Prognostic Value of the Overexpression of Fatty Acid Metabolism-Related Enzymes in Squamous Cell Carcinoma of the Head and Neck.

Reprogramming of cellular energy metabolism, such as lipid metabolism, is a hallmark of squamous cell carcinoma of the head and neck (SCCHN). However, whether protein expression related to fatty acid oxidation (FAO) affects survival in SCCHN remains unclear. We aimed to investigate FAO-related enzyme expression and determine its correlation with clinicopathological variables in SCCHN patients. Immunohistochemical analysis (IHC) of FAO-related protein expression, including carnitine palmitoyltransferase 1 (CPT1), the acyl-CoA dehydrogenase family, and fatty acid synthase (FAS), was performed using tissue microarrays from 102 resected SCCHN tumors. Expressions were categorized according to IHC scores, and the statistical association with clinicopathological factors was determined. Moderate-to-high expression of long-chain acyl-CoA dehydrogenase (LCAD) had a protective role against cancer-related death (adjusted hazard ratio (HR), 0.2; 95% confidence interval (CI), 0.05-0.87) after covariate adjustment. Age and clinical stage remained independent predictors of survival (adjusted HR, 1.75; 95% CI, 1.22-2.49 for age; adjusted HR, 14.33; 95% CI, 1.89-108.60 for stage III/IV disease). Overexpression of medium-chain acyl-CoA dehydrogenase and FAS correlated with advanced tumor stage (T3/T4); however, none of these factors were independent predictors of survival. Several FAO-related enzymes were upregulated and LCAD overexpression had a protective effect on overall survival in advanced SCCHN patients. FAO-related-enzyme expression might have a prognostic impact on survival outcomes in SCCHN.

Gastric parietal cell and thyroid autoantibodies in patients with Behcet's disease.

BACKGROUND/PURPOSE: Gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) were rarely examined in Behcet's disease (BD) patients. This study mainly assessed the frequencies of serum GPCA, TGA, and TMA positivities in 63 BD patients. METHODS: The frequencies of serum GPCA, TGA, and TMA positivities in 63 BD patients, 19 major-typed recurrent aphthous stomatitis (RAS)/BD (major RAS/BD) patients, 44 minor-typed RAS/BD (minor RAS/BD) patients, 520 RAS patients, and 126 healthy control subjects were calculated and compared. RESULTS: We found that 14.3%, 20.6%, and 20.6% of 63 BD patients, 21.1%, 21.1%, and 26.3% of 19 major RAS/BD patients, 11.4%, 20.5%, and 18.2% of 44 minor RAS/BD patients, 11.5%, 18.5%, and 18.3% of 520 RAS patients, and 1.6%, 2.4%, and 2.4% of 126 healthy control subjects had serum GPCA, TGA, and TMA positivities, respectively. BD, major RAS/BD, minor RAS/BD, and RAS patients all had significantly higher frequencies of serum GPCA, TGA, and TMA positivities than healthy control subjects (all P-values < 0.05). However, there were no significant differences in different serum autoantibody frequencies between BD, major RAS/BD, or minor RAS/BD patients and RAS patients. Of 16 TGA/TMA-positive BD patients whose serum thyroid-stimulating hormone (TSH) levels were measured, 87.5%, 6.3%, and 6.3% of these TGA/TMA-positive BD patients had normal, lower, and higher serum TSH levels, respectively. CONCLUSION: Approximately 35% BD patients have serum GPCA/TGA/TMA positivity. However, BD patients do not have significantly higher frequencies of serum GPCA, TGA, and TMA positivities than RAS patients.

Bacteria in the apical root canals of teeth with apical periodontitis.

