Activation Toll-Like Receptor7 (TLR7) Responsiveness Associated with Mitogen- Activated Protein Kinase (MAPK) Activation in HIOEC Cell Line of Oral Squamous Cell Carcinoma.

STATEMENT OF THE PROBLEM: Oral squamous cell carcinoma is the most common oral malignancy. Toll-like receptor (TLR) activation led to alterations in the levels of mRNA encoding the TLR accountable for recognizing the inducing agonist and cross-regulation of other TLR. PURPOSE: The purpose of this study is determination of mitogen-associated protein kinase (MAPK) activation in human immortalized oral epithelial cell (HIOEC) line via up regulating of TLR7. MATERIALS AND METHOD: expression of TLR7 was measured in HIOEC and normal cells by quantitative real-time polymerase chain reaction (qRT-PCR) and samples were calibrated by ß-actin. RESULTS: Western blot analysis discovered high expression of TLR7 and MAPK in HIOEC cell lines. TLR7 was over-expressed in HIOEC cell line. Imiquimod-induced expression of interleukin (IL)-6, IL-8, and vascular endothelial growth factor (VEGF) was inhibited by TLR7 siRNA in HIOEC cells as determined by reverse transcription polymerase chain reaction (RT-PCR). Mean fluorescence intensity of nuclear p38 expression was determined in HIOEC cell lines (p< 0.05). RT-PCR analysis of IL-6, IL-8, and VEGF mRNA expression in HIOEC cells stimulated with imiquimod (1 µg/ml) for indicated time points. CONCLUSION: TLR7 is functionally over-expressed in HIOEC cell line of oral squamous cell carcinoma and development of resistance to cisplatin in human oral squamous cell carcinoma might occur through the mechanism involving activation of TLR7 and its dependent signaling pathway.

Quercetin Decreases Th17 Production by Down-Regulation of MAPK- TLR4 Signaling Pathway on T Cells in Dental Pulpitis.

STATEMENT OF THE PROBLEM: Quercetin is a pharmacological flavonoid that can inhibit high mobility group box1 (HMGB1) protein, a non-histone nuclear protein that is implicated in inflammation. Th17 cells are important cells in the pathogenesis of inflammation. Pulpitis is the inflammation of dental pulp, which usually is accompanied by pain. Quercetin may alleviate this inflammation. PURPOSE: The current study aimed to compare blocking of HMGB1 function and stimulation of HMGB1 function with quercetin and investigate the effects of the blockage on T helper 17 (Th17) cells and mitogen-activated protein kinase Toll-like receptor 4 (MAPK-TLR4) signaling pathway. MATERIALS AND METHOD: T cells isolated from the pulp involved with pulpitis and the normal pulp were cultured. The cells suspensions were plated in 6-wells culture plates and stimulated with 0.5 µg/ml of HMGB1 for 2, 4, 8, and 12 hours. For blocking TLR4, 10 µg/ml rabbit anti-human TLR4 antibody was added 1 hour before treatment with HMGB1. RESULTS: The level of these cytokines decreased; moreover, western blot data showed that quercetin could decrease MAPK signaling pathway by means of inhibition of HMGB1 on T cells. The results showed the reduction of TLR4 pathway and Th17 cell polarization. CONCLUSION: Our results indicated that the levels of IL-17, IL-33, and IL-6 in supernatants from patients' cultured T cells were increased after stimulation with HMGB-1 following employing quercetin. It also could inhibit MAPK signaling pathway, which subsequently could decrease Th17 production and IL-17. Quercetin could decrease pro-inflammatory cytokines and IL-17 production.

Opium usage as an etiologic factor of oral cavity cancer.

PURPOSES: The aim of this study was to evaluate the role of opium in causing oral cancer. PATIENTS AND METHODS: Eighty patients and 80 selected matched controls who were referred to the ear-nose-throat department of an academic hospital were included in this study between October 2008 and September 2010. In addition to demographic data, information regarding alcohol, tobacco, and opium use was documented in the subjects. Finally, the effect of each risk factor was assessed. RESULTS: There was no significant difference in patient demographics between the 2 groups. Smoking (P = 0.042) and poor oral hygiene (P = 0.016) significantly correlated with cancer. Finally, opium addiction showed a significant relationship with oral cavity cancer with an odds ratio of 4 (95% confidence interval, 1.2-13.6). CONCLUSION: Opium use is among the possible risk factors for oral cancer.

Correlation of preoperative sinusitis patients' characteristics with final diagnostic findings.

