Endorsement of open science practices by dental journals: A meta-research study.

OBJECTIVES: This study evaluates the endorsement of open science practices by dental journals. MATERIALS AND METHODS: This was a meta-research study that included journals listed in the 2021 Journal Citation Reports under Dentistry. A comprehensive evaluation was performed by accessing journal websites to ascertain the availability of publicly accessible instructions to authors in Portuguese, English, or Spanish. A researcher extracted information from the "Instructions for Authors" section, encompassing the journal's impact factor, mention of any reporting guidelines, details on data sharing, acceptance of articles in preprint format, and information regarding study protocol registration. Descriptive data analysis was conducted using the Stata 14.0 program, and an Open Science Score (OSS) (ranging from 0 to 100 %) was calculated for each journal by considering five open science practices. Pearson's correlation test was conducted to determine the relationship between the OSS score and journal impact factor. RESULTS: Ninety journals were included in the study. Most journals (70 %) indicated the mandatory use of reporting guidelines, while 60 % recommended data sharing. Conversely, 46.7 % did not provide information on study protocol registration, and 44.4 % stipulated them as mandatory for authors. Regarding preprints, 50 % of the journals did not provide any information, but 46.7 % confirmed their acceptance. The mean OSS was 52.9 % (standard deviation 26.2). There was a weak correlation (Pearson's correlation coefficient of 0.221) between the journal impact factor and OSS (P-value=0.036). CONCLUSION: This study found varying degrees of endorsement of open science practices among dental journals. CLINICAL SIGNIFICANCE: Dental practitioners rely on high-quality, evidence-based research for informed decision-making. By assessing the endorsement of open science practices, our study contributes to improving the quality and reliability of dental research, ultimately enhancing the evidence base for clinical practice.

Demographics, smoking status, and systemic health factors associated with apical periodontitis in a Brazilian rural population: a cross-sectional study.

OBJECTIVE: To determine whether the systemic diseases diabetes mellitus (DM) and arterial hypertension (AH), and smoking status are associated with apical periodontitis (AP) in a representative rural population. MATERIALS AND METHODS: Cross-sectional study using a representative sample of individuals obtained from a population-based epidemiological survey carried out in the rural area of the city of Rosário do Sul, RS, Brazil, from March 2015 to May 2016. Data were collected through structured questionnaires and clinical examination. Binary logistic regression analysis was performed to identify variables independently associated with AP. RESULTS: Of the 584 individuals included in the study, 353 (60.4%) had AP. The presence of AP was independently associated with age ≥ 40 years (odds ratio [OR] = 1.867, 95% confidence interval [CI]: 1.193-2.923, p = 0.006), non-white ethnicity (OR = 1.509, 95% CI: 1.029-2.115, p = 0.035), active or former smoker (OR = 2.087, 95% CI: 1.241-3.510, p = 0.006) and DM or prediabetes (OR = 1.676, 95% CI: 1.150-2.443, p = 0.007). CONCLUSION: The study identified significant associations between AP and demographics, smoking status, and systemic disease in a Brazilian rural population. CLINICAL RELEVANCE: The study emphasized the significance of comprehending and managing associated factors in preventing and treating AP.

Dosimetric parameters and radiotherapy simulation methods used in preclinical studies of radiation damage to the dentition: a systematic review.

OBJECTIVE: This systematic review investigated the dosimetric parameters used in preclinical studies. STUDY DESIGN: Searches were performed in 3 databases (PubMed, Scopus, and Embase) and gray literature to identify studies for review. In vitro and ex vivo studies that examined the effect of radiation on human permanent teeth were included. The modified Consolidated Standards Of Reporting Trials checklist of items for reporting preclinical in vitro studies was used to assess the risk of bias. RESULTS: In total, 32 studies met the inclusion criteria. The average radiation dose of in vitro studies was 53 (±22) Gy and in ex vivo studies was 69 (±1) Gy. Twenty-two studies used 5 different fractionation schemes. Twenty-two of the included studies did not report the radiotherapy modality of those reporting. Twenty studies used linear accelerators, and 7 used Cobalt-60 with the source-surface-distance of radiation ranging from 1.5 to 100 cm. Distilled water was the storage solution for the dental structure used most commonly. Biases were observed, including small sample sizes, lack of randomization, and blinding processes. CONCLUSION: The dosimetric parameters used in the preclinical studies, including radiation dose, radiotherapy modality, fractionation regime, and the storage solutions used did not support the hypothesis of direct effects of radiation on the dental structure.

