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Mixed odontogenic tumors comprise a rare group of lesions ranging from hamartomas to true neoplasms. Ameloblastic fibroma (AF) predominantly affects the posterior mandible of children, presenting as a well-defined expansile radiolucency. Ameloblastic fibro-odontoma and fibrodentinoma (AFO/AFD) represent odontogenic tumors with similar features to AF that also show enamel and dentin formation. Many authors believe that some of them may be developing odontomas; however, cases with aggressive features support a neoplastic counterpart. Ameloblastic fibrosarcoma (AFS) represents the malignant counterpart of AF in which only the ectomesenchymal component shows features of malignancy. There is an ongoing debate whether AFO/AFD should be considered separate entities. Herein, we report the clinicopathologic features of a large series of AF, AFO/AFD, and AFS to provide insight into their biologic behavior and additional evidence for further classification. Clinical and radiographic data were retrieved from the archives of four oral pathology services, between 1991 and 2023. Deidentified slides were reviewed by two independent oral pathologists. Seventy-five cases were identified as follows: AF = 39 cases, AFO/AFD = 29 cases, AFS = 7 cases. Forty-two patients were male and 33 were female. The average ages for AF, AFO/AFD, and AFS were 14.7, 11.9, and 28.7, respectively. Tumors predominantly affected the posterior mandible as asymptomatic unilocular radiolucent or mixed lesions with an average size of 6 cm, causing tooth impaction and cortical expansion. Microscopically, all cases presented with cellular mesenchymal components resembling dental papilla containing branching strands and islands of odontogenic epithelium. AFOs/AFDs also showed dental hard tissue. AFS exhibited increased stromal hypercellularity with marked pleomorphism and fewer ameloblastic islands. Rare tumors were identified including the association of AF with calcifying odontogenic cysts and cemento-ossifying fibroma. This study represents one of the largest well-documented series of AF, AFO/AFD, and AFS, contributing additional clinicopathologic findings. [ABSTRACT FROM AUTHOR]

Foreign body gingivitis (FBG) is an inflammatory reaction associated with the presence of foreign material in the gingival tissues. Si is the element most prevalent in the foreign particles and is typically found in nature as SiO2 (silica). Silica is a major component of toothpaste, pumice, polishing paste, and carborundum. We have previously reported a significant association between the presence of foreign particles and epithelial dysplasia. Herein, we aim to evaluate the clinical and histologic features of additional gingival lesions of FBG with significant epithelial changes to better characterize the histologic spectrum of the host response and epithelial findings. Fourteen gingival lesions showing FBG and significant epithelial changes were retrieved from the archives of the Texas A&M Oral Pathology Services. Clinical records and deidentified microscopic slides were reviewed. Both sexes were affected equally, with an average age of 68.7 years. There was a strong predilection for the posterior gingiva (92.9% of cases), and the lesions were clinically suspected to be leukoplakia, proliferative verrucous leukoplakia, or dysplasia in the majority of cases. Microscopically, the predominant inflammatory cell type was lymphocytes followed by plasma cells, and the pattern of inflammation was lichenoid in 64.2%. A verrucous architecture was seen in 57.1% of the cases and varying degrees of dysplasia in 71.4 %. Although the effects of silica microparticles in oral tissues are poorly understood, they have been shown to cause significant changes such as silicosis and carcinoma in the lung. Given the recent increase in the prevalence of gingival carcinomas and the wide use of nano- and microparticles in dental and household products, the biological effects of these particles in oral epithelium need to be better elucidated. Further documentation and evidence are needed, and pathologists should evaluate and document all gingival premalignant lesions for foreign material. [ABSTRACT FROM AUTHOR]

