Assessment of salivary miRNA, clinical, and demographic characterization in colorectal cancer diagnosis.

AIM: Colorectal cancer (CRC), as the third most frequent malignancy in the world, is the fourth major cause of cancer-related mortality. Its early detection contributes significantly to a reduction in mortality. The objective of this case-control research was to analyze the salivary expression of microRNA-29a (miR-29a) and microRNA-92a (miR-92a), and also to consider demographic, clinical, and nutritional habits for differentiation between CRC patients and healthy controls, especially in the early stages. METHOD: A standard checklist was used to obtain the demographic information, clinical features, and dietary habits of the case and control groups. Samplings of whole unstimulated saliva samples were obtained from 33 healthy persons and 42 CRC patients. Through real-time PCR, statistical analyses, and machine learning analyses, miR-29a and miR-92a salivary expression levels were evaluated. RESULTS: The mean salivary expression of miR-92a and miR-29a in CRC patients was significantly higher than in healthy controls (p < 0.001). The area under the receiver operating characteristic curve for miR-92a and miR-29a salivary biomarkers was 0.947 and 0.978, respectively. The sensitivity and specificity values for miR-92a were 95.24 % and 84.85 %, respectively, whereas sensitivity and specificity for miR-29a were equal to 95.20 % and 87.88 %, respectively. Multiple logistic regressions considering demographics, clinical features, and nutritional habits led to values of 95.35 % and 96.88 % as sensitivity and specificity, respectively, and machine learning analysis led to values of 88.89 % and 86.67 % as sensitivity and specificity, respectively. CONCLUSION: CRC could be accurately diagnosed based on miR-92a and miR-29a levels in saliva. Statistical analysis and machine learning might develop cost-effective models for the distinction of CRC using a noninvasive technique.

Oral palisaded encapsulated neuroma; a diagnosis seldom suspected clinically.

Key Clinical Message: Palisaded encapsulated neuroma (PEN) is generally seen in the head and neck area as an asymptomatic nodule with the same color as the surrounding skin and rarely occurs in the oral cavity. The exact etiology of PEN is not known, but there is evidence supporting the role of trauma as its etiological factor. Abstract: Palisaded encapsulated neuroma (PEN) is one of the benign nerve sheath tumors of Schwann cell origin, which is commonly found in the skin of the head and neck area, and rarely occurs in the oral cavity. Its exact etiology is unknown, but there is evidence that supports the role of trauma as an etiological factor. Here we present a case of PEN in the hard palate of a 30-year-old patient and review the differential diagnoses of these nerve sheath tumors of the oral cavity.

The Effect of Acetyl-L-Carnitine (ALCAR) on Peripheral Nerve Regeneration in Animal Models: A Systematic Review.

Peripheral neuropathies caused by the peripheral nervous system (PNS) damage can occur due to trauma and other disorders. They present as altered sensation, weakness, autonomic symptoms, and debilitating pain syndrome with a wide range of clinical signs. Acetyl-L-Carnitine (ALCAR) is a biological compound with essential roles in mitochondrial oxidative metabolism and anti-oxidant effects that protects mitochondria from oxidative damage and inhibits apoptosis caused by mitochondrial damage. This study is a systematic review and meta-analysis of the effects of ALCAR on peripheral nerve injuries. This review examines studies on treating traumatic peripheral neuropathies in which ALCAR is administered to rats with sciatic nerve injury with an appropriate control group. The articles were divided based on the mode of ALCAR administration. If one method was used in more than one article, their results were entered in the "Revman5.4" software and were meta-analyzed. Studies were selected from 1994 to 2018 on rats with varying physical injuries to their sciatic nerves. In one study, ALCAR was provided to rats in their drinking water, while in other studies, ALCAR was injected intra-peritoneally. Different mechanisms of ALCAR actions have been suggested in this study, but the underpinnings of the neuroprotective effects of ALCAR are still unclear. Further studies are mandatory to clarify the actual mechanisms of the neuroprotective activity of ALCAR. Based on the results of existing studies, ALCAR effectively increases the tolerance threshold of thermal and mechanical stimuli, reduces latency, and reduces apoptosis; finally, adjusting the dose and duration of administration may increase the dose and duration axon diameter.

