Is the LRINEC score useful for predicting necrotizing fasciitis as a complication of MRONJ?

INTRODUCTION: Necrotizing fasciitis as a complication of medication-related osteonecrosis of the jaw (MRONJ), which we named "ONJ-NF", has been sometimes reported. This study aimed to investigate the usefulness of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for predicting ONJ-NF. MATERIALS AND METHODS: We included patients with acute MRONJ who required hospitalization at a single institution from April 2013 to June 2022. They were divided into two groups: patients with ONJ-NF and those with severe cellulitis as a complication of MRONJ, which we named "ONJ-SC." LRINEC scores were compared between the groups and the cut-off value of the score was set by creating a receiver operating characteristic curve. RESULTS: Eight patients with ONJ-NF and 22 patients with ONJ-SC were included. The LRINEC score was significantly higher in patients with ONJ-NF (median: 8.0 points, range 6-10 points) than in those with ONJ-SC (median: 2.5 points, range 0-6 points). A LRINEC score of ≥ 6 points had a sensitivity of 100.0%, a specificity of 77.3%, and an area under the curve of 0.97. Among 6 parameters of LRINEC score, only C-reactive protein (CRP) and white blood cell count (WBC) had significant differences between two groups. Most of the patients with ONJ-NF were rescued by antibiotic therapy and surgical drainage including debridement of necrotic tissues, but unfortunately, one patient did not survive. CONCLUSION: Our results suggested that the LRINEC score may be a useful diagnostic tool to predict ONJ-NF but valuating only CRP and WBC may be sufficient particularly in patients with osteoporosis.

Analysis of Parent/Nitrated Polycyclic Aromatic Hydrocarbons in Particulate Matter 2.5 Based on Femtosecond Ionization Mass Spectrometry.

Particulate matter 2.5 (PM2.5), collected from ambient air in Fukuoka City, was analyzed by gas chromatography combined with multiphoton ionization mass spectrometry using an ultraviolet femtosecond laser (267 nm) as the ionization source. Numerous parent polycyclic aromatic hydrocarbons (PPAHs) were observed in a sample extracted from PM2.5, and their concentrations were determined to be in the range from 30 to 190 pg/m(3) for heavy PPAHs. Standard samples of nitrated polycyclic aromatic hydrocarbons (NPAHs) were examined, and the limits of detection were determined to be in the picogram range. The concentration of NPAH adsorbed on PM2.5 in the air was less than 900-1300 pg/m(3). Graphical Abstract ᅟ.

Vascular endothelial growth factor C (VEGF-C) expression predicts metastasis in tongue cancer.

OBJECTIVE: We evaluated predictive factors for cervical lymph node metastasis of tongue squamous cell carcinoma (SCC). STUDY DESIGN: We present a retrospective analysis of 90 patients with T1-2 N0 SCC who underwent primary excision as initial treatment without preoperative radiotherapy or chemotherapy. We examined the clinicopathologic factors (gender, age, clinical stage, surgical margin, grade of differentiation, lymphatic invasion, tumor depth of invasion, pattern of invasion [POI]) and immunohistochemical factors (vascular endothelial growth factor [VEGF]-A and VEGF-C expression) to predict the probability of lymph node metastasis. RESULTS: The local progression-free 5-year survival rate was 100%. Tumor depth of invasion (≥4 mm, P = .022), POI (score >4, P = .000), and VEGF-C expression (P = .008) were associated with the lymph node metastasis of tongue SCC in a multiple logistic regression analysis (odds ratios [ORs]: 5.075, 17.383, and 9.533, respectively). CONCLUSIONS: The local control rate of tongue SCC in the early stages has significantly improved as a result of development of surgical techniques. On the other hand, we believe that tumor depth of invasion (≥4 mm), POI, and VEGF-C expression all need to be considered in the preoperative and postoperative planning stages for tongue cancer treatment.

Tunnel Technique for the Closure of an Oroantral Fistula with a Pedicled Palatal Mucoperiosteal Flap.

BACKGROUND: Oroantral fistula may develop as a complication of tooth extraction owing to infection, trauma, or removal of maxillary cyst or tumors. Closure by using a palatal mucoperiosteal flap with the greater palatine vessels is a very traditional and basic technique. The palatal mucosa is thick and is firm. However, deformation can occur with shifting of the mucoperiosteal flap, survival of the flap may be unsuccessful, and patients may have substantial intraoral discomfort felt until healing of the eminence with the arcuation. As a method to relieve these problems, we present a mucoperiosteal tunnel technique for the closure of oroantral fistula by using a palatal mucoperiosteal flap pedicled with the greater palatine vessels. METHOD: A 42-year-old man and a 69-year-old woman each had a palatal fistula after palatal tumor resection and tooth extraction, respectively. We designed a mucoperiosteal flap pedicled with the left greater palatine vessel. We ablated the mucoperiosteum between the fistula and the mucoperiosteal flap, and passed this flap under the ablated mucoperiosteum as a tunnel. RESULT: One year after surgery, the fistula had not reappeared and the mucoperiosteal flap harvest did not generate dyskinesis of the soft palate. CONCLUSION: Tunnel technique for the closure of an oroantral fistula with a pedicled palatal mucoperiosteal flap is obtains good fructification.

Spindle Cell Carcinoma of the Oral Cavity: the Impact of Chemotherapy on Pulmonary Metastatic Tumor Doubling Time.