Different surface treatment strategies on etchable CAD-CAM materials: Part 1-Effect on the surface morphology.

STATEMENT OF PROBLEM: Polymer-based computer-aided design and computer-aided manufacturing (CAD-CAM) materials have either a high content of ceramic filler particles or a ceramic network structure. Proper etching of these materials is challenging. Therefore, it is relevant to assess different surface etching strategies and morphological alterations as a result of these techniques. PURPOSE: The purpose of this 2-part in vitro study was to evaluate different etching strategies on the surface roughness and its relationship to the surface contact angle with a subsequent morphological characterization of different CAD-CAM materials. MATERIAL AND METHODS: Two CAD-CAM polymer-based materials and 1 CAD-CAM ceramic material were selected for this study. The materials were treated with different strategies, including a combination of airborne-particle abrasion and an application of 9% hydrofluoric acid etching. After the surface treatment, roughness measurements (Sa) were assessed by using an optical profilometer on an area of 1.47 mm2. Subsequently, the contact angle on the surface was examined by means of the sessile drop technique and an optical contact angle meter. The data were analyzed by using a 2-way analysis of variance, the post hoc Tukey test (α=.05), and the Pearson correlation coefficient. RESULTS: The 3 materials tested showed an increase in surface roughness when treated with surface airborne-particle abrasion. However, the materials with polymer in their composition concomitantly increased the contact angle. More hydrophilic surfaces were observed when hydrofluoric acid was applied, regardless of the composition of the materials. The surface roughness presented a strong positive linear tendency in the surface treatments used. CONCLUSIONS: The application of airborne-particle abrasion on the surface of the polymer-based CAD-CAM materials increased the roughness and contact angle. However, the application of acid etching after the airborne-particle abrasion decreased the contact angle for polymer-based CAD-CAM materials, resulting in considerable enhancement of the surface quality for proper bonding.

Different surface treatment strategies on etchable CAD-CAM materials: Part II-Effect on the bond strength.

STATEMENT OF PROBLEM: Bonding to recently launched polymer-based computer-aided design and computer-aided manufacturing (CAD-CAM) materials has been challenging. Evidence regarding etching strategies for dual-phase CAD-CAM materials is sparse, but adequate bonding is crucial for the clinical success and longevity of a restoration. PURPOSE: The purpose of this 2-part in vitro study was to evaluate and compare the effect of surface treatment strategies on the microshear bond strength and work of adhesion of polymer-based and ceramic materials. In addition, chemical elements present on the surface and the interface morphology after using those strategies were also assessed. MATERIALS AND METHODS: Two CAD-CAM polymer and 1 CAD-CAM ceramic materials were selected for this in vitro study. The materials were subjected to different surface treatment strategies, including airborne-particle abrasion and the application of 9% hydrofluoric acid. Specimens were submitted to microshear bond strength before and after thermocycling, and the failure mode was classified. The work of adhesion was calculated based on the water-to-air surface tension of 72.8 mN.m-1 and the Young- Dupré equation. The surfaces were submitted to energy-dispersive X-ray spectroscopy, and the interfaces were analyzed using a scanning electron microscope. Data were subjected to 2-way ANOVA and the Tukey post hoc test (α=.05). RESULTS: The highest microshear bond strength means were observed for the polymer-based materials when hydrofluoric acid or airborne-particle abrasion was applied. The 3 materials tested showed a decrease in microshear bond strength after thermocycling, except for applying airborne-particle abrasion to 1 of the polymer-based material tested. The ceramic material tested showed a high microshear bond strength with the application of airborne-particle abrasion and hydrofluoric acid combined. The work of adhesion varied across the materials and presented high means when hydrofluoric acid was used. CONCLUSIONS: A combination of airborne-particle abrasion plus hydrofluoric acid should be considered for polymer-based or feldspathic ceramic CAD-CAM materials. In this in vitro study, both etching procedures combined produced higher bonding values for all materials tested.

