Updated perspectives on the contribution of the microbiome to the pathogenesis of mucositis using the MASCC/ISOO framework.

Advances in the treatment of cancer have significantly improved mortality rates; however, this has come at a cost, with many treatments still limited by their toxic side effects. Mucositis in both the mouth and gastrointestinal tract is common following many anti-cancer agents, manifesting as ulcerative lesions and associated symptoms throughout the alimentary tract. The pathogenesis of mucositis was first defined in 2004 by Sonis, and almost 20 years on, the model continues to be updated reflecting ongoing research initiatives and more sophisticated analytical techniques. The most recent update, published by the Multinational Association for Supportive Care in Cancer and the International Society for Oral Oncology (MASCC/ISOO), highlights the numerous co-occurring events that underpin mucositis development. Most notably, a role for the ecosystem of microorganisms that reside throughout the alimentary tract (the oral and gut microbiota) was explored, building on initial concepts proposed by Sonis. However, many questions remain regarding the true causal contribution of the microbiota and associated metabolome. This review aims to provide an overview of this rapidly evolving area, synthesizing current evidence on the microbiota's contribution to mucositis development and progression, highlighting (i) components of the 5-phase model where the microbiome may be involved, (ii) methodological challenges that have hindered advances in this area, and (iii) opportunities for intervention.

Mönckeberg's medial arteriosclerosis in the oral and maxillofacial region: A pilot study.

OBJECTIVE: To evaluate the prevalence of medial vascular calcifications in the oral and maxillofacial region and their association with systemic diseases. MATERIALS AND METHODS: The study included 211 consecutive patients with systemic diseases (January 2015-May 2016). Medical history and radiographic images were evaluated. Univariate analysis (t-test) was performed for continuous variables (age). The Chi square test was applied for the categorical variables (Mönckeberg medial arteriosclerosis [MMA], gender). RESULTS: There was a 6.2% prevalence of MMA. The mean age of patients with MMA was 65.46 ± 13.38. The prevalence of kidney disease in patients with MMA was significantly higher than in those without MMA (p < 0.001). This finding was maintained even after adjusting for other systemic diseases (OR = 31.84 [8.63-136.78]). CONCLUSION: A significant prevalence of MMA in kidney disease patients was observed in this pilot study.

Different scoring methods of the VARK questionnaire to evaluate dentistry Students' learning styles.

INTRODUCTION: The way students process and organise information to facilitate learning is known as learning style. Knowing one's learning style can improve learning and help teachers choose their teaching methods more effectively. This study was conducted to investigate different scoring methods of the VARK questionnaire and compare different learning styles in different stages of dental school. MATERIALS AND METHODS: Students in three stages of the dental school participated in this study: basic sciences, preclinical and clinical. The validated reliable Persian VARK questionnaire was utilised. Collected data were computed and analysed in three ways: raw, normalised and weighted scoring by ANOVA and chi-squared tests (α = .05). RESULT: The most favoured learning style was auditory; however, the prevalence of other learning styles varied through stages. On analyses of visual and auditory learning styles by all methods of scoring, no significant difference was seen in different stages (study time). The kinetic learning style, using normalised scoring method, was used more significantly when the grade increased (p-value = .028). However, in the weighted method, this effect was not significant. The read-write learning style using all three scoring methods showed an inverse relationship with the level of education (p-value <.05), which means the tendency to use this style of learning decreased when the level of education increased. CONCLUSION: As the educational level increases, students are more inclined to use kinetic and less likely to employ read-write learning style. There was not a significant difference in the use of visual and aural learning styles in any stages of dental school.

Internal and External Loads in Training Week Before the Competition in U19 High-Level Soccer Players.

ABSTRACT: Martín-López, Á, Mendes, RS, and Castillo-Rodríguez, A. Internal and external loads in training week before the competition in U19 high-level soccer players. J Strength Cond Res 35(6): 1766-1772, 2021-Nowadays, the information about the load in training sessions (TRs) and the relationship of these TRs with official competition are necessary to gain the sport success in soccer. The aim of this study was to quantify the different loads in TRs according to days before the competition (P-4, P-2, and P-1) on soccer players U19 based on their playing position and their sport success. Twenty-four male Spanish high-level players (age: 16.5 ± 0.5 years; height: 1.69 ± 0.04 m; and body mass: 63.0 ± 6.3 kg) participated in the study. They were grouped according to their playing position: external defenders, internal defenders (ID), external midfielders, internal midfielders (IM), and forwards (FO). To conduct the study, global positioning system technology was used, and a 1-way analysis of variance and Pearson correlation were performed. The main results revealed that the highest physical and physiological responses in the TRs were shown by ID, IM, and players without sport success (p < 0.05), and during P-2. In addition, sport success is predicted by the mean heart rate (R2 = 0.33; p < 0.001). As conclusion, players covering central positions in the playing field performed higher physical and physiological demands than players covering exterior or forward positions. Furthermore, physical and physiological responses during the TRs P-2 may be similar to the responses produced in competition match and are notably different depending on the sport success of the soccer player.