Spindle cell carcinoma (SpCC) an aggressive squamous cell carcinoma, variant, frequently metastasizes to regional lymph nodes and distant organs. Unfortunately, an effective treatment method for oral SpCC distant metastasis has not yet been established. Here we present 2 of oral SpCC cases that showed distant metastases after initial treatment, and 2 that showed distant metastases following during surgery. We calculated the tumor doubling time (TDT) and onset of the pulmonary metastatic and examined the TDT of the pulmonary metastatic tumor in patients with or without chemotherapy to determine the effect of anticancer drugs on oral SpCC. Tumor growth curves revealed that pulmonary metastasis likely grew to 1mm, 122 days before the initial examination, indicating that most oral SpCC patients should be treated for metastases. Three patients underwent chemotherapy for pulmonary metastatic tumor, complete response (CR) in one patient and no change (NC) in two. Thus, SpCC patients may have pulmonary micro-metastases even at the initial examination. We recommend wide resection for oral SpCC patients, followed by chemotherapy to prevent metastases.

Signal enhancement by crossing the sample flow at a small angle against the laser beam in multiphoton ionization mass spectrometry.

To enhance sensitivity in multiphoton ionization/time-of-flight mass spectrometry, the sample, in the form of an effusive molecular flow, was introduced at a small angle relative to the laser beam. This approach enlarged the volume of interaction between the sample and the laser beam, thus increasing the number of ions formed by multiphoton ionization. The sensitivity obtained using this technique was compared with that obtained using a previous method based on the off-axis sample introduction technique with detection limits for organic hydrocarbons at the subfemtogram level. The detection limit was examined for dioxins and an improvement of 2.5 ± 0.4 fold was found. The technique developed herein is applicable for practical ultratrace analysis of persistent organic pollutants.

Influence of preoperative dental procedures on the prognosis of patients with squamous cell carcinoma of the gingiva.

Our aim was to investigate the prognosis of patients with squamous cell carcinoma (SCC) of the gingiva who had preoperative dental operations. We studied 102 patients who were being operated on for SCC of the gingiva with special reference to the effects of preoperative dental operations on the prognosis. Twenty-six patients had dental procedures such as tooth extraction, or incision, or curettage before they visited our hospital, while the remaining 76 had no such interventions. The percentage of patients with advanced T stage disease (T3 or T4) was higher among those who had interventions (17/26, 65%) than among those who had not (35/76, 46%). The difference was not significant. Histopathologically invaded nodes were detected in half the patients in the intervention group (13/26), while they were found in only 18/76 (24%) of those in the no intervention group (p<0.02). The incidence of nodal metastases with extranodal spread was significantly higher in the intervention group than in the no intervention group (p<0.05), and those in the intervention group were more likely to develop distant metastases than those in the other group (p<0.001). The 5-year survival in the two groups was 65% and 92%, respectively (p<0.01). Preoperative dental operations such as tooth extraction, incision, or curettage possibly lead to regional and distant metastases and therefore a poor prognosis in patients with SCC of the gingiva.

Analysis of persistent organic pollutants at sub-femtogram levels using a high-power picosecond laser for multiphoton ionization in conjunction with gas chromatography/time-of-flight mass spectrometry.

A low-energy, high-repetition-rate picosecond laser (40 µJ, 20 kHz, 258 nm) was used for multiphoton ionization (MPI) in gas chromatography/time-of-flight mass spectrometry to quantitatively determine dioxins (DXNs) and polycyclic aromatic hydrocarbons (PAHs). The sensitivity of the technique was compared with that obtained using a high-energy, low-repetition-rate femtosecond laser (86 µJ, 1 kHz, 261 nm). The limits of detection (LODs) for the picosecond laser were several femtograms for chlorinated DXNs with low numbers of chloro substituents, and were several times lower than values obtained using a femtosecond laser, although the LODs were increased, reaching values that were nearly identical to those for the femtosecond laser for octachlorodibenzo-p-dioxin (octaCDD) and octachlorodibenzofuran (octaCDF). The LODs were also measured for 16 PAHs specified by the United States Environmental Protection Agency; the values for half of these compounds were at sub-femtogram levels. The procedure was used to analyze a surface-water sample collected from a river.

Gas chromatography/multiphoton ionization/time-of-flight mass spectrometry of polychlorinated biphenyls.

A sample mixture of polychlorinated biphenyls (PCBs) was measured by gas chromatography/multiphoton ionization/time-of-flight mass spectrometry (GC/MPI/TOF-MS) using four types of laser sources. When a fourth harmonic emission (266 nm) of a picosecond Nd:YAG laser (1064 nm) was utilized, highly chlorinated PCBs larger than hepta-CBs were not observed. A fifth harmonic emission (213 nm) of the picosecond Nd:YAG laser allowed the measurement of PCBs from di-CBs to octa-CBs, and the limit of detection (LOD) was several pg for each component of PCBs. The LOD for the total amount of PCBs, which was calculated using the protocol provided by the Ministry of the Environment, Japan, was 1000 pg. The signal intensity of the congeners with chlorine atoms at the ortho positions (non-coplanar PCBs) was enhanced by using the fifth harmonic emission. When the fourth harmonic emission remaining after fifth harmonic generation was simultaneously used, the LOD for total PCBs was improved to 667 pg. The PCB sample was also measured using a third harmonic emission (267 nm) of a femtosecond Ti:sapphire laser (800 nm), providing an LOD of 677 pg. Thus, the two-color beam (266/213 nm) of a picosecond Nd:YAG laser had a comparable, or even slightly superior, performance to the more expensive femtosecond Ti:sapphire laser.