A qualitative analysis of patient's lived experience on their treatment journey with nasopharyngeal carcinoma.

OBJECTIVE: To explore and analyse the perspective of patients undergoing and recovering from nasopharyngeal carcinoma (NPC) therapy. METHODS: Thirty-three NPC patients at different stages of treatment were enroled. Seven were actively undergoing treatment, 13 were immediately post-treatment, and 13 were long-term. Patients were interviewed using a structured questionnaire based on a review of the literature that covered different phases of their treatment journey. The interview was recorded and transcribed for qualitative data analysis using a thematic inductive-deductive approach. RESULTS: Three main domains embracing aspects of NPC patients' experiences were identified; side effects, psychosocial well-being, and the role and support of healthcare workers. Side effects were experienced orally, locally, and systemically. Oral side effects (oral mucositis, xerostomia, altered taste, dysphagia) were the most significant challenge experienced by NPC patients. Locally, skin injury (desquamation, fibrosis, darkening of the skin, erythema, pruritus, and swelling around the neck region) and hair loss, resolved after cessation of therapy. Systemic side effects from the treatment were related to general weakness, weight loss and nausea. The psychosocial well-being of NPC patients was influenced by a range of issues including support (healthcare workers and family), pain management, functional limitations, nutritional needs, perceived level of information, emotion, and finances. CONCLUSION: NPC patients were significantly impacted based on the diagnosis, treatment and recovery phase affecting them locally, systemically, and psychologically. The role of family and healthcare staff was also influential in the overall treatment experience, and they have key roles to play in facilitating patients along their treatment journey. CLINICAL SIGNIFICANCE: Oral and general side effects from NPC treatment have significant impact on patients physical and emotional well-being. It is important for healthcare providers to have insights of these so as to understand and support patients during their treatment journey and recovery and be able to empathetically facilitate their clinical management.

"Three-in-one" patient-specific surgical guides for simultaneous dental implants in fibula flap jaw reconstruction: A prospective case series.

BACKGROUND: Conventional freehand immediate placement of dental implants is technically challenging in the jaw reconstructive surgery. Computer-aided surgery might be the best solution, however, there has not been any standard approach to ensure the accuracy and efficiency of simultaneous dental implants in fibula flap jaw reconstruction. PURPOSE: We aim to evaluate the clinical outcome of simultaneous dental implant in fibula flap using the "three-in-one" patient-specific surgical guide (3-in-1-PSSG) in an open-label, prospective, single-arm, and single-center clinical trial. MATERIALS AND METHODS: A novel computer-aided designed and three-dimensional (3D) printed 3-in-1-PSSG, which contains functions of fibula segmentation, surgical plate positioning and implant placement, was used to facilitate the reconstructive surgery and simultaneous dental implant placement. The intraoperative success of dental implant placement, implant survival rate and accuracy of dental implant placement were reported. RESULTS: From November 2018 to June 2020, 15 consecutive patients with 48 dental implants were enrolled in this study. Fifteen 3-in-1-PSSGs were fabricated with a mean number of dental implants per guide of 3.2 ± 1.5. The intraoperative success rate of this approach was 14 out of 15. With an average follow-up period of 40 weeks, the overall implant survival rate was 83.3% (40/48). Eight implants were removed due to two fibula flap failures. The mean deviation at the implant platform and implant apex were 2.8 mm (interquartile range [IQR]: 1.9-3.4) and 3.2 mm (IQR: 2.0-4.6), and the angular deviation was 2.5° (IQR: 1.1-6.8). CONCLUSIONS: Our preliminary data indicated that the 3D printed 3-in-1-PSSG facilitated simultaneous dental implant in fibula flap jaw reconstruction with a favorable intraoperative success and short-term clinical outcome. It might be a viable alternative to allow one-step immediate oral rehabilitation in patients underwent jaw reconstruction with free flaps. Long-term results with a larger sample size are warranted.

Effect of Fluoride-Modified Titanium Surface on Early Adhesion of Irradiated Osteoblasts.