Acid dissolution of ultrathin glass-ceramic and its correlation with flexural strength.

STATEMENT OF PROBLEM: When glass-ceramics are treated with hydrofluoric acid (HF), not only the area of application is affected but also other surfaces. Information regarding the correlation of the dissolution caused by HF and the flexural strength of the ceramic is lacking. PURPOSE: The purpose of this in vitro study was to investigate the effect of HF etching protocols on the flexural strength of 2 glass-ceramics, the correlation of their flexural strength with the internal and lateral dissolution, and the differences in Weibull characteristics concerning the etching protocols. MATERIAL AND METHODS: Specimens (4×12×0.3mm) of leucite-reinforced glass-ceramic-LEU (IPS Empress) and of lithium disilicate-reinforced glass-ceramic-LD (IPS e.max) were prepared. The specimens were divided into 5 groups (n=12) according to etching protocol: control-untreated; hydrofluoric acid (HF) 5% for 20 seconds (HF5%20s); HF5%60s; HF10%20s; and HF10%60s. Flexural strength was evaluated through 3-point bend testing. The fractured specimens were submitted to a morphological and metrical analysis of each pattern (LEU I-IV, LD I-III) on the lateral surface (LS) and of the dissolution areas (µm2) on the internal surface (IS) using a scanning electron microscopy (SEM) and a software program (FIJI). Flexural strength (MPa) values were analyzed by 1-way ANOVA, Bonferroni test, and Weibull and the correlation between flexural strength and dissolution by Pearson correlation coefficient (α=.05). RESULTS: ANOVA revealed that the HF etching protocol was significant (P<.001) for LEU ceramic. When HF10%60s was applied, LEU showed Weibull characteristic strength (σθ) values lower than those of the other protocols. LD showed no difference in σθ and reliability (m) among the groups. The internal dissolution areas concerning LEU had a significant high negative correlation with the flexural strength (r=-0.6; P<.001). LEU-IV on the LS was the only pattern to show a significant decrease in flexural strength (r=-0.3, P<.05). CONCLUSIONS: Special care should be taken when applying hydrofluoric acid on glass-ceramic restorations. Protocols with higher hydrofluoric acid concentrations and longer application times were more related to greater internal areas of dissolution which reduced the flexural strength of leucite ceramics.

Over 300 Radiation Caries Papers: Reflections From the Rearview Mirror.

Radiation caries (RC) is an aggressive oral toxicity in head and neck cancer survivors, which develops 6 to 12 months after head and neck radiotherapy. It initially affects the tooth cervical/incisal surfaces, and if not promptly diagnosed/managed, progresses to dental crown amputation and risk of osteoradionecrosis. It results from a multidimensional cluster of treatment-induced oral symptoms, including hyposalivation, dietary changes, and oral hygiene impairment. Although recognized as a frequent complication of radiotherapy and extensively assessed by a myriad of retrospective, in vitro, and in situ studies, RC patients are still orphans of clinically validated methods for risk prediction, prevention, and treatment of early lesions. This review provides a historical overview of science-based concepts regarding RC pathogenesis and treatment, emphasizing the growing demand for interventional clinical studies (randomized trials).

Is Edema Zone Volume Associated With Ki-67 Index in Glioblastoma Patients?

