Salivary metabolomics in early detection of oral squamous cell carcinoma - a meta-analysis.

INTRODUCTION: Oral squamous cell carcinoma (OSCC) represents the most prevalent form of oral cancer. Potentially malignant disorders of oral mucosa exhibit an elevated propensity for malignant progression. A substantial proportion of cases are discerned during advanced stages, significantly impacting overall survival. This investigation aims to ascertain salivary metabolites with potential utility in the early detection of OSCC. METHODS: A search encompassing PubMed, EMBASE, Scopus, Ovid, Science Direct, and Web of Science databases was conducted to identify eligible articles. The search strategy employed precise terms. The quality assessment of the included studies was executed using the QUADAS 2 ROB tool. This was registered with PROSPERO CRD42021278217. RESULTS: Upon removing duplicate articles and publications that didn't satisfy the inclusion criteria, seven articles were included in the current study. The Random Effects Maximum Likelihood (REML) model adopted for quantitative synthesis identified Nacetyl glucosamine as the sole metabolite in two studies included in this metaanalysis. The pathways significantly influenced by these identified metabolites were delineated. CONCLUSION: This study highlights Nacetyl glucosamine as a distinctive metabolite with the potential to serve as an early diagnostic marker for OSCC. Nevertheless, further research is warranted to validate its clinical utility.

Validation of Diagnostic Utility of Salivary Urea in Patients with Chronic Kidney Disease in Chennai: A Cross-Sectional Study.

BACKGROUND: Serum urea levels are essential for the diagnosis of chronic kidney disease (CKD), as they are a measure of renal function. Salivary urea has been used as an alternative to serum urea in patients with CKD. AIM: To estimate serum urea levels and their correlation with salivary urea levels in order to validate the use of saliva as an alternative diagnostic tool for renal dysfunction. PATIENTS AND METHODS: Thirty healthy individuals and 150 patients with CKD (30 from each CKD stage) were recruited for the study. Serum and salivary samples were collected to estimate the urea levels, and statistical analyses were performed. RESULTS: Statistically significant (P < 0.05) differences in the mean serum and salivary urea levels were observed between the healthy and each stage of the CKD group; significance at P < 0.05 was observed within the stages of CKD as well. Correlation analysis also showed significant differences between the serum and salivary urea levels at each stage of the disease. Receiver operating characteristic analysis revealed a higher area under the curve of 0.917 at a 95% confidence interval with a salivary urea cut-off of 28.25 mg/dl (sensitivity and specificity: 88% and 84%, respectively). CONCLUSION: The variability in salivary urea levels in the early and late stages suggests the use of salivary urea in the late stages of CKD. It is suggested that salivary urea levels may be used as an alternative to serum to assess and monitor the progression of renal impairment along with other standard renal function markers.

Salivary and serum level of CYFRA 21-1 in oral precancer and oral squamous cell carcinoma.

BACKGROUND: CYFRA 21-1, a constituent of the intermediate filament proteins of epithelial cells, is known to be increased in many cancers. This study was designed to estimate the levels of salivary and serum CYFRA 21-1 in patients with oral precancer and oral squamous cell carcinoma (OSCC) and compare them with healthy controls. MATERIALS AND METHODS: Each group comprised of 100 subjects. Saliva and blood samples were collected from patients with OSCC, premalignant subjects, and normal healthy subjects. Serum and salivary CYFRA 21-1 levels were measured by enzyme-linked immunosorbent assay. Appropriate statistical tests were employed to assess diagnostic potency of CYFRA 21-1. RESULTS: We found a significant increase in CYFRA 21-1 level in OSCC compared with PML and healthy subjects. Salivary CYFRA 21-1 levels in OSCC was threefold higher when compared to serum levels. PML group showed increased salivary CYFRA 21-1 when compared to control subjects, but it was significantly lower compared with OSCC. Receiver operator characteristic curve analysis showed salivary CYFRA 21-1 to have superior sensitivity in detecting OSCC compared with serum CYFRA 21-1. CONCLUSIONS: The outcome of this study suggests that salivary CYFRA 21-1 can be utilized as a biomarker in early detection of oral cancer.