Idiopathic gingival papillokeratosis with crypt formation (IGPCF) is an uncommon condition of unknown etiology, characterized by keratotic plaques in the upper labial attached gingiva of young patients. No treatment is required, although periodic follow-up is recommended as some lesions persist. Despite the limited number of published cases, the diagnosis of IGPCF is highly suggestive based on the distinctive clinical features, and biopsy is usually unnecessary. We aim to report seven additional patients with IGPCF from Brazil and the United States. Seven IGPCF cases were retrieved from the archives of the Oral Pathology Laboratories from the Federal University of Rio de Janeiro, Brazil, and Texas A&M University, USA, between 2017 and 2023. Six patients were male, and one patient was female, with an average age of 15.8 years (ranging from 12 to 21). All patients presented with asymptomatic bilateral papillary white plaques located exclusively in the attached anterior gingiva with a duration ranging from 4 to 12 months. Six cases presented in the maxillary labial gingiva, whereas a single case was located in the mandibular labial gingiva. Clinically, the lesions appeared as well-demarcated symmetric white plaques with an irregular surface, stopping abruptly at the mucogingival junction. Incisional biopsies were performed on six patients with exuberant lesions, while an exclusively clinical diagnosis was established in a single patient with discrete plaques. Microscopic analysis revealed gingival mucosa showing overlying parakeratosis with papillary architecture and multifocal epithelial crypt-like invaginations with parakeratin plugging. Mild pseudoepitheliomatous hyperplasia was noticed, with no signs of epithelial atypia. Clinicians should be aware of IGPCF and differentiate it from other papillary keratotic oral lesions. Reporting additional cases may provide further characterization of this unusual entity and improve understanding as it relates to etiology and prognosis. [ABSTRACT FROM AUTHOR]

There is a growing consensus favouring earlier use of highly effective disease modifying therapies (DMTs) in paediatric-onset multiple sclerosis (POMS). Real-world effectiveness data on ocrelizumab, a humanised monoclonal antibody that selectively depletes CD20+ B cells in POMS is limited. A prospective study was conducted including consecutive paediatric MS patients (<18 years) from three UK tertiary paediatric neurosciences centres who received ocrelizumab. Paired two-tailed t-test was used to compare annualised relapse rate (ARR), Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT) pre and on treatment. A total of 60 POMS patients were included; of which 49 were females (83%), 41werenon-white (68%), and median age was 14.6 years (interquartile range 13.3-15.5). Median follow-up was 1.0 yr (range, 0.1-2.6). Forty-three (72%) patients had ocrelizumab as their first DMT. Two patients relapsed within one month of starting ocrelizumab and 1 patient had an optic neuritis 6-months post ocrelizumab initiation. During the follow-up period, a median of 2 (range 1-5) repeated magnetic resonance imaging (MRI) scans were performed. Forty (93.0%) patients achieved no evidence of disease activity (NEDA-3) at 12-months follow-up; two patients had one new brain lesion each at 6-months and a different patient had optic neuritis without new brain lesions at 6-months post-treatment. Median EDSS score remained stable during follow-up; 1.0 at baseline and follow-up (p=0.21). In addition, there was no change in cognitive measures at follow-up; baseline SDMT mean score 48 (p=0.39). Infusion-related-reactions were most common adverse event (33/60, 55%), all of which were grade 1/2. This study confirms that ocrelizumab, which is proven efficacious for adults with MS, is also effective in POMS with a comparable safety profile. Assessment for long-term efficacy and safety is ongoing. [ABSTRACT FROM AUTHOR]

Introduction. Epithelial-mesenchymal transition (EMT) is a complex biologic process by which epithelial cells lose their cytomorphologic characteristics and assume the phenotype of mesenchymal cells. EMT is essential to normal human embryogenesis, and also occurs in wound healing, tissue repair and cancer progression. Acquisition of a mesenchymal phenotype via EMT enhances the migratory capacity of carcinoma cells, increasing their metastatic capability and worsening prognosis for patients. One emerging marker of EMT is brachyury, a T-box transcription factor protein. Recent studies have demonstrated upregulation of brachyury in several carcinoma types, includ- ing squamous cell carcinoma (SCC). Spindle cell carcinoma (SpCC) is a variant of SCC in which cancer cells have a predominantly spindled phenotype. Whether brachyury is expressed in SpCC and contributes to this pheno- typic change is not clear. Objective.To examine brachyury expression by immunohistochemistry in SpCC of the head & neck, hypothesizing that brachyury expression is increased in SpCC, as compared with other forms of SCC. Methods.Immunohistochemical staining for brachyury was performed on 20 head and neck carcinoma cases per group in each of four groups: SpCC; moderately- to well-differentiated SCC; moderately- to poorly-differentiated SCC; and verrucous carcinoma (VC). Uninflamed fibroma was the negative control; and human chordoma, along with a 14.5-day-old mouse embryo, were positive controls. Evaluation of brachyury reactivity was completed by light microscopy. Results.Brachyury expression was not seen in any of the experimental groups. Nuclear reactiv- ity was present in both positive controls, including within chordoma cells, and within the nucleus pulposus of the mouse embryo. Conclusions.Brachyury does not appear to be involved in the cytomorphologic changes present in SpCC, nor is it expressed in any head & neck SCC variants. Our results are contrary to those found in previous reports. This result supports the hypothesis that an alternate mechanism contributes to the phenotype of SpCC. [ABSTRACT FROM AUTHOR]