Mathematical Models to Measure the Variability of Nodes and Networks in Team Sports.

Pattern analysis is a widely researched topic in team sports performance analysis, using information theory as a conceptual framework. Bayesian methods are also used in this research field, but the association between these two is being developed. The aim of this paper is to present new mathematical concepts that are based on information and probability theory and can be applied to network analysis in Team Sports. These results are based on the transition matrices of the Markov chain, associated with the adjacency matrices of a network with n nodes and allowing for a more robust analysis of the variability of interactions in team sports. The proposed models refer to individual and collective rates and indexes of total variability between players and teams as well as the overall passing capacity of a network, all of which are demonstrated in the UEFA 2020/2021 Champions League Final.

Using Artificial Intelligence for Pattern Recognition in a Sports Context.

Optimizing athlete's performance is one of the most important and challenging aspects of coaching. Physiological and positional data, often acquired using wearable devices, have been useful to identify patterns, thus leading to a better understanding of the game and, consequently, providing the opportunity to improve the athletic performance. Even though there is a panoply of research in pattern recognition, there is a gap when it comes to non-controlled environments, as during sports training and competition. This research paper combines the use of physiological and positional data as sequential features of different artificial intelligence approaches for action recognition in a real match context, adopting futsal as its case study. The traditional artificial neural networks (ANN) is compared with a deep learning method, Long Short-Term Memory Network, and also with the Dynamic Bayesian Mixture Model, which is an ensemble classification method. The methods were used to process all data sequences, which allowed to determine, based on the balance between precision and recall, that Dynamic Bayesian Mixture Model presents a superior performance, with an F1 score of 80.54% against the 33.31% achieved by the Long Short-Term Memory Network and 14.74% achieved by ANN.

COVID-19: The immediate response of european academic dental institutions and future implications for dental education.

The COVID-19 pandemic has had an immediate and dramatic impact on dental education. The Association of Dental Education in Europe decided to carry out an investigation to assess the immediate response of European Academic Dental Institutions. An online survey was sent to both member and non-member dental schools to investigate the impact on non-clinical and clinical education, assessment and the well-being/pastoral care measures implemented. The preliminary findings and discussion are presented in this paper, for the responses collected between the 25 March and 5 April 2020. The survey at this time of publication is ongoing, and detailed results can be accessed https://adee.org/covid-19-european-dental-education%E2%80%99s-immediate-response.

The therapeutic effects of apigenin and dexamethasone on 5-fluorouracil-induced oral mucositis - a pilot study using a Syrian hamster model.

OBJECTIVE: Oral mucositis (OM) is a common complication of chemotherapy and radiotherapy. The aim of this study was to evaluate the effects of treating 5-fluorouracil-induced OM with apigenin and dexamethasone. METHODS: Thirty-six male Syrian hamsters were randomly assigned to one of three groups: control (50% acetic acid + 5-FU), 50% acetic acid + 5-FU + potassium Apigenin (KA), and 50% acetic acid + 5-FU + dexamethasone. The animals from each group were sacrificed 5, 7, 10, and 14 days after inducing the mucositis, and two samples collected from each animal, accounting a total of 72 samples. Macroscopic changes were assessed by histomorphometric analysis, with ulcers being assessed by imaging analysis and the number of inflammatory cells in the ulcerated region quantified in all periods through histomorphometric analysis (H&E). Furthermore, immunohistochemical changes were evaluated by proliferating cell nuclear antigen. RESULTS: All groups presented an increased inflammatory infiltrate after 7 days, compared to other evaluation times (P ≥ 0.05). There was significant difference between apigenin and control group in the 10-days period. Lower quantity of inflammatory cells in the apigenin-treated group in comparison with control group in the 7- and 10-days periods was observed (P < 0.05). No statistically significant difference was verified among the groups in 5- and 14-days periods. The healing process of the control group was slower than that of apigenin and dexamethasone-treated groups, with an overall significant difference between apigenin and the control group in the 10-days period. CONCLUSIONS: Apigenin treatment may enhance healing of OM induced by 5-fluorouracil, thus suggesting that more extensive research in this area may be useful to assess the role of agents of natural origin capable of preventing OM. Hence, further studies involving broader samples are need to confirm the therapeutic potential shown by this study.