(177)Lu-DOTATATE therapy in patients with neuroendocrine tumours: 5 years' experience from a tertiary cancer care centre in India.

PURPOSE: The choice of an appropriate treatment option in patients with inoperable or metastatic neuroendocrine tumours (NETs) is limited, and approximately 50 % of patients have advanced NET at diagnosis, and 65 % die within 5 years. Treatment with (177)Lu-DOTATATE ((177)Lu-[DOTA(0),Tyr(3)] octreotate) is a promising new option in the treatment of metastatic NETs. METHODS: Patients with metastatic NET who underwent (177)Lu-DOTATATE during the period 2009 to 2013 were included in this retrospective study. Follow-up imaging studies including a (68)Ga-DOTANOC PET/CT scan and a posttherapy (177)Lu-DOTATATE scan were compared with baseline imaging to determine response to treatment. Progression-free survival (PFS) was calculated using the Kaplan-Meier method and Cox regression analysis was also done. RESULTS: Ten patients (25 %) had a minimal response, 13 (32.5 %) had a partial response and 9 (22.5 %) had stable disease. Progressive disease was seen in 8 patients (20 %), including 6 patients who died during or after the treatment period. The estimated mean PFS in those who received one or two cycles of (177)Lu-DOTATATE was 8.3 months (95 % CI 6.2 to 10.3 months) compared to an estimated mean PFS of 45.6 months (95 % CI 40.9 to 50.2 months) in those who received more than two cycles of (177)Lu-DOTATATE (log-rank Mantel-Cox Χ (2) = 8.01, p = 0.005). CONCLUSION: Our study showed that treatment with (177)Lu-DOTATATE should be considered in the management of NETs, considering the limited success of alternative treatment modalities. Treatment response and PFS is determined primarily by the dose delivered and best results are obtained when more than two cycles of (177)Lu-DOTATATE are given, with careful monitoring for possible side effects.

Crystal structure of trans-aqua-(perchlorato-κO)bis-(propane-1,3-di-amine-κ(2) N,N')copper(II) perchlorate.

In the title compound, [Cu(ClO4)(C3H10N2)2(H2O)]ClO4, the Cu(II) atom has a distorted octa-hedral coordination sphere and is coordinated by the N atoms of two propane-1,3-di-amine ligands in the equatorial plane. The axial positions are occupied by a water O atom and an O atom of a disordered perchlorate anion [occupancy ratio 0.631 (9):0.369 (9)]. In the crystal, the various components are linked via O-H⋯O, N-H⋯O and C-H⋯O hydrogen bonds, forming sheets lying parallel to (001).

Incidence of Facial Nerve Injury and Sialocele Formation Following Mandibular Condylar and Sub-condylar Fracture Fixation.

Purpose: To study the incidence of sialocele formation in the parotid gland and to study the incidence of facial nerve affliction following treatment of mandibular condylar and sub-condylar fractures. Materials and methods: The present study is a retrospective study conducted on a total of 82 patients with 107 sub-condylar and condylar fractures treated in this centre from August 2008 to August 2020. The surgical approaches used to treat the fractures were considered, and the occurrence of sialocele, salivary fistula and facial nerve paralysis was noted. The facial nerve function was analysed using House-Brackmann system of classification. Results: The incidence of sialocele formation was seen in 15.87% of cases, and the incidence was seen more commonly during a preauricular approach (52.94%) followed by retromandibular (41.17%) followed by anterior parotid transmassetric approach (11.76%). The incidence of facial nerve affliction was seen in 17.57% of cases with majority of them showing temporal branch involvement in 21.05% of cases. Conclusion: During the treatment of condylar and sub-condylar fractures, the facial nerve is at considerable risk of damage; however, understanding the anatomy of the nerve is of importance to avoid such complications. Sialocele formation is also an undesirable complication of such surgeries, a prompt diagnosis and early treatment is mandatory to overcome further unwanted sequel.