This cross-sectional study examined risk and asset factors thought to be associated with fighting among a sample of 1,642 African American children and adolescents in a central Alabama school district. Results show that poor grades, parental abuse, and gang affiliation were significant risk factors associated with higher frequency of fighting. Results also show that parental monitoring and being happy at school were associated with lower frequency of fighting, suggesting the importance of continued support for outreach to parents and further efforts to reduce or eliminate the community factors that promote proliferation of gangs. Programs, either for an entire community or a school system within a community, must be sensitive to the specific risks, assets, and outcomes of that environment so that prevention and intervention are sensitive to cultural, environmental, and demographic distinctions in target populations. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The main goal of the study was to analyze youth's externalizing problem behaviors based on a risk and protective factors framework in two different cultural settings. METHOD: Data were collected among secondary school students in Szeged, Hungary (N=1240) and in Birmingham, AL, USA (N=1538). The self-administered questionnaires contained items on youth's externalizing problem behaviors as well as risk and protective factors. RESULTS: In both samples, first year students in secondary (high) schools and boys reported greater levels of problem behaviors. Multiple regression analyses revealed that substance use, gang membership and low academic achievement were consistent risk factors and associated with higher reporting levels of problem behaviors in both cultures. Parental monitoring served as an important protective factor in both samples, while school protective factors were only significant for American students. CONCLUSION: Findings draw attention to similar structures of certain risk and protective factors of youth's externalizing problem behaviors in different cultural settings. While there are universal risk factors (e. g., substance use, gang membership and low academic achievement), parental monitoring seems to be a universal protective factor against youth's externalizing problem behavior. An important difference is that the school domain seems to act as more important protection for American youth. [ABSTRACT FROM AUTHOR]

Cross-sectional data were collected on substance use behaviors and potential correlates in 1,494 African American students enrolled in grades 5-12 in eight schools in a central Alabama school district. Using a risk and asset framework, self-reported recent alcohol, cigarette, and marijuana use were analyzed by identifying and measuring levels of influence, including individual, family, and school. For alcohol and marijuana use, recurrent risk factors were age, being hit by a parent, affiliation with gangs, and a tolerant attitude of peers toward drug use. For cigarette use, risk factors were peer-oriented: associations with gangs or cohorts holding lenient attitudes about substance use. For all substances, salient asset factors were academic achievement and parental monitoring. Findings suggest that efforts to reduce substance use behaviors should be directed at adolescents in terms of academic achievement and grade level as well as their social environments. For the latter, peer/family risks and family/school assets should be the foci for programs to minimize the short- and long-term consequences of these behaviors. Hence, the emphasis should be placed on modeling attitudes, preventing gang and family violence, encouraging parental supervision, and building positive teacher-student interactions. [ABSTRACT FROM AUTHOR]

The types of stratification seen in the cholecystogram together with the edge-ring are demonstrated and the literature reviewed. Stratification which can be determined radio-graphically occurs in the majority of normal people after an all-night fast and before the first meal of the day. It disappears shortly afterwards. It is a normal finding and its transient nature would make it unlikely to be a gallstone precursor. There remain a few cases where layering occurs with stasis where excessive inspissation and stone formation would be a possibility. The author wishes to acknowledge the kindness of Dr. Karla Plehwe in translating the German texts. Without this assistance this paper could not have been written. [ABSTRACT FROM AUTHOR]

