The Importance of Immunohistochemistry in the Evaluation of Tumor Depth of Primary Cutaneous Melanoma.

Primary cutaneous melanoma (PCM) is the most aggressive skin malignancy, with an increasing incidence and significant mortality. Tumoral invasion, expressed as Breslow thickness, is routinely assessed on hematoxylin and eosin (HE), although this stain may sometimes underestimate the tumoral depth. The aim of this study was to compare the efficiency of the immunohistochemical (IHC) markers S-100, SOX10, Melan-A, and HMB-45 with HE for the evaluation of the Breslow thickness and staging of PCM. This retrospective study included 46 cases of PCM diagnosed between 2015 and 2022; for each case, the Breslow thickness using HE, S-100, SOX10, Melan-A, and HMB-45 was measured and the appropriate T category was recorded. The highest values of the Breslow thickness were observed for S-100. However, S-100, SOX10, and Melan-A provided statistically significant higher values of the Breslow thickness compared to HE, but no difference was noted between HMB-45 and HE. S-100 was most frequently involved in increasing the T category (26.1%), the majority of cases being upstaged from T1a to T1b. The IHC markers S-100, SOX10, and Melan-A contributed to better evaluation of the melanoma invasion, especially in thin melanomas, but their impact on staging and consecutive treatment remains to be confirmed by future studies.

The Impact of Living Arrangements on the Prevalence of Falls after Total Joint Arthroplasty: A Comparison between Institutionalized and General Geriatric Population.

Due to population aging, there is an increasing need for orthopedic surgery, especially total knee arthroplasty (TKA) and total hip arthroplasty (THA). In geriatric patients, postoperative falls are common events which can compromise the success of these expensive procedures. The aim of our study was to assess the influence of living arrangements on the prevalence of postoperative falls following joint replacement. We included 441 patients after TKA or THA, living in nursing homes, alone or with family. The prevalence of falls in the first 2 years (15.2%) was significantly influenced by living arrangements: patients with TKA or THA living alone had three times higher odds of falling compared to those living with family, and institutionalized patients with THA had four times higher odds of falling compared to those living with family. Of 67 patients who fell, 6 (8.9%) needed reintervention. For TKA patients, the fall rates were not significantly different between institutions and family, indicating the interest of nursing homes in offering proper care. However, for the THA group, the results were poorer, emphasizing the need for improvement in postoperative rehabilitation. Further multi-centric studies are required for generalizing the impact of living arrangements on fall prevalence after joint replacement.

The Use of Salivary Levels of Matrix Metalloproteinases as an Adjuvant Method in the Early Diagnosis of Oral Squamous Cell Carcinoma: A Narrative Literature Review.

Oral squamous cell carcinoma (OSCC) is an aggressive malignancy with increased mortality, in which the early diagnosis is the most important step in increasing patients' survival rate. Extensive research has evaluated the role of saliva as a source of diagnostic biomarkers, among which matrix metalloproteinases (MMPs) have shown a valuable potential for detecting even early stages of OSCC. The aim of this review was to present recent clinical data regarding the significance of salivary MMPs in the detection of early malignant transformation of the oral mucosa. A narrative review was conducted on articles published in PubMed, Cochrane Library, Web of Science, EBSCO and SciELO databases, using specific terms. Our search revealed that MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, MMP-10, MMP-12 and MMP-13 had significantly higher levels in saliva from patients with OSCC compared to controls. However, the strength of evidence is limited, as most information regarding their use as adjuvant diagnostic tools for OSCC comes from studies with a low number of participants, variable methodologies for saliva sampling and diagnostic assays, and insufficient adjustment for all covariates. MMP-1, MMP-3 and MMP-9 were considered the most promising candidates for salivary diagnosis of OSCC, but larger studies are needed in order to validate their clinical application.

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Early Diagnosis of Oral Mucosal Alterations in Smokers and E-Cigarette Users Based on Micronuclei Count: A Cross-Sectional Study among Dental Students.