Diaphragmatic and Pulmonary Functions Following an Ultrasound-Guided Supraclavicular Approach Versus a Costoclavicular Approach of a Brachial Plexus Block: A Randomized Study.

INTRODUCTION: A costoclavicular brachial plexus block is an emerging infraclavicular approach that targets the cords lateral to the axillary artery, providing rapid onset of sensory-motor blockade. However, the incidence of hemi-diaphragmatic paralysis (HDP), a potential complication, remains unclear compared to the widely used supraclavicular (SC) approach. This study aimed to compare the incidence of HDP between ultrasound-guided costoclavicular and SC brachial plexus blocks. OBJECTIVES: To compare the influence of ultrasound-guided SC and costoclavicular brachial plexus blocks on diaphragmatic excursion, thickness, and contractility along with pulmonary function. MATERIALS AND METHODS:  This prospective, randomized, observer-blinded controlled trial included 60 patients undergoing below-shoulder surgeries. Patients were randomized to receive either ultrasound-guided SC (Group S) or costoclavicular (Group C) brachial plexus block with 0.5% levobupivacaine. The diaphragmatic function was assessed using ultrasonographic evaluation of diaphragm thickness and diaphragmatic thickness fraction (DTF) pre- and postblock. Pulmonary function tests (PFTs) (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak expiratory flow rate (PEFR)) were performed preblock and two hours postblock. Block characteristics were compared. RESULTS: The SC group exhibited a significantly larger reduction in DTF from preblock to postblock compared to the costoclavicular group (mean ΔDTF: 34.38% vs. 14.01%, p<0.01). Both groups showed significant declines in FVC, FEV1, and PEFR postblock, but the magnitude of deterioration was significantly greater in the SC group, displaying no significant difference in block characteristics. CONCLUSION: The costoclavicular brachial plexus block demonstrated superior preservation of diaphragmatic contractility and lesser deterioration of PFTs compared to the SC approach while being equally effective. These findings highlight the potential benefits of the costoclavicular technique in minimizing diaphragmatic dysfunction and respiratory impairment, particularly in patients at risk for respiratory complications.

Nebulized Versus Intravenously Administered Dexmedetomidine for Obtunding Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: A Randomized Double-Blind Comparative Study.

Introduction Intravenous dexmedetomidine is known to cause major adverse effects such as bradycardia, hypotension, cardiac arrhythmias, and heart block when used as premedication for attenuation of the laryngoscopy and intubation response, limiting its routine use. Thus, it is important to study other routes of administration of dexmedetomidine. Objectives To compare the hemodynamic response and sedation score between intravenous and nebulized dexmedetomidine as premedication for the attenuation of the laryngoscopy and intubation response. Materials and methods In this study, 60 patients fulfilling inclusion criteria undergoing surgeries under general anesthesia (ASA Grade I and II) were randomly allocated into two groups of 30 patients each. Group IV received intravenous 1 mcg/kg dexmedetomidine in 100 mL normal saline, and Group IN received nebulization with 1 mcg/kg dexmedetomidine diluted to a total volume of 5 cc of normal saline, 30 minutes prior to the induction of general anesthesia. Sedation scores were calculated using the Ramsay sedation score at 20 minutes after the administration of the drug; patients were induced by the standard protocol, and laryngoscopy was performed. Vitals were recorded before the administration of the drug and after intubation at stipulated time intervals. Results The median heart rate becomes significantly lower at 15 minutes (70 vs. 76.5) and 20 minutes (66 vs. 76) after induction among Group IV as compared to Group IN. The median systolic blood pressure was significantly lower at 20 minutes in Group IV (110 mmHg) than in Group IN (119 mmHg). The median diastolic blood pressure was significantly lower at 10 minutes (76 vs. 79), 15 minutes (70 vs. 77), and 20 minutes (69 vs. 78.5) in Group IV than in Group IN. The median of mean arterial pressure was significantly lower at 15 minutes (84.8 vs. 91.5) and 20 minutes (83 vs. 92) in Group IV than in Group IN. A comparison of vitals after induction shows that the median heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were significantly lower statistically among Group IV as compared to Group IN at 0, 1, 3, 5, 10, 15, and 30 minutes after induction (except for systolic blood pressure at 3 minutes). The median sedation score was lower in Group IN (0) than in Group IV (1); this difference is statistically significant. Conclusion The obtundation of hemodynamic responses following laryngoscopy and maintaining hemodynamics intraoperatively is statistically better with nebulized dexmedetomidine compared to intravenous dexmedetomidine.