BACKGROUND/PURPOSE: Bacteria in the tooth root canal may cause apical periodontitis. This study examined the bacterial species present in the apical root canal of teeth with apical periodontitis. Antibiotic sensitivity tests were performed to evaluate whether these identified bacterial species were susceptible to specific kinds of antibiotics. METHODS: Selective media plating and biochemical tests were used first to detect the bacterial species in samples taken from the apical portion of root canals of 62 teeth with apical periodontitis. The isolated bacterial species were further confirmed by matrix-assisted laser desorption ionization-time of flight mass spectrometry. RESULTS: We found concomitant presence of two (32 teeth) or three species (18 teeth) of bacteria in 50 (80.6%) out of 62 tested teeth. However, only 34 bacterial species were identified. Of a total of 118 bacterial isolates (83 anaerobes and 35 aerobes), Prophyromonas endodontalis was detected in 10; Bacteroides, Dialister invisus or Fusobacterium nucleatum in 9; Treponema denticola or Enterococcus faecalis in 8; Peptostreptococcus or Olsenella uli in 6; and Veillonella in 5 teeth. The other 25 bacterial species were detected in fewer than five teeth. Approximately 80-95% of bacterial isolates of anaerobes were sensitive to ampicillin/sulbactam (Unasyn), amoxicillin/clavulanate (Augmentin), cefoxitin, and clindamycin. For E. faecalis, 85-90% of bacterial isolates were sensitive to gentamicin and linezolid. CONCLUSION: Root canal infections are usually caused by a mixture of two or three species of bacteria. Specific kinds of antibiotic can be selected to control these bacterial infections after antibiotic sensitivity testing.

Anemia and hematinic deficiencies in anti-gastric parietal cell antibody-positive or all autoantibodies-negative recurrent aphthous stomatitis patients.

BACKGROUND/PURPOSE: Approximately 13% of recurrent aphthous stomatitis (RAS) patients have serum anti-gastric parietal cell antibody (GPCA) positivity. This study assessed whether serum GPCA or RAS itself was a significant factor causing hematinic deficiencies and anemia statuses in GPCA-positive RAS (GPCA+/RAS) and all autoantibodies-negative RAS (Abs-/RAS) patients. METHODS: The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of three groups of 31 GPCA+/RAS patients, 240 Abs-/RAS patients, and 342 healthy control subjects. RESULTS: GPCA+/RAS patients had significantly lower mean Hb and serum iron level (for women only) as well as significantly greater frequencies of Hb, iron, and vitamin B12 deficiencies than healthy control subjects. Moreover, GPCA+/RAS patients had a significantly higher MCV and a significantly greater frequency of vitamin B12 deficiency than Abs-/RAS patients. Furthermore, Abs-/RAS patients did have significantly lower mean Hb, MCV, iron, and folic acid levels and significantly greater frequencies of Hb, iron, vitamin B12, and folic acid deficiencies than healthy control subjects. Of 31 GPCA+/RAS patients, 3 (9.7%) had PA, 6 (19.4%) had vitamin B12 deficiency, and 3 (9.7%) had macrocytosis. Moreover, normocytic anemia (54.0%) and iron deficiency anemia (26.4%) are the two more common types of anemia in our RAS patients. CONCLUSIONS: We conclude that serum GPCA plays a significant role in causing vitamin B12 deficiency and high MCV in GPCA+/RAS patients. RAS itself does play a significant role in causing anemia and hematinic deficiencies in both GPCA+/RAS and Abs-/RAS patients.

Anemia and hematinic deficiencies in gastric parietal cell antibody-positive and -negative oral mucosal disease patients with microcytosis.

