Invasive squamous cell carcinoma within a plaque of circumscribed palmar hypokeratosis.

Circumscribed palmar hypokeratosis (CPH) is a localized disorder of epidermal keratinization that is presented as a well-delimited, depressed, erythematous plaque on the palms or on the soles. It is histopathologically characterized by an abrupt thinning of the corneal epidermal layer. CPH is considered a benign condition, but a few cases with dysplastic changes/carcinoma in situ in the hypokeratotic epidermis have been described. We report hereby a case of invasive squamous cell carcinoma developed within a plaque of CPH. The pathogenesis of the malignant changes in this disorder remains to be clarified. Clinicians should be aware of the potential for developing malignancy in CPH and carry out a closer follow-up of this disorder.

Diagnosis and rehabilitation of an infant with palatal mucormycosis: A clinical report and systematic literature review.

STATEMENT OF PROBLEM: Oral mucormycosis is uncommon in pediatric patients with hematolymphoid diseases. Prosthetic rehabilitation is challenging, and protocols are scarce in the literature. PURPOSE: The purpose of this clinical report and systematic literature review of case reports and case series was to describe the clinicopathologic aspects of oral mucormycosis and the interim prosthetic rehabilitation of an affected infant. MATERIAL AND METHODS: The clinical lesions were ulcerative and necrotic with underlying bone exposure that affected the hard palate. The affected area underwent surgical debridement, and histopathologic analysis was performed. A literature search in PubMed/MEDLINE, Embase, Scopus, and Web of Science up to October 2023 was performed. RESULTS: The histopathological features were consistent with mucormycosis. Topical and systemic antifungals were prescribed. Tooth eruption was insufficient, and an acetate plate without clasp retention, but still with adequate retention, was fabricated. Articulatory, masticatory, and swallowing functions were restored, preventing the passage of food and fluids into the oroantral cavities. Twenty-five articles describing 26 patients with oral mucormycosis related to hematolymphoid disorders affecting the pediatric population were identified. None of the authors of these articles provided information about oral rehabilitation. CONCLUSIONS: Early diagnosis and treatment are essential to increasing the chances of survival for infants affected by oral mucormycosis. Custom-made rehabilitation should be provided to restore oral function and improve the patient's general health.

Marginal Mandibulectomy and Oral Rehabilitation of Xeroderma Pigmentosum Patient.

Xeroderma pigmentosum (XP) may cause tissue deformation in patients who have undergone oral cancer surgery requiring resection of any part of the mandible. Oral rehabilitation is a pivotal factor in the restoration of function and esthetics. The aim of this study was to report a clinical case of successful prosthetic rehabilitation of a 57-year-old woman who presented with marginal mandibulectomy and a significant reduction in maximal mouth opening after treatment for XP. With her reduced opening and considerable loss of structure and tissue, she had difficulty speaking, swallowing, and altered esthetics. The oral rehabilitation was performed with complete maxilla denture and mandible overdenture retained by 2 implants. This case demonstrates that the rehabilitation with mandible overdentures and complete maxilla dentures provide function and esthetic improvement in the mutilated area for XP patients with marginal mandibulectomies.

Oral Rehabilitation of Marginal Maxillectomy Patient After Local Flap Reconstruction.

The treatment of oral cancer can lead to various oral complications, including oral defects, tissue deformation, and trismus in patients who have undergone oral cancer surgery with resection of any part of the maxillary. Restoring the ability to chew, swallow, and maintain esthetics is essential and a significant challenge. The aim of this study was to report a successful clinical case of preprosthetic surgery and prosthetic rehabilitation of a 65-year-old man who had undergone marginal maxillectomy, resulting in tissue scarring and a significant reduction in maximal mouth opening. The oral rehabilitation was achieved using a conventional removable prosthesis. This case demonstrates that preprosthetic surgery combined with conventional removable prosthesis is an effective strategy for complex rehabilitations providing functional and esthetic improvement in the affected area for patients with marginal maxillectomies resulting from oral cancer.

Interplay between epithelial and mesenchymal cells unveils essential proinflammatory and pro-resolutive mediators modulated by photobiomodulation therapy at 660 nm.