Metal-free approach for imidazole synthesis via one-pot N-α-C(sp3)-H bond functionalization of benzylamines.

A metal-free one-pot method is established for the synthesis of tetrasubstituted imidazoles from the reaction of arylmethylamines and 1,2-dicarbonyls/benzoin. The N-α-C(sp3)-H bond functionalization of arylmethylamines using a catalytic amount of AcOH afforded polysubstituted imidazoles under aerobic conditions in significant yields of up to 95%.

Homeopathic treatment of patients with influenza-like illness during the 2009 A/H1N1 influenza pandemic in India.

INTRODUCTION: We conducted a prospective, multi-centre, data collection survey of homeopathic practice in treatment of influenza-like illness in India during the 2009 pandemic of A/H1N1 influenza ('swine flu', SF). AIMS: To survey the practice of homeopathic practitioners in India in the management of SF, with respect to: (a) patients' symptoms at presentation and at follow-up (FU) consultation; (b) homeopathic medicines prescribed. METHODS: Data collection took place from October 2009 to February 2010, at the peak of the pandemic. All patients satisfying the minimum diagnostic symptoms of SF were eligible for inclusion. Data per appointment (in person or by telephone) were recorded by practitioners in spreadsheet format. All records were anonymised and included: whether patient was immunised against A/H1N1; influenza symptoms at consultation; the homeopathic medicine/s prescribed; whether antiviral medicine prescribed. RESULTS: Twenty-three homeopathic physicians contributed to data collection. At the first appointment, 1126 patients had valid SF symptoms. A total of 89 different combinations of SF symptoms was observed, the most common being temperature >38°C + cough + runny nose (n = 170; 15.1%). A total of 44 different remedies (or combinations of remedies) were used at these first appointments, the most frequently prescribed being Arsenicum album (n = 265; 23.5%). For a total of 99 FU appointments with valid SF symptoms, Arsenicum album was prescribed most frequently overall (n = 28; 28.0%). CONCLUSIONS: In our sample, the 2009 A/H1N1 influenza pandemic in India was characterised by several prominent symptoms and symptom/medicine associations, particularly temperature >38°C + cough + runny nose, associated with Arsenicum album. Future studies should collect additional keynote prescribing symptoms that influence the choice of homeopathic medicine.

cis-Di-aqua-tetra-kis-(1-butyl-1H-imidazole-κN (3))nickel(II) dichloride.

In the title compound, [Ni(C7H12N2)4(H2O)2]Cl2, the nickel(II) ion has a distorted octa-hedral coordination environment. It is surrounded by three N atoms and one O atom occupying the equatorial plane, and one N and one O atom in the axial positions. The imidazole ring systems are inclined to one another with dihedral angles varying between 38.3 (4) and 74.1 (4)°. In the crystal, mol-ecules are linked via O-H⋯Cl hydrogen bonds involving one Cl(-) anion and the water mol-ecule in the equatorial plane, forming an inversion dimer-like arrangement. The water mol-ecule in the axial position is hydrogen-bonded to both Cl(-) anions. There are also a number of C-H⋯Cl hydrogen bonds present, forming a three-dimensional structure. All four alkyl chains are disordered over two positions with refined occupancy ratios of 0.395 (15):0.605 (15), 0.658 (14):0.342 (14), 0.332 (11):0.668 (11) and 0.622 (12):0.378 (12).

Rehabilitation of hemimaxillectomy with foldable obturator in restricted mouth opening: a case report.