Introduction Despite all the progress with genetic mapping and multimodal treatment, the prognosis of Glioblastoma multiforme (GBM) remains poor, with median overall survival (OS) of only 12 to 15 months. Several studies showed correlations between glioblastoma clinic and prognosis factors; however, it doesn`t occur with tumor radiological features. The purpose of this study is to determine possible correlations between the volumetric analysis of glioblastoma compartments and the proliferation index represented by Ki-67. Methods We performed a retrospective analysis of MRI studies of 70 patients with glioblastoma multiforme acquired up to one week before surgery. The tumor compartments were divided into enhancing zone; edema zone and tumor total zone. Each compartment was submitted to volumetric analysis using Horos Project software. A linear regression model was used to assess correlations between the ki-67 index and the volume of each compartment with a p-value of 0.05. Results The male/female ratio in our study was 1.7:1, at a mean age of 60.7 ± 14.6 years. Tumor predominant location was the temporal lobe with 25% of cases and cystic morphology was present in 17%. The median of Ki-67 was 40%. The average tumor compartment volume was 40 cm3 for the contrast-enhancing zone, 62 cm3for the edema zone, and 103 cm3 for the total tumor volume. A significant association between the Ki-67 index and edema zone volume (p=0.02) was found.  Conclusion Volumetric analysis of the glioblastoma edema zone by MRI allows for predicting tumor aggressiveness through correlation with the Ki-67 index.

Transtentorial spread of glioblastoma multiforme to cerebellopontine angle - A rare case report.

BACKGROUND: Glioblastoma multiforme (GBM) is the most common central nervous system malignant tumor in adults with 48.3% of cases. Despite it, the presence of transtentorial spread is uncommon, with few patients reported in the literature. In this study, the authors report a case of GBM transtentorial spread to cerebellopontine angle after resection and adjuvant treatment. CASE DESCRIPTION: A 55-year-old male patient with GBM, previously submitted to surgical resection and adjuvant treatment with radiotherapy and quemotherapy. Fourteen months after the first surgery, he developed headaches associated with dysphagia and dysphonia. Magnetic resonance imaging showed a recurrence of the left parietal lesion and a new mass in the right cerebellopontine angle. The patient underwent successful surgical resection of both lesions. Chemotherapy was maintained after the surgery. CONCLUSION: To the best of our knowledge, there are few cases of GBM metastasis to the cerebellopontine angle reported in the literature. Surgical management should be considered in cases of intracranial hypertension and patients with good performance status.

Preservation of immunoexpression of type I collagen, BSP and BMP4 in the dentin-pulp complex of head and neck cancer patients after radiotherapy.

This study tested the hypothesis that head and neck radiotherapy (HNRT) impacts the immunoexpression of type I collagen, bone sialoprotein (BSP) and bone morphogenetic protein 4 (BMP4), thereby leading to micromorphological changes in the dentin-pulp complex (DPC), and promoting the onset and progression of radiation caries (RC). Twenty-two demineralized sections of carious teeth (a group of 11 irradiated teeth and a control group of 11 non-irradiated teeth) extracted from 19 head and neck cancer patients were analyzed by conventional optical microscopy and immunohistochemistry to investigate the micromorphology (cellular layer hierarchy, blood vessels, odontoblasts, fibroblasts, extracellular matrix, calcification, necrosis, reactionary dentin formation, and chronic inflammation), and the patterns of staining/immunolocalization of type I collagen, BSP and BMP4 in the dental pulp of irradiated and control samples. No significant differences attributable to the direct impact of radiotherapy were detected in DPC micromorphology between the groups. In addition, the patterns of immunohistochemical staining and immunolocalization of the proteins studied did not differ between the irradiated and the control samples for type I collagen, BSP or BMP4. This study rejected the hypothesis that HNRT directly damages dentition by changing the organic components and the microstructure of the DPC, ultimately leading to RC.

