Ultrafast intraoperative parathyroid hormone monitoring system: prospective, multicentre, clinical validity study.

BACKGROUND: Intraoperative parathyroid hormone (PTH) monitoring is a proven and reliable adjunct to parathyroid surgery, able to improve the outcomes and efficiency of the diagnostic and therapeutic pathway for patients with primary hyperparathyroidism. This study evaluated the innovative, compact, fully automated NBCL CONNECT Analyzer, which can measure whole-blood PTH in 5 min. METHODS: A prospective multicentre study was conducted in stages: results reviews, recommendations, and implementation of improvements to the mechanical design, components of cartridges, calibration, and sampling protocols. Patients undergoing parathyroidectomy had PTH levels measured on the Analyzer and main laboratory platforms, either Roche or Abbott. The Miami criterion of a 50% drop in PTH concentration was used to define biochemical cure during surgery, and normal postoperative calcium level as cure of primary hyperparathyroidism. Measurements on the Analyzer were done by laboratory staff in London and nurses in Stuttgart. The Pearson coefficient (R) and Wilcoxon test were used for statistical analysis. RESULTS: Some 234 patients (55 male, 179 female) with a median age of 58.5 (age full range 15-88) years underwent parathyroidectomy (195 minimally invasive, 38 bilateral neck exploration, 1 thoracoscopic; 12 conversions) for primary hyperparathyroidism between November 2021 and July 2022. Primary hyperparathyroidism was cured in 225 patients (96.2%). The sensitivity, specificity, and overall accuracy of the Analyzer assay in predicting biochemical cure were 83.9, 100, and 84.8% in phase 1; 91.2, 100, and 91.3% in phase 2; and 98.6, 100, and 98.6% in phase 3. There were no false-positive results (positive predictive value 100%). Correlations between Analyzer measurements and those obtained using the Roche device were very strong (R = 0.98, P < 0.001 in phase 1; R = 0.92, P < 0.001 in phase 2; R = 0.94, P < 0.001 in phase 3), and correlations for Analyzer readings versus those from the Abbott platform were strong (R = 0.82, P < 0.001; R = 0.89, P < 0.001; R = 0.91, P < 0.001). The Analyzer showed continued good mechanical performance, with stable and repeatable operations (calibrations, quality controls). Introducing a stricter sampling protocol and improvements in the clot-detecting system led to a decrease in the number of clotted samples and false-negative results. Outcomes were not affected by measurements performed either by nurses or laboratory staff. CONCLUSION: Intraoperative PTH monitoring during parathyroid surgery can be done accurately, simply, and quickly in whole blood using the Analyzer.

ALDH1 immunoexpression in epithelial and stromal cells of oral lichen planus and lesions with lichenoid inflammatory infiltrate

Background: Oral Lichen Planus is a potential malignant disorder and shares clinical and histopathological features with other similar lesions. ALDH1 is a specific biomarker for stem cells identification, however its role in stromal cells of immune inflammatory infiltrate has not been explored. The aim of this study was to investigate the ALDH1 immunoexpression in epithelial and stromal cells of Oral Lichen Planus and other lesions with lichenoid inflammatory infiltrate. Material and Methods: 64 samples of Oral Lichen Planus, Oral Lichenoid Lesions, Oral Leukoplakia and Unspecific Chronic Inflammation were included. ALDH1 was evaluated in both epithelium and stromal cells. ALDH1+ cells ≥ 5% were considered positive in epithelium. Stromal cells were evaluated semi quantitatively. Fields were ranked in scores, according to criteria: 1 (0 to 10%); 2 (11 to 50%) and 3 (>50%). The mean value of the sum of the fields was the final score. Statistical differences among groups were investigated, considering p < 0.05. Results: ALDH1 expression in epithelium was low in all groups without difference among them. ALDH1+ cells in the lamina propria were higher for Lichen Planus [2.0], followed by Leukoplakia [1.3], Lichenoid lesions [1.2] and control [1.1] (p<0.05). Conclusions: ALDH1 immunoexpression in epithelium of lichenoid potential malignant disorders did not show a contributory tool, however ALDH1 in stromal cells of lichen planus might be involved in the complex process of immune regulation associated with the pathogenesis of this disease. (AU)