Photobiomodulation therapy (PBMT) has been widely used to promote tissue repair. However, PBMT's critical roles in the epithelial and mesenchymal tissues interactions are still barely known. Herein, we investigated light parameters on challenged keratinocytes (KC)-i.e., cultivated under oxidative stress-solely or associated with fibroblasts (FB) in a co-culture system. Cells were treated with PBMT at the wavelength of 660 nm, at 20 mW and 0.71 W/cm2 . Three different energy densities were primarily evaluated on KC: 1 (1.4 s), 5 (7 s), and 50 J/cm2 (70 s). Next, KC and FB were co-cultured and assessed at 5 J/cm2 . This energy density was also tested in ex vivo murine skin samples. Our main data suggest that PBMT can increase cellular proliferation at low doses and cell migration in a biphasic mode (1 and 50 J/cm2 ), both further confirmed by the epidermal growth factor receptor ligand-amphiregulin-upregulation. IL-1RA mRNA-the IL-1ß (interleukin-1ß) receptor antagonist recognized to fasten wound repair-was upregulated in the co-culture system. Upon PBMT, the ex vivo findings showed a progressive increase in the epidermal thickness, although presenting qualitatively less differentiated epithelium than the control group. In conclusion, PBMT effects are dependent on the cellular interactions with the surrounding microenvironment. Ultimately, PBMT is anti-inflammatory and contributes to the expression of critical mediators of wound repair.

Facial Scanning and Additive Manufacturing Used in Production Nasal Prosthesis.

Maxillofacial prosthesis is an effective treatment for patients with facial sequelae, but it remains challenging for professionals due to its high esthetic complexity. This study describes a clinical case of successful nasal prosthetic rehabilitation using digital technology and additive manufacturing. Initially, the 76-year-old patient, with a facial defect in the nasal region, had her face scanned with 3-dimensional scanner for laboratory planning of the prototype of a nasal prosthesis. After approving the prototype image, working models in muffle shape were obtained in additive manufacture for the inclusion of the prosthesis. In the final session, the prosthesis was colored extrinsically and installed. The procedures digital in the manufacture of the facial prosthesis was applicable and agile, allowing the professional greater predictability regarding the shape of the rehabilitated organ, esthetic improvement in the mutilated area and patient satisfaction in relation to the speed, of the procedure and the quality of the prosthesis.

Type IV hypersensitivity associated with restorative materials: Clinical report and systematic literature review.

STATEMENT OF PROBLEM: Type IV hypersensitivity reactions (Type IV HR) are immune responses mediated by antigen-specific effector T cells. PURPOSE: The purpose of this clinical report and systematic review was to report the clinicopathological features of Type IV HR in the oral mucosa and to present a systematic literature review of case reports and case series of individuals with Type IV HR in the oral mucosa related to contact with dental materials. MATERIAL AND METHODS: The presented clinical lesions were melanotic macules with burning that affected the internal labial mucosa in contact with composite resin veneer crowns. Histopathological and immunohistochemical analysis of the lesion was performed. The systematic literature review was performed based on a search in 4 electronic databases (PubMed/MEDLINE, Scopus, Web of Science, and Ovid). RESULTS: Immunohistochemistry showed positivity for CD4, CD8, CD20, CD3, tryptase, and CD117. After conservative treatment, the patient reported improvement of symptoms, and a decrease in the number of inflammatory cells was verified. Twenty-one articles were included in the review. Unlike the present patient, the authors of all the articles recommended radical treatment with the removal of the dental material. CONCLUSIONS: Type IV HR in oral mucosa is rare, and the assessment of clinical and histopathological characteristics is essential to perform an accurate diagnosis and provide appropriate treatment.

Disinfectant effects of Brazilian green propolis alcohol solutions on the Staphylococcus aureus biofilm of maxillofacial prosthesis polymers.

