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Circulating tumour cells (CTCs) are cancer cells released by cancer into the peripheral circulation. Haematogenous tumour spread is a hallmark of metastatic malignancy and a key factor in cancer recurrence and prognosis. CTCs have diagnostic and prognostic significance for a number of adenocarcinomas and melanoma. A review of the published peer-reviewed literature was performed to determine the clinical relevance of CTCs as a biomarker in the management of oral squamous cell carcinoma (OSCC). Fourteen studies met the eligibility criteria. With regard to patients with OSCC, this review found the following: (1) CTCs have been detected using multiple techniques; (2) the presence of CTCs does not appear to be related to tumour differentiation or size; (3) CTCs may be detected without lymph node involvement; (4) the detection of CTCs may be prognostic for both disease-free survival and overall survival; (5) quantification of CTCs may reflect the efficacy of therapy; (6) CTCs may be of value for ongoing patient monitoring. Preliminary evidence suggests that CTCs have diagnostic and prognostic potential as a biomarker for oral cancer management and warrant further investigation to determine their appropriate place in the management of OSCC patients.

Oral squamous cell carcinoma (OSCC) is a lethal and deforming disease of rising global significance. Although traditionally presenting in older patients, evidence suggests that OSCC is increasingly seen in the young (≤45 years at diagnosis), who are believed to exhibit aggressive disease and poor prognosis. By reviewing a cohort of 467 consecutive OSCC patients treated over a 19-year period, this study investigates the demographic profile, clinicopathological features and clinical outcomes characteristic of young OSCC patients in Hong Kong.

This work presents a novel technique for estimating the prestressing forces in simply supported beams with axial prestress force. The technique is based on the use of generic finite elements for modeling the beam and experimental time-domain response to simultaneously identify axial forces and generic parameters. Parameter updating is accomplished using a Simulated Annealing algorithm implemented for the solution of the prestress force identification problem. The effectiveness of the method was assessed in numerical simulations and was further verified on an experimental prestressed concrete beam. The results show that the inclusion of generic elements allows the identification of the force to be achieved even in the presence of errors in model parameters, thus eliminating the restraints of previous approaches.

To compare the treatment response and prognosis of oral cavity cancer between non-smoking and non-alcohol-drinking (NSND) patients and smoking and alcohol-drinking (SD) patients. A total of 313 consecutively treated patients from 2000 to 2019 were included. Demographic, clinicopathologic, treatment, and prognosis information were obtained. Relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were compared between NSND and SD groups using Kaplan-Meier plots, log-rank test, and multivariate Cox regression analysis. Sample prevalence of NSND patients was 54.6%. These patients were predominantly females in their eighth decade with lower prevalence of floor of the mouth cancers compared to SD patients (1.8% vs 14.8%). No difference in the RFS and DSS between both groups was found following multivariable analysis; however, NSND patients had better OS (HR (95% CI) − 0.47 (0.29–0.75); p = 0.002). Extracapsular extension was associated with significantly poorer OS, DSS, and RFS in this oral cavity cancer cohort. Treatment response and disease-specific prognosis are comparable between NSND and SD patients with oral cavity cancer. However, NSND patients have better OS. This study shows that oral cavity cancer in NSND is not less or more aggressive compared to SD patients. Although better survival is expected for NSND than SD patients, this is likely due to the reduced incidence of other chronic diseases in the NSND group.

Traditional Chinese medicine (TCM) is an ancient practice that dates back more than 2,000 years and has evolved into a unique system of diagnosis and disease management that, in particular, employs herbal medicines and dietary therapies but in addition utilises acupuncture, massage and qigong (meditation, breathing and movement) exercises.1,2 It is especially popular in Hong Kong and, following legislation to establish the Chinese Medicine Ordinance in 1999 and subsequent registration of TCM practitioners via the Chinese Medicine Council of Hong Kong, has seen widened patient participation.

Objectives: This study aims to determine the diagnostic test accuracy (DTA) of hypermethylated DNA biomarkers in saliva and oral swabs for oral squamous cell carcinoma (OSCC) detection from the prevalidation studies available. Materials and Methods: Electronic database searching of PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and LILACS was conducted to identify relevant articles that were published between January 1, 2000, and August 1, 2020. Results: Meta-analysis was conducted based on 11 of 20 studies selected for review. Included studies had high bias concerns on the QUADAS-2 study assessment tool. We found that salivary and oral swab hypermethylation markers had better specificity than sensitivity for oral cancer detection. Summary sensitivity and specificity (95% CI) of hypermethylation panels were 86.2% (60–96.2) and 90.6% (85.9–93.9) while for individual markers, summary sensitivity and specificity (95% CI) were 70% (56.9–80.5) and 91.9% (80.3–96.9), respectively. Respective positive and negative likelihood ratios for combined markers were 9.2 (5.89–14.36) and 0.15 (0.05–0.5), and 8.61 (3.39–21.87) and 0.33 (0.22–0.49) for single-application biomarkers. Conclusion: DNA hypermethylation biomarkers especially in combination have acceptable DTA that warrants further optimization with rigorous biomarker evaluation methods for conclusive determination of their efficacy.

