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Mastectomy with immediate reconstruction is a high-risk cohort for postoperative nausea and vomiting (PONV). Known risk factors for PONV include female gender, prior PONV history, nonsmoker, age < 50, and postoperative opioid exposure. The objective of this observational, cohort analysis was to determine whether a standardized preoperative protocol with nonopioid and anti-nausea multimodal medications would reduce the odds of PONV. After IRB approval, retrospective data were collected for patients undergoing mastectomy with or without a nodal resection, and immediate subpectoral tissue expander or implant reconstruction. Patients were grouped based on treatment: those receiving the protocol - oral a cetaminophen, p regabalin, c elecoxib, and transdermal s copolamine (APCS); those receiving none (NONE), and those receiving partial protocol (OTHER). Logistic regression models were used to compare PONV among treatment groups, adjusting for patient and procedural variables. Among 305 cases, the mean age was 47 years (21–74), with 64% undergoing a bilateral procedure and 85% having had a concomitant nodal procedure. A total of 44.6% received APCS, 30.8% received OTHER, and 24.6% received NONE. The APCS group had the lowest rate of PONV (40%), followed by OTHER (47%), and NONE (59%). Adjusting for known preoperative variables, the odds of PONV were significantly lower in the APCS group versus the NONE group (OR=0.42, 95% CI: 0.20, 0.88 p = 0.016). Premedication with a relatively inexpensive combination of oral non-opioids and an anti-nausea medication was associated with a significant reduction in PONV in a high-risk cohort. Use of a standardized protocol can lead to improved care while optimizing the patient experience. [ABSTRACT FROM AUTHOR]

Oral cancer is the most common malignancy of the head and neck region, characterized by a poor prognosis. Novel prognostic markers are needed to better stratify these patients. Lymphovascular invasion (LVI) has been included in the eighth edition of the AJCC Cancer Staging Manual as an additional prognostic factor, but its influence on the recurrence risk and lymph node metastasis is relatively understudied. This is a comprehensive review of the literature on the clinical and prognostic role of LVI in oral cancer. A relevant search of the PubMed, Scopus, and Web of Science databases yielded 29 articles that satisfied the inclusion criteria. Findings indicated that LVI is an independent negative prognostic factor in oral cancer patients and appears to be associated with cervical lymph node metastasis and loco-regional recurrence. Notably, in oral tongue cancer, survival outcomes progressively worsen when LVI is associated with other adverse pathological features, especially in the early stages. Therefore, these patients could benefit from elective neck dissection and/or adjuvant therapy. The high variability of LVI prevalence hinders the comparison of literature results. Several methodological limitations were found to be present in the collected articles, including the lack of a rigorous definition for LVI, the difficult detection in routine histological section, the presence of potential confounders, the retrospective nature, and an inadequate sample size in most studies. Therefore, it is necessary to conduct prognostic studies using standardized methods to define and quantify LVI. [ABSTRACT FROM AUTHOR]

Background: Clavicle fractures are common. An emergency physician needs to understand the diagnostic classifications of clavicle fractures, have a plan for immobilization, identify associated injuries, understand the difference between treating pediatric and adult patients, and have an approach to multimodal pain control. It is also important to understand when expert orthopedic consultation or referral is indicated.Objective Of the Review: To provide an evidence-based review of clavicle fracture management in the emergency department.Discussion: Clavicle fractures account for up to 4% of all fractures evaluated in the emergency department. They can be separated into midshaft, distal, and proximal fractures. They are also classified in terms of their degree of displacement, comminution and shortening. Emergent referral is indicated for open fractures, posteriorly displaced proximal fractures, and those with emergent associated injuries. Urgent referral is warranted for fractures with greater than 100% displacement, fractures with >2 cm of shortening, comminuted fractures, unstable distal fractures, and floating shoulder. Nondisplaced or minimally displaced fractures with no instability or associated neurovascular injury are managed non-operatively with a sling. Pediatric fractures are generally managed conservatively, with adolescents older than 9 years-old for girls and 12 years-old for boys being treated using algorithms that are similar to adults.Conclusions: When encountering a patient with a clavicle fracture in the emergency department the fracture pattern will help determine whether emergent consultation or urgent referral is indicated. Most patients can be discharged safely with sling immobilization and appropriate outpatient follow-up. [ABSTRACT FROM AUTHOR]