In vitro Effect of 810 nm and 940 nm Diode Laser Irradiation on Proliferation of Human Gingival Fibroblasts and Expression of Procollagen Gene.

Factors promoting fibroblast proliferation and collagen synthesis can subsequently enhance wound healing. This study aimed to assess the effect of 810 and 940 nm diode laser on fibroblast proliferation and procollagen gene expression. In this study, human gingival fibroblasts were cultured in Dulbecco's modified Eagle's medium and underwent 810 and 940 nm diode laser irradiation once, twice, thrice and four times at 1, 3, 5 and 7 days after culture. The methyl thiazolyl tetrazolium assay was performed to assess the proliferation while the real-time polymerase chain reaction was performed to assess the expression of procollagen gene at the mRNA level. We applied two-way ANOVA and Tukey's test for analysis. Wavelength had no significant effect on the proliferation of gingival fibroblasts, but increasing the number of irradiation sessions of both wavelengths increased the proliferation of human gingival fibroblasts. Significant differences were noted in the number of human gingival fibroblasts between groups irradiated 1 and 4 and also 2 and 4 times. Procollagen gene was well expressed in all groups but its expression was significantly higher in 940 nm laser group after four irradiation cycles. Four times radiation of 940 nm laser seems to be more effective than all others.

The Effect of Low-level Laser Therapy on VEGF, IL-6 Expression and Viability of Oral Squamous Cell Carcinoma Cells.

Low-level laser therapy has shown successful results in the prevention and treatment of oral mucositis. One of the concerns about low-level lasers is their effects on remaining malignant cells in the area. Interleukin-6 is a multifunctional cytokine that plays an important role in a wide range of biological activities in increasing tumor functions, decreasing survival and resistance to chemo-radiotherapy. Vascular-endothelial growth factor increases tumor vascularization. It has been shown in the previous studies that LLLT can cause an increase of IL-6 and VEGF in some cells. The present thesis aims to study the effects of LLLT on IL-6 and VEGF expression, as well as cell viability on OSCC cells. Tumorigenic cells of an oral squamous cell carcinoma cell line were irradiated with 3 different diode lasers, and were compared to the control group (660 nm-200 mW-4 J cm-2 , 810 nm-200 mW-4 J cm-2 , 940 nm-200 mW-4 J cm-2 ). MTT assay, ELISA and RT-PCR were used to measure cell viability, IL-6 and VEGF expression. Cell viability of all laser-irradiated groups was significantly lower than the control group. VEGF expression increased in laser-irradiated groups. This was only significant in the 810 nm group. IL-6 protein secretion was significantly higher in all laser-irradiated groups compared to the control group.

The Effect of Laser Bio-modulation on Dysplastic Lesions, an Animal Study.

Potentially malignant disorders are one of the clinical challenges. Dysplasia in these lesions can be a predictor of more potential for malignant changes. Photo-bio-modulation in benign lesions has advantages, but there is doubt on its safety in potentially malignant lesions. This study aims to assess if low-level laser can promote dysplastic changes while the method can play an important role in management of dysplastic lesions. Dysplasia was induced on anterior wall of the buccal pouch of 80 young Syrian male hamsters. Then, hamsters were divided to four groups to receive 4 and 12 sessions irradiation of 660 and 810 nanometers low-level lasers. For histopathologic study of the tissue, we used light microscopes. Using SPSS, data were analyzed via Wilcoxon signed rank test and Mann-Whitney U-test. In all of our four groups, the severity of dysplasia had no statistical difference in study sides comparing with their own controls. Wavelength and numbers of laser irradiation sessions had no statistically meaningful effect on the severity of dysplasia either. Low-level lasers appear to show no relevant or significant effect over the aggravation of the dysplasia's severity. Neither the wavelength nor the number of sessions appear to have any impact in the results.

The Relationship Between Serum Level of Vitamin D3 and Osseointegration Around the Dental Implant.

At present, dental implants are used more than before, and their high success rate is attributed to sufficient osseointegration, which depends on prosthetic-, implant-, and patient-related factors. The quality and quantity of bone and the host response are the main patient-related factors. Vitamin D3 affects bone metabolism by stimulating both osteoclasts and osteoblasts. This study aimed to review the human studies on the efficacy of vitamin D3 for dental implant osseointegration. Search of the literature yielded only 4 studies on human models, of which 2 showed the optimal efficacy of vitamin D3 for dental implant osseointegration, whereas the remaining 2 did not report any positive effect. However, this finding may be related to the small sample size of the vitamin D3-deficient group, which can compromise statistical analyses. In conclusion, vitamin D3 seems to be effective for dental implant osseointegration, although further research is required on human models.