As routine care was suspended in most countries, one could anticipate progression of undiagnosed and managed oral disease. Patients are usually unaware of the development of oral disease as it is not visible to them and largely asymptomatic, especially in its early stages. The natural progression of conditions such as caries and periodontitis is inevitable without diagnosis and management. The full extent of patient harm because of the suspension of routine dental care can only be estimated when routine oral examinations are fully re-established, and even then, we will probably never know the number of individuals impacted or the extent of disease progression and harm. In first-world countries, there has always been a back-up emergency treatment system for dental problems. For example, in the UK, the safety net for life-threatening swellings and for acute pain relief is the accident and emergency services. This system remained in place during the COVID-19 pandemic. Courts could be expected to understand the coronavirus context and would take this into account should there be a complaint against the clinician about access to care. The suspension of routine dental care to save lives will lead to the closure of many dental practices due to substantial financial impact. The return to routine care will be slow, with prioritisation of non-aerosol generating procedures while we look to further understand methods to mitigate transmission risk via infected aerosol and spatter. Inevitably, the cost of personal protective equipment and the lower volume of patients pose a continued threat to businesses., Key points Natural history of oral disease progression if not managed is described.Concerns about the medico-legal consequences of reduced access to dental care are discussed.The economic repercussions of the COVID-19 need for suspension of routine care and the future increased costs of practice are presented.

This review sought to determine the range and nature of prospective-sampling and blinding methods for validating nonviral biofluid markers diagnostic of head and neck carcinomas. Electronic database searching was conducted to identify studies published in English from January 1, 2009 to August 1, 2020. Sixteen studies from 17 articles published between 2011 and 2020 were included in this review. We found that about 3 out of 100 studies utilized at least one of the mock testing approaches for biomarker validation. Protein, mRNA, and metabolomic markers also represented the only groups whose validation has been attempted using these methods. Furthermore, studies that utilized both methods were found to have lower bias concerns on the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Overall, there is a need to include these protocols in research endeavours verifying diagnostic biomarkers for head and neck carcinomas following the preliminary establishment of their classification accuracy.

Internationalisation may be defined as a series of processes whereby an institute strives to increase its influence and effectiveness through global networking. In higher education, this offers opportunities to enhance communication and mobilisation between educational systems. To be globally competitive, the international university of the future must embrace digital technology, online courses and ongoing lifetime learning, especially for alumni to facilitate networks of global expertise. Oral disease neither recognises nor respects international boundaries, nor therefore should dental education, research and clinical expertise which are highly valued commodities in society. For dentistry, internationalisation offers real opportunities to influence and promote the highest standards of oral health education and clinical practice throughout the world. The international university of the future must recognise the importance of setting the highest standards for oral health across the world while maintaining regional structures and priorities.

Background: The global burden of oral squamous cell carcinoma (OSCC) remains formidable. Identifying factors predictive of aggressive tumour behaviour, disease progression and reduced survival time may assist in early identification of “high-risk” patients and appropriately target combination cancer therapies. Methods: A retrospective review of 467 OSCC patients treated over a 19-year period facilitated detailed clinico-pathological database analysis and determination of clinical outcome categories based upon time to progressive disease (loco-regional tumour recurrence and/or distant metastasis), overall death and OSCC-related death (death directly attributable to OSCC). Odds ratio (OR) and hazard ratio (HR) statistical measures were used to investigate relationships between patient demographics and clinico-pathological tumour features with clinical outcome. Results: Older age at presentation (P =.002) and a history of previous non–head and neck cancer (P =.010) increased the risk of overall death. OR for progressive disease development (P =.008) and OSCC-related death (P =.019) was most significant for buccal tumours. HR confirmed advanced-stage disease increased the risk of progressive disease (P

Background: The natural history of oral squamous cell carcinoma (OSCC) is complicated by progressive disease including loco-regional tumour recurrence and development of distant metastases. Accurate prediction of tumour behaviour is crucial in delivering individualized treatment plans and developing optimal patient follow-up and surveillance strategies. Machine learning algorithms may be employed in oncology research to improve clinical outcome prediction. Methods: Retrospective review of 467 OSCC patients treated over a 19-year period facilitated construction of a detailed clinicopathological database. 34 prognostic features from the database were used to populate 4 machine learning algorithms, linear regression (LR), decision tree (DT), support vector machine (SVM) and k-nearest neighbours (KNN) models, to attempt progressive disease outcome prediction. Principal component analysis (PCA) and bivariate analysis were used to reduce data dimensionality and highlight correlated variables. Models were validated for accuracy, sensitivity and specificity, with predictive ability assessed by receiver operating characteristic (ROC) and area under the curve (AUC) calculation. Results: Out of 408 fully characterized OSCC patients, 151 (37%) had died and 131 (32%) exhibited progressive disease at the time of data retrieval. The DT model with 34 prognostic features was most successful in identifying “true positive” progressive disease, achieving 70.59% accuracy (AUC 0.67), 41.98% sensitivity and a high specificity of 84.12%. Conclusion: Machine learning models assist clinicians in accessing digitized health information and appear promising in predicting progressive disease outcomes. The future will see increasing emphasis on the use of artificial intelligence to enhance understanding of aggressive tumour behaviour, recurrence and disease progression.

Background: Oral squamous cell carcinoma (OSCC) is a lethal and deforming disease of rising incidence. With poor 5-year survival rates associated with higher stage disease, there is a need in clinical practice for reliable prognostic determinants to consolidate treatment planning and coordinate therapeutic approaches to improve long-term clinical outcomes for patients. Methods: A retrospective clinicopathological review of 467 OSCC patients with documented clinical outcome and treated in Hong Kong over a 19-year period was undertaken to investigate the potential prognostic role of 4 specific histopathological features of invasive tumour behaviour: perineural invasion (PNI), bone invasion (BNI), lymphovascular invasion (LVI) and extra-nodal extension (ENE) in metastatic neck disease. Results: Histopathological data for PNI, BNI, LVI and ENE, and stratified as zero, one, two, three or four positives, were available for 279 patients. A trend for decreased disease-free status was seen with increasing numbers of positive histopathological features, although this was not statistically significant (P =.1076). The time to onset of further disease (loco-regional recurrence and/or distant metastasis) was statistically significant, however, with progressive disease presenting most rapidly with increasing numbers of positive invasive parameters (P =.000152). Conclusion: PNI, BNI, LVI and ENE, especially when found in combination, show promise as prognostic markers of poor clinical outcome following OSCC treatment. Further, multi-centre prospective studies are required to confirm the predictive value of multi-positive histopathological features in clinical practice and to help improve individualised treatment planning.