STATEMENT OF PROBLEM: Brazilian green propolis may be an alternative product that reduces the development of a microbial biofilm on the polymers used for maxillofacial prostheses. However, its effects as a disinfectant have not been fully established. PURPOSE: The purpose of this in vitro study was to investigate the effects of Brazilian green propolis alcohol solutions against the Staphylococcus aureus biofilm on polymers used in maxillofacial prostheses, the maxillofacial silicone elastomer (MDX4-4210), and specific acrylic resins for ocular prostheses. MATERIAL AND METHODS: A total of 324 disk-shaped specimens (3×10 mm) of each material were fabricated. All specimens were contaminated with S. aureus (108 cells/mL) to assess the antibiofilm activity of immersion solutions and protocols. Thus, 162 specimens of each material were randomly distributed and equally divided into 5 groups of disinfectants and 1 control group: 3 separate groups of 2.5%, 5%, and 10% propolis alcohol solutions, 1 group of 5% propolis alcohol gel, a positive control group of 2% chlorhexidine gluconate, and a negative control group of distilled water. Specimens (n=9) were disinfected by immersion for 5, 10, and 15 minutes and immersed in culture medium for 24 hours. Any notable turgescence in the final medium was considered indicative of a biofilm. The effects of disinfectants were analyzed by a turbidity assay and by scanning electron microscopy. Data were analyzed descriptively. RESULTS: The final medium with specimens disinfected with 10% propolis alcohol solution showed no turbidity, indicating constant efficacy against the S. aureus biofilm. Similarly, these findings were observed in the 2% chlorhexidine gluconate group. Scanning electron microscopy images demonstrated that the surface of the polymers treated with 10% propolis alcohol solution did not show bacterial colonies. CONCLUSIONS: Disinfection with 10% green propolis alcohol solution was effective in eliminating the S. aureus biofilm from specimens of maxillofacial elastomer and N1 acrylic resin specific to ocular prostheses by immersion for 5 minutes.

Mapping IPF helps identify geographic regions at higher risk for disease development and potential triggers.

BACKGROUND AND OBJECTIVE: The relationship between IPF development and environmental factors has not been completely elucidated. Analysing geographic regions of idiopathic pulmonary fibrosis (IPF) cases could help identify those areas with higher aggregation and investigate potential triggers. We hypothesize that cross-analysing location of IPF cases and areas of consistently high air pollution concentration could lead to recognition of environmental risk factors for IPF development. METHODS: This retrospective study analysed epidemiological and clinical data from 503 patients registered in the Observatory IPF.cat from January 2017 to June 2019. Incident and prevalent IPF cases from the Catalan region of Spain were graphed based on their postal address. We generated maps of the most relevant air pollutant PM2.5 from the last 10 years using data from the CALIOPE air quality forecast system and observational data. RESULTS: In 2018, the prevalence of IPF differed across provinces; from 8.1 cases per 100 000 habitants in Barcelona to 2.0 cases per 100 000 in Girona. The ratio of IPF was higher in some areas. Mapping PM2.5 levels illustrated that certain areas with more industry, traffic and shipping maintained markedly higher PM2.5 concentrations. Most of these locations correlated with higher aggregation of IPF cases. Compared with other risk factors, PM2.5 exposure was the most frequent. CONCLUSION: In this retrospective study, prevalence of IPF is higher in areas of elevated PM2.5 concentration. Prospective studies with targeted pollution mapping need to be done in specific geographies to compile a broader profile of environmental factors involved in the development of pulmonary fibrosis.

Genetic Variants of ANGPT1, CD39, FGF2 and MMP9 Linked to Clinical Outcome of Bevacizumab Plus Chemotherapy for Metastatic Colorectal Cancer.

Angiogenesis pathway genes show substantial genetic variability causing inter-individual differences in responses to anti-angiogenic drugs. We examined 20 single nucleotide polymorphisms (SNPs) in 13 of these genes to predict tumour response and clinical outcome measured as progression free survival (PFS) and overall survival (OS) in 57 patients with metastatic colorectal cancer (mCRC) given bevacizumab plus chemotherapy. SNPs were detected (iPLEX® Assay) in genomic DNA extracted from formalin-fixed paraffin-embedded tumour specimens. The variant allele CD39 rs11188513 was associated with a good tumour response (p = 0.024). Patients homozygous for the wild-type allele FGF2 rs1960669 showed a median PFS of 10.95 months versus 5.44 months for those with at least one variant allele-A (HR 3.30; 95% CI: 1.52-7.14; p = 0.001). Patients homozygous for wild-type MMP9 rs2236416 and rs2274755 showed a median PFS of 9.48 months versus 6 and 6.62 months, respectively, for those with at least one variant allele (p = 0.022, p = 0.043, respectively). OS was also lengthened to 30.92 months (p = 0.034) in carriers of wild-type ANGPT1 rs2445365 versus 22.07 months for those carrying at least one variant allele-A. These gene variants were able to predict clinical outcome and tumour response in mCRC patients given bevacizumab-based therapy.

