"Tailor-made" Total Cerebral Protection during Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) is an alternative treatment to surgical aortic valve replacement for treating severe aortic stenosis. With the increased use of TAVI, the risk of cerebrovascular complications during the procedure has become an emerging problem. We evaluated the safety and feasibility of our total cerebral protection methods using embolic protection devices (EPDs) for carotid artery stenting. We collected the results of cases in which the clinical team determined that our protection method was necessary among patients undergoing TAVI from May to October 2019 in our medical center. We applied this method to patients who had a potentially high risk of cerebrovascular events during the procedure. The methods of protection were selected comprehensively based on the potential of collateralization of brain perfusion when some arteries were blocked with a balloon, accessibility of the brain arteries, and the ability to cover the brain arteries with devices. Five patients, aged 83.8 ± 1.8 years, were included in the study. Technical success was achieved in all five patients. No cases showed any new neurological symptoms after the procedures; however, head MRI on the day after showed new ischemic lesions in three of five cases (60%). In all cases, emboli were found in the collected filters. This report demonstrates protection of the entire perfusion area in each case using EPDs in patients at high risk of intraoperative embolism. The methods we used were feasible and can potentially reduce cerebrovascular events following TAVI.

A retrospective analysis of the prevalence of dental diseases in patients with digestive system cancers.

The relationship between dental diseases and the prevalence of digestive system cancers remains unclear. The aim of the present study was to examine the prevalence of dental diseases in patients treated for digestive system cancers.The medical and dental records of patients treated for digestive system cancers were retrospectively reviewed, and the results obtained (decayed/filled/missing teeth [DMFT] indices and community periodontal index [CPI] codes) were compared with data from the national survey of dental diseases in order to investigate the relationship between oral health and digestive system cancers.DMFT, D, and F indices were significantly lower, while the M index was slightly higher in digestive system cancer patients than in the national survey. The proportions of individuals with more than 20 residual teeth and denture wearers were significantly lower in cancer patients than in the national survey. The prevalence of periodontitis (CPI codes 3 and 4) and severe periodontitis (CPI code 4) were significantly higher in cancer patients than in the national survey.The present results showed that digestive system cancers were closely associated with multi-tooth loss and/or a low denture-wearing rate. The prevalence of severe periodontitis was also found to be higher in cancer patients. These results suggest that periodontitis and associated multi-tooth loss play a potential role in digestive system cancers.

Treatment outcomes and prognostic factors of medication-related osteonecrosis of the jaw: a case- and literature-based review.

OBJECTIVES: The purpose of this study was to investigate the treatment outcomes and prognostic factors of medication-related osteonecrosis of the jaw (MRONJ) in Japanese patients. PATIENTS AND METHODS: Among 409 cases, treatment outcomes and prognostic factors were investigated in 275 patients. In statistical analyses, the 1-year cumulative curative rate was calculated with the Kaplan-Meier method, and significance was examined with the Wilcoxon test. Cox's proportional hazards regression analysis was used for the multivariate analysis. RESULTS: Resolution of the disease was achieved in 137 out of 275 MRONJ patients (49.8%). One-year cumulative curative rates were 39.8% in stage 1 patients, 26.3% in stage 2, and 19.0% in stage 3. The 1-year cumulative curative rates of treatment interventions were 17.2% for conservative treatment, 34.5% for sequestrectomy, and 40.7% for extended surgery including bone resection and segmental resection. As the prognostic factors of treatment outcomes, the type of medication, stage of MRONJ, and type of surgical intervention were identified as independent factors in a multivariate analysis. CONCLUSION: These results suggest that surgical interventions may lead to a good prognosis in MRONJ patients. CLINICAL RELEVANCE: This study indicated that surgical intervention for MRONJ might lead to improvement of prognosis and quality of life in MRONJ patients.

A Multicenter Retrospective Study of Elective Neck Dissection for T1-2N0M0 Tongue Squamous Cell Carcinoma: Analysis Using Propensity Score-Matching.