To realise the benefits of new diagnostic techniques for the prediction of oral cancer, further validation and multicentre analyses are needed to determine their clinical impact in contemporary practice.

Background: Preventive and early diagnostic methods such as health promotion and disease screening are increasingly advocated to improve detection and survival rates for oral cancer. These strategies are most effective when targeted at "high-risk" individuals and populations. Bayesian disease-mapping modelling is a statistical method to quantify and explain spatial and temporal patterns for risk and covariate factor influence, thereby identifying "high-risk" sub-regions or "case clustering" for targeted intervention. Rarely applied to oral cancer epidemiology, this paper highlights the efficacy of disease mapping for the Hong Kong population. Methods: Following ethical approval, anonymized individual-level data for oral cancer diagnoses were obtained retrospectively from the Clinical Data Analysis and Reporting System (CDARS) of the Hong Kong Hospital Authority (HA) database for a 7-year period (January 2013 to December 2019). Data facilitated disease mapping and estimation of relative risks of oral cancer incidence and mortality. Results: A total of 3,341 new oral cancer cases and 1,506 oral cancer-related deaths were recorded during the 7-year study period. Five districts, located in Hong Kong Island and Kowloon, exhibited considerably higher relative incidence risks with 1 significant "case cluster" hotspot. Six districts displayed higher mortality risks than expected from territory-wide values, with highest risk identified for two districts of Hong Kong Island. Conclusion: Bayesian disease mapping is successful in identifying and characterizing "high-risk" areas for oral cancer incidence and mortality within a community. This should facilitate targeted preventive and interventional strategies. Further work is encouraged to enhance global-level data and comprehensive mapping of oral cancer incidence, mortality and survival.

How can underlying disease be identified in patients with apparently routine signs and symptoms?

Oral squamous cell carcinoma is one of the commonest head and neck malignancies with approximately 350 000 cases reported annually and a mortality rate of 50% often attributed to late clinical presentation. Due to the close relationship between saliva bio-fluid and tumour lesions, optimizing salivary biomarkers for disease detection and screening provides a major new research direction in diagnostic oral oncology. As inter-tumour heterogeneity and intra-tumour heterogeneity are common within oral cavity neoplasms, it is unlikely that a single diagnostic or "risk-stratifying" saliva biomarker will suffice for universal translation to clinical practice. Therefore, this article highlights a number of promising saliva biomarker combinations for oral cavity cancer detection that require further research and validation to determine their true diagnostic potential.

Introduction Clinical management of oral potentially malignant disorders relies on accurate histopathological assessment of the presence and grade of oral epithelial dysplasia. Whilst adjunctive laboratory tests have provided useful prognostic information, none are in widespread clinical use. This study was performed to assess the clinical utility of two contemporary oral epithelial dysplasia grading systems. Methods Patients were identified from a clinical database. Oral epithelial dysplasia grading was performed by three oral and maxillofacial pathologists blinded to clinical outcome using the WHO 2017 system and a binary classification. The primary outcome measure was the development of oral squamous cell carcinoma, termed 'malignant transformation'. Results 131 cases satisfied the inclusion criteria, of which 23 underwent malignant transformation. There was substantial inter-rater agreement between the study pathologists for both grading systems, measured using kappa statistics (κ = 0.753-0.784). However, there was only moderate agreement between the consensus WHO 2017 dysplasia grade for the study against the original grade assigned by a pool of six pathologists in the context of the clinical service (κ = 0.491). Higher grade categories correlated with an increased risk of developing cancer using both grading systems. Conclusion This study demonstrates that the WHO 2017 and binary grading systems are reproducible between calibrated pathologists and that consensus reporting is likely to improve the consistency of grading. The WHO and binary systems were prognostically comparable. We recommend that institutions implement consensus oral epithelial dysplasia grading and prospectively audit the effectiveness of risk stratifying their patients with oral potentially malignant disorders. (249 words).

This scoping review was carried out to evaluate the important role Australian university-based dental teaching clinics and dental students might have in promoting oral cancer awareness in their patients. Four Online database (PubMed, OVID, Scopus and Emcare) were searched for studies that assessed oral cancer awareness amongst patients attending Australian university-associated (teaching) clinics. A total of five articles were retrieved for full-text analysis. All studies showed significant variation in patient awareness and understanding regarding the principal risk factors associated with oral cancer development. Smoking was predominantly identified as a significant risk factor, but alcohol consumption was less frequently recognized as relevant. Non-healing ulceration was most commonly identified as a symptom of concern, whilst red and/or white mucosal patches were infrequently recognized as potentially malignant conditions. Our review confirms that a significant lack of patient awareness regarding oral cancer risk and the signs /symptoms of early malignancy or potentially malignant disease exist in patients attending dental teaching clinics. Important opportunities exist to involve dental students proactively in raising oral cancer awareness, delivering smoking cessation interventions and safe alcohol consumption advice to their patients. Incorporation of established health educational models might deliver effective support for such student-delivered patient education.