PTEN microdeletions in T-cell acute lymphoblastic leukemia are caused by illegitimate RAG-mediated recombination events.

Phosphatase and tensin homolog (PTEN)-inactivating mutations and/or deletions are an independent risk factor for relapse of T-cell acute lymphoblastic leukemia (T-ALL) patients treated on Dutch Childhood Oncology Group or German Cooperative Study Group for Childhood Acute Lymphoblastic Leukemia protocols. Some monoallelic mutated or PTEN wild-type patients lack PTEN protein, implying that additional PTEN inactivation mechanisms exist. We show that PTEN is inactivated by small deletions affecting a few exons in 8% of pediatric T-ALL patients. These microdeletions were clonal in 3% and subclonal in 5% of patients. Conserved deletion breakpoints are flanked by cryptic recombination signal sequences (cRSSs) and frequently have non-template-derived nucleotides inserted in between breakpoints, pointing to an illegitimate RAG recombination-driven activity. Identified cRSSs drive RAG-dependent recombination in a reporter system as efficiently as bona fide RSSs that flank gene segments of the T-cell receptor locus. Remarkably, equivalent microdeletions were detected in thymocytes of healthy individuals. Microdeletions strongly associate with the TALLMO subtype characterized by TAL1 or LMO2 rearrangements. Primary and secondary xenotransplantation of TAL1-rearranged leukemia allowed development of leukemic subclones with newly acquired PTEN microdeletions. Ongoing RAG activity may therefore actively contribute to the acquisition of preleukemic hits, clonal diversification, and disease progression.

The relevance of PTEN-AKT in relation to NOTCH1-directed treatment strategies in T-cell acute lymphoblastic leukemia.

The tumor suppressor phosphatase and tensin homolog (PTEN) negatively regulates phosphatidylinositol 3-kinase (PI3K)-AKT signaling and is often inactivated by mutations (including deletions) in a variety of cancer types, including T-cell acute lymphoblastic leukemia. Here we review mutation-associated mechanisms that inactivate PTEN together with other molecular mechanisms that activate AKT and contribute to T-cell leukemogenesis. In addition, we discuss how Pten mutations in mouse models affect the efficacy of gamma-secretase inhibitors to block NOTCH1 signaling through activation of AKT. Based on these models and on observations in primary diagnostic samples from patients with T-cell acute lymphoblastic leukemia, we speculate that PTEN-deficient cells employ an intrinsic homeostatic mechanism in which PI3K-AKT signaling is dampened over time. As a result of this reduced PI3K-AKT signaling, the level of AKT activation may be insufficient to compensate for NOTCH1 inhibition, resulting in responsiveness to gamma-secretase inhibitors. On the other hand, de novo acquired PTEN-inactivating events in NOTCH1-dependent leukemia could result in temporary, strong activation of PI3K-AKT signaling, increased glycolysis and glutaminolysis, and consequently gamma-secretase inhibitor resistance. Due to the central role of PTEN-AKT signaling and in the resistance to NOTCH1 inhibition, AKT inhibitors may be a promising addition to current treatment protocols for T-cell acute lymphoblastic leukemia.

Could the PI3K canonical pathway be a common link between chronic inflammatory conditions and oral carcinogenesis?

The association between chronic inflammatory disorders and oral carcinogenesis has been both a source of interest and contention. Based upon its central importance in oral carcinogenesis, the finding that the PI3k/Akt/mTOR pathway is activated in oral lichen planus, chronic graft-versus-host disease, and chronic oral candidiasis suggests that it may provide a link between benign and malignant oral conditions. Here, we discuss a possible mechanistic rationale that addresses the activation of this important signaling pathway and its downstream events, while correlating it with the carcinogenic potential of chronic oral disorders.

Novel anticoagulants - an update on the latest developments and management for clinicians treating patients on these drugs.

There are several novel anticoagulant agents that are being increasingly used as an alternative to warfarin, with these drugs being reported to be at least as effective if not better. Their increased use means that oral care clinicians should have a sound understanding of the mechanism of action, pharmacology, reversal strategies and management of bleeding in patients taking these drugs. Surprisingly, there is little published in the current literature specific to professionals involved in oral health care. In this review, we provide an overview of these drugs and discuss the management of patients who need an oral procedure based on currently available literature and clinical trials.

Physical and technical performances are not associated with tactical prominence in U14 soccer matches.