Effects of 660 nm and 810 nm Low-Power Diode Laser on Proliferation and Invasion of Oral Cancer Cells in Cell Culture Media.

In the present study, the effects of 660 and 810 nm diode laser on the proliferation and invasion of cancer cells were investigated. Sixteen plates of oral cancer cells originated from tongue SCC were irradiated with diode laser at 660 nm (40 and 80 mW) and 810 nm (100 and 200 mW) with the energy density of 4 J cm-2 . One plate received no irradiation (the control). Irradiation was performed at four times (0, 24, 72 and 168 h). Cell proliferation was measured by MTT assay. The Ki67 and vascular endothelial growth factor (VEGF) markers were examined by real-time polymerase chain reaction (RT-PCR). Cyclin D1, E-cadherin, ß-catenin and matrix metalloproteinase-9 (MMP-9; flow cytometry) were also evaluated. Proliferation was lower in the irradiated groups. This result was significant for all groups at 24 h. The percentages of cyclin D1 and MMP-9 were higher in 810 nm groups, ß-catenin and E-cadherin were higher in 660 nm groups, VEGF marker was significantly lower in 810 nm/200 mW group, and Ki67 marker has no difference between the groups. According to the results of this study, laser irradiation at 0 and 24 h resulted in a significant inhibitory effect on cell proliferation especially in 660 nm/80 mW and 810 nm/200 mW. Further studies are needed in this respect.

Management of the essential data element in the differential diagnosis of oral medicine: An effective step in promoting oral health.

BACKGROUND: Oral soft tissue diseases include a broad spectrum, and the wide array of patient data elements need to be processed in their diagnosis. One of the biggest and most basic challenges is the analysis of this huge amount of complex patient data in an increasing number of complicated clinical decisions. This study seeks to identify the necessary steps for collecting and management of these data elements through establishing a consensus-based framework. METHODS: This research was conducted as a descriptive, cross-sectional study from April 2016 to January 2017, which has been performed in several steps: literature review, developing the initial draft (v. 0), submitting the draft to experts, validating by an expert panel, applying expert opinions and creating version v.i, performing Delphi rounds, and creating the final framework. RESULTS: The administrative data category with 17 and the historical data category with 23 data elements were utilized in recording data elements in the diagnosis of all of the different oral diseases. In the paraclinical indicator and clinical indicator categories, the necessary data elements were considered with respect to the 6 main axes of oral soft tissue diseases, according to Burket's Oral Medicine: ulcerative, vesicular, and bullous lesions; red and white lesions of the oral mucosa; pigmented lesions of the oral mucosa; benign lesions of the oral cavity and the jaws; oral and oropharyngeal cancer; and salivary gland diseases. CONCLUSIONS: The study achieved a consensus-based framework for the essential data element in the differential diagnosis of oral medicine using a comprehensive search with rich keywords in databases and reference texts, providing an environment for discussion and exchange of ideas among experts and the careful use of the Delphi decision technique.

Developing a new intelligent system for the diagnosis of oral medicine with case-based reasoning approach.

OBJECTIVE: Since the clinical manifestations of many oral diseases can be quite similar despite the wide variety in etiology and pathology, the differential diagnosis of oral diseases is a complex and challenging process. Intelligent system for differential diagnosis of oral medicine using the artificial intelligence (AI) capabilities helps specialists in achieving differential diagnosis in a wide range of oral diseases. MATERIALS AND METHODS: First, the essential data elements to design and develop an intelligent system were identified in a cross-sectional descriptive study. The case-based reasoning method was selected to design and implement the system, which consists of three stages: collect the clinical data, construct the cases database, and case-based reasoning cycle. The problem is solved by CBR method in a cycle consisting of four main stages of retrieval, reuse, review, and retention. The evaluation process was conducted in a pilot-based way through the evaluation of the system's performance in the clinical setting and also using the usability assessment questionnaire. RESULTS: The output of the present project is a web-based intelligent information system, which is developed using the Visual Studio 2015 software. The database of this system is the Microsoft SQL Server version 2012, which has been programmed based on Net framework (version 4.5 or higher) using Visual Basic language. The results of the system evaluation by specialists in clinical settings showed that the system's diagnosis power in different aspects of the disease is influenced by their prevalence and incidence. CONCLUSIONS: System development using the artificial intelligence capabilities and through the clinical data analysis has potential to help specialists to determine the best diagnostic strategy to achieve a differential diagnosis of a wide range of oral diseases. The results of evaluation present the potential of the system to improve the quality and efficiency of patient care.