BACKGROUND: Circulating tumour cells (CTCs) detected in patient blood samples are relevant as diagnostic and prognostic markers offering insights into tumour behaviour and guiding treatment of cancer at an individualised level. The aim of this study is to ascertain the feasibility of detecting CTCs in oral squamous cell carcinoma (OSCC) using two different methods so as to determine the optimal method for the study of this cancer. METHODS: Comparison of the numbers of CTCs, circulating tumour micro-emboli (CTMs) and circulating tumour endothelial cells (CTECs) was undertaken in forty clinical samples of oral squamous cell carcinoma (OSCC) determined by filtration (ISET®) ) and in-situ fluorescent immunostaining (i-FISH, Cytelligen®) immunostaining and in-situ hybridisation. RESULTS: i-FISH detected CTCs in 80% of samples compared to 40% of samples analysed by microfiltration. i-FISH detected CTCs in a further 40% of samples in which microfiltration did not detect CTCs. No CTC clusters were detected by microfiltration while i-FISH detected CTM in 12.5% of samples. i-FISH analysis detected CTECs in 20/40 samples. CONCLUSION: These results highlight significant differences in detection of CTCs, CTM and CTECs between i-FISH and microfiltration when applied to OSCC samples, suggesting that technologies capable of detecting circulating aneuploidic cells more accurately detect CTCs. i-FISH also detected CTM and CTEC not detected using ISET®. With proven prognostic relevance in adenocarcinomas, accurate enumeration of CTCs, CTMs and CTECs may be a clinically useful tool in the management of OSCC and may aid in the reduction of false negative diagnoses.

Importance: Oral squamous cell carcinoma (SCC) is a lethal malignant neoplasm with a high rate of tumor metastasis and recurrence. Accurate diagnosis, prognosis prediction, and metastasis detection can improve patient outcomes. Deep learning for clinical image analysis can be used for diagnosis and prognosis in cancers, including oral SCC; its use in these areas can improve patient care and outcome. Observations: This review is a summary of the use of deep learning models for diagnosis, prognosis, and metastasis detection for oral SCC by analyzing information from pathological and radiographic images. Specifically, deep learning has been used to classify different cell types, to differentiate cancer cells from nonmalignant cells, and to identify oral SCC from other cancer types. It can also be used to predict survival, to differentiate between tumor grades, and to detect lymph node metastasis. In general, the performance of these deep learning models has an accuracy ranging from 77.89% to 97.51% and 76% to 94.2% with the use of pathological and radiographic images, respectively. The review also discusses the importance of using good-quality clinical images in sufficient quantity on model performance. Conclusions: and Relevance Applying pathological and radiographic images in deep learning models for diagnosis and prognosis of oral SCC has been explored, and most studies report results showing good classification accuracy. The successful use of deep learning in these areas has a high clinical translatability in the improvement of patient care.

How have revolutionary cell proliferation theories progressed over the past 30 years?

Objective: To identify clinically relevant areas of concordance and discordance between product monographs for 4 direct oral anticoagulants (DOACs) approved by regulatory authorities in Europe, the United States, and Canada. Data Sources: For each DOAC (apixaban, dabigatran, edoxaban, rivaroxaban), manufacturer product monographs were retrieved from the European Medicines Database, US Food and Drug Administration, and Health Canada Drug Product Database. Data Extraction: Monographs for each DOAC were independently reviewed by 2 investigators to identify areas of concordance and discordance. Discordance existed if it was deemed that a potentially clinically relevant difference existed. A heat map summarizing the data was created to identify areas of complete concordance, partial concordance (concordance between 2 of 3 monographs), and complete discordance. Data Synthesis: The areas of concordance were indications for use, use in extremes of weight, and switching to/from the DOAC. Areas of discordance included the following: differing recommendations for use/dosing with renal dysfunction; contraindication or use with caution with drug interactions, pregnancy, and hepatic/renal dysfunction; and timing of DOAC with spinal/epidural anesthesia after a procedure or traumatic puncture. Relevance to Patient Care and Clinical Practice: Concordance was most evident for uncomplicated patients with atrial fibrillation or venous thromboembolism, whereas discordance emerged for those having characteristics/factors wherein clinicians may seek clarification within product monographs (eg, impaired renal/hepatic function, drug interactions). As such, clinicians must be familiar with product information within their country of practice. Conclusion: Variability between jurisdictions was evident, and variability of DOAC use is likely to increase with expanding worldwide uptake.

Background: Nomograms are graphical calculating devices used to predict risk of malignant transformation (MT) or response to treatment during cancer management. To date, a nomogram has not been used to predict clinical outcome during oral potentially malignant disorder (PMD) treatment. The aim of this study was to create a nomogram for use by clinicians to predict the probability of MT, thereby facilitating accurate assessment of risk and objective decision-making during individual patient management. Methods: Clinico-pathological data from a previously treated cohort of 590 newly presenting PMD patients were reviewed and clinical outcomes categorized as disease free, persistent PMD or MT. Multiple logistic regression was used to predict the probability of MT in the cohort using age, gender, lesion type, site and incision biopsy histopathological diagnoses. Internal validation and calibration of the model was performed using the bootstrap method (n = 1000), and bias-corrected indices of model performance were computed. Results: Potentially malignant disorders were predominantly leukoplakias (79%), presenting most frequently at floor of mouth and lateral tongue sites (51%); 99 patients (17%) developed oral squamous cell carcinoma during the study period. The nomogram performed well when MT predictions were compared with patient outcome data, demonstrating good bias-corrected discrimination and calibration (D = 0.58; C = 0.790), with a sensitivity of 87% and specificity 63%, and a positive predictive value of 32% and negative predictive value 96%. Conclusion: The “Newcastle Nomogram” has been developed to predict the probability of MT in PMD, based on an internally validated statistical model. Based upon readily available and patient-specific clinico-pathological data, it provides clinicians with a pragmatic diagrammatic aid for clinical decision-making during diagnosis and management of PMD.

