Search

Background There is a need for a novel therapeutic strategy for an earlier prediction of long bone union failure as compared to previous methodologies. This study aimed to determine whether a combination of two diagnostic tools would result in a more accurate diagnosis of delayed union. Methods The inclusion criteria were as follows: patients with tibial shaft fracture who underwent treatment with intramedullary nailing (IMN) as definitive internal fixation (IF). The study included a total of 114 patients with 116 tibial shaft fractures treated with IMN as definitive IF. Radiographic apparent bone gap (RABG) and nonunion risk determination score (NURDS) can be used to predict nonunion. However, this study aimed to determine whether combination of RABG and NURDS could help deduce a more accurate prediction of delayed union. Results The union rate was found to be 85% (99 fractures), the delayed union rate was found to be 15% (17 fractures), and the rate of nonunion requiring additional surgical intervention was estimated to be 4% (5 out of the 17 delayed union cases). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RABG were found to be 82.3%, 76.0%, 36.8%, and 96.2%, respectively, when an RABG cutoff value of 5.0 mm was applied to our patient cohort. The sensitivity, specificity, PPV, and NPV of NURDS were found to be 47.1%, 82.0%, 30.8%, and 90.1%, respectively, when a NURDS cutoff value of 8.0% was applied to our patient cohort. When RABG and NURDS were above their respective cutoff values, the sensitivity and PPV were estimated to be 90.0% and 56.3%, respectively. When RABG and NURDS were below their respective cutoff values, the specificity and NPV were estimated to be 90.1% and 98.5%, respectively. Conclusions The combination of RABG and NURDS evaluation immediately after surgery helps surgeons identify patients who are at a high risk of delayed union, facilitating careful monitoring of these patients and consideration of additional treatments.

Introduction The AO/OTA classification for diagnosing femoral trochanteric fractures (31A fractures) was revised in 2018. No studies have investigated whether the addition of CT to radiographic diagnosis improves the inter-rater reliability of classifying 31A fractures with the current AO/OTA criteria. The study aimed to test the hypothesis that the addition of three-dimensional CT (3D-CT) to radiographic diagnosis would improve diagnostic reliability. Methods A retrospective review was conducted to assess the diagnostic reliability of classification of 31A fractures with current AO/OTA criteria. Radiographs and 3D-CT images from 89 cases were assessed. Major fracture types (A1, A2, and A3) and subgroups were diagnosed by nine orthopedic surgeons who were classified into three groups (high-, intermediate-, and low-experience) according to their clinical experience. Anterior–posterior and lateral radiographs were provided to diagnose fracture type (first assessment). After a 6-week interval, radiographs and 3D-CT images of all cases were evaluated by each rater (second assessment). Fleiss's Kappa was used to determine inter-rater reliability. Results In the first assessment, the Kappa value indicated fair inter-rater reliability in all groups (high-experience group: κ = 0.296, 95% confidence interval [CI] 0.239–0.352; intermediate-experience group: κ = 0.367, 95% CI 0.305–0.428; low-experience group: κ = 0.304, 95% CI 0.246–0.362). With the addition of 3D-CT (second assessment), reliability improved from fair to moderate in the high- and intermediate-experience groups (κ = 0.483, 95% CI 0.428–0.539 and κ = 0.409, 95% CI 0.352–0.466, respectively). By contrast, reliability remained fair in the low-experience group (κ = 0.322, 95% CI 0.322–0.431). The inter-rater reliability of diagnosing subgroup fracture types improved for A2.3 and A3.1 in all three groups and for A3.2 and A3.3 in the intermediate- and low-experience groups. Conclusion The current AO/OTA classification revised in 2018 provided fair reliability in diagnosing femoral trochanteric fractures in all three surgeon groups. The addition of 3D-CT to radiographic image evaluation improved reliability in high- and middle-expertise groups. The addition of 3D-CT to radiographic evaluation often improved the diagnostic reliability for unstable fractures, although there was some variation among fracture subgroups.