BACKGROUND/PURPOSE: Microcytosis is defined as mean corpuscular volume (MCV) < 80 fL. This study assessed the anemia statuses and hematinic deficiencies in 30 patients with gastric parietal cell antibody-positive microcytosis (GPCA+/microcytosis) and 210 patients with GPCA-negative microcytosis (GPCA-/microcytosis). METHODS: We measured and compared the mean red blood cell (RBC) count, MCV, and RBC distribution width (RDW), as well as blood levels of hemoglobin, iron, vitamin B12, folic acid, and homocysteine among the aforementioned patient groups and 240 healthy controls. RESULTS: Compared with GPCA-/microcytosis, the positive counterparts presented with a lower mean serum vitamin B12 level (marginal significance), significantly higher mean RDW and serum homocysteine level, and significantly greater frequencies of vitamin B12 deficiency and high homocysteine level. GPCA-/microcytosis patients had significantly greater frequencies of hemoglobin, iron, vitamin B12, and folic acid deficiencies and of RBC count > 5 × 1012/L than healthy controls. Moreover, 19 of 30 GPCA+/microcytosis patients and 143 of 210 GPCA-/microcytosis patients had anemia, with iron deficiency anemia being the most common type, followed by thalassemia trait-induced anemia and microcytic anemia due to other causes. CONCLUSION: We conclude that GPCA in microcytosis patients' sera may have caused significantly lower mean vitamin B12 level as well as significantly higher mean RDW and serum homocysteine level in our GPCA+/microcytosis patients than in GPCA-/microcytosis patients. Herein, iron deficiency anemia was the most common type of anemia in anemic GPCA+/microcytosis and GPCA-/microcytosis patients.

Cryogun cryotherapy for oral leukoplakia and adjacent melanosis lesions.

BACKGROUND: Our previous study has shown that cryogun cryotherapy is a good and effective treatment modality for oral leukoplakia. METHODS: In this study, we used cryogun cryotherapy to treat 72 oral leukoplakia and adjacent smoking-induced melanosis (OLM) lesions on the buccal mucosae. RESULTS: Of 72 OLM lesions, 14 had epithelial hyperplasia with parakeratosis, 24 had epithelial hyperplasia with hyperkeratosis, 26 had mild dysplasia, seven had moderate dysplasia, and one had severe dysplasia. Complete regression was achieved in all 72 OLM lesions after a mean of 3.3 ± 1.3 cryogun cryotherapy treatments. We found that OLM lesions in patients without smoking habit, with the greatest diameter < 2.8 cm, with epithelial dysplasia, or with a surface keratin thickness ≤ 50 µm needed significantly fewer mean number of cryogun cryotherapy treatment to achieve complete regression than those OLM lesions in patients with smoking habit, with the greatest diameter ≥ 2.8 cm, without epithelial dysplasia, or with a surface keratin thickness > 50 µm (all P-values < 0.001), respectively. Univariate logistic regression analyses showed that the greatest diameter, epithelial dysplasia, smoking habit, and surface keratin thickness were the factors influencing the cryogun cryotherapy treatment number (all P-values < 0.001). However, only the greatest diameter < 2.8 cm (P < 0.001) was an independent factor influencing the number of cryogun cryotherapy treatment required to achieve complete regression of the OLM lesion by multivariate logistic regression analyses. CONCLUSION: Cryogun cryotherapy is an effective treatment modality for OLM lesions.

Hemoglobin, iron, and vitamin B12 deficiencies and high blood homocysteine levels in patients with anti-thyroid autoantibodies.

BACKGROUND/PURPOSE: Autoimmune thyroiditis can be diagnosed by measuring patients' serum levels of thyroid stimulating hormone (TSH), anti-thyroglobulin antibody (TGA), and anti-thyroid microsomal antibody (TMA). This study evaluated whether there were hematinic deficiencies, high blood homocysteine levels, and serum gastric parietal cell antibody (GPCA) positivity in patients with TGA or TMA. METHODS: The blood hemoglobin (Hb), iron, vitamin B12, folic acid, homocysteine and TSH concentrations and the serum GPCA level in 190 TGA- or TMA-positive patients were measured and compared with the corresponding levels in 190 age- and sex-matched healthy control subjects. RESULTS: We found that 31 (16.3%), 27 (14.2%), 12 (6.3%), and 2 (1.1%) TGA- or TMA-positive patients had deficiencies of Hb (Men<13g/dL, Women<12g/dL), iron (< 60µg/dL), vitamin B12 (< 200pg/mL), and folic acid (< 4ng/mL), respectively. Moreover, 25 (13.2%) and 48 (25.3%) TGA- or TMA-positive patients had abnormally high blood homocysteine level and serum GPCA positivity, respectively. TGA- or TMA-positive patients had a significantly higher frequency of Hb (p<0.001), iron (p<0.001), or vitamin B12 deficiency (p=0.001), of abnormally elevated blood homocysteine level (p=0.001), or of serum GPCA positivity (p<0.001) than healthy control subjects. Of 190 TGA- or TMA-positive patients, 8 (4.2%) had lower serum TSH level (< 0.1µIU/mL, suggestive of hyperthyroidism), 163 (85.8%) had serum TSH level within normal range (0.1-4.5µIU/mL), and 19 (10%) had higher serum TSH level (>4.5µIU/mL, suggestive of hypothyroidis). CONCLUSION: There are significant deficiencies of hemoglobin, iron, and vitamin B12, abnormally high blood homocysteine levels, and serum GPCA positivity in TGA- or TMA-positive patients. In addition, the majority (85.8%) of TGA- or TMA-positive patients had euthyroid and only a small portion (14.2%) of TGA- or TMA-positive patients had either hypothyroidism or hyperthyroidism.