Context: Many people claim winter sea bathing gives them energy and health. According to the psychoneuroendocrinoimmunology (PNEI) paradigm, the stress response elicited by cold water immersion could indeed induce several beneficial psychophysical alterations.Objective: To determine the effects of winter sea bathing on psychological wellbeing, stress and immune markers.Design: A cross-sectional study.Participants: 228 people, between 19 and 88 years, including 107 winter sea bathers and 121 controls.Main Outcome Measures: A battery of questionnaires was administered to assess sociodemographic characteristics, self-perception of mental and physical heath, the number, duration and intensity of Upper Respiratory Tract Infections (URTIs) in the last year, and Big Five personality traits. 17 winter sea bathers and 15 controls (mean age 67 years) were further examined to evaluate physiological health, underwent one ear-nose-throat (ENT) examination, and provided saliva samples for measurements of biological markers (cortisol, sIgA, IL-1β, IL-6).Results: Winter sea bathing was associated with lower levels of self-reported stress and higher wellbeing. The ENT examinations did not reveal signs of URTIs in winter sea bathers, who exhibited significantly higher levels of salivary sIgA compared to controls. Neither salivary IL-1β nor cortisol levels were significantly different between the two groups.Conclusions: Winter sea bathers (even the elderly) had a perception of higher wellbeing and reported better health: thus, they appeared to take advantage of potential distress (cold water exposure) to improve their health. [ABSTRACT FROM AUTHOR]

Background: To present the outcomes for a case of unilateral mandibular subcondylar fracture with dislocation in an 11-year-old female treated with an acrylic splint for functional repositioning of the mandible.Clinical Presentation: A splint was placed in the upper arch to restore the functional repositioning of the mandible. The splint's height was increased up to 5.5 mm on the side of the fracture to stimulate growth on the deficient side. To correct the mandibular asymmetry, a construction bite was made by 4 mm advancing. The total treatment time was 16 months. Long-term five-year follow up showed complete healing. A portion of the ramus appeared lateral with respect to the condylar head, whereas the mandibular deviation to the right side was fully corrected.Conclusion: Conservative treatment may be an appropriate method for children in select cases, as they have an increased potential for spontaneous regeneration. [ABSTRACT FROM AUTHOR]

Objectives A decrease in Ki67 during neoadjuvant therapy predicts response to tamoxifen. Previous trials have shown a decreased Ki67 in breast tumors with as little as two or more weeks of preoperative tamoxifen. Shortening the preoperative treatment time in window of opportunity clinical trials makes these trials more attractive to women. POWERPIINC examined the effect of 7 days of preoperative tamoxifen on breast tumor proliferation and patient symptoms. Methods Women with untreated stage I/II, ER-positive, invasive breast cancer with no contraindications to tamoxifen were enrolled. Women received 20 mg of tamoxifen for 7 days up to the day of surgery. Proliferation was assessed by Ki67 immunohistochemistry before and after 7 days of tamoxifen. Symptoms and QOL were assessed by the FACT-ES and MENQOL. Adherence was measured by pill counts. Results 52 women were enrolled, and 44 were evaluable for Ki67. The median age was 58.5 years, and the median tumor diameter was 1.2 cm. Most women (73%) were post-menopausal. Most tumors were PR positive (88%) and HER2-negative (92%). The Ki67 decreased by a geometric mean of 40% (95% CI 29%–63%), and 73% (95% CI 57%–85%) of women had tumors with decreased proliferation (p = 0.0001 by paired t -test). Adherence to taking tamoxifen during the preoperative period was 100%. Women reported minimal bother from psychosocial or physical symptoms at baseline or on the day of surgery. Conclusion Seven days of tamoxifen showed a similar relative decrease in Ki67 as that reported for longer courses, was acceptable to women, and could be considered for window of opportunity studies. [ABSTRACT FROM AUTHOR]