Background Post-traumatic shoulder stiffness is not a rare condition. However, no study has been performed to investigate the dynamic magnetic resonance imaging (MRI) findings of post-traumatic shoulder stiffness. Therefore, the current preliminary study was performed to investigate the dynamic MRI findings in patients with post-traumatic shoulder stiffness. Methods We retrospectively analyzed the data of patients with post-traumatic shoulder stiffness. The patients’ baseline characteristics, range of active shoulder motion, shoulder pain, and location of abnormal enhancement on dynamic MRI were assessed. Results Five patients (two men, three women) with post-traumatic shoulder stiffness were included in this study. Their mean age was 58.6 ± 6.3 years (range, 49–68 years). All patients had abnormal enhancement in the rotator interval and axillary pouch. Conclusions This study presents the first case reports of the dynamic MRI findings of post-traumatic shoulder stiffness. All patients had abnormal enhancement at the rotator interval and axillary pouch.

Background Prognostic factors for fatal outcomes of patients with necrotizing fasciitis remain unclear. Methods We retrospectively analyzed data of patients with necrotizing fasciitis from January 1998 to July 2019 using our hospital's medical database. Clinical characteristics of patients who died during hospitalization or had been discharged were evaluated. Sex, age, body mass index, smoking history, alcohol use, comorbidities (diabetes mellitus, arteriosclerosis obliterans, heart disease, obstructive arteriosclerosis, dialysis, cancer, skin disease, steroid use history), shock vital, physical findings, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, sepsis, disseminated intravascular coagulation, fascial administration, tracheal intubation, and surgical treatment (dismemberment and/or debridement) were compared between the survivor (group S) and nonsurvivor (group N) groups. Results Fifty-five patients with necrotizing fasciitis were included (40 patients in group S and 15 patients in group N). Serum creatine was a significant prognostic factor (odds ratio [OR], 3.03; 95% confidence interval [CI], 0.15–0.75; P = 0.0078), with a cutoff value of 1.56 mg/dL. Moreover, the estimated glomerular filtration rate was a significant prognostic factor (OR, 1.06; 95% CI, 1.02–1.10, P = 0.000548), with a cutoff value of 20.6 mL/min. Conclusion Renal dysfunction is a significant prognostic factor for fatal outcomes of patients with necrotizing fasciitis. Level of Evidence Level IV, Case series.

Background A tibial plateau fracture is one of the most challenging fractures for both knee and trauma surgeons because of the high incidence of post-traumatic knee osteoarthritis. To our knowledge, there has been no study concerning the clinical outcomes after surgery in patients with non-union of complex intra-articular tibial plateau fractures. Thus, the present study aimed to assess and report the clinical outcomes in them. Methods The study included four patients with non-union of complex tibial plateau fractures who underwent failed initial fixation treatment or could not undergo initial fixation owing to concomitant injury and who were followed up with a diagnosis of non-union for a minimum of 6 months. At the latest follow-up, patient-reported outcome measures, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford 12-item Knee Score (OKS), were assessed. Additionally, the knee range of motion (ROM) was evaluated. Results The mean duration from the initial surgery to revision surgery was 8.8 months, and the mean duration from the revision surgery to fracture union was 4.8 months. At the latest follow-up, the mean WOMAC score was 9.8 and the mean OKS was 43.5. Additionally, the mean knee ROM values were −11 degrees of extension and 100 degrees of flexion. All four patients had become able to walk without any aid after averaged 4.5-years follow up. Conclusion Favorable clinical outcomes can be achieved following revision surgery involving open reduction and IF in patients with non-union of complex tibial plateau fractures after failed initial treatment. Level of evidence Level IV, Case report.

Infected non-union of subtrochanteric fractures is challenging to treat. We experienced two cases and had good clinical results. Treatment strategy comprised debridement without hesitation after considering later limb lengthening; insertion of the proximal lateral bone edge spike into the distal bone marrow cavity until achieving medial-side bony contact and holding good alignment to compensate for the medial-side bone loss, according to the modified Dimon method; and internal fixation with an angled plate in the decubitus position. The angle of the angled plate should be directed toward the abundant cancellous bone using preoperative computed tomography. Residual limb shortening after ORIF was improved by limb lengthening. Keywords: Subtrochanteric fracture, Fracture non-union, Infected non-union, Modified Dimon method