Chronic rhinosinusitis (CRS) is a common disease which is usually diagnosed clinically, considering the combination of natural history, physical examination and imaging studies. This study aimed to evaluate the clinical value of routine postoperative histopathologic examination (POHE) in patients with a clinical diagnosis of chronic rhinosinusitis with polyposis (CRSWP), or without polyposis (CRSWOP One hundred of patients with clinically approved CRSWP and CRSWOP were enrolled in this study. All patients underwent complete physical examination, scoring paranasal sinuses involvement by Lund-Mackay (LM) CT scoring scale, determining the extent of polyposis by Stumberger's endoscopic classification, and assessing health related quality of life by Sinonasal Test 22 (SNOT22) questionnaire. After FESS, histopathologic results were compared with preoperative clinical diagnosis. Among our patients, 65% were male, and the rest of them were female. Also, 66% of them suffered from CRSWP, and the rest of them were CRSWOP. LM CT score and SNOT22 score was 36.62±12, 17.11±6, and 43.62±20 respectively. Only in one of patients with CRSWP, POHE was other than what was expected preoperatively (adenoid cystic carcinoma). In all other cases,  POHE was well correlated with preoperative clinical diagnosis. HRQOL was better in males, absence of septal deviation and CRSWOP (P<0.05). Para nasal sinuses involvement in preoperative CT was more severe in the presence of eosinophil in POHE (P=0.008) and in patients with class 3 Stumberger's classification (P<0.001). This study suggested preoperative clinical diagnosis of CRS considering the combination of natural history, physical examination and imaging studies can be accurate, and POHE is indicated only in suspicious cases.

Characterization of Alloiococcus otitidis strains isolated from children with otitis media with effusion by Pulsed-Field Gel Electrophoresis.

OBJECTIVE: Alloiococcus otitidis is a slow growing organism which has been isolated in a few studies on patients with otitis media with effusion (OME). According to the literature review, there is no study about the molecular typing of A. otitidis. In this study, the characteristics of A. otitidis isolates from patients with OME were investigated via Pulsed-Field Gel Electrophoresis (PFGE) typing method. METHODS: A total of 50 children with OME, who underwent myringotomy or who had an insertion of a ventilation tube, were included in this study. The isolates were identified to the species level as A. otitidis using standard biochemical methods, following which the amplification and sequencing of the 16S rRNA gene were carried out. The molecular characteristic of A. otitidis was investigated by PFGE technique. RESULTS: Fifteen isolates of A. otitidis were identified in the middle ear fluid of the patients. All the isolates were susceptible to ampicillin, amoxicillin/clavulanate and fluoroquinolones. All of the 15 isolates were typed by PFGE method and were found to include 13 different PFGE types. CONCLUSION: The current study, being the first reports on the molecular typing of A. otitidis by PFGE method, shows that A. otitidis is a heterogenic organism in Iranian children who have OME.

Augmentation rhinoplasty with combined use of Medpor graft and irradiated homograft rib cartilage in saddle nose deformity.

BACKGROUND: We used the irradiated homograft rib cartilage as an augmentation tip support and Medpore alloplast for reconstruction of the dorsum in patients with saddle nose deformities. Thereafter, the safety and efficiency of this method was evaluated to determine if this can be a safe and efficient technique for patients with saddle nose deformities. METHODS: A total of 32 patients who suffered from saddle nose deformities due to past trauma or aggressive rhinoplasty underwent reconstruction using the Medpor prosthesis for dorsum reconstruction and irradiated rib cartilage as acolumellar strut during the same technique. After at least one year follow up, patients' satisfaction and their aesthetic indexes were evaluated and compared with preoperative results. RESULTS: More than 84% of patients were satisfied from the results of the surgery and only one patient had a complication of the infection which resulted in removal of the prosthesis. There were statistically significant differences between most of the pre- and postoperative aesthetic indexes. CONCLUSION: Despite the superiority of autogenous material in nose reconstruction, lack of such materials in revision rhinoplasty cases present challenges to surgeons. This study proposes the safety and efficiency of the Medpor alloplast for reconstruction of the dorsum and irradiated rib cartilage for the tip, at least for a short period of time.

Frequency of Alloicoccus otitidis, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae in children with otitis media with effusion (OME) in Iranian patients.