High-risk Human Papillomavirus Determination in Formalin-fixed, Paraffin-embedded Cervical Tissue Using the Roche Cobas 4800 System: A Comparative Study With Liquid-based Cytology.

Roche cobas 4800 human papillomavirus (HPV) test is an automated real-time polymerase chain reaction-based system that allows the simultaneous detection of 14 human papillomavirus high-risk (HR-HPV) genotypes. This test is Food and Drug Administration approved since 2011 for HPV determination in liquid-based cytologic samples, but a clinically validated technique for formalin-fixed, paraffin-embedded (FFPE) tissue specimens is presently not commercially available. In our laboratory, we have developed an HPV detection procedure in FFPE tissue by cobas 4800 HPV test. In order to validate our method, we retrospectively studied 165 FFPE cervical biopsy and conization specimens with varied diagnoses from our files. In 50 of them, we contrasted the results with those obtained from simultaneous liquid-based cytologies from the same patients. Finally, seeking the possible complementary clinical usefulness of the procedure, we compared the HPV genotypes detected in cervical intraepithelial neoplasia grade 1 (CIN1)-diagnosed biopsies from 20 patients with a subsequent high-grade CIN (CIN2+) diagnosis with those from another group of 20 patients without a subsequent CIN2+ diagnosis. Eighty-seven percent of the assays provided informative results. HR-HPV was detected in 28 of 32 (88%) invasive cervical squamous carcinomas. Coincidental HR-HPV genotypes were obtained in 32 of 50 (64%) cases with simultaneous cervical biopsy and liquid-based cytologic samples. A significant higher risk of progression to CIN2+ was found when HPV16 (P=0.022) or any HR-HPV genotype (P=0.037) was detected in CIN1 biopsies. The reported procedure provides an automated, technically time-saving, easy to integrate into laboratory routine, and reliable method of HR-HPV determination in FFPE specimens.

Relationship between the respiratory microbiome and the severity of airflow limitation, history of exacerbations and circulating eosinophils in COPD patients.

BACKGROUND: The respiratory microbiome is altered in COPD patients but its relationship with core components of the disease, such as the severity of airflow limitation, the frequency of exacerbations or the circulating levels of eosinophils, is unclear. METHODS: Cross-sectional study comprising 72 clinically stable COPD patients (mean age 68 [SD 7.9] years; FEV1 48.7 [SD 20.1]% of reference) who provided spontaneous sputum samples for 16S rRNA gene amplification and sequencing. The microbiome composition was analysed with QIIME. RESULTS: We observed that: (1) more severe airflow limitation was associated with reduced relative abundance (RA) of Treponema and an increase in Pseudomonas; (2) patients with ≥2 exacerbations the previous year showed a significantly different bacterial community with respect to non-exacerbators (p = 0.014), with changes in 13 genera, including an increase of Pseudomonas, and finally, (3) peripheral eosinophils levels ≥2% were associated with more diverse microbiome [Chao1 224.51 (74.88) vs 277.39 (78.92) p = 0.006; Shannon 3.94 (1.05) vs 4.54 (1.06) p = 0.020], and a significant increase in the RAs of 20 genera. CONCLUSION: The respiratory microbiome in clinically stable COPD patients varies significantly according to the severity of airflow limitation, previous history of exacerbations and circulating eosinophils levels.

Fabrication of a custom pediatric nasal mask for noninvasive ventilation using a maxillofacial elastomer: A straightforward technique.