Estudo comparativo da expressão de ALDH1 em líquen plano oral, lesão liquenoide e leucoplasia em epitélio e no infiltrado inflamatório liquenoide / Comparative study of ALDH1 expression in oral lichen plane, lichenoid lesion and leucoplasia in epithelial and lichenoid inflammatory infiltrate

O líquen plano oral é uma doença potencialmente maligna e compartilha muitas características clínicas e histopatológicas com outras lesões semelhantes. O ALDH1 é um biomarcador específico na identificação de células-tronco, porém seu papel nas células estromais do infiltrado inflamatório imune não foi explorado. O objetivo deste estudo foi investigar a imunoexpressão de ALDH1 em células epiteliais e estromais de Líquen Plano Oral e outras lesões liquenóides. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (UFMG) sob o parecer no 5.410.374, CAAE: 52763021.0.0000.5149. Foi realizada uma busca no arquivo do laboratório de Patologia Oral e Bucomaxilofacial da UFMG em um período de 10 anos (2011 ­ 2021) de casos diagnosticados como Líquen Plano oral, Lesão Liquenoide, Leucoplasia e Processo Inflamatório Inespecífico (controle). Foram selecionados 633 casos e após a utilização dos critérios de inclusão e exclusão, a expressão imuno-histoquímica do ALDH1 foi investigada em 64 casos, 16 de cada diagnóstico. O ALDH1 foi avaliado tanto no epitélio quanto nas células estromais do infiltrado inflamatório liquenóide. Um percentual de 5% de células ALDH1+ foi considerado positivo no epitélio. A avaliação das células estromais foi feita de forma semiquantitativa. Os campos foram classificados em escores, segundo os critérios: 1 (0 a 10%); 2 (11 a 50%) e 3 (mais de 51%). O valor médio da soma dos campos foi o escore final. Diferenças estatísticas entre os grupos foram investigadas e a significância foi estabelecida considerando p < 0,05. A análise estatística foi realizada utilizando o software: SPSS ­ Statistical Package for the Social Science® (versão 26.0, 2019, Chicago, IL, USA). A expressão de ALDH1 no epitélio foi baixa em todos os grupos sem diferença entre eles, embora a maioria dos casos tenha sido encontrada na amostra de inflamação crônica inespecífica. O escore de células ALDH1+ na lâmina própria foi maior para LPO (2,0), seguido por Leucoplasia (1,3), LLO (1,2) e processo inflamatório inespecífico (1,1) (p<0,05). A imunoexpressão do ALDH1 no epitélio de lesões com um infiltrado liquenóide não mostrou uma ferramenta contributiva, porém o ALDH1 em células estromais no infiltrado inflamatório do líquen plano merece atenção, pois pode estar envolvido no complexo processo de regulação imune associado à patogênese desta doença.

