When is surgical intervention needed in oral and maxillofacial space infection patients? A retrospective case control study in 46 patients.

OBJECTIVE: Patients with mild oral and maxillofacial space infection (OMSI) usually need only antimicrobial therapy. However, surgical intervention is eventually needed after using antibiotics for a period. The objective of this study was to explore the risk factors for drug therapy failure in OMSI. SUBJECTS AND METHODS: A retrospective case‒control study was designed. From August 2020 to September 2022, patients at Shanghai Jiao Tong University Affiliated Ninth People's Hospital who were diagnosed with OMSI were retrospectively reviewed. The outcome variable was surgical intervention after the use of antibiotics. We collected common biological factors, including demographic characteristics, routine blood test results, C-reactive protein (CRP) levels and composite indicators, such as neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The χ2 test and binary logistic regression were used to examine the association between biological factors and the outcome variable. RESULTS: Forty-six patients were included in this study. Further surgical intervention was needed in 20 patients (43.5%). The NLR showed a significant association with further surgical drainage (p = 0.01). A binary logistic regression equation was found by using stepwise regression based on the Akaike information criterion (R2 = 0.443), which was associated with sex (odds ratio [OR], 0.216; p = 0.092), NLR (OR, 1.258; p = 0.045), red blood cell (RBC) count (OR, 4.372; p = 0.103) and monocyte (MONO) count (OR, 9.528, p = 0.023). Receiver operating characteristic analysis produced an area under the curve for NLR of 0.725 (p = 0.01) and for the binary logistic regression model of 0.8365 (p < 0.001). CONCLUSION: Surgical interventions are needed in some mild OMSI patients when antimicrobial therapy fails to stop the formation of abscesses. The binary logistic regression model shows that NLR can be used as an ideal prognostic factor to predict the outcome of antimicrobial therapy and the possibility of requiring surgical intervention. STATEMENT OF CLINICAL RELEVANCE: Using simple, inexpensive, and easily achieved biological parameters (such as routine blood test results) and composite indicators calculated by them (such as NLR) to predict whether surgical intervention is needed in the future provides a reference for clinical doctors and enables more cost-effective and efficient diagnosis and treatment.

Bactericidal effects and accelerated wound healing using Tb4O7 nanoparticles with intrinsic oxidase-like activity.

BACKGROUND: Nanomaterials that exhibit intrinsic enzyme-like characteristics have shown great promise as potential antibacterial agents. However, many of them exhibit inefficient antibacterial activity and biosafety problems that limit their usefulness. The development of new nanomaterials with good biocompatibility and rapid bactericidal effects is therefore highly desirable. Here, we show a new type of terbium oxide nanoparticles (Tb4O7 NPs) with intrinsic oxidase-like activity for in vitro and in vivo antibacterial application. RESULTS: We find that Tb4O7 NPs can quickly oxidize a series of organic substrates in the absence of hydrogen peroxide. The oxidase-like capacity of Tb4O7 NPs allows these NPs to consume antioxidant biomolecules and generate reactive oxygen species to disable bacteria in vitro. Moreover, the in vivo experiments showed that Tb4O7 NPs are efficacious in wound-healing and are protective of normal tissues. CONCLUSIONS: Our results reveal that Tb4O7 NPs have intrinsic oxidase-like activity and show effective antibacterial ability both in vitro and in vivo. These findings demonstrate that Tb4O7 NPs are effective antibacterial agents and may have a potential application in wound healing.

Error detection using EPID-based 3D in vivo dose verification for lung stereotactic body radiotherapy.

PURPOSE: To investigate the error detectability limitations of an EPID-based 3D in vivo dosimetry verification system for lung stereotactic body radiation therapy (SBRT). METHODS: Thirty errors were intentionally introduced, consisting of dynamic and constant machine errors, to simulate the possible errors that may occur during delivery. The dynamic errors included errors in the output, gantry angle and MLC positions related to gantry inertial and gravitational effects, while the constant errors included errors in the collimator angle, jaw positions, central leaf positions, setup shift and thickness to simulate patient weight loss. These error plans were delivered to a CIRS phantom using the SBRT technique for lung cancer. Following irradiation of these error plans, the dose distribution was reconstructed using iViewDose™ and compared with the no error plan. RESULTS: All errors caused by the central leaf positions, dynamic MLC errors, Jaw inwards movements, setup shifts and patient anatomical changes were successfully detected. However, dynamic gantry angle and collimator angle errors were not detected in the lung case due to the rotation-symmetric target shape. The results showed that the γmean and γpassrate indicators can detect 13 (81.3%) and 14 (87.5%) of the 16 errors respectively without including the gantry angle error, collimator angle error and output error. CONCLUSIONS: In summary, iViewDose™ is an appropriate approach for detecting most types of clinical errors for lung SBRT. However, the phantom results also showed some detectability limitations of the system in terms of dynamic gantry angle and constant collimator angle errors.

Multiple organ metastases from ameloblastoma detected by FDG PET/CT imaging.

A 74-year-old patient was admitted to our hospital with recurrent ameloblastoma of the right mandible. Multiple lung nodules were noted during the presurgical evaluation. FDG PET/CT was subsequently performed to assess the nature of the nodules and search the possible primary tumors. The images showed abnormal FDG activity not only in the lung nodules but also in the lumbar vertebral body and the liver. Pathologic examination after hepatic biopsy demonstrated metastases from ameloblastoma.