local inflammatory responses, which suggests its involvement in the pathophysiology of GT.

Oral changes in patients with psoriasis.

Psoriasis is one of the most frequent skin diseases. The cause of psoriasis is not fully expained as there are many factors (infectious, traumatic, hormonal, and chemical) that may play a role in the manifestation of its symptoms. One of the factors that may contribute to the appearance of psoriatic lesions may be the lesions in the oral cavity. The occurrence of lesions in the oral cavity is defined as rare, what can be explained by their nonspecific clinical image, and also by the possibility of being overlooked. Most characteristic symptoms of psoriasis occurring in the oral cavity are the geographic tongue and fissured tongue. It is also believed that there is a correlation between psoriasis and oral health- the periodontal and teeth condition as well as changes in saliva secretion. The psoriasis arthritis changes can also affect temporomandibular joint and impair the function of stomatognathic system. Because of these reports, cooperation of dermatologists and dentists in psoriasis care seems to be necessary.

Fissured Tongue among Patients Visiting the Department of Oral Medicine and Radiology in a Tertiary Care Centre.

Introduction: Examination of the tongue and knowledge of its variation can aid clinicians in correctly assessing the cause of a patient's complaint. Despite World Health Organization recommendations to encourage more epidemiological assessment of oral mucosal variations and lesions, the volume of literature in this area is limited. This study aimed to find out the prevalence of fissured tongues among patients visiting the Department of Oral Medicine and Radiology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Department of Oral Medicine and Radiology in a tertiary care centre. Data was collected from 12 March 2023 to 10 May 2023 after obtaining ethical approval from the same institute. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 540 patients, the prevalence of fissured tongue was 73 (13.51%) (10.63-16.40, 95% Confidence Interval). A total of 34 (46.57%) were males and 39 (53.42%) were females. Conclusions: The prevalence of fissured tongue among patients visiting the Department of Oral Medicine and Radiology was higher than other studies done in similar settings. Keywords: anatomic variation; fissured tongue; Nepal; oral mucosa; prevalence.

The risk factors associated with geographic tongue in a southwestern Chinese population.

OBJECTIVE: The goal of this study was to look into age, genetics,sex, oral mucosa diseases, and systemic diseases as potential risk factors for the geographic tongue (GT) in a Chinese population. STUDY DESIGN: This retrospective cross-sectional study used the demographic and medical data of 3400 patients between March 2021 and August 2021 from the Department of Oral Medicine at West China Hospital of Stomatology. Binary logistic regression was conducted to analyze the association of GT and age, fissured tongue (FT), burning mouth syndrome (BMS), oral lichen planus (OLP), gastrointestinal disorders, and hematologic disorders and to acquire the adjusted odds ratio (AOR). RESULTS: GT occurred in 3.6% of patients, with 15 out of 123 (12.2%) patients with GT having a family history. Binary logistic regression found age <30 years (AOR: 4.4; [95% CI: 2.8-6.9]), FT (28.8 [17.1-48.4]), BMS (0.3 [0.1-0.6]), OLP (0.2 [0.0-0.5]), and gastrointestinal disorders (4.3 [2.7-6.7]) were significantly associated with GT, and GT was unrelated to recurrent aphthous ulcer (RAU) or systemic diseases such as cardiovascular diseases. CONCLUSION: In the Chinese population, GT was more prevalent in patients with <30 years of age, FT, and gastrointestinal disorders, and it was less prevalent in BMS and OLP.

Oral Lesions in Patients With Psoriasis: Prevalence and Association With Its Clinical and Epidemiological Characteristics. / Manifestaciones orales en pacientes con psoriasis. Prevalencia y asociación con sus características clínicas y epidemiológicas.

BACKGROUND AND OBJECTIVE: Psoriasis is a multisystem disease associated with an increased prevalence of oral lesions. The aim of this study was to determine the prevalence of oral lesions in patients with psoriasis and examine associations with clinical and patient characteristics. MATERIAL AND METHODS: We conducted a cross-sectional study of patients with psoriasis and healthy controls seen between December 2019 and February 2020. We recorded biometric data, comorbidities associated with psoriasis, oral examination findings, and clinical characteristics of psoriasis. RESULTS: We studied 100 patients with psoriasis and 100 controls. Oral lesions were more common in the psoriasis group (74% vs 46%, P<.001). The most common lesions were fissured tongue (39% vs 16%, P<.001) and periodontitis (28% vs 16%, P=.04). Geographic tongue was uncommon in both the study and the control group (4% vs 2%, P=.68). In the psoriasis group, patients with fissured tongue had a higher prevalence of cardiovascular disease (23.1% vs 4.9%), diabetes mellitus (28.2% vs 8.2%), and psoriatic arthritis (15.4% vs 1.6%) than those without this condition. Periodontitis was also associated with a higher prevalence of cardiovascular disease (28.6% vs 5.6%). Type of psoriasis, location, and time since onset were not significantly associated with oral lesions. Patients with oral lesions, however, had more severe disease (Psoriasis Area Severity Index [PASI], 3.9 vs 2.4; P=.05). Mean PASI was also higher in patients with fissured tongue (4.7 vs. 2.7, P=.03) and periodontitis (5.1 vs. 2.9, P=.04). CONCLUSIONS: The prevalence of oral lesions, especially fissured tongue and periodontitis, is higher in patients with psoriasis than in healthy controls. Oral lesions were associated with more severe psoriasis and a higher prevalence of associated comorbidities. We recommend examining the oral cavity of patients with psoriasis, especially those with more severe disease and comorbidities, irrespective of type of psoriasis, location, or time since onset.

