The Prevalence and Treatment Costs of Non-Melanoma Skin Cancer in Cluj-Napoca Maxillofacial Center.

Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients' features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options.

Fall Risk in Elderly with Insomnia in Western Romania-A Retrospective Cross-Sectional Study.

Background and Objectives: Falls are frequent among the elderly, imply large social and economic costs, and have serious outcomes. The purpose of this study was to investigate the links between insomnia, comorbidities, multisite pain, physical activity, and fall risk in the elderly. Materials and Methods: This retrospective cross-sectional study included persons recruited from nursing homes for the elderly in Timisoara. We separated the participants into two groups by the absence (group I) or presence of fractures (group II) starting with the age of 65 years. Participants were asked how they feel about their sleep using one item on a 4-point scale from the Assessment of Quality of Life questionnaire. The risk of fall was evaluated using the Falls Risk Assessment Tool. Results: The study enrolled 140 patients with a mean age of 78.4 ± 2.4 years (range 65-98 years), 55 of them being males (39%). By comparing the two groups, we found that the elderly with a history of fractures had a greater number of comorbidities, a higher risk of fall, and more severe sleep disturbances. When using univariate logistic regression, the occurrence of fractures in the elderly was significantly associated with the number of comorbidities, the risk of fall, and the presence of sleep disturbances (p < 0.0001). The multivariate regression analysis selected four independent parameters significantly linked to fractures, and these were the number of comorbidities (p < 0.03), the risk of fall score (p < 0.006), and the sleep disturbances of type 3 (p < 0.003) and 4 (p = 0.001). Conclusions: A fall-risk score over 14 and a number of comorbidities over 2 were notably associated with the occurrence of fractures. We also found strong positive correlations between the type of sleep disturbance and the risk of fall score, the number of comorbidities, and the number of fractures in the elderly.

Salivary Exosomal MicroRNA-486-5p and MicroRNA-10b-5p in Oral and Oropharyngeal Squamous Cell Carcinoma.

Background and Objectives: The research aimed at evaluating the capacity of salivary exosomal miR-10b-5p and miR-486-5p for oral and oropharyngeal cancer detection. Materials and Methods: The saliva samples were harvested from histopathological diagnosed oral and oropharyngeal squamous cell carcinoma patients and healthy volunteer subjects. The exosomes were isolated by differential ultracentrifugation and quantified by Nano Track Analysis. The microRNAs were extracted and quantified from salivary exosomes by quantitative Real-Time Polymerase Chain Reaction. Results: This research comprised fifty participants. When compared to healthy controls, salivary exosomal miR-486-5p was elevated and miR-10b-5p was reduced in oral and oropharyngeal squamous cell carcinoma. Moreover, miR-486-5p had a high expression level in stage II of cancer in comparison to the other cancer stages. The cancer samples presented an increased exosome dimension compared to the control samples. Conclusions: Salivary exosomal miR-10b-5p and miR-486-5p have an altered expression in oral and oropharyngeal cancer.

Elastofibroma Dorsi, a Rare Condition, with Challenging Diagnosis. Case Report and Literature Review.

Elastofibroma dorsi (ED) is known as a particular clinical and biological entity. We report a case of a bilateral elastofibroma dorsi (ED) in a 65-year-old female who presented to the Department of General and Oncologic Surgery of Emergency Clinical Municipal Hospital Timisoara, Romania. The patient was symptomatic on the right side, presenting pain in the interscapulothoracic region associated with a variable tumoral mass, dependent on the position of the right arm. Imaging studies revealed a well-defined, bilateral tumoral mass with alternation of the muscular and fatty tissue. The initial diagnosis of lipoma was taken into consideration based on the CT scan and clinical findings. Surgical excision of the right subscapular tumor was performed without any postoperative complications. Microscopic examination of hematoxylin and eosin, Masson's trichrome, and orcein stained slides revealed the diagnosis of ED. Considering the high rate of reported postoperative complications and the asymptomatic presentation of the contralateral subscapular mass, the patient underwent clinical and imagistic monitoring for the contralateral tumor. Due to its rare nature, ED is a difficult preoperative diagnosis that can, however, be suggested by its specific location and may require an accurate histopathological examination for a final diagnosis.