Rat heme-binding protein 23 (HBP23)/peroxiredoxin (Prx I) belongs to the 2-Cys peroxiredoxin type I family and exhibits peroxidase activity coupled with reduced thioredoxin (Trx) as an electron donor. We analyzed the dimer-oligomer interconversion of wild-type and mutant HBP23/Prx I by gel filtration and found that the C52S and C173S mutants existed mostly as decamers, whereas the wild type was a mixture of various forms, favoring the decamer at higher protein concentration and lower ionic salt concentration and in the presence of dithiothreitol. The C83S mutant was predominantly dimeric, in agreement with a previous crystallographic analysis (Hirotsu, S., Abe, Y., Okada, K., Nagahara, N., Hori, H., Nishino, T., and Hakoshima, T. (1999) Proc. Natl. Acad. Sci. U. S. A. 96, 12333-12338). X-ray diffraction analysis of the decameric C52S mutant revealed a toroidal structure (diameter, approximately 130A; inside diameter, approximately 55A; thickness, approximately 45A). In contrast to human Prx I, which was recently reported to exist predominantly as the decamer with Cys(83)-Cys(83) disulfide bonds at all dimer-dimer interfaces, rat HBP23/Prx I has a Cys(83)-Cys(83) disulfide bond at only one dimer-dimer interface (S-S separation of approximately 2.1A), whereas the interactions at the other interfaces (mean S-S separation of 3.6A) appear to involve hydrophobic and van der Waals forces. This finding is consistent with gel filtration analyses showing that the protein readily interconverts between dimer and oligomeric forms. The C83S mutant exhibited similar peroxidase activity to the wild type, which is exclusively dimeric, in the Trx/Trx reductase system. At higher concentrations, where the protein was mostly decameric, less efficient attack of reduced Trx was observed in a [(14)C]iodoacetamide incorporation experiment. We suggest that the dimerdecamer interconversion may have a regulatory role.

Although placental proteins play multiple roles in fetal and placental development and in the maintenance of pregnancy, many remain inadequately characterized. In the present study, we comprehensively analyzed these proteins by using a proteomic approach. Samples were denatured with guanidine hydrochloride, which was found to be superior to the commonly used urea for the present purpose, and subjected to 2-dimensional (2D) electrophoresis (2-DE) to obtain placental proteome maps. The identified protein spots (ca. 60% of the total) on the proteome maps included several pregnancy-related proteins (PRPs). Furthermore, a novel 2D immunoblotting (2-DI) analysis of molecules related to pre-eclampsia revealed three immunopositive spots that appeared to correspond to dynactin p-50, a protein related to cell turn-over. The rate of positivity for dynactin p-50-reactive antibodies was significantly (P = 0.0024) higher in 26 pre-eclamptic women than in 58 normally pregnant women. These results indicate that dynactin p-50 may be involved in the pathophysiology of pre-eclampsia.

Rat 3-mercaptopyruvate sulfurtransferase (MST) contains three exposed cysteines as follows: a catalytic site cysteine, Cys247, in the active site and Cys154 and Cys263 on the surface of MST. The corresponding cysteine to Cys263 is conserved in mammalian MSTs, and Cys154 is a unique cysteine. MST has monomer-dimer equilibrium with the assistance of oxidants and reductants. The monomer to dimer ratio is maintained at ∼92:8 in 0.2 m potassium phosphate buffer containing no reductants under air-saturated conditions; the dimer might be symmetrical via an intersubunit disulfide bond between Cys154 and Cys154 and between Cys263 and Cys263, or asymmetrical via an intersubunit disulfide bond between Cys154 and Cys263. Escherichia coli reduced thioredoxin (Trx) cleaved the intersubunit disulfide bond to activate MST to 2.3- and 4.9-fold the levels of activation of dithiothreitol (DTT)-treated and DTT-untreated MST, respectively. Rat Trx also activated MST. On the other hand, reduced glutathione did not affect MST activity. E. coli C35S Trx, in which Cys35 was replaced with Ser, formed some adducts with MST and activated MST after treatment with DTT. Thus, Cys32 of E. coli Trx reacted with the redox-active cysteines, Cys154 and Cys263, by forming an intersubunit disulfide bond and a sulfenyl Cys247. A consecutively formed disulfide bond between Trx and MST must be cleaved for the activation. E. coli C32S Trx, however, did not activate MST. Reduced Trx turns on a redox switch for the enzymatic activation of MST, which contributes to the maintenance of cellular redox homeostasis.