BACKGROUND: This multicenter retrospective study aimed to determine whether elective neck dissection (END) can be performed for T1-2N0M0 tongue cancer. METHODS: Patients with T1-2N0M0 tongue squamous cell carcinoma who received treatment between January 2000 and December 2012 were enrolled at 14 multicenter study sites. The 5-year overall survival (OS) and 5-year disease-specific survival (DSS) were compared between the propensity score-matched END and observation (OBS) groups. RESULTS: The results showed that the OS rates among the 1234 enrolled patients were 85.5% in the END group and 90.2% in the OBS group (P = 0.182). The DSS rates were 87.0% in the END group and 94.3% in the OBS group (P = 0.003). Among the matched patients, the OS rates were 87.1% in the END group and 76.2% in the OBS group (P = 0.0051), and the respective DSS rates were 89.2% and 82.2% (P = 0.0335). CONCLUSION: This study showed that END is beneficial for T1-2N0M0 tongue cancer. However, END should be performed for patients with a tumor depth of 4-5 mm or more, which is the depth associated with a high rate of lymph node metastasis. The use of END should be carefully considered for both elderly and young patients.

Significant prognostic factors affecting treatment outcomes of salivary gland carcinoma: a multicenter retrospective analysis.

The purpose of this study was to investigate the prognostic factor in salivary gland carcinoma patients. Clinical and pathological data of 211 consecutive patients who treated with curative intent were analyzed. The overall survival (OS) rate, local control rate, and distant metastasis rate were calculated. To examine a prognostic factor in salivary gland carcinoma patients, a multivariate analysis was performed. The 5-year-OS rate was 84.0%, and 10-year was 69.2%. The 5-year-local control rate was 84.6%, and 10-year was 70.1%. The 5-year-distant metastasis rate was 16.9%, and 10-year was 21.1%. In a multivariate analysis, the OS rate was affected by pN(+), high-grade malignancy, and primary tumor size. The local control was affected by the primary tumor size, high-grade malignancy, and the status of the surgical margin. The primary tumor size and pN(+) were associated with the distant metastasis. The results of this study suggested that pN(+), malignancy grade, primary tumor size, and the margin status might affect the prognosis of salivary gland carcinoma patients. Postoperative radiotherapy and adjuvant chemotherapy were suggested the possibility of contribution to the good prognosis of salivary gland carcinoma patients.

A Novel Sterically Bulky Hole Transporter to Remarkably Improve the Lifetime of Thermally Activated Delayed Fluorescent OLEDs at High Brightness.

For the practical application of organic light emitting devices (OLEDs) based on thermally activated delayed fluorescence (TADF) for large area TV and solid state lighting, low power consumption as well as the operation lifetime at high brightness over 1000 cd m-2 must be improved. Here, we have developed a novel hexaphenylbenzene-based sterically bulky hole-transport layer named 4DBTHPB with deep ionization potential of 5.8 eV and high triplet energy of 2.7 eV. By using 4DBTHPB, we can realize a highly efficient and stable TADF OLED exhibiting external quantum efficiency of 21.6 % and power efficiency of 54.3 lm W-1 and operation lifetime at 50 % (LT50 ) of approximately 10 000 h at an initial luminance of 1000 cd m-2 . These performances are comparable to those of the state-of-the-art green phosphorescent OLEDs reported in the scientific literatures.

Progression level of extracapsular spread and tumor budding for cervical lymph node metastasis of OSCC.

OBJECTIVES: The progression level of extracapsular spread (ECS) for cervical lymph node metastasis of oral squamous cell carcinoma (OSCC) was previously divided into three types, and their relationships with the prognosis of patients were re-examined. PATIENTS AND METHODS: The Kaplan-Meier method was used to examine overall survival (OS) and relapse-free survival (RFS) curves. Prognosis factor for recurrence was analyzed with univariate and multivariate analysis. RESULTS: ECS was detected in 216 cases of OSCC and analyzed. The 5-year overall survival and RFS rates of patients with type C, which was microscopically defined as tumor invasion to perinodal fat or muscle tissue, were significantly poor at 40.6 and 37.8%, respectively. The results of a univariate analysis suggested that the prognosis of ECS in OSCC patients is associated with its progression level, particularly type C. The 5-year RFS rate of type C with tumor budding was significantly poor at 31.5%. Type C with tumor budding correlated with local and regional recurrence as well as distant metastasis. In a multivariate analysis, tumor budding was identified as an independent prognostic factor. CONCLUSIONS: These results suggest that the progression level of ECS and tumor budding are useful prognostic factors in OSCC patients. CLINICAL RELEVANCE: This study indicated that the progression level and tumor budding of ECS for cervical lymph node metastasis were useful prognostic factors in OSCC patients.