Correlation between multifidus fatty atrophy and lumbar disc degeneration in low back pain.

BACKGROUND: Chronic low back pain (LBP) is common and associated with lumbar disc herniation. The purpose of this study was to investigate if the grade of lumbar disc degeneration correlates with the degree of lumbar multifidus muscle (LMM) fatty atrophy. METHODS: A retrospective analysis on 16 males and 19 females with chronic LBP and a mean age of 47.2 years. Using MRI, the grade of lumbar intervertebral discs degeneration was assessed according to the Pfirrmann classification at L4/L5 and L5/S1 levels. Fatty infiltration of the LMM was graded as normal, mild, moderate and severe. Adobe Photoshop CS6 was used for qualitative image analysis by measuring the Cross-sectional area (CSA) of the pure fat component of LMM. RESULTS: There was a low correlation (R = 0.37) and significant association (ANOVA, p = 0.001, 95% CI 2.07-8.14) between the grade of lumbar disc degeneration and the degree of LMM fatty atrophy. Mean value of intervertebral disc degeneration was 2.9 for the L4/L5 level and 3.2 for L5/S1 respectively. The percentage of fat infiltration of the LMM at both studied levels showed a mean value of 22.91+/- 13.19% for L4/L5 and a higher mean value of 26.37+/- 12.89% for L5/S1. There were higher fatty atrophy scores in women and more disc degeneration in men. CONCLUSION: The percentage of LMM atrophy is higher in the lower levels (L5/S1) and shows a low correlation with the grade of disc degeneration.

Comparative biomechanical analysis of three implants used in bicondylar tibial fractures.

BACKGROUND: Currently, the most difficult-to-treat tibial plateau fractures are complex, comminuted fractures, which result from high-energy trauma. The anatomical reconstruction of the articular surface and the preservation of the soft tissue envelope are required for a good functional result. The aim of this study is to perform a biomechanical evaluation of three constructs used in the treatment of bicondylar fractures: the L­shaped plate, the LCP locking plate, and the hybrid external fixator. METHODS: We used 30 experimental models divided into three study groups. There were ten models for each type of implant. RESULTS: The best biomechanical behavior was found with the LCP locking plate, which showed minimal deformation upon cyclic loading, followed by the hybrid external fixator. CONCLUSIONS: The LCP plate is the optimal implant for the stabilization of Schatzker type V tibial plateau fractures, with low rates of degradation for the implant and the bone-implant assembly.

Utility of Kansas City Cardiomyopathy Questionnaire (KCCQ) in Assessing Quality of Life among Patients with Heart Failure Undergoing Exercise Training Rehabilitation: A Systematic Review.

This systematic review evaluates the effectiveness of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in assessing quality of life improvements among patients with heart failure (HF) undergoing various forms of exercise training rehabilitation, including telemedicine and in-person modalities, across all stages of HF, irrespective of ejection fraction (EF) and clinical status. The aim was to collate evidence from studies employing the KCCQ as a measure of quality of life (QoL). A comprehensive search strategy was implemented across PubMed, Scopus, and Embase databases, adhering to the PRISMA guidelines, including literature up until October 2023. Inclusion criteria encompassed studies on patients diagnosed with HF undergoing exercise training rehabilitation assessed by KCCQ. Nine articles met the inclusion criteria, involving a total of 3905 patients from various global locations and conducted between 2012 and 2022. Results indicated significant heterogeneity in exercise interventions and patient characteristics. Notably, high-intensity interval training (HIIT) showed a marked improvement in KCCQ scores (from 68.0 to 80.0) compared to moderate continuous training (MCT) and control groups, underscoring its potential for enhancing QoL. Additionally, a significant improvement in the 6-min walking test (6MWT) outcomes was observed, with an average increase of 106 m (95% CI: 60, 152) in one study, reflecting physical capacity enhancements. However, the difference in KCCQ scores between intervention and control groups was not statistically significant in several studies. In conclusion, the KCCQ's effectiveness is highlighted by its ability to detect clinically meaningful improvements in QoL across diverse exercise modalities, including HIIT and MCT, tailored to the specific needs of HF populations. The consistent correlation between KCCQ score improvements and enhanced physical outcomes, such as the 6MWT, supports its reliability in capturing the nuanced benefits of exercise interventions on patient well-being.