A Model for Induction of Dysplasia in Hamster Mucosal Pouch.

Induction of premalignant lesions in animal models is of high value for research purposes. This study aimed to induce dysplasia in hamster mucosal pouch for investigation of dysplastic lesions using dimethylbenz(a)anthracene. The buccal pouch of 10 hamsters was painted with dimethylbenz(a)anthracene for 10 weeks every other day. At 5 and 10 weeks, they underwent histopathological analysis. Clinically, there was no change until week 7; after which mucosal thickening occurred. Hamsters scarified at 5 weeks and 10 weeks demonstrated mild and moderate dysplasia, respectively. dimethylbenz(a)anthracene is a useful tool for inducing dysplastic lesions in the buccal pouch mucosa of hamsters.

A Comparative Study of Low-Level Laser Therapy and Transcutaneous Electrical Nerve Stimulation as an Adjunct to Pharmaceutical Therapy for Myofascial Pain Dysfunction Syndrome: A Randomized Clinical Trial.

OBJECTIVES: Myofascial pain dysfunction syndrome (MPDS) is the most common form of temporomandibular disorders. Because of the multifactorial nature of the problem, its management usually involves several treatment modalities to maximize their synergistic effects. This randomized clinical trial aimed to assess the efficacy of low-level laser therapy (LLLT) and transcutaneous electrical nerve stimulation (TENS) as an adjunct to pharmaceutical therapy for treatment of MPDS. MATERIALS AND METHODS: This clinical trial evaluated 108 MPDS patients. First, the initial pain intensity of patients was determined using a visual analogue scale (VAS). The first phase of the study included education, awareness, self-care, behavior and relaxation therapy. After 1 month, the pain score was measured again using VAS. Patients who acquired a pain score >1 were divided into three groups of LLLT with diode (GAAlAr) laser with 0.2 W power, TENS, and control, using block randomization. All groups received 10 mg fluoxetine once daily, 0.25 mg clonazepam once daily and 10 mg baclofen three times a day. ANOVA was used to compare the recovery rate of the three groups. RESULTS: Pain in the trapezius muscle and pain on mouth opening resolved faster in the laser + medication group. The recovery rate was faster in the mean muscle pain, general pain reported by patients, pain in the masseter and pterygoid muscles and pain and limitation in lateral movements in both laser + medication and TENS groups. CONCLUSION: Combination of LLLT and TENS with medication accelerated pain relief and resolved movement restrictions in MPDS patients.(IRCT registration number: IRCT201411113144N4).

Clinical Evaluation of High and Low-Level Laser Treatment (CO2vsInGaAlP Diode Laser) for Recurrent Aphthous Stomatitis.

STATEMENT OF THE PROBLEM: Recurrent aphthous stomatitis (RAS) is one of the most common lesions in the oral cavity. Due to its multifactorial nature, there is no definitive treatment for RAS. Laser therapy is one of the suggested treatments to reduce patient's discomfort. PURPOSE: The purpose of the present clinical trial is to assess the effect of low and high level laser therapy on pain control and wound healing of RAS. MATERIALS AND METHOD: Thirty six patients with minor RAS were divided into three groups. Group 1 (n=14) received CO2 laser, group 2 (n=12) were treated with InGaAlP Diode laser and group 3 (n=10) received sham laser as placebo. All patients were evaluated daily up to 15 days after receiving one session of laser therapy. Pain severity before and after treatment, wound healing, patient's satisfaction, and functional disturbance before and after treatment were recorded for each patient. RESULTS: According to statistical analysis, pain reduction after treatment in group 1 was 7.00±2.41, in group 2 was 2.08±2.31, and in group 3 was 1.40±1.77. In addition, a significant difference was observed in the reduction of functional complications in CO2 laser treated patients compared to the other two groups. CONCLUSION: High-level laser treatment showed analgesic effects on RAS, but no healing was observed. Low-level laser therapy demonstrated no positive effect on recurrent aphthous ulcers.