Impact of head and neck radiotherapy on the longevity of dental adhesive restorations: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Established restorative protocols for patients after head and neck radiotherapy are lacking, increasing the failure rates of dental adhesive restorations. PURPOSE: The purpose of this systematic review and meta-analysis was to analyze the evidence regarding the impact of head and neck radiotherapy on the longevity of dental adhesive restorations. MATERIAL AND METHODS: A search was performed using PubMed, Scopus, and Embase in May 2018 (updated in November 2020). Data extraction was performed regarding the percentage of restoration failure among dental adhesive materials, including glass ionomer cements, resin-modified glass ionomer cements, and composite resins. Risk of bias was assessed by the meta-analysis of statistics assessment and review instrument (MAStARI). Confidence in cumulative evidence was evaluated by the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. RESULTS: Four studies met the inclusion criteria. All included studies were classified as having a moderate risk of bias and reported results regarding class V restorations. Overall, composite resins presented lower failure rates at 2 years (30%) when compared with resin-modified glass ionomer (41%) and glass ionomer cements (57%). Meta-analysis showed that the risk of failure with glass ionomer cements was greater than with resin-modified glass ionomer cements (RR: 1.71, P<.001). Composite resins presented lower risk of failure when compared with glass ionomer (RR: 2.29, P<.001) and resin-modified glass ionomer cements (RR: 1.30, P=.03). Three studies reported results regarding fluoride compliance, which had a negative effect on the survival rates of glass ionomer and resin-modified glass ionomer cements and a positive effect on composite resin restorations. CONCLUSIONS: The results suggest that composite resin restorations associated with fluoride gel compliance seems to be the best alternative for restoring class V lesions in patients after head and neck radiotherapy. However, the results showed moderate certainty of evidence, which justifies the need for more randomized clinical trials regarding this subject.

Preservation of immunoexpression of type I collagen, BSP and BMP4 in the dentin-pulp complex of head and neck cancer patients after radiotherapy

Abstract This study tested the hypothesis that head and neck radiotherapy (HNRT) impacts the immunoexpression of type I collagen, bone sialoprotein (BSP) and bone morphogenetic protein 4 (BMP4), thereby leading to micromorphological changes in the dentin-pulp complex (DPC), and promoting the onset and progression of radiation caries (RC). Twenty-two demineralized sections of carious teeth (a group of 11 irradiated teeth and a control group of 11 non-irradiated teeth) extracted from 19 head and neck cancer patients were analyzed by conventional optical microscopy and immunohistochemistry to investigate the micromorphology (cellular layer hierarchy, blood vessels, odontoblasts, fibroblasts, extracellular matrix, calcification, necrosis, reactionary dentin formation, and chronic inflammation), and the patterns of staining/immunolocalization of type I collagen, BSP and BMP4 in the dental pulp of irradiated and control samples. No significant differences attributable to the direct impact of radiotherapy were detected in DPC micromorphology between the groups. In addition, the patterns of immunohistochemical staining and immunolocalization of the proteins studied did not differ between the irradiated and the control samples for type I collagen, BSP or BMP4. This study rejected the hypothesis that HNRT directly damages dentition by changing the organic components and the microstructure of the DPC, ultimately leading to RC.

Dissolution Depth and Surface Morphological Alterations in Ultrathin Glass Ceramic Etched with Different Hydrofluoric Acid-etching Protocols.

PURPOSE: To evaluate the effect of different HF-etching protocols on the dissolution depth and micromorphology of the etched and adjacent surfaces of ultrathin glass-ceramic specimens. MATERIALS AND METHODS: One hundred twenty specimens (6 x 6 x 0.3 mm) of leucite-reinforced glass-ceramic (LEU, IPS Empress, Ivoclar Vivadent) and lithium-disilicate-reinforced glass-ceramic (LD, IPS e.max, Ivoclar Vivadent) were prepared. Specimens were divided into 5 groups (n = 12) according to etching protocol: G1: control, untreated; G2: 5% hydrofluoric acid (HF) etching for 20 s (HF5%20s); G3: HF5%60s; G4: HF10%20s; and G5: HF10%60s. To analyze the dissolution depth, specimens were sectioned into two similarly sized halves using a chisel to create an internal surface (IS). Specimens were analyzed with scanning electron microscopy (SEM) on the following surfaces: HF application surface (AS), lateral surface (LS), internal surface (IS), and the surface opposite to the AS (OS). Dissolution patterns were identified. Data were submitted to one-way ANOVA and Bonferroni's test (α = 0.05). Dissolution depth data were submitted to Kruskal-Wallis and Mann-Whitney U-tests (α = 0.05). The prevalence of different dissolution patterns was analyzed using SEM. RESULTS: HF gel applied on the AS also affected the adjacent surfaces of all specimens. Different dissolution patterns were observed, which were dependent of HF-etching protocol and proportion of the glass phase in the ceramic. These patterns were categorized into four types for LEU (I-IV) and three for LD (I-III) according to the micropore size. The greater the micropore size, the more pronounced the etching pattern (p < 0.001). Higher HF times and concentrations showed prevalence of more severe etching patterns. HF10%60s produced greater dissolution depth in both materials when compared with other HF-etching groups (p < 0.05). CONCLUSION: Hydrofluoric acid etching not only affects the surface upon which it is applied, but internal, lateral and even opposite edges of glass ceramic. Different dissolution patterns and depths can be formed which are dependent of hydrofluoric acid concentration, application time, and proportion of the glass phase in the ceramic.