The aim of this study was to analyse the association between physical/technical variables and the tactical prominence variables in U14 soccer matches. Twenty-two young amateur soccer players (13.5 [Formula: see text] 0.5 years old, 5.4 [Formula: see text] 0.5 years of practice, 163.3 [Formula: see text] 9.8 cm in body height) from two teams of the Portuguese regional league volunteered for the study. Our results showed positive and moderate correlation between dribbling test and betweenness centrality (r = 0.324; p = 0.142), and negative moderate correlation between %fatigue index and betweenness centrality (r = -0.390; p = 0.073). Physical and technical variables had no statistical differences among tactical positions. Nevertheless, when tactical prominence of players from four tactical positions were compared, significant differences were found in terms of degree prestige (p = 0.001) and degree centrality (p = 0.002). This pilot study did not find strong correlations between physical/technical levels and tactical prominence in soccer matches.

Acute effects of the number of players and scoring method on physiological, physical, and technical performance in small-sided soccer games.

This study aims to examine the effect of differences in the number of players and scoring method on heart rate responses, time-motion characteristics, and technical/tactical performance during small-sided soccer games. Ten male amateur soccer players (26.4 ± 5.3 years old, 8.4 ± 3.2 years of practice, 179.3 ± 5.2 cm body height, 71.2 ± 7.1 kg body weight, 45.8 ± 2.6 ml.kg(-1)min(-1)VO2max) from the Portuguese regional league played nine different small-sided games (i.e., 3 formats × 3 scoring methods). The study used two-way MANOVA, two-away ANOVA, and one-way ANOVA, depending on the specific procedure for the analysis. Compared with other formats, 2v2 induced significantly greater values of technical/tactical indexes (p = 0.001), 3v3 induced significantly higher %HRreserve values (p = 0.001), and 4v4 led to significantly greater distance coverage and speed (p = 0.001). The study provided evidence for coaches to set different small-sided game conditions depending on the training purpose in terms of physiological, physical, and technical performance.

Physical and Physiological Demands of Amateur Portuguese Field and Assistant Football Referees.

Referees are crucial elements in football, and they must meet the physical and physiological demands each match poses to them. The aim is to analyse the physical and physiological demands of amateur referees in games at the regional level (4th division), examining the differences between the first and second halves and between assistant (age: 25.10 ± 4.97) and main referees (age: 25.65 ± 5.12). A total of 29 matches were analysed with GPS devices, and internal and external load metrics were analysed. Overall, main referees, due to their central role in game management, showed higher levels of physical and physiological load than assistant referees, with more high-intensity activities, greater distance covered and higher heart rate. The results also revealed that there were no differences between the halves for total distance covered for either the main or assistant referees. However, the main referees covered a greater distance in high-intensity running during the first half (p = 0.05; d = 0.389). These findings emphasise the importance of tailored training protocols to enhance performance and reduce fatigue-related errors, highlighting the significance of endurance, high-intensity running ability, and strategies to manage transient fatigue in referee preparation.

Flow Training Program: Mindfulness, Decision Making, and Mental Well-Being of Young and Adult Elite Handball Athletes.

This study aimed to analyze the effect of a flow training program based on mindfulness applied to young and adult elite handball athletes. A quantitative, quasi-experimental, descriptive data analysis approach was carried out. The sample included 105 athletes (51 female and 54 male). The athletes were divided into two groups: (i) experimental (n = 53) and (ii) control (n = 52). The results of the repeated ANOVA indicated that the experimental group achieved significant improvements compared to the control group in decision making (n2p = 0.086), mental well-being (n2p = 0.045), dispositional flow state (n2p = 0.103), non-judgment (n2p = 0.040), refocusing (n2p = 0.052), and mindful traits in daily life (n2p = 0.058). A Pearson analysis demonstrated a positive correlation between dispositional flow state and mindfulness in sport and mental well-being. The correlation analysis also showed an inverse correlation between decision making and sense of control and mindful traits in daily life. The findings revealed that the program can be effective in decision making, mental well-being, dispositional flow state, mindfulness in sport, and mindful traits in daily lives of athletes.

Methodology and Experimental Protocol for Studying Learning and Motor Control in Neuromuscular Structures in Pilates.