Prognostic value of matrix metalloproteinase-9 expression in oral squamous cell carcinoma and its association with angiogenesis.

BACKGROUND: Breakdown of extracellular matrix (ECM) is one of the important hallmarks of cancer progression which facilitates the invasion of tumoral cells to the surrounding tissue. Matrix metalloproteinases (MMPs) can degrade various components of the ECM and basement membrane. The aim of this study was to determine the role of matrix metalloproteinases-9 protein in the biologic behavior of oral squamous cell carcinoma (OSCC) and its relation with tumor angiogenesis. MATERIAL AND METHODS: In this study 42 OSCC and 15 normal epithelium were reviewed by immunohistochemical staining for matrix metalloproteinases-9 and CD105. RESULTS: Matrix metalloproteinases-9 expression was detected in 32 OSCC specimens (76.1%), with 28 specimens (66.6%) showing moderate or strong expression. We observed that the expression level of matrix metalloproteinases-9 was positively correlated with the status of lymph node metastasis (N0vs. N1) (P =0.00), and clinical stage (I-II vs. III-IV) in OSCC patients. Microvessel density in intratumoral tissue has an association with lymph node metastasis and advanced clinical stage (P=0.003 and p=0.01, respectively). We observed that tumors with matrix metalloproteinases-9 overexpression had a higher microvessel density counts compared with tumors with absent or focal immunostaining(16.2±5.6 vs 10.3±3.5 respectively, P =0.03). CONCLUSIONS: In conclusion present results demonstrate the marked expression of matrix metalloproteinases-9 and CD105 in OSCC and suggest that the expression of these markers is associated with tumor progression and could offer additional information about the aggressiveness of OSCC. In addition a significant relationship was noted between microvessel density count and expression of matrix metalloproteinases-9 which suggest that MMP9 expression may be closely related to tumor angiogenesis. KEY WORDS: Matrix metalloproteinases-9, CD105, squamous cell carcinoma, immunohistochemistry.

Comparing the effects of cryotherapy with nitrous oxide gas versus topical corticosteroids in the treatment of oral lichen planus.

BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucosa with treatment challenges for clinicians. AIMS: The objective of this study is to compare the effects of cryotherapy as a new modality with topical corticosteroids as a conventional therapy in the treatment of OLP. MATERIALS AND METHODS: Thirty patients with bilateral OLP lesions were selected. From each patient a lesion on one side was chosen randomly for a single session of cryotherapy with nitrous oxide gas and the lesion on the other side received triamcinolone acetonide 0.1% ointment in orabase. Treatment outcome was measured by means of an appearance score, pain score (visual analogue scale), and severity of lesions before treatment and after 2, 4 and 6 weeks of treatment. STATISTICAL ANALYSIS USED: Paired samples t-test and Wilcoxon test. RESULTS: In both methods of treatment sign score, pain score and severity of lesions was significantly reduced in all follow-up sessions (P<0.05). But the treatment outcome and relapse was not significantly different between the two treatment methods (P>0.05). CONCLUSION: Cryotherapy with nitrous oxide gas is as effective as topical triamcinolone acetonide in the treatment of OLP with no systemic side effects and needs less patient compliance. It can be considered as an alternative or adjuvant therapy in OLP patients to reduce the use of treatments with adverse effects.

Evaluation of levels of knowledge about etiology and symptoms of oral cancer in southern Iran.