Clinical investigation of 38 cases of oral mucosal melanoma: A multicentre retrospective analysis in Japan.

BACKGROUND/OBJECTIVES: The aim of the present study was to investigate treatment modalities and outcomes in oral mucosal melanoma. METHODS: The clinical and pathological data of 38 consecutive patients with oral mucosal melanoma were retrospectively analyzed. Patients' characteristics were analyzed and overall survival (OS) rates were calculated. RESULTS: Sixteen patients had stage III (42%), 19 IVA (50%), and three had stage IVC (8%) disease. Among the therapeutic approaches used, 31 patients (82%) received radical therapy (surgery +/- chemotherapy). The 5-year OS rate was 40%. Five-year OS rates according to the clinical stage were 71% for stage III, 24% for stage IVA, and 0% for stage IVC. Five-year OS rates according to therapeutic approaches were 52% in the radical therapy group and 0% in the palliative therapy and best supportive care groups. CONCLUSIONS: The results of this multicentre retrospective analysis of patients with oral mucosal melanoma suggest that radical therapy based on surgical treatments with complete surgical excision with clear margins leads to a better prognosis.

Increasing Risk of Disturbed Root Development in Permanent Teeth in Childhood Cancer Survivors Undergoing Cancer Treatment at Older Age.

BACKGROUND: Structural anomalies of teeth are observed at high rates in childhood cancer survivors (CCS). Several therapeutic exposures have been shown to be associated with dental developmental disturbances. This study was conducted to analyze the risk factors for dental developmental abnormality (DDA) and investigate the association between age at the time of cancer treatment and DDA in CCS. PATIENTS AND METHODS: Fifty-six CCS were enrolled. Orthopantomography and dental examination were performed in all the patients. We evaluated the prevalence of DDA and analyzed the risk factors for each type of DDA. RESULTS: DDAs were observed in 46.4% of CCS, including hypodontia in 9 (16.1%), abnormal roots in nine (16.1%), enamel defects/hypoplasia in 6 (10.7%), and microdontia in 12 (21.4%) patients. The number of patients with abnormal roots was significantly higher in the group treated with stem cell transplantation or at an age older than 4 years. We observed that the formation period of abnormal teeth coincided with the treatment period in the majority of CCS with DDA. CONCLUSIONS: Particularly regarding the root abnormality, treatment at elder age may be a risk factor for root developmental disturbances. Risk evaluation, appropriate follow-up, and early detection of dental issues are required for all CCS.

Healthy life expectancy of oral squamous cell carcinoma patients aged 75years and older.

OBJECTIVES: Healthy life expectancy, an extension of the concept of life expectancy, is a summary measure of population health that takes into account the mortality and morbidity of a population. The aim of the present study was to retrospectively analyze the self-reliance survival times of oral squamous cell carcinoma (OSCC) patients. MATERIALS AND METHODS: One hundred and twelve patients aged 75years or older with primary OSCC were included and examined at Shinshu University Hospital. To investigate healthy life expectancy, OSCC patients older than 75years were divided into 3 groups: 75-79, 80-84, and older than 85years. The Kaplan-Meier method was used to estimate the median times of healthy life expectancy. The Log-rank test was used to test significant differences between actual curves. RESULTS: The median self-reliance survival times of patients aged 75-79, 80-84, and older than 85years were 5.7, 1.6, and 1.4years, respectively. Most patients with early stage cancers underwent curative treatments and showed a health expectancy of more than 5years. In patients with advanced cancers, health expectancy was poor (less than one year), except among patients aged 75-79years who underwent standard treatments. CONCLUSIONS: It seems that in patients with advanced cancers, health expectancy was poor (less than 1year), except among patients aged 75-79years who underwent standard treatments. In elderly patients, healthy life expectancy (self-reliance survival time) may be one of the measures of patient prognosis as well as overall survival times.