Damage in civil structures such as bridges has generally been identified by visual inspections, however dynamic structural health monitoring has been proposed as an alternative. This paper presents the experimental evaluation of three damage identification techniques on a full-scale footbridge. One of the evaluated techniques is based on damage localization vectors. A second technique is based on changes in the mode shapes curvature. The third technique uses a numerical model and artificial neural networks for locating the damaged section. Five scenarios of controlled damage were induced in the footbridge. Output-only ambient vibration tests were performed at each damage state and the results of the identification techniques were analyzed. The three implemented techniques showed promising results for the numerical simulations, and two of these techniques produced satisfactory results in the experimental evaluation. Resumen El daño en estructuras civiles como puentes, generalmente ha sido identificado por inspección visual, sin embargo, el monitoreo dinámico de salud estructural ha sido propuesto como una alternativa. Este artículo presenta la evaluación experimental de tres técnicas de identificación de daño en un puente peatonal en escala real. Una de las técnicas evaluadas está basada en vectores de localización de daño. Una segunda técnica está basada en cambios de la curvatura de formas modales. La tercera técnica utiliza un modelo numérico y redes neuronales artificiales para localizar la sección dañada. Cinco escenarios de daño controlado fueron inducidos en el puente. Ensayos de vibración ambiental con solo salidas fueron realizados para cada estado de daño y los resultados de las técnicas de identificación fueron analizados. Las tres técnicas implementadas muestran resultados prometedores para las simulaciones numéricas, y dos de estas técnicas produjeron resultados satisfactorios en la evaluación experimental.

Oral potentially malignant disorders (PMDs) are clinically identifiable mucosal diseases that share an increased risk of squamous cell carcinoma (SCC) development. This article presents a rationale for defined terminology to encourage uniformity both in clinical practice and in research.

Base isolation systems reduce the action of earthquakes on buildings by disconnecting the structure from the ground through different devices, being the steel reinforced isolators (SREIs) the most common used. However, due to the high initial costs of SREIs, this technique is mainly implemented in special projects and is rarely used for residential buildings in developing countries with high seismic risk. This paper presented a thorough investigation on novel and unbounded rubber isolators which, based on the satisfactory behavior shown during experimental tests, could be a viable alternative to conventional isolators to be mainly implemented in Colombia for the low-rise residential buildings. Rubber and reinforcement materials employed in the manufacturing of the isolator prototypes were obtained locally to minimize the cost of the new devices. Different isolator configurations, including steel versus nylon/carbon fiber reinforcement (FREI) and bolted versus unbounded connections, were investigated to provide technological competitiveness. In the first phase, a high damping rubber was developed and characterized. In the second phase, prototypes of isolators designed for a real building were built and tested using combined compression and shear test. The results highlight an interesting comparison between vertical and horizontal properties of classical SREIs and unbolted FREIs, both satisfying required design values. Specifically, experimental results show that the behavior of the FREIs, in the horizontal direction, is similar to the SREIs, whereas the damping ratio is higher. Satisfactory results were also obtained with nylon reinforcement. Regarding the connection, the unbonded prototypes showed a better behavior respect to classical SREI, achieving higher deformations without failing. Therefore, this type of unbounded FREIs could represent a very promising option with higher potential to be implemented as a low-cost seismic isolation system in residential low-rise buildings of developing countries.

Oral cavity cancer is often described as a lifestyle-related malignancy due to its strong associations with habitual factors, including tobacco use, heavy alcohol consumption, and betel nut chewing. However, patients with no genetically predisposing conditions who do not indulge in these risk habits are still being encountered, albeit less commonly. The aim of this review is to summarize contemporaneous reports on these nonsmoking, nonalcohol drinking (NSND) patients. We performed database searching to identify relevant studies from January 1, 2000 to March 31, 2021. Twenty-six articles from 20 studies were included in this study. We found that these individuals were mostly females in their eighth decade with tumors involving the tongue and gingivobuccal mucosa. This review also observed that these patients were likely diagnosed with early stage tumors with overexpression of programmed death-ligand 1 (PD-L1) and increased intensity of tumor infiltrating lymphocytes. Treatment response and disease-specific prognosis were largely comparable between NSND and smoking/drinking patients.

Objectives Machine learning platforms are now being introduced into modern oncological practice for classification and prediction of patient outcomes. To determine the current status of the application of these learning models as adjunctive decision-making tools in oral cavity cancer management, this systematic review aims to summarize the accuracy of machine-learning based models for disease outcomes. Methods Electronic databases including PubMed, Scopus, EMBASE, Cochrane Library, LILACS, SciELO, PsychINFO, and Web of Science were searched up until December 21, 2020. Pertinent articles detailing the development and accuracy of machine learning prediction models for oral cavity cancer outcomes were selected in a two-stage process. Quality assessment was conducted using the Quality in Prognosis Studies (QUIPS) tool and results of base studies were qualitatively synthesized by all authors. Outcomes of interest were malignant transformation of precancer lesions, cervical lymph node metastasis, as well as treatment response, and prognosis of oral cavity cancer. Results Twenty-seven articles out of 950 citations identified from electronic and manual searching were included in this study. Five studies had low bias concerns on the QUIPS tool. Prediction of malignant transformation, cervical lymph node metastasis, treatment response, and prognosis were reported in three, six, eight, and eleven articles respectively. Accuracy of these learning models on the internal or external validation sets ranged from 0.85 to 0.97 for malignant transformation prediction, 0.78–0.91 for cervical lymph node metastasis prediction, 0.64–1.00 for treatment response prediction, and 0.71–0.99 for prognosis prediction. In general, most trained algorithms predicting these outcomes performed better than alternate methods of prediction. We also found that models including molecular markers in training data had better accuracy estimates for malignant transformation, treatment response, and prognosis prediction. Conclusion Machine learning algorithms have a satisfactory to excellent accuracy for predicting three of four oral cavity cancer outcomes i.e., malignant transformation, nodal metastasis, and prognosis. However, considering the training approach of many available classifiers, these models may not be streamlined enough for clinical application currently.