The purpose of this study was to investigate the association of the expression of vascular endothelial growth factor-C (VEGF-C) with regional lymph node metastasis in oral squamous cell carcinoma (OSCC). The expression of VEGF-C in biopsy specimens obtained from 62 patients with OSCC was examined by immunohistochemistry. In the early stages of T1 and T2 (38 cases), VEGF-C expression strongly correlated with lymph node metastasis (P

In this study, we examined the expression of cyclins, cyclin dependent kinase (CDKs) and CDK inhibitors by immunohistochemical analysis in 20 normal mucosa, 42 epithelial dysplasia (ED), and 117 oral squamous cell carcinoma. Neither Cyclin D1 nor CDK2 were detectable in normal tissue and ED. Their presence, however, was detectable in squamous cell carcinoma (SCCs) (Cyclin D1, 35.9%; CDK2, 66.7%). Cyclin E was detectable in 57.1% of severe ED and 62.8% of SCCs. For the CDK inhibitors, these proteins were detectable in all normal mucosa and most of the mild and moderate ED. For severe ED, expression of these proteins was not observed in some cases (p12(DOC-1), 14.3%; p16(INK4A), 28.6%; p27(KIP1), 7.1%). For SCCs, the expression of p12(DOC-1) was lost in 71.8%, p16(INK4A) in 69.2% and p27(KIP1) in 35.9%. These results suggest that elevated expression of cyclin D1, cyclin E, CDK2 and loss of p12(DOC-1), p16(INK4A) and p27(KIP1) may contribute to the multistep nature of oral carcinogenesis.

Connective tissue growth factor (CTGF) is known to be a potent angiogenic factor. Here, we present the evidence that the hypoxic induction of angiogenesis by human breast cancer cells (MDA-231) can be ascribed at least in part to CTGF. Our results indicate that (i) CTGF is abundantly present in MDA-231 cells in vitro and in vivo, (ii) its secretion is up-regulated by hypoxia, and (iii) its gene expression is enhanced in MDA-231 cells cultured under hypoxic conditions. These data suggest CTGF may stimulate angiogenesis by paracrine mechanisms, thereby contributing to the invasion of breast cancer cells. This is the first evidence that human cancer cells differentially express CTGF protein and mRNA under the control of hypoxic conditions.

Objective. The purpose of this study was to discriminate radiographically between dentigerous cysts (DCs) and odontogenic keratocysts (OKCs) associated with a mandibular third molar. Study design. The material consisted of panoramic radiographs of dentigerous cysts (44 patients, 45 cysts) and odontogenic keratocysts (15 patients, 16 cysts), all of which were related to a mandibular third molar. The radiographic images were analyzed with reference to the patients’ ages and symptoms. Results. The mean age of patients in the OKC group was less than that of patients in the DC group. The mean area of the cysts in the OKC group was larger than that of those in the DC group. The mean distance from the second to the third molar in the DC group was greater than that in the OKC group. Although there was a significant correlation between the area and distance in the DC and OKC groups, the patients’ ages did not significantly correlate to the area and distance of either cyst. Conclusions. The OKCs had a tendency toward rapid growth in the patient’s youth but short movement of a third molar compared with the DCs. The DCs and OKCs do not appear to develop gradually from the period when follicles or dental lamina were formed but arise at various periods randomly. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:743-7)

Many studies focused on the tumour thickness in oral squamous cell carcinomas, suggesting a relationship with the occurrence of cervical metastasis. Accurate preoperative assessment of the tumour thickness of oral cancer would provide useful information for targeting those patients who need elective treatment of the neck. Some useful diagnostic aids to evaluate oral cancer are computed tomography (CT), magnetic resonance imaging (MRI), and intraoral ultrasonography. The purpose of the present study is to compare intraoral ultrasonography with CT and MRI in delineating the disease extent and in measuring the tumour thickness of oral carcinoma. Thirty-nine patients with oral cancer were preoperatively evaluated with intraoral ultrasonography, and CT, and in 26 of them MRI was carried out. High-quality ultrasonographic images were obtained and the tumour thickness was measured within 1 mm. However, in most tumours less than 5.0 mm in thickness, CT and MRI could not detect a sufficient density difference from the normal tissue to accurately delineate the extent of the tumour. There was a significant correlation between measurements by intraoral ultrasonography and the histological sections. The present study shows that ultrasonography is superior to CT and MRI in assessment of the primary lesion of oral carcinoma.