Platelet-Rich Fibrin Treatment Evaluation in Patients with Medication-Related Osteonecrosis of the Jaw and Osteoradionecrosis.

Background. Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are associated with severe disability and continuous pain, both of which are very difficult to control. This study aims to evaluate the outcome of platelet-rich fibrin (PRF) treatment compared to iodoform gauze packing and the primary suture of oral mucosa in patients with both MRONJ and ORN. Methods. Patients suffering from MRONJ and ORN who were treated in the Oral and Maxillofacial Surgery Clinic of Cluj-Napoca in the last 10 years were selected for this study from the hospital database. Results. PRF treatment proved to be a reliable method to help heal the necrotic bone sites. High-ASA risk patients and immunosuppressed patients are more prone to recurrence and persistent signs and symptoms. Intravenous bisphosphonates produce more intense symptomatology compared to oral administration. The posterior mandible is more difficult to treat compared to other sites. Conclusions. The quality of life of MRONJ and ORN patients may be improved by a protocol that reduces pain and hospitalization.

Impact of the COVID-19 Pandemic on the Surgical Management of Head and Neck Non-Melanoma Skin Cancers in a Maxillofacial Center of Cluj-Napoca.

Background: The COVID-19 era has been a bleak period for both cancer and non-cancer patients, with delayed non-emergency treatments, such as for non-melanoma skin cancer (NMSC). This study aimed to evaluate how the treatment of NMSC patients was influenced by the management of the COVID-19 pandemic in an Eastern European Maxillofacial Surgery center. Materials and Methods: A total of 176 patients with a histopathological diagnosis of head and neck NMSC who were surgically treated in Cluj-Napoca Emergency County Hospital between 2016 and 2022 were included in this study, and divided into two samples, pre-pandemic (2016-2019) and COVID-19 (2020-2022) periods. Results: The pandemic presented with a decrease of 46.15% in patients' hospitalization, with wealthy and educated patients being prevalent. Even if the waiting time for surgery was increased, the stage of cancer and preference method for reconstruction did not differ. Despite the lower addressability of NMSC patients during the pandemic, there were no changes in surgical treatment. Conclusions: During COVID-19, the number of patients was reduced, with a longer waiting time for surgery, but without any changes in tumor stage and treatment preferences. However, the benefit of removing a cancer tumor is higher compared to the risk of developing COVID-19 infection during hospitalization.

Analogies Between Platelet-Rich Plasma Versus Hyaluronic Acid Intra-articular Injections in the Treatment of Advanced Knee Arthritis: A Single-Center Study.

Background Knee osteoarthritis (KOA), a degenerative joint disease, is a common cause of chronic knee pain and disability in adults. Conservative management options are the first-line approach, but intra-articular injections, such as platelet-rich plasma (PRP) and hyaluronic acid (HA), are considered for advanced cases. This study aims to compare the efficacy of PRP versus HA injections in patients with advanced KOA. Methods A retrospective study was conducted on 145 patients with advanced KOA. Seventy patients received PRP injections, while 75 patients received HA injections. The Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and International Knee Documentation Committee (IKDC) score were employed to evaluate the treatment's efficacy. Adverse events associated with these injections were also recorded. Results Both PRP and HA injections significantly reduced pain and improved joint function in patients with advanced KOA. PRP injections were slightly more effective than HA injections in reducing pain scores. Both treatments showed similar improvements in functional outcomes. Adverse events were minimal and self-limiting for both treatments. Conclusions Both PRP and HA injections effectively ameliorate advanced KOA by reducing pain and improving function. PRP injections showed a slightly greater improvement in pain scores and functional outcomes. The choice between PRP and HA injections may depend on factors like cost, availability, and patient preference. Further research is needed to validate these findings and understand treatment suitability for different patient populations.

Superomedial Scapula Angle Osteochondroma with Winging in a Young Female Patient-Case Report and Literature Review.