Cryotherapy for oral precancers and cancers.

Previous studies have used cryotherapy for the treatment of oral precancers including oral leukoplakia (OL) and oral verrucous hyperplasia (OVH) as well as oral cancers including oral verrucous carcinoma (OVC) and oral squamous cell carcinoma (OSCC). Cryotherapy is a method that locally destroys lesional tissues by freezing in situ. It can be carried out by either an "open" or a "closed" system. Lesional tissues are destroyed mainly through disruption of cell membrane, cellular dehydration, enzyme and protein damage, cell swelling and rupture, thermal shock injury to cells, damage to vasculature, and immune-mediated cytotoxicity. Cryotherapy is used frequently for the treatment of OL lesions with promising results. It can also be used to treat OVH and OVC lesions. Because OVH and OVC lesions are usually fungating and bulky, a combination therapy of shave excision and cryotherapy is needed to achieve a complete regression of the lesion. OSCCs have also been treated by cryotherapy. However, cryotherapy is not the main-stream treatment modality for OSCCs. Cryotherapy seems suitable for treatment of thin or relatively thick plaque-typed lesions such as OL lesions. By careful selection of patients, cryotherapy is a simple, safe, easy, conservative, and acceptable treatment modality for certain benign oral lesions and oral precancers.

Expression of Bak and Bak/Mcl-1 ratio can predict photodynamic therapy outcome for oral verrucous hyperplasia and leukoplakia.

BACKGROUND: Our previous studies showed that topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) is very effective for oral verrucous hyperplasia (OVH) and relatively less effective for oral leukoplakia (OL) lesions. Nevertheless, there has been no report on the association of the expression of apoptosis-related proteins in OVH and OL biopsy tissues prior to PDT with PDT treatment outcomes. METHODS: This study used immunohistochemistry to evaluate whether the expression of Bak, Mcl-1, caspase-3, caspase-8, caspase-9, p53, p21, or PCNA protein in biopsy specimens of OVH and OL lesions could be used to predict the clinical outcomes of 18 OVH and 40 OL lesions treated with topical ALA-PDT. The marker labeling score (LS) was defined as labeling index (positive cells/total cells) multiplied by staining intensity. The lesions after ALA-PDT treatment were divided into complete response (CR) group and partial or no response (PR/NR) group. RESULTS: The mean Bak LS and the mean Bak/Mcl-1 LS ratio were significantly higher in the CR group than in the PR/NR group. However, there was no significant difference in the Mcl-1, caspase-3, caspase-8, caspase-9, p53, p21, or PCNA protein LS between the CR and PR/NR groups. CONCLUSION: We conclude that the Bak LS or Bak/Mcl-1 LS ratio may be a useful biomarker to predict the clinical outcomes of OVH and OL lesions treated with topical ALA-PDT. Pre-PDT epithelial cell levels of Mcl-1, caspase-3, caspase-8, caspase-9, p53, p21, and PCNA may not have a significant influence on the clinical outcome of OVH and OL lesions treated with topical ALA-PDT.