Prognostic and staging implications of mandibular canal invasion in lower gingival squamous cell carcinoma.

A multi-institutional study was undertaken to determine whether mandibular canal (MC) invasion and mandibular medullary bone invasion are independent factors in lower gingival squamous cell carcinoma (SCC). A total of 345 patients with lower gingival SCC were retrospectively reviewed. Mandibular bone invasion was categorized into three types; no bone invasion; invasion through cortical bone (medullary); and MC invasion. The overall survival rate and factors affecting local, regional, and distant failures were assessed by Cox proportional hazards regression analysis and Kaplan-Meier estimates. Bone invasion was present in 201 (58%) patients, of whom 107 (31%) had medullary invasion and 94 (27%) had MC invasion. Using the International Union Against Cancer (UICC) staging system and American Joint Committee on Cancer (AJCC) system, 171 (50%) patients were classified as T4a. When the bone invasion criteria were excluded from the UICC/AJCC system definition, 152 T4a tumors were downstaged and reclassified to T1 in 12 (3%), to T2 in 98 (28%), and to T3 in 42 (12%). In Cox multivariate analysis, MC invasion was an independent predictor of overall survival but medullary bone invasion was not. Medullary bone invasion was an independent variable for distant control. The current T staging system has restricted prognostic utility. The authors recommend a modified T staging system, whereby tumors with MC invasion instead of medullary bone invasion are classified as T4a, and tumors are first classified as T1 to T3 based on size and then upstaged by one T classification in the presence of medullary invasion.

A case of peri-implantitis and osteoradionecrosis arising around dental implants placed before radiation therapy.

A little is known about the effect of radiotherapy on the dental implants that have previously been osseointegrated and charged. Here, we reported a case of osteoradionecrosis which arose around dental implants placed before radiation therapy.

Multicenter Retrospective Study of Adjuvant Therapy for Patients with Pathologically Lymph Node-Positive Oral Squamous Cell Carcinoma: Analysis of Covariance Using Propensity Score.

BACKGROUND: The presence of pathologically positive lymph nodes (pN+) is a well-known prognostic factor in oral squamous cell carcinoma (OSCC). The aims of this retrospective multicenter study were to assess the prognosis of OSCC patients with pN+ disease; to compare the prognosis of patients with pN+ disease who underwent surgery plus radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) with that of patients who underwent surgery only; and to account for biases associated with treatment selection of adjuvant RT or CCRT. METHODS: The records of 313 OSCC patients with pN+ disease were retrospectively reviewed. The main outcome measures were 5-year disease-specific survival (DSS) and overall survival (OS) rates. To reduce selection biases associated with retrospective data, the treatment groups were evaluated by Cox proportional hazard analysis with propensity score as a covariate. RESULTS: The 5-year OS and DSS survival rates for the entire patient cohort were 51.8 and 59.2 %, respectively. T3-4 stage, closed (<5 mm) margin distance, ≥4 involved nodes, and extracapsular spread were significant poor prognostic factors for OS and DSS. In the propensity score analysis, postoperative RT/CCRT significantly improved OS and DSS compared to surgery only. However, OS and DSS were not significantly different between patients who received postoperative RT and CCRT. CONCLUSION: The addition of cytotoxic chemotherapy to RT does not provide additional survival benefit in OSCC patients with pN+ disease. Alternative strategies, such as molecular targeted therapies, are needed to further improve the survival of high-risk OSCC patients with pN+ disease.

Predictability of staged localized alveolar ridge augmentation using a micro titanium mesh.