Acquired defects of the head and neck region as in case of hemimaxillectomy can be devastating to the patients and presents considerable reconstructive challenge for the Prosthodontists. The defects created by the surgery results in damaging effects on functional, cosmetic, and psychological aspects of the patient. The purpose of this clinical report is to discuss the method of fabricating a foldable obturator for rehabilitation of a patient of hemimaxillectomy with restricted mouth opening.

Clinical and CT Scan Evaluation of Outcomes of Modified SARPE Using a Bone-Borne Hyrax Appliance in Unilateral Posterior Crossbite.

Objective: The objective of this study was to evaluate, using clinical and computed tomography, outcomes of unilateral SARPE with a bone-borne hyrax appliance in case of unilateral crossbite and to assess the correlations between hyrax appliance opening and post-SARPE skeletal changes. Materials and Methods: Two patients of unilateral crossbite underwent Unilateral SARPE and post-surgical expansion of maxilla using a bone-borne hyrax appliance. Computed tomography was used to make comparative linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla. The correlation between maxillary expansion and appliance opening was also investigated. Results: Significant overall expansion was observed with maximum expansion in the anterior and inferior portions of the maxilla. The degree of appliance opening was significantly greater than that of the skeletal expansion. Comparative CAD measurements showed maximum increase in interdental width at the second premolar level. Conclusion: The transverse expansion of the maxilla obtained with a bone-borne hyrax is less than uniform. The lack of linear correlation between appliance opening and skeletal expansion is attributable to multiple factors, including those related to the device, the surgical technique, and the craniofacial deformity itself.

Micro-Raman spectroscopy analysis of dentin remineralization using eggshell derived nanohydroxyapatite combined with phytosphingosine.

The aim of this study was to assess the remineralization efficacy of chicken eggshell-derived nano-hydroxyapatite (CEnHAp) combined with phytosphingosine (PHS) on artificially induced dentinal lesions. PHS was commercially procured whereas CEnHAp was synthesized using microwave-irradiation method and characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), high-resolution scanning electron microscopy-energy-dispersive X-ray spectroscopy (HRSEM-EDX), and transmission electron microscopy (TEM). A total of 75 pre-demineralized coronal dentin specimens were randomly treated with one of the following test agents (n = 15 each): artificial saliva (AS), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CEnHAp, PHS, and CEnHAp-PHS under pH cycling for 7, 14, and 28 days. Vickers microhardness indenter, HRSEM-EDX, and micro-Raman spectroscopy methods were used to assess the mineral changes in the treated dentin samples. Data were submitted to Kruskal-Wallis and Friedman's two-way analyses of variance (p < 0.05). HRSEM and TEM analysis depicted irregular spherical structure of the prepared CEnHAp with a particle size of 20-50 nm. The EDX analysis confirmed the presence of Ca, P, Na and Mg ions. The XRD pattern showed the characteristic crystalline peaks for hydroxyapatite and calcium carbonate that are present in the prepared CEnHAp. Dentin treated with CEnHAp-PHS revealed highest microhardness values along with complete tubular occlusion compared to other groups at all test time intervals (p < 0.05). Specimens treated with CEnHAp showed increased remineralization than those treated with CPP-ACP followed by PHS and AS groups. The intensity of mineral peaks, as observed in the EDX and micro-Raman spectra, confirmed these findings. Further, the molecular conformation of the collagen's polypeptide chains, and amide-I and CH2 peaks attained peak intensities in dentin treated with CEnHAp-PHS and PHS whereas other groups revealed poor stability of collagen bands. Microhardness, surface topography, and micro-Raman spectroscopy analyses revealed that dentin treated with CEnHAp-PHS have an improved collagen structure and stability as well as highest mineralization and crystallinity.

Technique for Foot Reconstruction with Custom-made Calcaneal Prosthesis in Primary Malignancy - A Case Report.

The foot is an uncommon location for osseous tumors, comprising ∼ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Radioactive Iodine Uptake in Postoperative Seroma: A Cause for False Positivity.

Besides the known physiologic uptake of 131I, the literature describes various false-positive findings on 131I scans in benign lesions, inflammation, traumatic sites, and postsurgical sites, to name a few. However, to the best of our knowledge, no study has shown false-positive uptake of 131I in a postoperative seroma at the postsurgical site. We describe such a case here.