A clinicopathological study of 338 dentigerous cysts.

BACKGROUND: Dentigerous cyst (DC) is one of the most common developmental odontogenic cysts. This hospital-based retrospective study evaluated the clinical and histopathological features of 338 DCs in Taiwanese patients. METHODS: In this study, 338 consecutive cases of DCs were collected from January 1995 to December 2009. The demographic data and clinicopathological features of these DC cases were reviewed and analyzed. RESULTS: The 338 DCs were taken from 332 patients (212 men and 120 women, mean age 33.0 years, range 5-83 years). There was a significant difference in the mean age between male and female patients (P < 0.05). Of the 338 DCs, 122 were found in the maxilla and 216 in the mandible. The most common site for DCs was the mandibular molar region (169 cases) and the most frequently involved tooth was the mandibular third molar (153 cases). Forty-six of the 338 DCs were found to be associated with supernumerary teeth. Microscopically, 317 cysts were lined by stratified squamous epithelium, 9 by mucoepidermoid-typed epithelium, and 12 by ciliated pseudostratified columnar epithelium. Hyaline bodies of Rushton, odontogenic epithelial rests, cholesterol clefts, foamy histiocytes, hemosiderin-laden macrophages, and dystrophic calcifications were discovered in 11, 78, 90, 33, 62 and 45 DCs, respectively. CONCLUSION: Our results indicate that DCs of Taiwanese patients have a male predominance and occur more frequently in patients between 10 and 29 years of age. The most commonly affected site for DCs is the mandibular molar region and the most frequently involved tooth is the mandibular third molar.

Significant reduction of serum homocysteine level and oral symptoms after different vitamin-supplement treatments in patients with burning mouth syndrome.

BACKGROUND: Serum homocysteine level is a biomarker of cardiovascular disease. METHODS: In this study, 399 primary and secondary burning mouth syndrome (BMS) patients without or with hematinic deficiencies were treated with vitamin BC capsules plus none, one, or two deficient hematinics depending on the corresponding deficiency statuses of the patients. One hundred and seventy-seven patients showed complete remission of all oral symptoms after treatment. The blood homocysteine, vitamin B12, folic acid, iron, and hemoglobin concentrations at baseline and after treatment till all oral symptoms had disappeared in these 177 complete-response BMS patients were measured and compared by paired t-test. RESULTS: For BMS patients with concomitant deficiencies of vitamin B12 only (n = 48), folic acid only (n = 12), vitamin B12 plus folic acid (n = 9), or vitamin B12 plus iron (n = 15), supplementations with vitamin BC capsules plus corresponding deficient hematinics could significantly reduce the abnormally high serum homocysteine levels to normal levels after a mean treatment period of 5.4-8.2 months (all P-values < 0.01). For BMS patients without definite hematinic deficiencies (n = 62), supplementation with vitamin BC capsules only could also significantly decrease the relatively higher homocysteine levels to significantly lower levels after a mean treatment period of 10.2 months (P < 0.001). CONCLUSION: Specific supplementations with vitamin BC capsules plus none or corresponding deficient vitamin B12 and/or folic acid can reduce the abnormally high serum homocysteine levels to normal levels in BMS patients without or with deficiencies of corresponding hematinics.

Burning mouth syndrome: a review and update.