The facial masks commercially available for noninvasive positive pressure ventilation therapy for children with clinical conditions of hypoventilation are limited by size and hardness. The present report describes a straightforward method of developing a nasal mask from a room-temperature vulcanizing silicone elastomer for daily contact with the nasal mucosa of babies during noninvasive positive pressure ventilation. The fabrication of the silicone mask with nasal tubes is based on maxillofacial prosthesis techniques, with retention with steel prongs and elastics.

Optical parameters and hardness of two maxillofacial elastomers after immersion in different solutions of Brazilian green propolis extract.

STATEMENT OF PROBLEM: Maxillofacial elastomers undergo physical and mechanical degradation with disinfecting solutions. Solutions of Brazilian green propolis extract may be suitable alternatives for infection control of maxillofacial prostheses. However, their effects on the properties of the material are unknown. PURPOSE: The purpose of this in vitro study was to evaluate the effect of disinfection with solutions of Brazilian green propolis extract on the transmittance, translucency parameter, contrast ratio, and hardness of 2 maxillofacial elastomers (MDX4-4210 and MED-4014). MATERIAL AND METHODS: Fifty disk-shaped specimens (3×10 mm) of each elastomer were randomly and equally divided into 4 groups of disinfectant agents and 1 control group: 3 separate groups of 11% green propolis extracts including aqueous (PAQ), glycolic (PGL), and alcoholic (PAL), a 2% chlorhexidine gluconate (CHX) group, and the control group of distilled water. Specimens were subjected to disinfection by immersion 3 times a week for 60 days. Color differences (ΔE values) were calculated with CIELab and CIEDE2000 formulas. Optical parameters and Shore A hardness were determined at 2 time points: at baseline and after the period of specimen disinfection. Data were analyzed by parametric and nonparametric analysis of variance and by multiple-comparison tests (α=.05). RESULTS: The ΔE values of specimens immersed in 11% PAL were not clinically acceptable for either elastomer. Regarding translucency parameter and contrast ratio, the immersion in 11% PAL and 11% PGL resulted in greater opacity and lower translucency of the material. Mean Shore A hardness values were not statistically significantly different at baseline or after 60 days of immersion in the solutions. CONCLUSIONS: The solution of Brazilian green propolis extract tested showed changes in optical parameters. Elastomers immersed in 11% alcoholic green propolis extract showed clinically unacceptable color and translucency changes. All hardness values of the tested elastomers were clinically acceptable after immersion in all tested disinfectant groups.

A Painting Technique Using Ceramic Pigments for the Artificial Iris of an Ocular Prosthesis Guided by Applying Newton's Color Wheel.

This article describes a simple method for painting an artificial iris for the manufacturing of an ocular prosthesis with dark and light tones, both with excellent esthetic results. The challenge of choosing colors around the pupil and medium zone during painting is aided by the application of Newton's color wheel theory. This technique provides a safer choice of color during the painting procedure by using a mixture of ceramic pigments.

The influence of composite resin restoration radiopacity on radiographic diagnosis and decision-making.

The objective of this study was to evaluate the influence of the radiopacity of composite resin restorations on the interpretation of phantom radiographic images and to correlate the diagnosis with clinical management. Eighty healthy extracted human third molars were divided into 4 groups (n = 20 each): 3 restorative groups and 1 group of untreated teeth. The radiopacity of the materials was evaluated objectively using 10-mm discs of the composite resins SureFil SDR Flow (SDR), Filtek Bulk Fill Flowable Restorative (Filtek Bulk), and Filtek Z250 XT (Z250). Standard Class II cavities were prepared in the teeth. In the SDR and Filtek Bulk groups, the respective material was placed as a 2-mm base, and the remainder of the cavity was restored with Z250. In the Z250 group, the entire preparation was filled with Z250 composite resin. Ten phantoms of 6 teeth each were created; each phantom included 1 molar selected randomly from each of the 4 groups and 2 healthy premolars. Bitewing radiographs of the phantoms were obtained with a digital phosphor plate system and stored. For the subjective analysis, 5 examiners evaluated each of the molars on the radiographs and established the diagnosis and treatment plan. The radiopacity of the materials was statistically similar (P = 0.413), and there was no statistically significant difference between groups in the interpretation of the images. The radiopacity of the materials met ISO standard 4049/2009. Diagnosis and decision-making were influenced by the radiopacity of the materials. Filtek Z250, which had the lowest radiopacity, was diagnosed correctly more often than SDR, which had higher radiopacity. Filtek Bulk had the highest opacity and the highest percentage of correct diagnoses. In clinical practice, radiographic visualization of restorations and dental structures is essential for establishing a correct diagnosis and treatment plan. A restorative material may be within the established requirements for radiopacity, but on radiographic evaluation it might not be differentiated from mineralized dental tissues.