Objectives: Oral epithelial dysplasia (OED) represents an essential challenge for clinicians, considering the possibility of oncological progression. Several studies have examined the expression of miRNAs from human specimens (blood serum/plasma, saliva, tissue) as potential diagnostic and prognostic biomarkers. Among these miR-21, miR-27b, and miR-181b have been shown to be promising. This exploratory study evaluates the different expressions of those miRNAs in the saliva of patients with oral potentially malignant disorders (OPMD) as biomarkers for oral dysplasia. Methods: Eleven patients with OPMD were enrolled at the Oral Medicine Unit of the University of Campania "L. Vanvitelli". At the examination, the salivary samples were collected. Patients were divided into subgroups based on their histopathological diagnosis and the grade of OED - WHO classification, 2017. Saliva from 10 healthy donors was used as the control. After salivary miR-21, miR-27b, and miR-181b extraction a qRT-PCR was performed. The expression of each miRNA tested was normalized by the ΔΔCt method. Statistical analysis was performed by SPSS software (ver.28.0). ΔCt difference among groups was calculated using One-way ANOVA. Post hoc tests were used for multiple comparisons. Kruskal-Wallis test was used to assess the differences within the study group. The significance level was considered at p≤0.05. Results: Four patients presented epithelial hyperkeratosis with no dysplasia, 3 were diagnosed with low-grade OED, and 4 with high-grade OED. Salivary expression of miR-21 (p=0.942) and miR-27b (p=0.945) between groups was not significant. The expression of miR-181b increased (p = 0.041) from the epithelial hyperkeratosis to the high-grade OED (mean difference 5,36 ± 1.38; p = 0.043). No difference was found between low-grade and high-grade OED (p = 0.432). In any case, in patients with high-grade OED, miR-181b was found to be over-expressed compared to controls by 6.01 folds - p = 0.004. Conclusions: Salivary miRNAs may be a promising biomarker for OED. In the present study, the expression of miR-181 correlates with high-grade OED. However, further studies with a wider sample size are needed to determine its usefulness as a salivary biomarker. [ABSTRACT FROM AUTHOR]

Purpose: Human papillomavirus (HPV) is the most common sexually transmitted virus worldwide. Our purpose was to examine people's experiences with HPV using narratives posted on a website entitled, Experience Project. Method: We conducted a content analysis of 127 HPV narratives to identify stigma, emotion-focused and problem-focused coping, and misinformation. Results: Negative self-image was the most commonly identified type of stigma. There were more instances of problem-focused than emotion-focused coping. Sources of confusion were mostly about HPV treatment and side effects/symptoms. Conclusions: These findings have implications for how nurses and other health professionals can care for individuals living with HPV. Based on these findings, it would be beneficial for clinics/providers to implement on-line forums where myths about HPV can be debunked and accurate information provided. Both patients and the public need to be better informed about HPV, in order to decrease the negative stigma that can create a mental burden for individuals with HPV. [ABSTRACT FROM AUTHOR]

Purpose. To identify potential antigenic targets for Porphyromonas gingivalis vaccine development. Materials and methods. In the present study, we analyzed the Porphyromonas gingivalis, fimA type II primary amino acid sequence and characterized the similarity to the human proteome at the pentapeptide level. Results. We found that exact peptide-peptide profiling of the fimbrial antigen versus the human proteome shows that only 19 out of 344 fimA type II pentapeptides are uniquely owned by the bacterial protein. Conclusions. The concept that protein immunogenicity is allocated in rare peptide sequences and the search the Porphyromonas gingivalis fimA type II sequence for peptides unique to the bacterial protein and absent in the human host, might be used in new therapeutical approaches as a significant adjunct to current periodontal therapies. [ABSTRACT FROM AUTHOR]