Oral lichen planus (OLP) is a potentially malignant lesion and shares clinical and histopathological features with similar lesions. ALDH1 is a specific biomarker in the identification of stem cells, but its role in the stromal cells of the immune inflammatory infiltrate has not been elucidated yet. The aim of this study was to investigate the ALDH1 immunoexpression in epithelial and stromal cells from OLP and other lichenoid lesions. The study was approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais (UFMG) under protocol no 5.410.374, CAAE: 52763021.0.0000.5149. An search of the biopsy records of the Oral and Maxillofacial Pathology Laboratory at UFMG in a period of 10 years (2011 - 2021) was performed including the diagnosis of Oral Lichen Planus (OLP), Oral Lichenoid Lesion (OLL), Oral Leukoplakia (OLK) and Unspecific Inflammatory Process (UIP) ­ as control. Initially were obtained 633 cases. After inclusion and exclusion criteria a total of 64 cases were investigated for the ALDH1 immunohistochemical expression, 16 cases of each diagnose. ALDH1 was evaluated both in the epithelium and in the stromal cells. A percentage of ≤5% of ALDH1+ cells was considered positive in the epithelium. The evaluation of stromal cells was performed semi-quantitatively. The fields were classified into scores, according to the following criteria: 1 (0 to 10%); 2 (11 to 50%) and 3 (more than 51%). The mean value of the sum of the fields represented the final score. Statistical differences between groups were investigated and significance was established considering p < 0.05. Statistical analysis was performed using the software: SPSS ­ Statistical Package for the Social Science® (version 26.0, 2019, Chicago, IL, USA). The expression of ALDH1 in the epithelium was low in all groups with no difference between them, although most cases were found in the UIP samples. ALDH1+ cells in the lamina propria was higher for OLP (2.0) than others followed by OLK (1.3), OLL (1.2) and UIP (1.1) (p<0.05). The ALDH1 immunoexpression in the epithelium of lichenoid diseases did not prove to be contributory to show a malignant potential, but ALDH1 in stromal cells from OLP infiltrate might be involved in the complex immune regulation process associated with the pathogenesis of this disease.

Denture-related oral mucosal lesions in Alzheimer disease: a case-control study.

The aim of this case-control study was to evaluate the association between denture-related oral mucosal lesions and Alzheimer disease (AD) in older adults (60 years and older). Seventy elderly adults (35 with AD and 35 classified as mentally healthy) were included in this study, which was carried out in a Brazilian medical center. Clinical data on oral lesions and mucosal findings were recorded, including alterations in the color or appearance of any lesions, if present. The influence of possible confounding factors, including sex, age, race, education level, health conditions, harmful habits, gait speed, and oral status (use of removable prostheses and denture hygiene), was analyzed. There was no statistically significant difference between groups in the frequency of denture-related oral mucosal lesions. Logistic regression analysis showed a higher prevalence of AD among individuals aged 80 years and older, those who were illiterate, users of tobacco, and patients with a slower gait. These results suggest that AD is not a risk factor for denture-related oral mucosal lesions.

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center / Diagnosticando sífilis adquirida através de lesões orais: a experiência de 12 anos de um Centro de Medicina Oral

Abstract Introduction: A resurgence of syphilis in Brazil has been reported in recent years. Objective: With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. Methods: A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. Results: A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). Conclusion: The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.

Resumo Introdução: Um ressurgimento da sífilis no Brasil tem sido relatado nos últimos anos. Objetivo: Investigar a frequência, as características demográficas e clínicas dos pacientes com sífilis adquirida com envolvimento oral que receberam atendimento médico em um centro de referência em medicina oral em um hospital público brasileiro. Método: Estudo retrospectivo, abrangeu 12 anos, feito para identificar tendências de mudança na sífilis. Registros médicos de todos os pacientes diagnosticados com sífilis adquirida que receberam atendimento médico na clínica de medicina oral do hospital de 2005 a 2016 foram revisados e os dados demográficos e clínicos foram coletados. Resultados: Foram diagnosticas 85 pacientes com sífilis adquirida, com um aumento significativo no número de casos nos últimos 5 anos. A idade dos pacientes variou de 16 a 76 anos, com pico na terceira e quarta décadas; 48 casos eram do sexo masculino (56,5%) e 37 do sexo feminino (43,5%). A maioria das lesões orais apareceu como úlceras ou placas únicas, os lábios e a língua representaram os locais mais afetados. Todos os casos foram positivos para Venereal Disease Research Laboratory e Fluorescent Treponemal Antibody Absorption Test e o tratamento foi feito com penicilina G benzatina na maioria dos casos (84,7%). Conclusão: A frequência da sífilis oral tem aumentado com o tempo e as lesões orais podem representar uma pista diagnóstica; portanto, os profissionais de saúde bucal devem ser conscientizados e devidamente treinados na tentativa de desenvolver um alto grau de suspeição clínica no diagnóstico da sífilis.