Burning mouth syndrome (BMS) is characterized by the presence of burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations. It occurs more commonly in middle-aged and elderly women and often affects the tongue tip and lateral borders, lips, and hard and soft palate. In addition to a burning sensation, the patients with BMS may also complain unremitting oral mucosal pain, dysgeusia, and xerostomia. BMS can be classified into two clinical forms: primary and secondary BMS. The primary BMS is essential or idiopathic, in which the organic local/systemic causes cannot be identified and a neuropathological cause is likely. The diagnosis of primary BMS depends mainly on exclusion of etiological factors. The secondary BMS is caused by local, systemic, and/or psychological factors; thus, its diagnosis depends on identification of the exact causative factor. When local, systemic or psychological factors are present, treatment or elimination of these factors usually results in a significant clinical improvement of BMS symptoms. Vitamin, zinc, or hormone replacement therapy has been found to be effective for reducing the oral burning or pain symptom in some BMS patients with deficiency of the corresponding factor. If patients still have the symptoms after the removal of potential causes, drug therapy should be instituted. Previous randomized controlled clinical trials found that drug therapy with capsaicin, alpha-lipoic acid, clonazepam, and antidepressants may provide relief of oral burning or pain symptom. In addition, psychotherapy and behavioral feedback may also help eliminate the BMS symptoms.

Prompt healing of erosive oral lichen planus lesion after combined corticosteroid treatment with locally injected triamcinolone acetonide plus oral prednisolone.

BACKGROUND/PURPOSE: Erosive oral lichen planus (EOLP) is a T-cell-mediated inflammatory disease that is refractory to treat. This study tested whether local injection of triamcinolone acetonide plus oral administration of low- or medium-dose prednisolone could hasten the healing of EOLP lesions. METHODS: In this study, 50 EOLP patients were treated with local injection of Kenacort A (40 mg triamcinolone acetonide once weekly for 3 and 2 weeks for 30 major and 20 minor EOLP patients, respectively) plus oral administration of prednisolone (25-30 mg and 15-20mg of prednisolone once daily for 2 weeks for 30 major and 20 minor EOLP patients, respectively). The oral administration of prednisolone was tapered to 5mg per day and stopped in 7 days. Then, the patients were treated with topical Dexaltin (0.1% dexamethasone, once or twice per daily) and oral administration of vitamin Bc (one capsule twice daily) thereafter. RESULTS: After 3-week treatments, the 30 major EOLP patients showed complete response (lack of detectable erosive or ulcerative lesion with absence or regression of reticular or papular OLP) in 27 cases (90%) and partial response (reduction of erosive or ulcerative lesion by at least 30% in diameter with regression of reticular or papular OLP) in cases (10%); and 20 minor EOLP patients demonstrated complete response in 18 cases (90%) and partial response in two cases (10%). However, all the 45 complete response major or minor EOLP patients showed recurrence of erosive or ulcerative lesion after 3-24 (mean 12) months of follow-up. CONCLUSION: Prompt and complete healing of the EOLP lesions could be achieved in a relative short period of time after treatment with our protocol. Although complete response EOLP lesions recurred after a follow-up period of 3-24 months, patients did have an average remission period of 12 months after treatment with our protocol.

Modulation of serum smooth muscle antibody levels by levamisole treatment in patients with oral lichen planus.

BACKGROUND/PURPOSE: Serum autoantibodies have been found in patients with oral lichen planus (OLP). This study evaluated whether OLP patients had significantly higher frequencies of serum smooth muscle antibody (SMA) than healthy control individuals, and assessed whether levamisole treatment could modulate the serum SMA levels in OLP patients. METHODS: This study used an indirect immunofluorescence technique to measure the baseline serum SMA levels in a group of 647 OLP patients and 53 controls. Ninety-five SMA-positive OLP patients were treated with levamisole under a regular follow-up schedule, and their serum SMA levels were measured after treatment. RESULTS: The frequencies of serum SMA in patients with OLP (21.9%), erosive OLP (EOLP, 21.6%), major EOLP (17.9%), minor EOLP (24.2%), and nonerosive OLP (24.4%) were all significantly higher than that (0%) in healthy controls (all p < 0.001). Of 142 SMA-positive OLP patients, 95 were treated with levamisole under a regular follow-up schedule. Treatment with levamisole for a period of 2-29 months (mean, 9.4 ± 6.0 months) effectively reduced the high mean serum SMA titer (71.0 ± 7.2) at baseline to an undetectable level (0) in all SMA-positive OLP patients, regardless of different initial serum SMA titers. CONCLUSION: There was a significantly higher frequency of serum SMA (21.9%) in OLP patients than in healthy controls. Treatment with levamisole for 2-29 months significantly reduced the high serum SMA to an undetectable level, and significantly improved the signs and symptoms in all treated OLP patients.