BACKGROUND: Knowledge regarding risk factors and primary signs of oral cancer in the general population can help them to avoid risky behaviour and seek timely advice from a physician. The aim of this study was to survey adult knowledge about risk factors and signs of oral cancer in Shiraz Dental University. MATERIALS AND METHODS: In this descriptive cross-sectional study using an investigator-made questionnaire, 783 adults who were referred to Shiraz Dental University participated. Questionnaire data were analyzed by ANOVA and T-test. RESULTS: The results showed that 32.3% of participants were aware of oral cancer and gained their knowledge from the media. The risk factors mentioned by these participants was as follows: sunlight 30.8%, hot and peppery food 40.7%, alcoholic drinks 47.4% and smoking 73.6% (there was significant relationship for drinking alcohol and gender, education and times of using dental service, p<0.05). They also mentioned the primary signs of oral cancer as follows: red patch without pain 27.8%, white patch without pain 13.5% and prolong scarring without pain 56.7% (there was significant relationship between these three signs and education and times of using dental service, p<0.05). The mean knowledge about the risk factors and signs of oral cancer were 1.94 from 5 with 1.14 standard deviation and 0.96 from 3 with 0.93 standard deviation. CONCLUSIONS: The observed low level of knowledge of people regarding both risk factors and signs of oral cancer emphasizes the need for more efforts to be made about the above mentioned issues by the media.

Lack of association between Helicobacter pylori infection and oral lichen planus.

Oral lichen planus is a premalignant chronic inflammatory mucosal disorder with unknown etiology. It is a multifactorial disease and in addition to genetic background, infections, stress, drug reactions are suggested as risk factors. Helicobacter pylori which is involved in development of many gastrointestinal lesions may also be implicated in oral lichen planus induction. This is of clear importance for cancer prevention and the present study was performed to determine any association between H. pylori infection and oral lichen planus in southwestern Iran. Anti H. pylori IgG levels were determined in 41 patients and 82 sex-age matched controls. The results showed no association between H. pylori infection and oral lichen planus (51% in patients vs. 66% in control). or any of its clinical presentations.

Comparison of clinical efficacy of temporalis myofascial flap and dermal graft as interpositional material in treatment of temporomandibular joint ankylosis.

UNLABELLED: Temporomandibular joint (TMJ) ankylosis is a very distressing structural condition. Interpositional arthroplasty has become the acceptable standard for the primary surgical management of TMJ ankylosis. Up to now, diverse interpositional materials have been proposed in this regard, with especial advantages and limitations. The temporalis muscle and facial flap, as well as the dermal graft, are among the most popular ones. This study aimed to compare the short-term clinical consequences between these 2 interpositional materials in patients with operated TMJ ankylosis. MATERIALS AND METHODS: Twenty patients with TMJ ankylosis were randomized in 2 age- and sex-matched 10-patient groups and received either a temporalis muscle and facial flap or a dermal graft as the interpositional material. The maximal incisal opening (MIO) and the amount of lateral excursion (LE) were measured before and 3 months after surgery, and the mandibular deviation (MD) at the mouth opening 3 months after operation was compared between the 2 groups. RESULTS: Twenty patients were enrolled in the study. The presurgical MIO and LE were not significantly different between the 2 groups. Three months after the operation, evaluation of the patients did not reveal a significant difference considering the amount of the MIO, LE, or MD. The mentioned parameters were significantly improved 3 months after the operation in both groups. CONCLUSIONS: The interpositional arthroplasty in TMJ ankylosis patients using either a temporalis muscle and facial flap or a dermal graft would yield a comparable and almost satisfactory clinical outcome.

Comparing the effect of 3 orthognathic surgical methods on the mandibular range of movement.

BACKGROUND: Mandibular setback for the treatment of mandibular prognathism is a common orthogenetic surgical procedure carried out using various intraoral and extraoral methods. Reduced mandibular movement range (MMR) is one of the common complications of this surgery. OBJECTIVES: The aim of this study was to compare the reduction of MMR after 3 surgical procedures including sagittal split osteotomy (SSO), intraoral vertical ramus osteotomy (IVRO), extraoral vertical ramus osteotomy (EVRO). METHODS: In this clinical trial, 150 patients with mandibular prognathism were divided into 3 groups of 50 patients. In the first group, mandibular setback was performed using SSO; in the second group, we used IVRO, and EVRO was the method used in the third group. In each group, before and 3 months after the surgery, maximum interincisal opening and the range of right and left lateral and protrusive movements were measured and compared. RESULTS: Although the mean amount of MMR reduced in all the groups, it was not equal in all the groups. Sagittal split osteotomy and the EVRO resulted in the most and least reduction of MMR, respectively. CONCLUSIONS: Reduced MMR is one of the complications of SSO, IVRO, and EVRO; however, SSO resulted in the most and EVRO in the least effect on limitation of movement after surgery.