Diode laser surgery versus electrocautery in the treatment of inflammatory fibrous hyperplasia: a randomized double-blind clinical trial.

OBJECTIVES: To compare the efficacy and safety of diode laser and electrocautery techniques for inflammatory fibrous hyperplasia (IFH) removal. MATERIALS AND METHODS: In this randomized double-blind clinical trial, 40 individuals were randomly allocated to two groups: group 1 (G1) consisted of 20 individuals assigned to treatment with diode laser and group 2 (G2) consisted of 20 individuals assigned to treatment with electrocautery. The following transoperative parameters were evaluated: bleeding, temperature, and surgical technique parameters (energy deposited on tissue, flow rate, and time of incision). The postoperative parameters evaluated were as follows: pain, functional alterations (chewing, speaking), analgesic medication intake, swelling, healing of the wound area, and patient satisfaction. RESULTS: Among the 40 individuals included in the study, four (two in G1 and two in G2) did not complete the entire follow-up. Therefore, 36 individuals (18 in G1 and 18 in G2) participated. Participants in G1 and in G2 had similar demographic characteristics. No difference regarding the trans- or postoperative parameters evaluated was observed between G1 and G2 (p > 0.05). Also, no difference regarding the time for healing was observed between groups. CONCLUSIONS: Diode laser seems to be as effective and safe as electrocautery when applied under similar conditions for IFH removal. CLINICAL RELEVANCE: IFH corresponds to 65% of the lesions observed in denture wearers. This study shows that under similar conditions diode laser is as effective and safe as electrocautery for removal of IFH.

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center.

INTRODUCTION: A resurgence of syphilis in Brazil has been reported in recent years. OBJECTIVE: With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. METHODS: A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. RESULTS: A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). CONCLUSION: The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.

Impact of intraoperative parathyroid hormone monitoring on the management of patients with primary hyperparathyroidism.

BACKGROUND/OBJECTIVE: Intraoperative parathyroid hormone (IOPTH) monitoring during surgery for primary hyperparathyroidism (PHPT) could improve cure rate and simplify current care pathways. This study assesses the performance of US, MIBI and IOPTH monitoring and their impact on outcomes and perioperative strategy. DESIGN: This is a retrospective study of a prospectively maintained database of patients who underwent parathyroidectomy guided by preoperative US, MIBI and IOPTH monitoring. Test performance (sensitivity, specificity, PPV, NPV, accuracy) and IOPTH added value (percentage of patients in whom test contributed to achieving cure) were calculated. RESULTS: A total of 617 patients (median age 59 years, 75% females), 603 (97.7%) of them cured, were included in analysis. Sensitivity of US was higher than MIBI (78.2% vs 70%, P < 0.05), but both were inferior to IOPTH (98.6%, P < 0.05). US and MIBI were more sensitive at detecting single gland disease (SGD) than multigland disease (MGD) (85% vs 55% and 77.5% vs 45.5%, respectively, P < 0.05), while IOPTH performed well in both situations (98.8% vs 96.7%, P > 0.05). In 41 patients with incorrect US predictions, MIBI gave correct result only in 12 (29.3%) cases, while IOPTH gave correct predictions in all but one patient (97.6%). Minimally invasive parathyroidectomy (MIP) was completed in 409 patients, with a similar completion rate regardless whether both or one scan was positive. IOPTH added value was significant in whole cohort (14%) and in subgroups of patients with concordant vs discordant scans, minimally invasive vs conventional surgery, and initial vs reoperative surgery. CONCLUSIONS: Intraoperative parathyroid hormone monitoring is more accurate at predicting cure than US and MIBI are at identifying abnormal glands in patients undergoing parathyroidectomy for PHPT and significantly contributes to cure rate in range of clinical scenarios. This implies that its routine use could facilitate successful surgery in patients with single positive imaging and increase number of MIPs while maintaining high cure rate.

Mature dendritic cell density is affected by smoking habit, lesion size, and epithelial dysplasia in oral leukoplakia samples.