Purpose. Oral Lichen Planus (OLP) is a chronic inflammatory disease of skin and mucous membranes. Approximately 20% of women with oral lichen planus develops lesions in the genital mucosa. In 1982, Pelisse described a special form of lichen planus (LP), which consists of a triad of symptoms: vulval, vaginal and gingival (VVG)-LP lesions. Aim of the present report is to report two new cases and review the international literature. Material and methods. Two cases of VVG-LP are reported and a review of recent literature is performed. Results. The onset of erosive or ulcerative mouth lesions may precede or follow by months or even years the onset of vulvovaginal lesions. Vaginal agglutination is associated with the postmenopausal state in conjunction with a dermatologic condition. Intra-lesional corticosteroids have a role in localized chronic ulceration, while systemic therapies such as corticosteroids, azathioprine, mycophenolate mofetil, hydroxychloroquine, ciclosporin, methotrexate, retinoids, thalidomide and photo chemotherapy have been used in more severe cases with varying success. Conclusions. VVG-LP is rather a rare condition and has been documented in the literature mainly in the form of case reports. Lack of a precise diagnostic criteria of VVG-LP depends on the specialists. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to assess local vascular architecture in atrophic-erosive oral lichen planus (OLP).Materials and Methods: We investigated the capillary structure of the oral mucosa in 31 patients with OLP and 32 healthy controls. Capillaries images were captured in vivo through a capillaroscope. We applied fractal analysis to quantify the microvasculature morphometric changes in the oral mucosa of atrophic-erosive OLP patients in terms of their fractal dimension (D).Results: The oral vascular networks of atrophic-erosive OLP lesions had a significantly higher D, both in buccal mucosae (D=1.167, P=.019) and in tongue (D=1.196, P=.038), compared with the control population (1.123 for both locations, respectively).Conclusions: The present study confirms previous literature data on a close relationship between abnormal vascular architecture and atrophic-erosive OLP. Fractal analysis provided a quantitative descriptor of the complexity of the vascular patterns, which increases in the OLP samples. These data may provide new information on the OLP pathogenesis, as well as serve as morphologic quantifiers for monitoring treatment strategies. [ABSTRACT FROM AUTHOR]

• Photodynamic therapy (PDT) is treatment option for oral potentially malignant disorders. • Toluidine Blue role is still discussed as a photosensitizer in the treatment of oral mucosa lesions. • Oral Lichen Planus (OLP) is considered a oral potentially malignant disorder. • This study investigated effectiveness of toluidine blue-PDT for the treatment of OLP. Topical Photodynamic Therapy (PDT) is a minimally invasive technique used in various medical specialties. The method involves the use of a light source and a photosensitizer leading to the release of Reactive Oxygen Species and a cytotoxic effect on lesional tissue. PDT can treat various lesions , and in particular Oral Potentially Malignant Disorders (OPMD). We present a case illustrating the feasibility of PDT in the treatment of oral lichen planus (OLP). To objectively evaluate the clinical evolution, we used postproduction analysis of the photo taken before (T0), seven days after (T1), and twenty-eight days (T2) after PDT. Lesional measures were used to rate each picture on the Thongprasom score, Clinical Severity Index, and Efficacy Index. Postproduction analysis showed a significant decrease in dimensions and concomitant improvement on all evaluated scales. Our results ar in line with previous literature on the application of PDT to OPMD and specifically confirm the benefit of this therapeutic approach in OLP. Postproduction analysis appears to be a useful tool to further validate this technique. [ABSTRACT FROM AUTHOR]

Abstract: microRNAs (herein after miRNAs) represent a recently uncovered class of small and endogenous non-coding RNAs. miRNAs play a well conserved and crucial role in normal biological processes, such as cell differentiation, proliferation and apoptosis through a complicated gene regulation networking. The recent rise of interest in miRNAs in cancer research is ascribed to the breakthrough of their role in many pathological processes, including malignant transformation. miRNAs signatures have been clearly defined for certain types of cancer, with correlation to tumor aggressiveness, therapy response and patient outcome. Furthermore, the use of miRNAs as therapeutic targets for cancer is currently under investigation. The aim of this review is to focus on the role of miRNAs in breast cancer development and to summarize the evidence for their potential diagnostic and therapeutic applications in clinical practice. [Copyright &y& Elsevier]