PURPOSE: The aim of this study is to retrospectively evaluate the success rate of staged localized alveolar ridge augmentation using titanium micromesh. In addition, the factors that influenced the success were analyzed. METHODS: Twenty-three alveolar ridges (posterior mandible 12, anterior maxilla 7, anterior and posterior maxilla 3, and posterior maxilla 1) were augmented using titanium micromesh and were retrospectively assessed. RESULTS: Thirty sites were judged as successful with a success rate of 56.6 % (posterior mandible 58.3 %, anterior maxilla 57.1 %, anterior and posterior maxilla 33.3 %, and posterior maxilla 100 %). The span of the augmentation site was significantly correlated with the success rate (goodness test of fit for chi-square, p < 0.05). The success rate was low if infection of the grafted material was observed, while the exposure of titanium mesh had no negative impact. CONCLUSIONS: This limited study suggested that the predictability of augmented bone volume in staged alveolar ridge augmentation using titanium micromesh was not sufficient to expect an ideal and planned implant placement. The success was influenced by the distance of the augmentation site and the infection of the graft material, which were associated with moderate to severe vertical ridge resorption and/or mechanical and functional loading on the surgical site.

[Retrospective analysis of clinical and pathological factors that influence patient survival in salivary gland cancer - could chemotherapy improve survival ?].

The purpose of this retrospective study was to evaluate the prognostic factors in salivary gland cancer using a multivariate analysis. In total, 45 consecutive patients who underwent planned radical resection for salivary gland cancer between 1985 and 2010 were analyzed. Univariate and multivariate analyses were performed to analyze the clinical and pathological factors that influence patient survival in salivary gland cancer(tumor location, T and N classification, histological grade, excision margin status, postoperative radiotherapy, and postoperative adjuvant chemotherapy). The results of the multivariate analysis showed that T classification(odds ratio[OR]: 2.93, 95%confidence interval[CI]: 1.47-5.82), and excision margin status(OR: 4.86, 95% CI: 1.76-13.44)had a significant impact on tumor-free survival time, suggesting that both are important prognostic factors in salivary gland cancer. Moreover, postoperative adjuvant chemotherapy showed a tendency to improve tumor free survival time(OR: 0.28, 95% CI: 0.07-1.11), thereby indicating its potential in improving prognosis in patients with salivary gland cancer.

Effectiveness of vital staining with iodine solution in reducing local recurrence after resection of dysplastic or malignant oral mucosa.

The purpose of this retrospective study was to assess the effect of vital staining with iodine solution in reducing local recurrence after resection of dysplastic or malignant oral mucosa. The historical control group had dysplastic or malignant mucosal lesions resected solely on the evidence of direct inspection and palpation. In the vital staining group tissue was resected only after vital staining with iodine solution. Seven of 25 patients in the conventional group developed recurrent dysplastic or cancerous oral mucosa around the primary site, while no patient among 23 reported recurrence in the vital staining group (p<0.01). Kaplan-Meier assessment showed that the 5-year primary control rate was 100% in the vital staining group and 75% in the conventional group. Although this retrospective study has some limitations, the results suggest that vital staining with iodine may be useful in reducing the incidence of recurrence of dysplastic or cancerous epithelium at a primary site. Further well-controlled study is essential.

Impact of different surgical margin conditions on local recurrence of oral squamous cell carcinoma.

The purpose of this study was to analyze the impact of different surgical margin conditions on local recurrence of oral squamous cell carcinoma (SCC) in 148 consecutive patients who underwent planned radical resection of oral SCC. The patients were classified into four categories according to the status of the surgical margin: clear (no SCC within 5mm, n=103), close (SCC within 5mm, n=21), dysplasia (dysplastic epithelium at margin, n=13), and involved (SCC at margin, n=11). Cox's proportional hazard model showed that the status of the surgical margin had a significant impact on local recurrence (p<0.003); hazard ratio was 3.79 (95%CI: 1.17-12.28) with a close and 7.89 (2.38-26.17) with an involved margin. The presence of mucosal dysplasia at the surgical margin was also a significant predictor of local recurrence (hazard ratio: 5.29, 95%CI: 1.31-21.29). Local recurrence was observed only with severe dysplasia, while no recurrence with mild and moderate dysplasia. In the patients with a clear and closed surgical margin, local recurrence was related with T4 tumor and an advanced mode of tumor invasion. The results of this study suggested that the presence of tumor cells at or close to the surgical margin increased the risk of local recurrence. The presence of dysplastic epithelium (especially severe dysplasia) at the mucosal surgical margin has a significant impact on local control. It was also suggested that not simply the width of the free margin but also clinical and histological risk factors should be included in deciding the necessity for adjuvant radiotherapy.