(1) Background: Osteochondromas are the most common benign bone tumors, primarily found in long bones, while scapular osteochondromas are rare and account for less than 1% of all osteochondromas. (2) Methods: We present a case of a young female patient with a unique presentation of scapular osteochondroma. The patient exhibited superomedial scapula angle osteochondroma with winging, a rare manifestation of scapular osteochondroma. The patient had a slow-growing mass on the left scapula for several years. Physical examination revealed a visible deformity with significant winging of the scapula. Imaging studies demonstrated a large osteochondroma arising from the superomedial angle of the left scapula, with a bony stalk. (3) Results: Surgical excision was performed, and histopathological analysis confirmed the diagnosis of osteochondroma. Following the surgery, the patient experienced a significant improvement in scapular winging. A comprehensive literature review revealed only a limited number of reported cases of scapular osteochondroma with winging, underscoring the significance of this case report as a valuable addition to the existing literature. The diagnosis of scapular osteochondroma should be considered in the differential diagnosis of patients presenting with a scapular mass, particularly when associated with winging. Surgical excision is the recommended treatment, and complete excision is crucial to prevent recurrence. (4) Conclusions: This case report highlights a rare presentation of scapular osteochondroma with winging and emphasizes the importance of considering this diagnosis in patients with scapular masses accompanied by winging. The successful surgical intervention in our case resulted in significant improvement. Clinicians should be aware of this entity and consider prompt surgical intervention for complete excision, ensuring optimal patient outcomes and preventing recurrence. Further research and additional case reports are necessary to enhance our understanding of scapular osteochondroma and its varied clinical presentations. Furthermore, comprehensive studies involving larger patient cohorts are necessary to explore the full spectrum of clinical presentations of scapular osteochondromas. By documenting and analyzing a wider range of cases, including variations in tumor location, size, and associated symptoms, researchers can identify patterns and establish more accurate diagnostic criteria. This will facilitate early detection and appropriate management of scapular osteochondromas, ultimately improving patient outcomes.

The Arterial Axis Lesions in Proximal Humeral Fractures-Case Report and Literature Review.

BACKGROUND: This comprehensive review delves into the nuanced domain of arterial axis lesions associated with proximal humeral fractures, elucidating the intricate interplay between fracture patterns and vascular compromise. Proximal humeral fractures, a common orthopedic occurrence, often present challenges beyond the skeletal realm, necessitating a profound understanding of the vascular implications. METHODS: The study synthesizes the existing literature, presenting a collective analysis of documented cases and their respective clinical outcomes. The spectrum of arterial axis lesions, from subtle vascular compromise to overt ischemic events, is systematically examined, highlighting the varied clinical manifestations encountered in proximal humeral fractures. Diagnostic modalities, including advanced imaging techniques such as angiography and Doppler ultrasound, are scrutinized for their efficacy in identifying arterial axis lesions promptly. The review emphasizes the critical role of early and accurate diagnosis in mitigating the potential sequelae associated with vascular compromise, thereby underscoring the importance of a vigilant clinical approach. RESULTS: Therapeutic strategies, ranging from conservative management to surgical interventions, are critically evaluated in the context of existing evidence. The evolving landscape of endovascular interventions and their applicability in addressing arterial axis lesions specific to proximal humeral fractures is explored, providing valuable insights for clinicians navigating the therapeutic decision-making process. Furthermore, the review addresses gaps in current knowledge and proposes avenues for future research, emphasizing the need for tailored, evidence-based guidelines in the management of arterial axis lesions in proximal humeral fractures. By consolidating current understanding and pointing towards areas warranting further exploration, this review contributes to the ongoing discourse surrounding the intricacies of vascular complications in orthopedic trauma. CONCLUSIONS: this comprehensive review provides a synthesized overview of arterial axis lesions in proximal humeral fractures, offering a valuable resource for clinicians, researchers, and educators alike. The findings underscore the multifaceted nature of these lesions and advocate for a holistic, patient-centered approach to their management.

Radical resection of mandibular ameloblastoma and functional reconstruction with a fibula free flap. Report of two cases and review of the literature.