Awareness of the risk of radiation-related caries in patients with head and neck cancer: A survey of physicians, dentists, and patients.

OBJECTIVES: Radiation-related caries (RRC) is one of the most aggressive complications of radiotherapy (RT) in survivors of head and neck cancer (HNC). Lack of RRC awareness may contribute to the occurrence of this oral cavity complication. RRC may be considered a "forgotten oral complication" by patients with HNC, oncologists, and dentists. The present study aimed to assess the level of awareness of RRC among physicians, dentists, and patients. STUDY DESIGN: Physicians (group 1, G1), dentists (group 2, G2), and patients with HNC undergoing RT (group 3, G3) answered questionnaires concerning their awareness of RRC. Physicians (G1) were divided into group 1A (oncological experience) and group 1B (general physicians/other specialties). Dentists (G2) were divided into group 2A (oncological experience) and group 2B (general dentists/other specialties). Personalized questionnaires were designed for each group. RESULTS: Recruitment was as follows: physicians (n = 124): 1A (n = 64), 1B (n = 60); dentists: (n = 280), 2A (n = 160), 2B (n = 120). In addition, 58 patients answered the questionnaire. In terms of RRC awareness, 46.77% of physicians, 81.78% of dentists, and 24.13% of patients had some knowledge of the problem. CONCLUSION: Patient awareness of RRC was poor. The heterogeneity of answers among physicians and dentists suggests an opportunity to improve patient education and prevention of this serious oral complication of RT.

Impact of dietary acids on the surface roughness and morphology of composite resins.

This in vitro study was performed to evaluate the surface roughness (Ra) and morphology by scanning electron microscopy (SEM) of composite resins that had been stored in acidic solutions typical of those present in the diet. Three composite resins (4 Seasons, Z250, and P90) were selected and divided into three groups (n = 7) according to the solutions tested: G1: distilled water; G2, Coca-cola, and G3: orange juice. The Ra test was repeated after immersion periods of 15, 90, and 180 days. The mean Ra values were subjected to LS means analysis and the Tukey-Kramer (P < 0.05). One test specimen of each composite resin was selected for SEM analysis after each period. The Ra data indicated that P90 had the lowest Ra values. 4 Seasons and Z250 had statistically similar roughness values for all the solutions and evaluation periods. With the exception of 180-day immersion in Coca-cola, 4 Seasons showed significantly higher values than Z250. SEM analysis showed that P90 was the composite resin most resistant to the actions of all acid solutions for the periods analyzed. Interaction between components of the solutions and the active components of other dietary items, as well as oral hygiene, may affect the chemical degradation of composite resins.

Adult Nasoethmoidal Encephalocele Corrected by Supraorbitary Approach: Case Report and Literature Review

Encephalocele is a protrusion of the central nervous system elements through a defect in the dura mater and in the cranium. The prevalence of encephalocele ranges from 0.08 to 0.5 per 1,000 births. The posterior encephaloceles are more common in North America and Europe, while frontal defect is frequently found in Asia. The present paper describes a 26-year-old male patient presenting with cerebrospinal fluid leak and meningitis symptoms. He was diagnosed with congenital nasoethmoidal encephalocele and treated surgically using a supraorbital approach without complications.