Background Applying machine learning to predicting oral cavity cancer prognosis is important in selecting candidates for aggressive treatment following diagnosis. However, models proposed so far have only considered cancer survival as discrete rather than dynamic outcomes Objectives To compare the model performance of different machine learning-based algorithms that incorporate time-to-event data. These algorithms included DeepSurv, DeepHit, neural net-extended time-dependent cox model (Cox-Time), and random survival forest (RSF). Materials and Methods Retrospective cohort of 313 oral cavity cancer patients were obtained from electronic health records. Models were trained on patient data following preprocessing. Predictors were based on demographic, clinicopathologic, and treatment information of the cases. Outcomes were the disease-specific and overall survival. Multivariable analyses were conducted to select significant prognostic features associated with tumor prognosis. Two models were generated per algorithm based on all-prognostic features and significant-prognostic features following statistical analysis. Concordance index (c-index) and integrated Brier scores were used as performance evaluators and model stability was assessed using intraclass correlation coefficients (ICC) calculated of these measures obtained from the cross-validation folds. Results While all models were satisfactory, better discriminatory performance and calibration was observed for disease-specific than overall survival (mean c-index: 0.85 vs 0.74; mean integrated Brier score: 0.12 vs 0.17). DeepSurv performed best in terms of discrimination for both outcomes (c-indices: 0.76 – 0.89) while RSF produced better calibrated survival estimates (integrated Brier score: 0.06 – 0.09). Model stability of the algorithms varied with the outcomes as Cox-Time had the best intraclass correlation coefficient (mean ICC: 0.995) for disease-specific survival while DeepSurv was most stable for overall survival prediction (mean ICC: 0.992). Conclusions Machine learning algorithms based on time-to-event outcomes is successful in predicting oral cavity cancer prognosis with DeepSurv and RSF producing the best discriminative performance and calibration.

Reinforced concrete thin walls buildings have become one of the most common alternatives for housing construction in Colombia. However, some studies on this system have reported that walls have a limited deformation capacity and may suffer brittle failures. In this paper, a numerical model developed in OpenSees was used to represent the behavior of thin and slender reinforced concrete walls. The model was evaluated and fitted with the experimental response of two representative walls of this type of construction in high seismic hazard zone, in addition to the results of cyclic tests of other investigations with walls of similar characteristics. The experimental response of the walls indicated that, despite reaching a moderate deformation capacity, for the 1% drift limit, the level of damage was severe and lost 77% and 67% of their initial stiffness, respectively, which confirms that their performance is limited and provides a warning that the design practices may be insufficient. The numerical simulation correlated well with the experimental response in terms of displacement capacity, strength, and hysteric behavior.

El sistema constructivo de muros delgados de concreto reforzado (MDCR) es uno de los más utilizados actualmente en países como Bolivia, Perú, Venezuela, Ecuador, y Colombia. Estas edificaciones se han diseñado con la normatividad de estos países, la cual, en la mayoría de los casos no tiene prescripciones específicas adecuadas para este tipo de construcción, puesto que sus lineamientos para diseño de concreto reforzado se basan en las versiones previas del ACI-318, definidas para el sistema tradicional de muros de concreto reforzado, que dispone de muros con espesores mayores que facilitan el detallado del refuerzo, el confinamiento del concreto y permiten controlar la inestabilidad fuera del plano. Diversas investigaciones y los eventos sísmicos de Chile en 2010 y Nueva Zelanda en 2011 sugieren que el sistema de MDCR podría presentar un desempeño limitado ante un evento sísmico, por lo tanto, se requiere caracterizar mejor su comportamiento estructural. Con la finalidad de evaluar el desempeño de estas edificaciones, se propone el uso de un software comercial, ampliamente usado en las oficinas de cálculo, para la modelización de MDCR y de los edificios de este sistema constructivo, considerando su comportamiento no lineal. Se usará la formulación de elementos en capas (Shell layered) del programa ETABS. Los modelos de muros son ajustados mediante la respuesta experimental de ensayos de muros representativos de este sistema estructural, tomados de referencias bibliográficas reconocidas. El modelo de las edificaciones se ajustará mediante la identificación de las propiedades dinámicas reales obtenidas de la instrumentación de un edificio típico, mediante una prueba de vibración ambiental. Los resultados de la simulación numérica permitieron evaluar el comportamiento de estas construcciones y confirman que este tipo de software es una herramienta válida, relativamente simple y de bajo consumo computacional para obtener una respuesta más acertada del desempeño de este sistema constructivo.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols. The impact on the provision of dental care has been profound, with routine care restricted or paused for a period around the world. There have been adverse consequences for dental education and clinical research. Emergency and urgent care provisions have generally proceeded. However, even when a patient's condition is deemed urgent, access to the appropriate care may not have been possible due to lack of the recommended personal protective equipment. The common dental diseases of caries and periodontitis usually present with signs and symptoms after some advancement, hence the recommended regular dental examination so that these may be diagnosed early by a professional with suitable lighting, instruments and radiography. Conditions such as oral cancer similarly present in their early stages without symptoms. Many countries introduced telephone and video consultations for patients with symptoms but much disease has gone undiagnosed and without management. It is difficult to ascertain the full effect of the disruption to dental services, education and research but it is likely to be substantial. The immediate future will focus on return to routine care provision with likely longer-term permanent changes., Key points Emergency and urgent care descriptions are presented.The need for the UK to pause routine dental care due to COVID-19 is discussed and compared with Hong Kong.Planning for a safe return to routine dental care and associated dental education is discussed.