INTRODUCTION: Ameloblastoma is a borderline bone tumor that origins from the residual epithelium of the teeth germs, the epithelium of the enamel organ or the epithelium of odontogenic cysts. Ameloblastoma management is challenging owing to the necessity of tumor radical excision and the functional and aesthetic reconstruction of the surgical defect. The fibula-free flap (FFF) provides a high-quality and predictable mandibular reconstruction due to the high-caliber vascular pedicle, the bone length that can reconstruct large defects, the possibility for implants-based prosthetic reconstruction, and the possibility of harvesting a composite flap that can replace the mucosa, hence protecting the underlying bone reconstruction. CASE REPORTS: We report adult female and elder male patients, who were addressed to our hospital for mandible swelling and histopathological results of ameloblastoma. The lesions were treated by segmental mandibulectomy and FFF reconstructions. Osteosynthesis plates and screws were enough for the female patient's reconstruction of the lateral mandible defect and a load-bearing plate was necessary for the male patient's reconstruction of the surgical defect that included the anterior part of the mandible. The facial artery was used in both cases, and the surgeries lasted approximately 8 hours. No recurrence was observed at the follow-up and the aesthetic function was well re-established. CONCLUSION: Radical treatment of ameloblastoma is mandatory. The aesthetic function could be properly maintained by FFF. Also, the FFF reconstruction is a reliable method for head and neck large bone and soft tissue defects, microvascular anastomosis on facial artery offering a good blood SUPPLY OF THE FLAP. KEY WORDS: Ameloblastoma, Fibula-free flap, Maxillofacial reconstruction, Radical treatment.

Unexpected Repercussions of the COVID-19 Pandemic on Total Hip Arthroplasty with Cemented Hip Prosthesis versus Cementless Implants.

(1) Background: Total hip arthroplasty (THA) is one of the most common procedures used for adult hip reconstruction, employing mainly two types of prostheses: cemented (CHP) and cementless (CLHP). This study aims to analyze the impact of the COVID-19 pandemic on THA with CHP and CLHP, in terms of the benefit/cost ratio. (2) Methods: This article represents a retrospective analysis of the differences concerning the benefit/cost ratio between THA with the two types of prostheses in 2950 patients admitted for THA in the two orthopedic clinics of our hospital between 1 January 2015-1 March 2020 in comparison with 1005 THA subjects seen between 1 April 2020-31 December 2022. (3) Results: In the first period, THA with CHP was performed in 45.83% of cases, while CLHP was used in 54.16% of patients. During the COVID-19 period, CHP was inserted in 52% of THA patients, while the other 48% had CLHP inserted, with a hospitalization duration reduced by over 50% for both types of implants (p ˂ 0.001). (4) Conclusions: CHP offered good outcomes, with quicker mobilization, and shorter hospitalization duration, compared to CLHP, but optimization of the patients' management can be achieved mainly by reducing the length of hospitalization through an appropriate preoperative patient evaluation through a multidisciplinary approach, an aspect that was proven during the COVID-19 pandemic.

Design of a Synthetic Long Peptide Vaccine Targeting HPV-16 and -18 Using Immunoinformatic Methods.

Human papillomavirus types 16 and 18 cause the majority of cervical cancers worldwide. Despite the availability of three prophylactic vaccines based on virus-like particles (VLP) of the major capsid protein (L1), these vaccines are unable to clear an existing infection. Such infected persons experience an increased risk of neoplastic transformation. To overcome this problem, this study proposes an alternative synthetic long peptide (SLP)-based vaccine for persons already infected, including those with precancerous lesions. This new vaccine was designed to stimulate both CD8+ and CD4+ T cells, providing a robust and long-lasting immune response. The SLP construct includes both HLA class I- and class II-restricted epitopes, identified from IEDB or predicted using NetMHCPan and NetMHCIIPan. None of the SLPs were allergenic nor toxic, based on in silico studies. Population coverage studies provided 98.18% coverage for class I epitopes and 99.81% coverage for class II peptides in the IEDB world population's allele set. Three-dimensional structure ab initio prediction using Rosetta provided good quality models, which were assessed using PROCHECK and QMEAN4. Molecular docking with toll-like receptor 2 identified potential intrinsic TLR2 agonist activity, while molecular dynamics studies of SLPs in water suggested good stability, with favorable thermodynamic properties.