OBJECTIVE: The present study aimed to investigate the effect of fluoride-modified titanium surface on adhesion of irradiated osteoblasts. MATERIALS AND METHODS: Fluoride-modified surface was obtained and the morphology, roughness, and chemical composition of the surface were evaluated by scanning electron microscopy, atomic force microscopy, and X-ray photoelectron spectroscopy, respectively. The adhesion of irradiated osteoblast-like cells, in terms of number, area, and fluorescence intensity on the titanium surface, was evaluated using immunofluorescence staining. RESULTS: Numerous nanosize pits were seen only in the F-TiO surface. The pits were more remarkable and uniform on F-TiO surface than on TiO surface; however, the amplitude of peaks and bottoms on F-TiO surface appeared to be smaller than on TiO surface. The Sa value and Sdr percentage of TiO surfaces were significantly higher than those of F-TiO surface. The concentrations of main elements such as titanium, oxygen, and carbon were similar on both surfaces. The number of irradiated osteoblasts adhered on the control surface was larger than on fluoride-modified surface. Meanwhile, the cells on the fluoride-modified surface formed more actin filaments. CONCLUSIONS: The fluoride-modified titanium surface alters the adhesion of irradiated osteoblasts. Further studies are needed to investigate the proliferation, differentiation, maturation, gene expression, and cytokine production of irradiated osteoblasts on fluoride-modified titanium surface.

Effects of calcium phosphate nanocrystals on osseointegration of titanium implant in irradiated bone.

Radiotherapy may compromise the integration of implant and cause implant loss. Implant surface modifications have the possibility of promoting cell attachment, cell growth, and bone formation which ultimately enhance the osseointegration process. The present study aimed to investigate the effects of calcium phosphate nanocrystals on implant osseointegration in irradiated bone. Sixteen rabbits were randomly assigned into control and nano-CaP groups, receiving implants with dual acid-etched surface or dual acid-etched surface discretely deposited of nanoscale calcium-phosphate crystals, respectively. The left leg of all the rabbits received 15 Gy radiation, followed by implants placement one week after. Four animals in each group were sacrificed after 4 and 12 weeks, respectively. Implant stability quotient (ISQ), ratio of bone volume to total volume (BV/TV), bone growth rate, and bone-to-implant contact (BIC) were evaluated. The nano-CaP group showed significantly higher ISQ (week 12, P = 0.031) and bone growth rate (week 6, P = 0.021; week 9, P = 0.001) than that in control group. No significant differences in BV/TV and BIC were found between two groups. Titanium implant surface modified with CaP nanocrystals provides a potential alternative to improve bone healing around implant in irradiated bone.

Dose-dependent effect of radiation on titanium implants: a quantitative study in rabbits.

OBJECTIVES: The aim of the study was to investigate the dose-dependent effect of radiation on dental implant stability and osseointegration using a series of quantitative analyses. MATERIAL AND METHODS: Six rabbits were randomly assigned to 15 and 30 Gy radiation groups. Each rabbit received radiation at the tibial and femoral metaphyseal region of left hind leg. The right leg was used as control. Implant surgery was performed on tibial and femoral metaphyses after 1 week. Totally 24 implants were inserted. The animals were killed at postoperative week four. Implant stability was measured using resonance frequency analysis. Ratio of bone volume to total volume (BV/TV), rate of bone growth, and bone-to-implant contact (BIC) were assessed using micro-computed tomography (micro-CT), fluorochrome labeling analysis, and histomorphometric analysis, respectively. RESULTS: After 4 weeks of healing, all implants were integrated (n = 6). Implant stability was significantly compromised by 15 Gy (P = 0.010) and 30 Gy (P = 0.025) of radiation. Radiation decreased BV/TV, and the significant effect was detected at the dose of 15 Gy (P = 0.008) and 30 Gy (P < 0.001). Bone growth in osseointegration was impaired by radiation. In 15 Gy group, the radiation side showed significant lower rate of bone growth than the control side at week 3 (P = 0.001), while the undistinguishable signals on 30 Gy radiation side suggested the low rate of new bone formation at each time point. Histomorphological BIC had no significant difference between 15 Gy control side and 15 Gy radiation side. 30 Gy radiation side showed a significantly lower BIC than 30 Gy control side (P < 0.001) as well as 15 Gy radiation side (P < 0.001). CONCLUSIONS: Implant stability and osseointegration were compromised by radiation. Radiation compromised osseointegration in a dose-dependent manner.