Significant association of hematinic deficiencies and high blood homocysteine levels with burning mouth syndrome.

BACKGROUND/PURPOSE: Burning mouth syndrome (BMS) is characterized by a burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations. In this study, we evaluated whether there was an intimate association of the deficiency of hemoglobin (Hb), iron, vitamin B12, or folic acid; high blood homocysteine level; and serum gastric parietal cell antibody (GPCA) positivity with BMS. METHODS: Blood Hb, iron, vitamin B12, folic acid, and homocysteine concentrations and the serum GPCA level were measured in 399 BMS patients and compared with the corresponding levels in 399 age- and sex-matched healthy control individuals. RESULTS: We found that 89 (22.3%), 81 (20.3%), 10 (2.5%), and six (1.5%) BMS patients had deficiencies of Hb (men: <13 g/dL, women: <12 g/dL), iron (<60 µg/dL), vitamin B12 (<200 pg/mL), and folic acid (<4 ng/mL), respectively. Moreover, 89 (22.3%) BMS patients had abnormally high blood homocysteine level and 53 (13.3%) had serum GPCA positivity. BMS patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency; of abnormally elevated blood homocysteine level; or of serum GPCA positivity than the healthy control group (all p < 0.001 except for vitamin B12 deficiency, for which p = 0.004). However, no significant difference in frequency of folic acid deficiency (p = 0.129) was found between BMS patients and healthy control individuals. CONCLUSION: We conclude that there is a significant association of deficiency of Hb, iron, and vitamin B12; abnormally high blood homocysteine level; and serum GPCA positivity with BMS.

Morbidity and mortality of oral cancer in Taiwan: Trends from 2000 to 2021.

Background/purpose: Oral cancer is a major cause of cancer morbidity and mortality worldwide, especially in Taiwan. This study investigated the morbidity and mortality of oral cancer in Taiwan from 2000 to 2021. Materials and methods: The population data and the records of cancer registry were obtained from the websites of the Ministry of the Interior and the Ministry of Health and Welfare, respectively. The numbers of oral cancer cases and deaths were analyzed from 2000 to 2021. Results: The numbers of oral cancer cases and deaths increased from 3378 to 1494 in 2000-8277 in 2020 and 3395 in 2021, respectively. The total increase of oral cancer cases was 4899 with a total increase rate of 145.03%, while the total increase of oral cancer deaths was 1901 with a total increase rate of 127.24%. The changes in the numbers of all cancer cases and deaths, as well as the morbidity and mortality of oral cancer or all cancers also showed similar trends. Furthermore, the death-to-case ratio of oral cancers decreased from 44.23% in 2000 to 40.84% in 2020. The total decrease was 3.39% with a total decrease rate of 7.66%. Conclusion: In Taiwan, people's awareness of oral mucosal health is still inadequate. Obviously, there is still much room for improvement in the oral mucosal health education for our people. With the expertise and responsibility for taking good care of oral health of our people, the dental personnel should take active roles in the prevention and screening for oral cancers.

Significant association of deficiency of hemoglobin, iron and vitamin B12, high homocysteine level, and gastric parietal cell antibody positivity with atrophic glossitis.