Calcifying odontogenic cyst, dentinogenic ghost cell tumor, and ghost cell odontogenic carcinoma: A systematic review.

BACKGROUND: The aim of this study was to integrate the available data published on calcifying odontogenic cyst (COC), dentinogenic ghost cell tumor (DGCT), and ghost cell odontogenic carcinomas (GCOCs) into a comprehensive analysis of their clinicoradiological features, treatment, and recurrence. MATERIALS AND METHODS: An electronic search with no publication date restriction was undertaken in October 2017 in the following databases: PubMed, Medline Ovid, Web of Science, and Scopus. Eligibility criteria included publications containing enough clinical, radiological, and histopathological information to confirm a definite diagnosis of these lesions. Data were evaluated descriptively. RESULTS: The literature review indicated a total of 234 publications reporting 367 COCs, 55 DGCTs and 44 GCOCs. These lesions have a predilection for Asian males. COCs mainly affect the mandible and patients in the second decade of life, DGCTs mostly affect the mandible and patients in the fourth decade of life, and GCOCs mostly affect the maxilla and patients in the fifth decade of life. CONCLUSION: Conservative surgery was the most common therapy for COCs and DGCTs, while radical surgery was most common for GCOCs. This study provides important and interesting data that could help clinicians and surgeons as well as oral and maxillofacial pathologists with the diagnosis and management of these lesions.

Custom-Made Ocular Prosthesis for Atrophic Anophthalmic Cavity.

The ocular prosthesis is a modality of facial prosthesis that acts on the repair of loss or deformity of the ocular globe. Prosthetic rehabilitations destined to anophthalmic cavities that suffered cicatricial retraction represent a challenge during fabrication since they often need to be reduced due to atrophic of the cavity and simultaneously need to have a good esthetic appearance regarding the contour and artificial iris. This clinical report describes the ocular prosthetic rehabilitation of a 77-year-old man with anophthalmic atrophic cavity due to herpes zoster-induced loss. The treatment focused on comfort and adaptation during use, on satisfactory retention and esthetic appearance, and on care to achieve total eye closure while wearing the ocular prosthesis. This article shows an unusual prosthetic rehabilitation of atrophic anophthalmic cavity with 6 months of follow-up.

Prevalence of persistent blood eosinophilia: relation to outcomes in patients with COPD.

The impact of blood eosinophilia in chronic obstructive pulmonary disease (COPD) remains controversial.To evaluate the prevalence and stability of a high level of blood eosinophils (≥300 cells·µL-1) and its relationship to outcomes, we determined blood eosinophils at baseline and over 2 years in 424 COPD patients (forced expiratory volume in 1 s (FEV1) 60% predicted) and 67 smokers without COPD from the CHAIN cohort, and in 308 COPD patients (FEV1 60% predicted) in the BODE cohort. We related eosinophil levels to exacerbations and survival using Cox hazard analysis.In COPD patients, 15.8% in the CHAIN cohort and 12.3% in the BODE cohort had persistently elevated blood eosinophils at all three visits. A significant proportion (43.8%) of patients had counts that oscillated above and below the cut-off points, while the rest had persistent eosinophil levels <300 cells·µL-1 A similar eosinophil blood pattern was observed in controls. Exacerbation rates did not differ in patients with and without eosinophilia. All-cause mortality was lower in patients with high eosinophils compared with those with values <300 cells·µL-1 (15.8% versus 33.7%; p=0.026).In patients with COPD, blood eosinophils ≥300 cells·µL-1 persisting over 2 years was not a risk factor for COPD exacerbations. High eosinophil count was associated with better survival.