Classification of fissured tongue images using deep neural networks.

BACKGROUND: Tongue inspection is vital in traditional Chinese medicine. Fissured tongue is an important feature in tongue diagnosis, and primarily corresponds to three Chinese medicine syndromes: syndrome-related hotness, blood deficiency, and insufficiency of the spleen. Diagnosis of the syndrome is significantly affected by the experience of clinicians, and it is difficult for young doctors to perform accurate diagnoses. OBJECTIVE: The syndrome not only depends on the local features based on fissured regions but also on the global features of the whole tongue; therefore, a syndrome diagnosis framework combining the global and local features of a fissured tongue image was developed in the present study to achieve a quantitative and objective diagnosis. METHODS: First, we detected the fissured region of a tongue image using a single-shot multibox detector. Second, we extracted the global and local features from a whole tongue image and a fissured region using TongueNet (developed in-house). Third, we developed a classifier to determine the final syndrome. RESULTS: Based on an experiment involving 721 fissured tongue images, we discovered that TongueNet affords better feature extraction. The accuracy of TongueNet was 4% (p< 0.05) and 3% (p< 0.05) higher than that of InceptionV3 and ResNet18, respectively, for whole tongue images. Meanwhile, at local fissured regions, the accuracy of TongueNet was 3% (p< 0.05) higher than that of InceptionV3 and equal to that of ResNet18. Finally, the fusion features outperformed the global and local features with a 78% accuracy. CONCLUSIONS: Our findings indicate that TongueNet designed with batch normalization and dropout is more suitable for uncomplicated images than InceptionV3 and ResNet18. In addition, compared with the global features, the fusion features supplement the detailed information of the fissures and improve classification accuracy.

Risk factors associated with tongue lesions: a propensity score-matched case-control study.

BACKGROUND: to analyse the potential risk factors of tongue lesions, comparing the results with a control group. MATERIAL AND METHODS: An observational, case-control study was designed. The study included a case group comprising 336 patients with tongue lesions and 336 sex and age-matched controls. We recorded tobacco/alcohol habits, presence of dentures, allergies, medical conditions, and medications. Statistical analysis was performed via logistic regression models to estimate the odds ratio (OR) adjusted for gender, age, tobacco, and alcohol using propensity score-matching analysis (PSM). RESULTS: According to the final PSM model, patients with tongue lesions were more likely to suffer from allergies (OR 2.13; 1.27-3.66) or medical conditions (OR 2.14; 1.19-3.85), and more likely to take medication (OR 1.99; 1.11-3.57). Elderly individuals were more prone to hairy tongue (OR 3.82; 1.53-10.47). Smoking was associated with coated tongue (OR 2.05; 1.12-3.63), hairy tongue (OR 3.77; 1.52-9.22) and median rhomboid glossitis (OR 40.49; 5.84-860.43). Allergic individuals were more likely to exhibit sublingual varices (OR 1.73; 1.02-2.88). Medical conditions increased the chances of having coated tongue (OR 2.44; 1.36-4.64) or crenated tongue (OR 2.70; 1.42-5.30). Arterial hypertension was associated with median rhomboid glossitis (OR 5.85; 1.08-34.18). Individuals on medication showed a higher risk of fissured tongue (OR 1.87; 1.20-2.94) and varices (OR 2.42; 1.58-3.80). Agents acting on the alimentary tract and metabolism increased the probability of fissured tongue (OR 2.31; 1.42-3.79). CONCLUSIONS: As far as we are aware, this is the first study on lingual pathology to include a PSM analysis. The results suggest that a history of allergies, the presence of medical conditions, and the use of medication are associated with increased probability of tongue lesions. The analysis of diseases and medications by subgroups requires studies matched by habits with larger sample sizes, in order to corroborate our observations.

Psoriasis is associated with fissured tongue but not geographic tongue: a prospective, cross-sectional, case-control study.