The benefits of Pilates have been extensively researched for their impact on muscular, psychological, and cardiac health, as well as body composition, among other aspects. This study aims to investigate the influence of the Pilates method on the learning process, motor control, and neuromuscular trunk stabilization, specifically in both experienced and inexperienced practitioners. This semi-randomized controlled trial compares the level of experience among 36 Pilates practitioners in terms of motor control and learning of two Pilates-based skills: standing plank and side crisscross. Data will be collected using various assessment methods, including abdominal wall muscle ultrasound (AWMUS), shear wave elastography (SWE), gaze behavior (GA) assessment, electroencephalography (EEG), and video motion. Significant intra- and inter-individual variations are expected, due to the diverse morphological and psychomotor profiles in the sample. The adoption of both linear and non-linear analyses will provide a comprehensive evaluation of how neuromuscular structures evolve over time and space, offering both quantitative and qualitative insights. Non-linear analysis is expected to reveal higher entropy in the expert group compared to non-experts, signifying greater complexity in their motor control. In terms of stability, experts are likely to exhibit higher Lyapunov exponent values, indicating enhanced stability and coordination, along with lower Hurst exponent values. In elastography, experienced practitioners are expected to display higher transversus abdominis (TrA) muscle elasticity, due to their proficiency. Concerning GA, non-experts are expected to demonstrate more saccades, focus on more Areas of Interest (AOIs), and shorter fixation times, as experts are presumed to have more efficient gaze control. In EEG, we anticipate higher theta wave values in the non-expert group compared to the expert group. These expectations draw from similar studies in elastography and correlated research in eye tracking and EEG. They are consistent with the principles of the Pilates Method and other scientific knowledge in related techniques.

Implementing regular physical activity for older individuals in the family strategy program using the RE-AIM framework to ensure feasibility and sustainability: EISI study protocol.

The EISI study protocol aims to address the low participation rate in physical exercise programs among older individuals, emphasizing its significance as a non-pharmacological therapeutic approach for overall health and increased physical activity. The objectives include implementing physical activity (PA) and educational health programs in Jequié, Bahia, Brazil, targeting the Family Health Strategy population to enhance local physical activity levels among older individuals. The study also seeks to evaluate the program's feasibility, safety, and sustainability for large-scale implementation, along with assessing its impact on immune and inflammatory response biomarkers to the SARS-CoV virus, as well as physical-functional and brain health. Participants, aged 60 or above, will be divided into two groups: multicomponent exercise (MCE) and behavioral change interventions (BCI). The study employs a mixed-method approach, utilizing a non-randomized controlled short-term pathway model for a 4-8 weeks of pilot study and 16-week intervention impact assessment. Data collection encompasses various aspects such as sociodemographic information, mental health, physical fitness, fall risk, functional capacity, anthropometric measurements, hemodynamic assessment, habitual physical activity, and health-related quality of life. Blood and saliva samples are collected for cytokine and antibody biomarker analysis related to SARS-CoV immunity. Pre- and post-intervention evaluations for both groups will be conducted, with the hypothesis that MCE will yield more favorable responses compared to BCI. The study's holistic approach, including the assessment of feasibility, safety, and sustainability, aims to contribute to achieving Sustainable Development Goals (SDG) 3 and SDG 9 b y promoting accessible and sustainable healthcare initiatives for older individuals. This research aligns with global efforts to enhance health and well-being, emphasizing the importance of regular exercise in the aging population.

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi study.

Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022-July 2023). The first phase involved a survey to MASCC-MSG members (January 2022-May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023-May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received.

The variability of the serve toss in tennis under the influence of artificial crosswind.

This study was made to analyze the variability and stability of the serve toss in tennis, on the x (side-to-side), y (back-to-front) and z (vertical) axes, with 12 experienced players under the influence of crosswind (induced aerodynamic flow) produced by an industrial ventilator. The players were analyzed individually after serving at maximum speed and accuracy to the intersection point of the centre line and service line ("T "point). The results allow us to conclude that the experienced players tend to stabilize the vertical dimension of the service (z axis). Additionally, this study confirms the invariability of the player height ratio: height of impact (1:1.5) in experienced players even when constrained by the "artificial crosswind. "Given the above, the vertical dimension of the tennis serve is assumed as a constant feature, which is guaranteed in the remaining varying dimensions (y and x axes) of the ball toss. Thus, the variability should be seen as part of the solution and not as something to be avoided by players and coaches. Key PointsAnalysis of the tennis serve variability under the effect of artificial crosswindTwelve experienced tennis players performed a set of 20 free serves (without wind constraints), and four other sets of 20 serves under different practice conditions (with different crosswind intensities)The players tend to stabilize in the z axis and vary in the y- (back-to-front) and x-axes (side-to-side) during the ball toss tennis serve in all the practice conditions (with and without crosswind)THE MAINTENANCE OF A PLAYER HEIGHT RATIO: impact height of approximately 1:1.5 in experienced players, even when constrained by "artificial crosswind".