Purpose: Cellular populations of gingival crevicular fluid cytological analysis of integrated implants sites have been investigated by using sulcular cytological brushing, as a means of providing an objective and reproducible technique for monitoring periimplant tissue health. Materials and Methods: A total of 60 patients with osteointegrated implants bearing at least for 2 years were divided in 2 groups, A and B. Group A consisted of 30 subjects who presented scarce oral hygiene. In Group B, 30 subjects with a good oral hygiene were included. Results: Comparative analysis of the data obtained by sulcular microbrushing of the 2 groups put into evidence significative differences in the expression of the microbiological and the cytological parameters. Conclusion: Clinical monitoring of parodontal and periimplant tissues makes use of several diagnostic tests ranging from clinical and radiological tests to biological assays. However, none of these techniques allows to evaluate periimplant tissue cytological status. This preliminary study suggested sulcular microbrushing might be a useful tool in the early diagnosis and in the micrological monitoring of peri-implantitis. [ABSTRACT FROM AUTHOR]

Objective: This pilot study evaluated the baseline effectiveness of a novel handheld fluorescent confocal microscope (FCM) specifically developed for oral mucosa imaging and compared the results with the literature. Study Design: Four different oral sites (covering the mucosa of the lip and of the ventral tongue, the masticatory mucosa of the gingiva, and the specialized mucosa of the dorsal tongue) in 6 healthy nonsmokers were imaged by an FCM made up of a confocal fiberoptic probe ergonomically designed for in vivo oral examination, using light at the wavelength of 457 nm able to excite the fluorophore acriflavine hydrochloride, topically administered. In total, 24 mucosal areas were examined. Results: The FCM was able to distinctly define epithelial cells, bacterial plaque, and inflammatory cells and to image submucosal structures by detecting their intrinsic fluorescence. Conclusions: When compared with other devices, this FCM allowed the user to image each oral site at higher magnification, thus resulting in a clearer view. [Copyright &y& Elsevier]

Abstract: Fibrous histiocytomas are uncommon mesenchymal tumours of the soft tissue in the head and neck region. We report two cases that occurred in the oral cavity, one of a benign fibrous histiocytoma (BFH) and another of an angiomatoid variant of fibrous histiocytoma (AFH). BFH is a benign neoplasm composed of cells with fibroblastic and histiocytic characteristics, while AFH is considered as a distinct type of fibrous histiocytoma with an intermediate malignancy grade that combines features of both fibrohistiocytic and vascular neoplasm. We describe the clinicopathological and histological characteristics of these lesions to clarify and facilitate their diagnosis. In the BFH case, the surgical specimen had many histiocytes positive for lysozime, whereas the AFH cells showed positivity for endothelial cell marker (anti-CD34 antibody). In both cases the tumours were positive for fibronectin and negative for S100 and SMA. Ki-67. Immunohistochemistry was performed in all cases to reveal the different mitotic activity between AFH and BFH tumour cells. Finally, differential diagnoses and therapeutic treatments are discussed. [Copyright &y& Elsevier]

Background: Lichen planus with simultaneous oral and genital involvement in males is a quite rare condition and often difficult to diagnose. The prevalence, treatment options, and management for this condition are far from being established, and research in this area primarily relies on anecdotes. We present the clinical features of eight cases of peno-gingival lichen planus and propose a management algorithm for this condition based on the best available published evidence.Methods: Personal medical history was collected for all cases. Following careful examination of the oral and genital mucosae, pathology was obtained, previous treatments and duration of mucosal lesions ascertained, treatment initiated, and response evaluated at 8 weeks on both oral and genital lesions. The first-line drug was topical clobetasol propionate 0.05% cream in all cases; in case of failure, topical cyclosporin was used. A review of the literature on treatment options for this rare condition was performed based upon standard literature review practices.Results: Five cases presented gingival lesions that clinically resembled lichen planus. Glans penis was involved in all patients. All patients responded to treatment except for one. Oral candidiasis was the only observed side effect.Conclusions: Genital lichen planus may be suspected in males when atrophic-erosive gingival lichen planus is found. A thorough multidisciplinary medical management and active early treatment are necessary to improve symptoms and prevent genital sequelae and, given the risk of squamous cell carcinoma, as a preventative strategy, although this area still needs investigation. Therapeutic trials relating to the treatment of peno-gingival lichen planus may be undertaken considering that current management relies exclusively on observations of case reports. [ABSTRACT FROM AUTHOR]

A foreword to the March 1, 2002 issue of "The Journal of Egyptian Archaeology" is presented.