Radiation-related caries: current diagnostic, prognostic, and management paradigms.

OBJECTIVE AND STUDY DESIGN: This narrative review summarizes the current state of art of radiation-related caries (RC), an aggressive disease that affects approximately 30% of post-head and neck radiotherapy (HNRT) patients. RESULTS: RC mainly affects the tooth cervical areas and incisal/cuspal tips and develops 6 to 12 months after HNRT. Early RC signs include black/brownish tooth discoloration and enamel cracks, which progress to enamel delamination, exposing underlying dentin to a highly cariogenic oral environment and rapid tooth destruction/dental crown amputation. As RC advances and renders the tooth nonrestorable, it may lead to osteoradionecrosis spontaneously or upon extraction if the tooth is in a highly irradiated field of the oral cavity. This requires aggressive treatment, which would have a negative impact on a cancer survivor's quality of life and contribute to the incremental cost of cancer care. Chlorhexidine mouth rinses and topical fluoride applications are effective agents used in RC prevention; however, there are no well-established treatment protocols. Once RC progresses, dental restorations should be performed with adhesive materials in association with systematic fluoride application as illustrated in the clinical case presented in this review. Post-HNRT patients should be closely followed up for optimal RC prevention, early diagnosis, and prompt treatment. CONCLUSIONS: Future clinical studies are necessary to establish a contemporary, clinically validated protocol for RC management.

Brain Metastasis of Wilms Tumor in Adult.

BACKGROUND: Wilms tumor is a rare renal tumor in adults. To the best of our knowledge, only a small number of cases of brain metastasis have been reported in the literature. We report the case of a 29-year-old female with headache and dizziness, with a parietal mass and pathologic diagnosis of Wilms tumor metastasis. CASE DESCRIPTION: The patient was admitted with a 3-month history of lumbar pain and 2 months of progressive headache associated with dizziness. Abdomen magnetic resonance imaging showed a renal mass. Post nephrectomy, the neurologic signs worsened and a head magnetic resonance imaging presented in the right parietal lobe, convexity, heterogeneous lesion with little perilesional edema. The patient underwent a complete surgical resection with success. The adjuvant treatment was chemotherapy. CONCLUSIONS: Few cases of brain metastasis of Wilms tumor exist in the literature. Surgical management is considered in cases with intracranial hypertension or focal signs. The adjuvant treatment options are immunotherapy and chemotherapy.

Impact of Clustering Oral Symptoms in the Pathogenesis of Radiation Caries: A Systematic Review.

Radiation-related caries (RRC) is a disease with a high potential for destruction of the dentition, which impairs quality of life in head-and-neck (HN) cancer (HNC) patients who undergo radiotherapy. In light of the recently described "clustering of oral symptoms theory," the present systematic review (PROSPERO CRD42019132709) aims to assess HN and gastrointestinal (GI) symptom clusters among HNC patients and discusses how these indirect effects of cancer therapy play a pivotal role in the pathophysiology of RRC. The search was performed at PubMed, Scopus, and Embase and resulted in 11 studies that met the inclusion criteria. Data extraction was performed with respect to the presence of HN/GI symptom clusters among HNC patients. The methodological data of the studies included were assessed using the MAStARI and GRADE instruments. The most prevalent reported HN symptoms were dysphagia, xerostomia, and pain. Taste alterations and fatigue were also commonly reported by the patients. Loss of appetite and weight loss were regularly reported in the studies, as well as nausea and vomiting. The results of the present study suggest that HNC treatment generates clusters of oral symptoms, leading to dietary changes, impaired oral hygiene, enamel fragility, and a highly cariogenic oral environment, which may impact the risk for RRC. A better understanding of oral symptom clustering could be of considerable clinical significance for the oral health and quality of life of HNC patients. Therefore, contemporary protocols of RRC prevention must take this broader treatment scenario of symptom clusters such as oral side effects into account.