BACKGROUND: This study was undertaken to develop and validate a gene expression signature that characterises oral potentially malignant disorders (OPMD) with a high risk of undergoing malignant transformation. METHODS: Patients with oral epithelial dysplasia at one hospital were selected as the ‘training set’ (n = 56) whilst those at another hospital were selected for the ‘test set’ (n = 66). RNA was extracted from formalin-fixed paraffin-embedded (FFPE) diagnostic biopsies and analysed using the NanoString nCounter platform. A targeted panel of 42 genes selected on their association with oral carcinogenesis was used to develop a prognostic gene signature. Following data normalisation, uni- and multivariable analysis, as well as prognostic modelling, were employed to develop and validate the gene signature. RESULTS: A prognostic classifier composed of 11 genes was developed using the training set. The multivariable prognostic model was used to predict patient risk scores in the test set. The prognostic gene signature was an independent predictor of malignant transformation when assessed in the test set, with the high-risk group showing worse prognosis [Hazard ratio = 12.65, p = 0.0003]. CONCLUSIONS: This study demonstrates proof of principle that RNA extracted from FFPE diagnostic biopsies of OPMD, when analysed on the NanoString nCounter platform, can be used to generate a molecular classifier that stratifies the risk of malignant transformation with promising clinical utility.

Obtaining consensual molecular markers for contemporary clinical practice to diagnose head and neck cancer subtypes remains an all-important cause in diagnostic oncology. Biofluid specimens obtaine...

Assessing the baseline knowledge status and expectations of the target population of any health promotion and secondary prevention program is essential to the success of such intervention. To obtain this information about the Hong Kong population a priori to implementing these preventive strategies for oral cancer in addition to determining the willingness of potential screening participants to take risk-profiling assessments, a cross-sectional survey was conducted between November 2019 and March 2020. A total of 964 residents between the ages 18 and 86 years were invited to participate in this study across the three geographical areas in Hong Kong. Most participants self-reported being aware of oral cancer (86.3%), although the proportion of those with substantial knowledge on salient risk factors and early identifiable signs were very low (2.9%). Age and level of education were the only demographic characteristics associated with the knowledge status. The proportion of participants willing to attend community screening and partake in risk profiling assessment was high (83.9% and 80.9% respectively). Willingness to attend community screening was directly associated with respondents’ self-reported oral cancer awareness status (OR: 1.9, 95% CI: 1.22–2.96). Also, we observed that those participants who were willing to attend screening are more inclined to take risk prediction assessments that those not willing to attend. These findings have showcased the need to intensify health promotion via personal skills development to encourage early disease presentation and will assist in the planning of these programs accordingly in the Hong Kong population.

BackgroundThe association between socioeconomic disadvantage (low education and/or income) and head and neck cancer is well established, with smoking and alcohol consumption explaining up to three-quarters of the risk. We aimed to investigate the nature of and explanations for head and neck cancer risk associated with occupational socioeconomic prestige (a perceptual measure of psychosocial status), occupational socioeconomic position and manual-work experience, and to assess the potential explanatory role of occupational exposures.MethodsPooled analysis included 5818 patients with head and neck cancer (and 7326 control participants) from five studies in Europe and South America. Lifetime job histories were coded to: (1) occupational social prestige—Treiman’s Standard International Occupational Prestige Scale (SIOPS); (2) occupational socioeconomic position—International Socio-Economic Index (ISEI); and (3) manual/non-manual jobs.ResultsFor the longest held job, adjusting for smoking, alcohol and nature of occupation, increased head and neck cancer risk estimates were observed for low SIOPS OR=1.88 (95% CI: 1.64 to 2.17), low ISEI OR=1.74 (95% CI: 1.51 to 1.99) and manual occupations OR=1.49 (95% CI: 1.35 to 1.64). Following mutual adjustment by socioeconomic exposures, risk associated with low SIOPS remained OR=1.59 (95% CI: 1.30 to 1.94).ConclusionsThese findings indicate that low occupational socioeconomic prestige, position and manual work are associated with head and neck cancer, and such risks are only partly explained by smoking, alcohol and occupational exposures. Perceptual occupational psychosocial status (SIOPS) appears to be the strongest socioeconomic factor, relative to socioeconomic position and manual/non-manual work.

Utilising biomarkers for COVID-19 diagnosis, prediction of treatment response and overall prognostication have been investigated recently. However, these ventures have only considered the use of blood-based molecular markers. Saliva is another biofluid that warrants being applied in similar fashion with major advantages that centres on its non-invasive and repeatable collection as well as cost-efficiency. To this end, this article presents a hypothesis for the sources of biomarkers useful clinically for COVID-19 disease outcome estimation and identify the likely implications of their detection in saliva.