Correlation between Ankle Imaging Findings and Self-Reported Outcomes: A Longitudinal Assessment in Patients with Tibiofibular Diastasis.

BACKGROUND AND OBJECTIVES: This longitudinal study investigated the correlation between imaging findings and self-reported questionnaire outcomes in patients with tibiofibular diastasis, exploring the effects of surgical screw removal versus conservative treatment. This study was conducted at "Victor Babes" University of Medicine and Pharmacy in Timisoara between 2018 and 2023. MATERIALS AND METHODS: The study involved 85 patients in the screw removal group and 44 in the conservative group, assessed at 2 and 6 months post-surgery, answering the SF-36, HADS, and WHOQOL questionnaires. RESULTS: Significant differences were observed at 2 months post-surgery, with the screw removal group showing lower shear wave velocities in ankle dorsiflexion (8.9 ± 1.4) and anterior talofibular ligament (2.8 ± 0.9), indicating better mobility compared to the conservative group (ankle dorsiflexion: 10.1 ± 1.8, ATFL: 3.2 ± 1.1). Radiographically, lower tibiofibular overlap (8.1 ± 2.1) in the screw removal group suggested improved joint fixation quality. These physical improvements were mirrored in the quality-of-life assessments, where the screw removal group reported higher physical health scores on the SF-36 survey at 2 months, a trend that continued at 6 months. At 2 months, ankle dorsiflexion demonstrated a strong negative correlation with the SF-36 Physical score (r = -0.417) and WHOQOL Physical domain (r = -0.394), and a positive correlation with HADS Anxiety (r = 0.312). Similarly, ATFL and CFL velocities negatively correlated with the SF-36 Physical score (ATFL: r = -0.251; CFL: r = -0.237). Radiographic tibiofibular overlap and clear space positively correlated with WHOQOL Physical domain (TOL: r = 0.291; TCS: r = 0.276), with TCS also negatively correlating with HADS Anxiety (r = -0.228). At 6 months, these correlations persisted, with notable negative correlations between ultrasound ankle dorsiflexion and both SF-36 Physical score and WHOQOL Physical domain. CONCLUSIONS: These findings underscore the advantages of screw removal in enhancing physical recovery and reducing anxiety in the short term, while indicating similar long-term mental health outcomes between treatment approaches.

Bleeding and thromboembolic risk in patients under anticoagulant therapy receiving oral surgery: a systematic review.

Background and aims: There is an increasing number of patients with cardiovascular diseases who require anticoagulant treatment to address the underlying disease. Types of anticoagulants include vitamin K antagonists, such as warfarin and coumarin derivatives, and also newer oral anticoagulants, including rivaroxaban, apixaban, edoxaban, and dabigatran. The use of these anticoagulants may impact the condition of patients undergoing oral surgery. If the treatment is discontinued, the patient may be at risk of thrombosis. On the other hand, if the treatment is continued, the patient may experience a postoperative bleeding episode, placing them at risk of both thrombosis and bleeding. Method: The present article systematically reviews two different therapeutic regimens and their influence on hemorrhagic and thromboembolic events. The review included research from three databases and four specialized journals. The regimens examined were continuous versus discontinuous anticoagulant treatment and continuous versus interruption and switch to bridging therapy. Results: The most common surgical procedure examined in the review was tooth extraction, with a few studies also including soft tissue procedures. A total of seven eligible articles were identified, with five using the first treatment regimen of continuous versus discontinuous anticoagulant. These studies reported several cases of bleeding under continuous anticoagulant treatment during surgery. Two articles used the second treatment regimen of continuous versus interruption and switch to bridging therapy. Conclusions: The results of both treatment categories (continuous versus discontinuous anticoagulant and continuous versus interruption and switch to bridging therapy) showed no significant differences in terms of bleeding events. However, the use of scores that assess the risk of thrombosis and bleeding can assist surgeons in anticipating the degree of postoperative complications and making informed treatment decisions.

A New Detection Method of Oral and Oropharyngeal Squamous Cell Carcinoma Based on Multivariate Analysis of Surface Enhanced Raman Spectra of Salivary Exosomes.