p16 INK4A inactivation was analyzed in ten squamous cell carcinoma (SCC) cell lines and 32 primary SCCs, using the polymerase chain reaction (PCR), PCR–single-strand conformation polymorphism, methylation-specific PCR, and cycle sequencing. In the study of cell lines, we detected three deletions in exon 1α and exon 2, and detected two methylations. Among tumor samples, we detected the homozygous deletions (HDs) of 43.8% in exon 1α 34.4% in exon 2, and methylation was found in 50.0%. The lack of p16 INK4A with immunohistochemistry was detected in 71.9% and matched the alteration of p16 INK4A gene. These results suggest that p16 INK4A inactivation is predominantly caused by HD and methylation, and immunohistochemical evaluation of p16 INK4A is a useful method.

This study was carried out to elucidate whether apoptosis and p53 can be used to stratify oral cancer patients into groups with a favorable or unfavorable response to preoperative radiation therapy. Thirty-two patients were evaluated. The apoptosis index was 1.7+/-0. 9% in the ineffective cases, and it was significantly lower than effective cases (3.2+/-1.2%). While 14 of 16 effective cases (86.7%) did not express p53, 13 of 16 ineffective cases (81.3%) overexpressed p53. These results suggest that mutated p53 in tumors is associated with a poor response to radiation which may be related to evasion of apoptosis in oral cancer.

The mechanism of osteolysis associated with metastatic cancer of the jaws is essentially osteoclast-mediated. Therefore, it is likely that potent osteoclastic bone resorption inhibitors such as bisphosphonates would be efficacious for the treatment of jaw metastasis. We examined the effects of a third generation bisphosphonate, YM175, in a nude mice jaw metastasis model with intracardiac injection of a human breast cancer cell line, MDA-MB-231. The metastatic lesions in untreated mice were radiographically observed at the body and angle of the mandible. Histology of the mandible of untreated mice revealed that most of the bone marrow cavities had been occupied by the metastatic tumor with active osteoclasts along the trabecular bone. The experimental group showed that YM175 markedly reduced the size of tumor and the number of osteoclasts. These results suggest that YM175 may suppress metastasis formation and tumor growth in jaw through inhibition of osteoclastic bone resorption.

doc-1 is a putative tumor suppressor gene isolated and identified from the hamster oral cancer model. Here, we report the molecular cloning and the functional characterization of the human ortholog of the hamster doc-1 gene. Human doc-1 cDNA is 1.6 kilobase pairs in length and encodes for a 115-amino acid polypeptide (12.4 kDa, pI 9. 53). Sequence analysis showed 98% identity between human and hamster doc-1 protein sequences. DOC-1 is expressed in all normal human tissues examined. In oral keratinocytes, expression of DOC-1 is restricted to normal oral keratinocytes. By immunostaining of normal human mucosa, DOC-1 is detected in both the cytoplasm and nuclei of basal oral keratinocytes; while in suprabasilar cells, it is primarily found in the nuclei. Human oral cancers in vivo did not exhibit immunostaining for DOC-1. Like murine DOC-1, human DOC-1 associates with DNA polymerase alpha/primase and mediates the phosphorylation of the large p180 catalytic subunit, suggesting it may be a potential regulator of DNA replication in the S phase of the cell cycle. Using a human doc-1 cosmid as a probe, human doc-1 is mapped to chromosome 12q24. We identified four exons in the entire human doc-1 gene and determined the intron-exon boundaries. By polymerase chain reaction and direct sequencing, we examined premalignant oral lesion and oral cancer cell lines and found no intragenic mutations.