OBJECTIVE: To compare the densities of CD1a + immature and CD83+ mature dendritic cells, and inflammatory infiltrate cells between smokers and non-smokers with oral leukoplakia. Parameters associated with malignant transformation were also evaluated. DESIGN: 21 smokers and 23 non-smokers diagnosed with oral leukoplakia were obtained. Densities of inflammatory infiltrate cells were calculated in H&E sections. Immunohistochemistry using anti-CD1a and anti-CD83 was performed and densities were calculated. Comparisons and statistical analyses were performed among the groups and parameters as gender, lesion size, site, and presence of cell dysplasia were analyzed. RESULTS: A lower density of CD83+ cells was observed in smokers compared to non-smokers (P < 0.05). For samples of smokers, a lower density of CD1a + cells, CD83+ cells, and inflammatory infiltrate cells was observed in samples with <10 mm compared to samples ≥10 mm of diameter (P < 0.05), and a lower density of CD83+ cells was also observed between samples without dysplasia compared to samples with dysplasia (P < 0.05). CONCLUSION: In oral leukoplakia samples, dendritic cell density decreases in the presence of smoking habit, and increases in larger lesions and with epithelial dysplasia. Smoking habit is an external factor that contribute to alteration of the anti-tumoral immune defense system in lesions of oral leucoplakia, reinforcing that smoking elimination is important to control the development of this disease.

The use of social networks in scientific research with questionnaires

Aim: The aim of this study was to determine the response rate of the SF-36 quality of life questionnaire sent and received by mail and over a social network to caregivers of individuals with epidermolysis bullosa (EB) in Brazil. Methods: All volunteers were first-degree relatives of patients with EB that directly spent time helping them with their basic activities of daily living. A maximum of two caregivers per patient could answer the questionnaire. Volunteers were divided into two groups: for group 1, questionnaires were sent to 53 members of a support association for the disease by mail, and for group 2, 798 members of the Facebook™ page of friends and relatives of patients with EB were invited to participate using an access link to Google Drive™ to gain access to the questionnaire. The data from both groups were analyzed 150 days after the start the study. Descriptive analysis was performed by EpiInfo8 and the return of questionnaires was evaluated according to age, sex, and time of return using the Chi-squared and Fisher's exact test. Results: After 150 days, 30 questionnaires were returned, 17 (56.7%) of which from group 1 and 13 (43.3%) from group 2. Approximately 12 questionnaires were returned by mail and 11 over the social network. Conclusions: The data collection of the SF-36 quality of life questionnaire from caregivers of individuals with EB over a social network seems to be efficient mainly when it is necessary to collect results within a short timeframe, highlighting the importance of social networks as a means for conducting this type of research. However, in our study, the most efficient method was distributing the questionnaires by mail

Desmoplastic fibroblastoma (collagenous fibroma) of the oral cavity.

UNLABELLED: Desmoplastic fibroblastoma is benign soft tissue tumor, with fibroblastic or myofibroblastic origin, that rarely occurs in oral cavity. We reported the case of a 56-year-old man who presented a tumor in the left mandibular alveolar ridge, with slow and asymptomatic growth, with no osseous involvement. The tumor was sessile with lobulated surface, covered by healthy mucosa with erythematous areas. The lesion was excised and specimens sent to histopathology and immunohistochemistry. Histopathological exam showed a non-encapsulated fibroblastic proliferation, characterized by myofibroblasts, spindle and stellate fibroblasts with large or oval nuclei and bi or tri nucleation, immersed in an abundant hypocellular dense collagen stroma. Tumor cells were positive for vimentin, HHF35, α-smooth muscle actin and factor XIIIa. The diagnosis of desmoplastic fibroblastoma was based in the clinical history of absence of trauma related to the growth in the alveolar ridge, associated with macroscopic, microscopic and immunohistochemical features. The patient is free-diseases by eight months. KEY WORDS: Collagenous fibroma, desmoplastic fibroblastoma, neoplasm of connective and soft tissue.