BACKGROUND: Atrophic glossitis (AG) is considered to be a marker of nutritional deficiency. In this study, we evaluated whether there was an intimate association of the deficiency of hemoglobin, iron, vitamin B12 or folic acid, high blood homocysteine level, and serum gastric parietal cell antibody (GPCA) positivity with AG. METHODS: The blood hemoglobin, iron, vitamin B12, folic acid, and homocysteine concentrations and the serum GPCA level in 176 AG patients were measured and compared with the corresponding levels in 176 age- and sex-matched healthy control subjects. RESULTS: We found that 39 (22.2%), 47 (26.7%), 13 (7.4%), and 3 (1.7%) AG patients had deficiencies of Hb (men < 13 g/dl, women < 12 g/dl), iron (<60 µg/dl), vitamin B12 (<200 pg/ml), and folic acid (<4 ng/ml), respectively. Moreover, 38 (21.6%) AG patients had abnormally high blood homocysteine level, and 47 (26.7%) AG patients had serum GPCA positivity. AG patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency, of abnormally elevated blood homocysteine level, or of serum GPCA positivity than healthy control subjects (all P-values = 0.000). However, no significant difference in frequency of folic acid deficiency was found between AG patients and healthy control subjects. CONCLUSION: We conclude that there is a significant association of deficiency of hemoglobin, iron and vitamin B12, abnormally high blood homocysteine level, and serum GPCA positivity with AG.

Oral medicine education for medical students - A retrospective evaluation of the course in MacKay Medical College from 2016 to 2021.

Background/purpose: The oral medicine education for medical students is very important and a necessary part for the comprehensive medical education. The purpose of this study was to evaluate the oral medicine course for medical students by evaluating students' perspectives and the instructor's observation. Materials and methods: The medical students who took the compulsory course entitled "Introduction to Oral and Maxillofacial Medicine" in MacKay Medical College from 2016 to 2021 were invited to fill out the questionnaire for course satisfaction survey regarding their satisfied level with the course and their feelings about the instructors or suggestions, and the participatory observation was performed throughout the course activities and instructor-student interactions. Results: From 2016 to 2021, of a total of 268 medical students, 202 (75%) participated in the surveys. The results of the surveys and the instructor's observation showed that students satisfied with the course, and the course helped them to have a basic understanding of oral medicine. Moreover, all the mean scores and the rates of respondents who answered as agree for each item were 4.22-4.92 and 85%-100%, respectively. Conclusion: In this study, the oral medicine education for medical students contributed to an increase in students' awareness and understanding of oral health and dentistry. Considering the reported effectiveness of the course, students' satisfaction with the course content and teaching materials, and the instructor's teaching, this model of providing dental and oral health knowledge for the medical students may be a good one for further use in other medical institutions.

Modulation of serum antinuclear antibody levels by levamisole treatment in patients with oral lichen planus.

BACKGROUND/PURPOSE: Serum autoantibodies, including antinuclear antibodies (ANAs), have been found in patients with oral lichen planus (OLP). This study evaluated whether Taiwanese OLP patients had significantly higher frequencies of serum ANAs than healthy control subjects, and whether levamisole treatment could modulate the antibody levels. METHODS: This study used an indirect immunofluorescence technique to measure the baseline serum levels of ANA in a group of 583 Taiwanese OLP patients and 53 healthy control subjects. Seventy-nine ANA-positive OLP patients were treated with levamisole under a regular follow-up schedule in our dental clinic, and their serum ANA levels were measured after treatment. RESULTS: We found that the frequencies of serum ANA in patients with OLP (23.2%), erosive OLP (EOLP, 23.8%), major EOLP (31.5%), and minor EOLP (18.1%) were all significantly higher than that (5.7%) in healthy control subjects. In addition, major EOLP patients had a significantly higher serum ANA positive rate than minor EOLP or non-erosive OLP patients. Of 135 ANA-positive OLP patients, 79 were treated with levamisole under a regular follow-up schedule. We found that treatment with levamisole for a period of 2-38 months (mean, 12 ± 9 months) effectively reduced the high mean serum ANA titer (557 ± 98) at baseline to an undetectable level (0) in all ANA-positive OLP patients, regardless of different high initial serum titers of ANA. CONCLUSION: There was a significantly higher frequency of serum ANA (23.2%) in Taiwanese OLP patients than in healthy control subjects. Treatment with levamisole for 2-38 months reduced the high serum ANA to an undetectable level, and significantly improved the signs and symptoms in all treated OLP patients.