Background: Oral potentially malignant disorders are a clinical conundrum as there are no reliable methods to predict their behaviour. We combine conventional oral epithelial dysplasia grading with DNA ploidy analysis to examine the validity of this approach to risk assessment in a cohort of patients with known clinical outcomes. Methods: Sections from diagnostic biopsies were assessed for oral epithelial dysplasia using the WHO grading system, and DNA ploidy analysis was performed using established methods. Patients reviewed for a minimum of 5 years who did not develop oral squamous cell carcinoma were classified as “non-transforming” cases. Patients that developed oral squamous cell carcinoma ≥ 6 months after the initial diagnostic biopsy were classified as having “malignant transformation.” Results: Ninety cases were included in the study. Seventy cases yielded informative DNA ploidy results. Of these 70 cases, 31 progressed to cancer. Oral epithelial dysplasia grading and DNA ploidy status were both significantly associated with clinical outcome (P < 0.05). Severe dysplasia had a hazard ratio of 3.50 (CI: 1.46, 8.45; P = 0.005) compared to cases with mild dysplasia. Aneuploidy had a hazard ratio of 2.09 (CI: 1.01, 4.32; P = 0.046) compared to cases with a diploid/tetraploid status. Receiver operating characteristic analysis gave an area under the curve of 0.617 for DNA ploidy status and 0.688 when DNA ploidy status was combined with dysplasia grading. Conclusion: Our findings suggest that combining dysplasia grading with DNA ploidy status has clinical utility which could be used to develop novel management algorithms.

We have reported previously on the organisation of oral and maxillofacial surgery (OMFS) services in Hong Kong, and the role of the academic discipline within the Faculty of Dentistry at the University of Hong Kong. 1 This article reviews OMFS involvement in the management of dental and facial deformity, with particular reference to the treatment needs of the local population.

Revisiting the eponymous “Peter Principle,” in this article the author reflects upon a professional lifetime as a clinician, surgeon and researcher, and summarises his efforts to improve contemporary understanding of oral cancer development, refine diagnostic procedure and facilitate efficacious, early treatment intervention to halt the process of carcinogenesis. The author reviews the principles underpinning effective translational research. Utilising his own work in oral epithelial cell science, interventional surgery and potentially malignant disorder patient management and surveillance, a number of significant advances in our knowledge base and their specific clinical application and potential impact are discussed. Research remains an active and ongoing process, however, and the author believes it essential for future relevance that hypotheses should always be initiated, led and mentored by experienced clinical practitioners.

Seismic Force Assessment in structural design of bridges requires a good estimation of the fundamental period. Estimated periods, using current methodologies in seismic provisions, are approximations that may significantly differ from the real periods. These differences are related to assumptions and simplifications made in the model development. Through Operational Modal Analysis (OMA) it is possible to estimate operational frequencies of a bridge and provide evidence about its current dynamic behavior. In this paper, vertical operational frequencies of 451 structures, 285 pedestrian bridges and 166 vehicular bridges, and horizontal operational frequencies of 111 structures, 101 pedestrian bridges, 9 vehicular bridges and 1 railway bridge of the transportation network of Santiago de Cali, Colombia, were estimated using ambient vibration tests through OMA. Data were obtained using smartphones and processed using NExT-ERA and SSI techniques. For a sample of thirteen bridges, the results were compared with OMA results using seismic sensors. The results show that the smartphones used are appropriate as instrumentation systems for modal identification of flexible structures. The experimental frequencies identified using both time-domain techniques are similar among them and to equations proposed in technical literature. The damping ratios associated to the identified operational frequencies do not show relation with the geometric characteristics of the bridges or a clear difference between materials. Equations relating fundamental frequencies with structural characteristics of the bridges are presented.

For many years, early diagnosis and management of OSCC have been areas of clinical practice where variability in decision-making and lack of high-quality evidence confounded treatment initiatives. Could an improved understanding of minimal interventional therapy offer an opportunity to improve clinical care?

How research can help identify those most at risk of oral carcinogenesis.

Background Clinically identifiable potentially malignant disorders (PMD) precede oral squamous cell carcinoma development. Oral lichenoid lesions (OLL) and proliferative verrucous leukoplakia (PVL) are specific precursor lesions believed to exhibit both treatment resistance and a high risk of malignant transformation (MT). Methods A retrospective review of 590 PMD patients treated in Northern England by CO2 laser surgery between 1996 and 2014 was carried out. Lesions exhibiting lichenoid or proliferative verrucous features were identified from the patient database and their clinicopathological features and outcome post-treatment determined at the study census date of 31 December 2014. Results One hundred and 98 patients were identified as follows: 118 OLL and 80 PVL, most frequently leukoplakia at ventrolateral tongue and floor of mouth sites, equally distributed between males and females. Most exhibited dysplasia on incision biopsy (72% OLL; 85% PVL) and were treated by laser excision rather than ablation (88.1% OLL; 86.25% PVL). OLL were more common in younger patients (OLL 57.1 year; PVL 62.25 years; P = .008) and more likely than PVL to present as erythroleukoplakia (OLL 15.3%; PVL 2.5%; P = .003). Whilst no significant difference was seen between OLL and PVL achieving disease-free status (69.5% and 65%, respectively; P = .55), this was less than the overall PMD cohort (74.2%). MT was identified in 2 OLL (1.7%) and 2 PVL (2.5%) during follow-up. Conclusion One-third of PMD cases showed features of OLL or PVL, probably representing a disease presentation continuum. Post-treatment disease-free status was less common in OLL and PVL, although MT was infrequent.

As our regular contributor takes up a new academic role at Hong Kong University, he reflects on the evolution of the specialty in the region.

The following account of the fortunes of the Braunton trading ketch Agnes in the brutal winter of 1947 complements the overview, published in The Mariner’s Mirror, of how the Bristol Channel coastw...