Usefulness of a commercial enzyme-linked immunosorbent assay kit for Candida mannan antigen for detecting Candida in oral rinse solutions.

OBJECTIVE: The aim was to test the performance of a commercial enzyme-linked immunosorbent assay (ELISA) kit for Candida mannan antigen for detecting Candida in oral rinse solutions. STUDY DESIGN: Forty-eight oral rinse solutions (38 from patients and 10 from healthy volunteers) were available. Mannan antigen was measured using a commercial sandwich ELISA kit, Unimedi Candida. The result of the mannan assay was compared with the result of conventional detection and identification by culture. RESULTS: The result of the mannan assay revealed that 31 of 38 clinical and 3 of 10 healthy volunteer samples were positive for Candida. Using the culture as a gold standard, the overall sensitivity and specificity of the mannan antigen detection were 90.9% and 46.2%, respectively. CONCLUSIONS: The results of this study suggested that mannan antigen detection might be a possible and sensitive technique for the detection of oral Candida. The conditions of the ELISA-based assay should be optimized for oral rinse solutions.

Intraoperative tissue staining of invaded oral carcinoma.

The purpose of this study was to assess the ability of intraoperative tissue staining with consecutive application of 0.4% indigo carmine and 0.5% Congo red to demonstrate the extent and border of oral carcinoma invasion. Seventeen patients were included in the study. Once the oral tumor was resected, a vertical section of surgical specimen was taken from the central part of the tumor. The extent and border of the invaded carcinoma were assessed on digital microscopic examination with tissue staining. The results of assessments were compared with corresponding results of conventional histopathological analysis with HE staining, which is considered the gold standard. Tissue staining produced a brown-black stain on normal muscle, connective, and salivary tissues but not tumor and epithelial tissues. It clearly demonstrated the extent and border of tumor invasion in 13 of 17 patients (76.5%); however, detection of remnant vital tumor cells in scar tissue after neoadjuvant chemotherapy, and distinction between the tumor and adipose tissue scattered in the muscle tissue was difficult. The results of this study showed that intraoperative tissue staining was a possible method in demonstrating the extent and border of carcinoma deeply invaded in the soft tissue and selecting the site for additional frozen section analysis, although the method needed some refinement.

Accuracy of intraoperative tissue staining in delineating deep surgical margins in oral carcinoma surgery.

The purpose of this study was to assess the accuracy of this tissue staining assessment of surgical specimens in delineating deep surgical margins in oral cancer surgery. Fifteen patients who underwent surgery for oral carcinoma were included in the study. Once the tumor was resected, a vertical section of the surgical specimen was taken from the central part of the tumor. The section was consecutively stained with 0.4% indigo carmine and 0.5% Congo red, and deep surgical margins were assessed using a digital microscope with a magnification power of 25-175x. The results of tissue staining analysis were compared with the corresponding results of conventional histopathological analysis with HE staining, which is considered the gold standard. The extent of carcinoma invasion could be visualized after the application of tissue staining solutions. Tissue staining analysis was accurate in 12 of the 15 patients (80%) in evaluating the closest deep surgical margin. There was no significant difference in the tumor-margin distance between tissue staining and histopathological assessment in these 12 patients (Wilcoxon signed-ranks test, P>0.63). The results of this study showed that intraoperative tissue staining of surgical specimens permitted visual inspection and assessment of tumor spread to surgical margin, although the method has some limitations. The method had a possible ability in controlling the deep surgical margin.