OBJECTIVE: To determine the presence of common bacterial agents of otitis media with effusion (OME), together with investigation these agent in the adenoid tissue and antimicrobial susceptibility pattern of isolated bacteria in Iranian children with OME. METHODS: Polymerase chain reaction (PCR) and bacterial culture methods were used for detection and isolation of Alloicoccus otitidis, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae in 63 middle ear fluid samples and 48 adenoid tissues from 48 OME patients. Fifteen patients were bilaterally affected. Antimicrobial susceptibility of all bacterial isolates were determined by disk agar diffusion (DAD) method. RESULTS: Bacteria were isolated from 47% (n=30) of the middle ear fluid samples and 79% (n=38) of the adenoid tissue specimens in OME patients. A. otitidis was the most common bacterial isolated from the middle ear fluid 23.8% by culture and 36.5% by PCR method. S. pneumoniae was the most prevalent pathogen (35.5% and 31.2% by culture and PCR) in the adenoid tissues. In 10 patients the same organisms were isolated from the middle ear fluid and adenoid tissue. Antimicrobial susceptibility pattern showed taht most isolates of bacteria were sensitive to ampicillin, Amoxicillin/Clavulanate and fluoroquinolones. CONCLUSION: The present study, being the first report on the isolation of A. otitidis by culture method in Iran and Asian countries, shows that A. otitidis is the most frequently isolated bacterium in Iranian children having otitis media with effusion. In this study A. otitidis, S. pneumoniae, H. influenzae and M. catarrhalis are the major bacterial pathogens in patients with OME and we found that ampicillin and Amoxicillin/Clavulanate have the excellent activity against bacterial agents in Iranian children with OME.

Epidemiology of oral cavity cancers in a country located in the esophageal cancer belt: a case control study.

INTRODUCTION: As one of the most common cancers among head and neck malignancies, cancer of the oral cavity probably has some variations in countries with a high prevalence of esophageal cancer. MATERIALS AND METHODS: Patients with oral cavity cancer who were treated at two tertiary referral centers from January 1999 to January 2009 were included in this study. In addition to demographic data, information regarding personal and family history of head and neck cancer, use of dentures, presence of immune deficiency, consumption of alcohol, and incidence of cigarette smoking was collected. Additionally, a history of opium usage was obtained from the participants in this study. Moreover, an appropriately matched control group was selected for comparisons between the risk factors. RESULTS: A total of 557 patients were entered into this study over a 10-year period, of whom 219 (39.3%) were female and the remaining 338 (60.7%) were male. The tongue was the most common site of cancer and 9% of the patients had a history of opium abuse, but more than half of the patients did not have any recognized risk factors. The incidence and stage of cancer had a significant relationship with cigarette smoking (P= 0.013). CONCLUSION: Tongue cancer in non-smokers is the predominant pattern of oral cavity cancer in Iran.

Epidemiologic and clinicopathologic characteristics of tongue cancer in Iranian patients.

Oral cancer is considered a great threat to public health. Tongue cancer accounts for nearly 30% of all oral cancers and usually seen in 50 to 60 year old men. Oropharyngeal cancers account for 3% of all cancers in Iran; as reported in 2003. The present study was designed to assess the epidemiologic and clinicopathologic characteristics of tongue cancer patients in two Tehran's referral university hospital between the years 2003 and 2008. In a retrospective study 87 files of patients, diagnosed with tongue cancer who were referred to Imam Khomeini and Loghman Hospitals and Iranian Cancer Institute in Tehran-Iran from 2003 to 2008 were reviewed. Participants were selected from all the patients who had a record of their specimens in the pathology ward registry and their tongue cancer diagnosis was confirmed by a expert pathologist. Patients characteristics (age, gender and presence of risk factors) and chief complain at the time of diagnosis and their tumor related data (type of cancer, staging, grading, morphology and location of tumor) were recorded. Tongue cancer was most frequently seen in the eighth decade of life among both men and women, but had the lowest frequency among patients with less than 40 years of age. Squamous cell carcinoma had the highest prevalence in our patients. Tongue cancer was the most common cancer of oral cavity among Iranian patients and similar epidemiologic and clnicopathological characteristics of the disease were found in our patients. Assessing variables such as socioeconomic levels and religious believe require further studies with large sample sizes.

Litigation after nasal plastic surgery.

INTRODUCTION: Esthetic surgeries are among the commonest medical procedures in the world nowadays; and as statistics declare, there has been a rapid increase in the rate of rhinoplasty during the recent years. Hence, as the number of cosmetic surgeries rises, the increment in the number of physicians being sued is quite inevitable; either due to complication in rhinoplasties or even inability to fulfill the patients' expectations. This article aims to clarify the aspects of causes leading to these legal claims. MATERIALS AND METHODS: We designed a retrospective study according to the available files in the Iranian Organization for Forensic Medicine in which physicians were sued for the outcomes of rhinoplasty through the years 2004 to 2010. In addition, information on the patients' demographic data, surgeons' specialty and experience, and method of anesthesia were also collected. RESULTS: One hundred twenty six patients entered the study among which 77 (61%) were female and 49 (39%) male. Mean age was obtained as 26.9 ± 7.7yrs. Up to 79.4% of patients had complaints concerning the cosmetic outcomes, 39.7% with respiratory and 4.8% with olfactory problems. The reason to sue the physician had a significant relationship with the patients' age and sex, and also with the surgeons' experience. CONCLUSION: There are multiple reasons impelling the patients to sue surgeons after rhinoplasty, some are related to physicians' malpractice and some to the patients' social and personal circumstances.