Raman spectroscopy recently proved a tremendous capacity to identify disease-specific markers in various (bio)samples being a non-invasive, rapid, and reliable method for cancer detection. In this study, we first aimed to record vibrational spectra of salivary exosomes isolated from oral and oropharyngeal squamous cell carcinoma patients and healthy controls using surface enhancement Raman spectroscopy (SERS). Then, we assessed this method's capacity to discriminate between malignant and non-malignant samples by means of principal component-linear discriminant analysis (PC-LDA) and we used area under the receiver operating characteristics with illustration as the area under the curve to measure the power of salivary exosomes SERS spectra analysis to identify cancer presence. The vibrational spectra were collected on a solid plasmonic substrate developed in our group, synthesized using tangential flow filtered and concentrated silver nanoparticles, capable of generating very reproducible spectra for a whole range of bioanalytes. SERS examination identified interesting variations in the vibrational bands assigned to thiocyanate, proteins, and nucleic acids between the saliva of cancer and control groups. Chemometric analysis indicated discrimination sensitivity between the two groups up to 79.3%. The sensitivity is influenced by the spectral interval used for the multivariate analysis, being lower (75.9%) when the full-range spectra were used.

Odontogenic Keratocyst: The Dos and Don'ts in a Clinical Case Scenario.

BACKGROUND Odontogenic keratocysts are odontogenic cysts that increase in dimension based on growth factors and have a high recurrence rate. The radiological features of odontogenic keratocysts can be confusing owing to their similarity with other intraosseous cysts. The aim of treatment is to minimize patient morbidity and to reduce the risk of recurrence, along with complete surgical excision. CASE REPORT We report a case of a young man who presented to our hospital for a cystic lesion located in the posterior left mandible with clinical and radiological features of a dentigerous cyst. The lesion was treated accordingly for this diagnosis by enucleation. During surgery, a thick and firm cystic membrane was identified. Histopathological examination of the specimen established the final diagnosis of odontogenic keratocyst by identifying squamous epithelium with focal parakeratosis and ulceration and a diffuse inflammatory lymphoplasmacytic infiltrate. The patient's evolution was favorable, with no sign of recurrence on cone beam computed tomography examination at the 6-month follow-up and with healing of the surgical defect. CONCLUSIONS The diagnosis of odontogenic keratocyst is challenging, requiring preoperative 3-dimensional imaging and biopsy for extensive lesions. Adjuvant biochemical and immunological examination of cystic aspirate could sometimes be helpful for making a correct diagnosis. The treatment needs to be individualized according to the patient's age and the tumor's histopathological type and features. If the histopathological examination of surgical specimen indicates a more aggressive lesion than expected, a careful and individualized follow-up is imperative. No reintervention is needed if the patient does not present evidence of recurrence.

Salivary exosomal microRNAs as biomarkers for head and neck cancer detection-a literature review.

BACKGROUND: MicroRNAs (miRs) are small, non-coding mRNA molecules which regulate cellular processes in tumorigenesis. miRs were discovered in extracellular environment and biological fluids, carrying marks of head and neck squamous cell carcinoma (HNSCC). They were also identified in abundance in salivary exosomes, in which they are protected by exosome lipid barrier against enzymatic injuries and therefore, the accuracy of exosomal miR-based cancer detection increase. This systematic review aimed to reveal and inventorize the most reliable exosomal miRNAs in saliva samples which can be used as novel biomarkers for early detection of HNSCC. MATERIALS AND METHODS: A systematic literature search, according to PRISMA guideline, was performed on Pubmed and Google Academic libraries, based on specific keywords. Original articles published between 2010 and 2021 were selected. The quality of each paper was assessed using the Quality Evaluation Scoring Tool. RESULTS: At the end of selection process, five studies met the inclusion criteria. These studies analyzed twelve salivary exosomal miRs, presenting different methods of exosome and miR identification for HNSCC detection. A comprehensive explanation of the miR pathways of action was drawn and illustrated in this review. CONCLUSION: Exosomal miRs are promising biomarkers for oral cavity and oropharyngeal cancer detection. miR-10b-5p, miR-486-5p, miR-24-3p and miR-200a stand as the most useful ones in saliva sample examination.