BACKGROUND AND OBJECTIVES: It has been postulated that psoriasis is associated with tongue lesions and geographic tongue might be "oral psoriasis". However, reports are inconclusive, prevalence rates vary and data for Europe are sparse. In this prospective case-control study we investigated the point-prevalence of tongue conditions in an Austrian cohort. PATIENTS AND METHODS: Psoriasis patients and healthy volunteers were assessed regarding tongue and skin lesions, age, sex, smoking habits, allergies, onset of psoriasis, PASI scores and anti-psoriatic treatment. RESULTS: We included 173 psoriasis patients, 58 women, 115 men (median age: 50 [37-60] years), and 173 volunteers, 79 women, 94 men (median age: 54 [43-64] years). Overall, 95 subjects had allergies, 64 psoriasis patients and 50 volunteers were smokers. Median age at onset of psoriasis was 26 (12-40) years, the median PASI score was 2 (0-4.1), most patients received ustekinumab (n = 47). Fissured tongue was significantly associated with psoriasis (25 [14.4 %] psoriasis patients, 13 [7.5 %] volunteers; P = 0.04). Geographic tongue was present in four individuals of each group (2.3%) and associated with smoking (P = 0.01) but not with psoriasis. CONCLUSIONS: Overall, we found a low point-prevalence of tongue lesions in this Austrian cohort. Psoriasis was associated with fissured tongue but not with geographic tongue. Thus, we cannot corroborate the hypothesis that geographic tongue is an oral manifestation of psoriasis.

Rare diagnosis of Melkersson-Rosenthal syndrome in a paediatric patient.

Melkersson-Rosenthal syndrome (MRS) is a rare neurocutaneous syndrome characterised by the triad of recurrent orofacial swelling, facial nerve palsy and fissured tongue. This diagnosis is particularly rare in children. We aim to increase awareness of the syndromic association of these clinical features since most patients present with a monosymptomatic form, reiterating the importance of detailed history and thorough physical examination, for the timely identification of these patients. Not only the recurring of symptoms, but also the association of MRS with other medical conditions, make 'earlier' diagnosis of the Syndrome beneficial. The average delay in diagnosis is 4-9 years. Although most cases resolve without treatment, when treated,steroids are most commonly used. Variable options have been tried for refractory and frequently recurrent cases. We present a case of MRS in a 12-year-old girl, diagnosed 3 years after onset of symptoms. We reviewed updated literature for MRS and associated clinical conditions as well as published treatment options.

[Study on the oral mucosal diseases in patients with cerebrovascular diseases].

Objective: To investigate the prevalence of oral mucosal diseases (OMD) in patients with cerebrovascular disease. Methods: A total of 182 patients with cerebrovascular disease and 166 controls were examined for OMD to compare the differences of prevalence rates. Results: The prevalence of OMD in patients with cerebrovascular disease appeared higher than that in the control group. Oral candidiasis was most commonly seen (11.1%, 20/182), followed by fissured tongue (5.0%, 9/182), traumatic ulcer (2.8%, 5/182), herpes labialis (2.2%, 4/182), recurrent oral ulcer (1.6%, 3/182), chronic cheilitis (1.6%, 3/182) and oral leukokeratosis (1.6%, 3/182). Conclusion: Patients with cerebrovascular diseases were susceptible to OMDs, especially to oral candidiasis that called for more attention.

Melkersson-Rosenthal syndrome with coeliac and allergic diseases.

A 45-year-old man presented with a 10-year history of relapsing oedema of the lips. Moreover, he exhibited recurrent facial nerve palsy since the age of 10 years, coeliac disease since the age of 12 years, atopic eczema, allergic rhinitis and asthma. Physical examination revealed lip swelling and lingua plicata. Thus, he presented the classic triad of Melkersson-Rosenthal syndrome which includes recurrent orofacial oedema, facial nerve palsy and fissured tongue. A lip biopsy confirmed our clinical diagnosis.This case is particularly rare, as the classic triad is seen only in a minority of the cases. Moreover, allergic and coeliac diseases were observed concomitantly. This paper illustrates a potential pathophysiological interconnection between these pathologies in which interferon gamma could play a key role. To our knowledge, this is the first case report in which Melkersson-Rosenthal syndrome has been observed concurrently with coeliac disease.

[Recurrent and alternating peripheral facial palsy in a Rehabilitation department]. / Parálisis facial periférica recurrente y alternante en un servicio de Rehabilitación.

Peripheral facial palsy is a relatively frequent condition in rehabilitation departments. The most common aetiology is idiopathic, known as Bell's palsy, which usually has a good prognosis and resolves without sequels. The presence of uncommon symptoms with the facial palsy should lead to suspicion of another possible aetiology, as occurred in the case presented here. Melkersson-Rosenthal's syndrome is one of the entities to keep in mind in the diagnosis of atypical facial palsies. This is an underdiagnosed disease due to the variability of its clinical manifestations. Classically, it manifests as a recurrent and alternating facial edema with peripheral facial palsy and fissured tongue.