Urban bus drivers' sleep problems and crash accidents.

Sleep problems and their direct consequence, sleepiness, results in critical effects on psychomotor skills, memory, decision making, concentration and learning; all of which may play roles in accidents and errors. Despite the importance of quality of sleep among drivers there are only few researches that deal with them. Therefore, we designed this research to better understand possible relationships. This cross-sectional study was performed between 2006 and 2007 among 175 bus drivers of a transportation company in Tehran, the capital of Iran. Participants filled out a questionnaire concerning their demographic and personal history, associated disease, the insomnia index, the Epworth sleepiness scale (ESS), and the apnea index. Then they elaborated their history of crashes. Data was analyzed with the SPSS software through χ(2), Oneway ANOVAs, and Pearson correlation tests. The mean age, and body mass index (BMI) were 43.47 ± 6.85 years and 26.35 ± 3.87 kg/m(2). The mean duration of sleep among these drivers was 6.37 ± 1.62 h per day. The mean accident rate was 2.31 ± 1.83 per year. There was a significant correlation between the insomnia index and BMI (P = 0.014), age (0.00), marital status (0.00), associated disease (0.005), and drug history (0.028). There was a significant relationship between marital status and the ESS, and also between age and accident rate in the past years. Sleep problems were a frequent finding among the studied group and had a significant relationship with their crash history. These results can be an alarming sign to choose bus drivers more carefully and pay more attention to treating their sleep disorders.

The effect of functional endoscopic sinus surgery on pulmonary improvement of controlled asthmatic patients with chronic sinusitis.

The relationship between asthma and sinusitis has been proposed in many reports but the role of sinus surgery in their treatment is still controversial. Therefore, the effect of functional sinus surgery in patients with controlled asthma was evaluated. Fifty six patients with a history of sinusitis in whom maximum medical treatment had failed and also those with a history of asthma who were in a stable condition at time of surgery and were candidates for endoscopic sinus surgery were selected. All those who underwent functional endoscopic sinus surgery were re-evaluated at last one year later for pulmonary and sinus status. The patients' characteristics were prospectively recorded during the study period from January 2007 to November 2009. Finally, the results of the assessments were analyzed. Among 56 studied patients, 35 (62.5%) were female and 21 (37.5%) male. Preoperative imaging, evaluated according to Lund Mac Kay score, had a mean score of 19.5±5. The average effect of FESS in asthma improvement was 69.6%. Asthma improvement had a significant relationship with the duration of asthma and sinusitis before surgery. Functional endoscopic sinus surgery can effectively treat sinusitis in asthmatic patients. Earlier intervention in the course of pulmonary disease may warrant a better outcome.

The epidemiology of laryngeal cancer in a country on the esophageal cancer belt.

OBJECTIVE: Laryngeal cancer is one of the most common malignant neoplasms of the head and neck and occurs predominantly in males. Squamous cell carcinomas arising in the glottic region are the most common of all laryngeal cancers and more prevalent than the supraglottic ones. But this pattern is reverse in some countries. This study was done to investigate the epidemiologic aspect of this subject in Iran. STUDY DESIGN: Cross-sectional study SUBJECTS AND METHODS: During a ten-year period from 1997 to 2007, all patients referred to two tertiary referral hospitals with a diagnosis of laryngeal cancer were enrolled in this study. RESULTS: Laryngeal cancer was diagnosed in a total of 453 patients and confirmed histologically. The average patient age was 59.92 years. Men outnumbered women (9.5:1). Four hundred patients (88.5%) were tobacco smokers. The primary location of the tumor was supraglottic in 221 (49%) cases, followed by glottic in 163 (36.2%), transglottic (the tumor involved all regions of the larynx and the origin was unspecified) in 60 (13.3%), and subglottic in 7 (1.6%). CONCLUSION: In our series, although we excluded transglottic tumors, the supraglottic tumor was dominant and the ratio of supraglottic to glottic tumors was 1.36. This is compatible with results from countries with a reverse ratio.