Fine structures in refractive index of sapphire at the L(II,III) absorption edge of aluminum determined by soft x-ray resonant reflectivity.

The optical constants of sapphire crystal (α-Al(2)O(3)) and amorphous Al(2)O(3) in the soft x-ray region (67-85 eV) around the aluminum LII,III absorption edge (73.1 eV) are determined by angle-dependent x-ray reflectivity. The differences between the optical constant values of both the samples are discussed. The fine structures obtained in the absorption of crystalline sapphire are explained. An absorption feature at 70.2 eV is observed for the first time for crystalline alumina. Both datasets are compared to the tabulated values of Henke et al. [At. Data Nucl. Data Tables 54, 181 (1993)], Weaver et al. [Physik Daten, Physics Data: Optical Properties of Metals (Fach-information zentrum, 1981), Vols. 18-1 and 18-2], and [Handbook of Optical Constants of Solids II (Academic, 1991)].

Kigelia africana fruit biofibre polysaccharide extraction and biofibre development by silane chemical treatment.

Silane-treated natural cellulosic Kigelia africana fruit fibre (KAF) was experimentally established to have strong strength after removing hydrophilic materials. Silane treatment makes it compatible with hydrophobic biopolymeric materials than existing non-grafted KA fibre. In this work, the polysaccharide was extracted from the KAF and found to have all the essential compounds. KA fruit-based cellulosic fibre was extracted and treated with different concentrations of silane solution. Silane-treated (13%) KAF has a cellulose content of about 76.86%. The peak found at 1734 cm-1 shows the hemicellulose in untreated fibres, and its intensity decreased after silane treatment, as confirmed by FTIR. X-ray diffraction investigation indicated that silane-treated (5%) KAF has a crystallinity index of 70.22%. After treatment, the tensile strength of 5% silane-treated KAF shows a tensile strength of 490.77 MPa, giving more viability to biofibre reinforcement.

Bisphosphonate Osteonecrosis in a Case of Langerhans Cell Histiocytosis: Report of a Case and Review of Literature.

Langerhans Cell histiocytosis is a rare multisystem disease originating from dendritic cell lines primarily characterized by osteolytic lesion of the skeleton. Chemotherapy along with bisphosphonates have been used to control the progression of the disease and prevent the osteolysis associated with the disease. Bisphosphonate osteonecrosis of the jaws is a common finding following treatment with bisphosphonates for osteoporosis, metastatic tumors to the bone or the osteolytic lesions of multiple myeloma. The article highlights a rare case of bisphosphonate osteonecrosis of the mandible in a case of long-standing Langerhans cell histiocytosis.

Rapid economical acetic acid Papanicolaou staining procedure versus conventional staining procedure in normal oral mucosa.

Background: Papanicolaou (Pap) staining technique is a conventional technique used in cytology but it is time consuming. Aim: The aim of the study was to determine the efficacy of Rapid Economical Acetic acid Papanicolaou stain (REAP) over conventional staining technique in studying normal oral mucosa. Materials and Methods: Eighty patients were selected and were grouped based on their habits. Two smears were obtained from each patient and were subjected to both the staining techniques. A total of 160 slides were studied for features such as cellular outline, nuclear outline, nuclear details, cellular differentiation, micronuclei and cellular transparency. Results: The conventional staining procedure showed 79 cases of optimal cellular staining, 78 cases of optimal nuclear staining, 35 cases of optimal nuclear details, 57 cases of optimal differentiation and 27 cases of optimal transparency and 33 cases of optimal micronuclei. REAP staining showed 75 cases of optimal cellular staining, 64 cases of optimal nuclear staining, 20 cases of optimal nuclear details, 36 cases of optimal differentiation and 28 cases of optimal transparency and 25 cases of optimal micronuclei. Conclusion: REAP staining effectively reduces the time and the cost factor, but the cytological details are well observed under conventional staining technique in normal patients.