The use of diverse terminology may lead to inconsistency in the diagnosis and subsequent treatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objective of this study was to determine inter-observer variability between pathologists in the diagnosis of PVL spectrum lesions. Digitally scanned slides of 40 PVL lesions of varying stages were diagnosed by six oral pathologists (OP) and six head and neck pathologists (HNP) at multiple institutions. Inter-observer agreement on diagnoses was evaluated by Fleiss' kappa analysis using Microsoft Excel 2013 and IBM SPSS version 25 software. The responses provided were grouped into five broad categories. Category 1, simple hyperkeratosis with/without low-grade dysplasia; category 2, verrucous hyperplasia/keratosis with/without low-grade dysplasia; category 3, high-grade dysplasia or carcinoma-in-situ with/without verrucous surface change; category 4, verrucous carcinoma (VC) or atypical epithelial proliferation suggestive of but not fulfilling criteria of VC or squamous cell carcinoma (SCC) and; category 5, papillary or conventional SCC. The overall level of agreement between all pathologists for all cases as measured by Fleiss' kappa (KF) was 0.270, considered fair agreement. Amongst OP the KF was 0.225, whereas amongst HNP the KF was 0.344. The best agreement between pathologists was on category 5 lesions (KF=0.650) followed by category 1 (KF=0.312). The least agreement was within categories 2 (KF=0.150), 3 (KF=0.192) and 4 (KF=0.156). This study reflects the lack of standardized diagnostic criteria and terminology for lesions in the PVL spectrum. We recommend that standardized criteria and terminology be proposed and established by an expert panel position paper, which would assist pathologists and clinicians to uniformly diagnose and manage PVL spectrum lesions more effectively. [ABSTRACT FROM AUTHOR]

This study evaluated the percentage of cases correctly identified as epulis fissuratum based on the clinical impression and histopathologic diagnosis and evaluated the percentage of cases identified as a malignancy by the histopathologic diagnosis with a clinical impression of epulis fissuratum. A search in the database systems at the biopsy services of University of Nebraska Medical Center College of Dentistry and Tufts University School of Dental Medicine for the clinical impression term epulis/epulis fissuratum from January 1, 2012 until July 1, 2017 was performed which identified 187 cases. The Fisher's exact test measured the similarity between dental practitioners' clinical impression of epulis fissuratum and histopathologic findings. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the dental practitioners' clinical impression about the malignancy of epulis fissuratum were calculated. P value < 0.05 was considered statistically significant. From the 187 cases, there was a female predilection (67%), more than half of the cases (55%) were in the maxillary region (palate, vestibule), and patients wearing ill-fitting dentures were identified at sixty percent. Seven cases (3%) were identified as malignant by the histopathologic diagnosis which included squamous cell carcinoma and melanoma, but malignancy was not suspected in two of the seven cases. Epulis fissuratum was listed as the only clinical impression. More than half of the cases (54%) were correctly identified as epulis fissuratum based on the clinical impression and histopathologic diagnosis. Based on the collected data, dental practitioners should remove and submit excised tissue for microscopic analysis to rule out malignancy in suspected cases of epulis fissuratum. [ABSTRACT FROM AUTHOR]

The article offers the author's insights about how a leader can be a good coach. The author provides an overview on the definition of leading as a coach. She emphasizes that coaching requires a level of emotional intelligence that makes most of people uncomfortable. Also tackled are the things to consider to be a better coach.

Aims and objectives To analyse the quality of online information available to patients regarding dental implants.Design Cross sectional survey.Setting The websites analysed were UK based, owned by private practices and NHS secondary and tertiary care services. Information was collated in November 2013.Methods UK-based websites were analysed using UK based search engines.Outcome measures Websites were analysed based on content and reliability. Information regarding the speciality of authors and accreditation/affiliation to professional groups/medical institutions was also collated.Results Overall, website content quality was low, with 63% of sites averaging below 7/14 for their mean summed website content scores, and 67% of sites averaging below 8/16 for their mean reliability scores. 86.7% were accredited by a recognised national/international dental/surgical body but only 26.7% were affiliated to a professional group/medical institution. The authors were mainly dentists (73.3%).Conclusions These findings suggest that the online information regarding implant treatment is generally of low quality and many aspects such as long term outcomes and complications are overlooked. There is a need for the improvement of the quality of online information available to patients in order to make the best use of this tool in helping patients to make informed choices about their dental care. The Internet has the potential to dramatically change the clinician-patient relationship. Moreover, in light of the guidelines produced by the General Dental Council (GDC) in 2012 on the principles of ethical advertising, GDC registrants run the risk of fitness to practise proceedings and medico-legal challenges if the website content has potential to mislead patients. [ABSTRACT FROM AUTHOR]