1. Lustman J, Milhem J: Mandibular fractures in infants: Review of literature and report of seven cases. J Oral Maxillofac Surg 52:240, 1994 2. Kaban LB: Diagnosis and treatment of fractures of the facial bones in children 1943-1993. J Oral Maxillofac Surg 51:722, 1993 3. Thaller SR, Mabourakh S: Pediatric mandibular fractures. Ann Plast Surg 26:511, 1991 4. Waite DE: Diagnosis and treatment pediatric fractures of jaw and facial bones. Pediatrics 51:551, 1973 5. Cherick DG, Buchman SR, Patel PP: Pediatric facial fractures: Analysis of differences in subspecialty care. Plast Reconstr Surg 102:28, 1998 6. Monks FT: A fractured mandible in the newborn. Br J Oral Surg 14:270, 1977 7. Ahluwalia TPS, Sandu SS, Kapila BK: Mandibular fracture in a 4-week-old infant. J Indian Dent Assoc 55:269, 983 8. York BV: Management of mandibular fracture in 3-week-old infant: Report of case. J Oral Surg 28:857, 1970 9. Chidzonga MM: Mandibular fracture in a neonate: Report of a case. J Oral Maxillofac Surg 54:1452, 1996 10. Priest HJ: Treatment of a mandibular fracture in a neonate. J Oral Maxillofac Surg 47:77, 1989

Purpose: This report reviews the results and complications of immediate reconstruction using a single stainless steel A-O plate after resection of mandibles invaded by malignant tumors. Patients and Methods: Thirty-four patients were retrospectively evaluated. According to the extent of the tumor, hemimandibulectomy or segmental resection were performed in 4 and 30 cases, respectively. Five of 34 cases required a myocutaneus flap to close soft tissue defects. Results: Nine of the 34 patients died during the follow-up period. Complications occurred in 7 of these patients: plate exposure was caused by local tumor recurrence (4 cases), screw loosening (1 case), and temporomandibular joint pain (2 cases). Twenty-five of the 34 patients (73.5%) were alive, with a mean follow-up of 47.4 months (range 6 to 115 months). Eighteen of the 25 surviving patients with the single A-O plate reconstruction did not show any complications. Thirteen of these (52%) patients had not undergone secondary reconstruction. Five of the 25 patients received secondary reconstruction for cosmetic or masticatory function reasons. Postoperative complications occurred in 7 of the 25 surviving patients (28%): extraoral plate exposure (2 cases), fracture of the plate (1 case), mandibular fracture (1 case), screw loosening (3 cases), and screw fracture (1 case). Conclusions: On the basis of the findings, it was concluded that a single A-O reconstruction plate can be used for temporary, or sometimes even permanent, reconstruction after mandibular resection.

The calcifying odontogenic cyst (COC) was first recognized by Gorlin et al’ in 1962 and described by the World Health Organization’ in 1971 as a cystic lesion that shows an epithelial lining with a well-defined basal layer of columnar cells, an overlying layer that may resemble the stellate reticulum, and masses of ghost cells. A carcinoma forming in a COC was originally shown in the same publication on odontogenie tumors.’ The term odontogenic ghost cell carcinoma (OGCC)” was used later to defined this rare entity that has features of COC and an infiltrative pattern, epithelial cell atypia (pleomorphic epithelial cells with pleomorphic and vesicular nuclei), numerous mitoses, and necrotic foci. Only six cases of simultaneous occurrence of COC and its malignant transformation have been reported in the English language literature.2*4-7 The present article describes a case of OGCC of the maxilla in a 72-yearold woman and discusses the treatment and prognosis of the cases previously reported.

The effects produced in vitro by minocycline (MINO), aminobenzyl penicillin (ABPC) and cefotiam (CTM) on polymorphonuclear leukocytes (PMN) chemotaxis were investigated in this study using the Boyden chamber technique and polarization assay. The following results were obtained: CTM brought about a significant increase of PMN chemotaxis at the therapeutic dose (10, 100 micrograms/ml), MINO reduced PMN chemotaxis significantly at a concentration as low as 1 microgram/ml and ABPC did not influence PMN chemotaxis at concentrations up to 100 micrograms/ml in both methods. Furthermore, using a checkerboard assay, it was shown that CTM worked as a chemokinetic factor.

The nm23 gene is a potential metastasis suppressor gene originally identified using a murine melanoma cell line. Immunohistochemical investigation on the role of nm23 gene product (nucleoside diphosphate kinase: NDPK) in squamous cell carcinomas of the oral cavity was performed and compared to clinical and histopathological factors. The stainability of NDPK did not correlate to tumour extent, differentiation and mode of invasion. However, the NDPK positive group tended to have a lower frequency of lymph node metastasis, and a better prognosis than the NDPK negative group. Consequently, nm23/NDPK is suggested to be a metastasis suppressor factor that may be useful for predicting tumour metastasis and prognosis in oral squamous cell carcinoma.