The presence of micronuclei in oral epithelial cells is considered a marker of genotoxicity, which can be identified using exfoliative cytology. The aim of this study was to investigate cytotoxic damage through the evaluation of micronuclei in the oral mucosa of smokers and e-cigarette users compared to nonsmokers. We obtained smears from the buccal mucosa of 68 participants divided in 3 groups (smokers, e-cigarette users and nonsmokers), which were further processed with Papanicolaou stain. The frequencies of micronuclei and micronucleated cells were recorded and statistically analyzed at a level of significance of p < 0.05. The mean micronuclei values per 1000 cells were 3.6 ± 1.08 for smokers, 3.21 ± 1.12 for e-cigarette users and 1.95 ± 1.05 for nonsmokers. The mean values of micronucleated cells per 1000 cells were 2.48 ± 0.91 for smokers, 2.39 ± 1.07 for e-cigarette users and 1.4 ± 0.68 for nonsmokers. Smokers and e-cigarette users had significantly higher values of micronuclei and micronucleated cells compared to nonsmokers, but there were no significant differences between smokers and e-cigarette users. We concluded that the micronuclei count can be used as an early indicator for alterations of oral mucosa and exfoliative cytology represents an accessible tool which could be applied for mass screening.

The Correlation between Oral Self-Harm and Ethnicity in Institutionalized Children.

Oral self-harm was described in institutionalized children who share a lack of emotional attention; frequently these children experience feelings such as neglect, loneliness, isolation or lack of connection with the world. The aim of our paper was to conduct a cross-sectional study in order to assess the prevalence of this behavior and its correlation with ethnicity among children from three institutions located in the central part of Romania. We examined 116 children from three ethnic groups, Romanians, Hungarians and local Roma population aged between 10-14 years old. The oral soft tissues were evaluated by one dentist who recorded the lesions of lips, buccal mucosa, commissures and tongue; data were statistically analyzed at a level of significance of p < 0.05. We found oral self-harm lesions in 18.1% participants, with statistically significant higher odds in girls (p = 0.03). The results showed an association between ethnicity and the development of these lesions (Chi-square p = 0.04). The most frequent lesions were located at oral commissures (35.48%), buccal mucosa (29.03%) and upper lip (19.36%). Oral self-harm lesions have a high incidence among institutionalized children in Romania. Identification of these cases in early stages is important, as these conditions are known to be aggravated during adolescence and adulthood.

The Evaluation of Dental Anxiety in Primary School Children: A Cross-Sectional Study from Romania.

Current data report that high levels of dental anxiety in children have a negative impact on oral health. The aim of this study was to measure dental anxiety, based on the Abeer Children Dental Anxiety Scale (ACDAS) used as a self-reported measure and to correlate its values with the salivary cortisol levels. The study was conducted in 2019 and included 389 children aged 6-9 years old; evaluation of dental anxiety and saliva sampling were performed. The influence of gender on the presence of dental anxiety was analyzed using Fisher's exact test, the salivary cortisol level was compared between anxious and non-anxious children and was further correlated with the ACDAS score (p < 0.05). Girls had higher odds of experiencing dental anxiety (odds ratio: 1.533, p = 0.041). Salivary cortisol levels were higher in anxious compared to non-anxious children (median 1.251 vs. 1.091 ng/mL, p < 0.001) and showed a positive moderate correlation with the ACDAS score (r = 0.411, p < 0.001). Children aged 6-9 years have a high prevalence of dental anxiety, with girls being more susceptible to this condition. Salivary cortisol levels are higher in anxious children and correlate positively with the ACDAS score, proving that ACDAS can be used for the detection of dental anxiety.

Prevalence of the fabella and its association with pain in the posterolateral corner of the knee: A cross-sectional study in a Romanian population.

The functions and clinical consequences of the fabella, a sesamoid bone found in the posterolateral aspect of the knee joint, are still a reason of intense debate in the scientific literature. Its incidence was reported to range between 20% and 87% and its presence was usually associated with the persistent pain in the posterolateral region of the knee. The aim of our study was to measure the prevalence, anatomic and clinical features of the fabella within a cross-sectional study, conducted in a Romanian orthopaedic center. Between 2015 and 2017, a consecutive series of 562 patients with knee injuries or persistent knee pain has been examined by radiographs and Magnetic Resonance Imaging and a set of anatomical and clinical parameters have been recorded. Collected data was evaluated with RadiANT DICOM Viewer and statistically analyzed with GraphPad Prism 7. The level of significance was set at P <.05. The incidence of the fabella in our study group was 16.93%, lower than previously reported for Caucasian populations. We found statistically significant differences regarding the possible association of the fabella with pain in the posterolateral corner of the knee (P = .04) and the 2 dimensions of the bone according to gender (P = .03 respectively P = .01), but the prevalence was not influenced by gender (P = .6). The anatomic characteristics could be important in differentiating this sesamoid bone from calcifications or loose bodies located in the knee joint region. Due to the high association with the posterolateral knee pain, the fabella should be recorded during knee examination as a differential diagnosis, before any surgical procedure.