A Prospective Observational Study to Determine the Correlation of Clinical, Ultrasonography, and Pathological Examination of Cervical Lymph Nodal Staging in Oral Squamous Cell Carcinoma

Clinical, Radiological and Histological Features and Their Association with Extranodal Extension in Buccoalveolar Complex Squamous Cell Carcinoma

Jeyashanth RijuObjectives  The study was aimed to (1) evaluate the effectiveness of clinical examination, intraoperative finding, and contrast-enhanced computed tomography (CECT) to detect extranodal extension (ENE) in buccoalveolar complex squamous cell carcinoma (BAOSCC), (2) to know various factors influencing ENE, and (3) to evaluate survival outcome in patients with ENE. Materials and Methods  This was a retrospective cohort study, which included 137 patients with BAOSCC who underwent curative treatment between May 2019 and April 2021. Collaborative findings suggestive of ENE were noted during preoperative clinical examination, CECT, and intraoperatively, and their efficacy was compared with postoperative histopathology. Also, the various factors associated with ENE were evaluated and compared. Statistical Analysis  Univariate and multivariate analysis of parameters was done using multiple logistic regression analysis and significant correlation was determined using chi-square test between ENE positive and negative categories. Analysis of prognosis and survival was done by Kaplan-Meier curve plotting using regression analysis and its significance was compared. Results  The overall prevalence of ENE was 18.98% and that of lymph node involvement was 40.88%. CECT (73.1%) was found to be more sensitive in detecting ENE compared to intraoperative examination (46.2%) and clinical examination (34.6%).In comparison with clinical examination (91.9%) or CECT (78.38%), intraoperative examination (93.7%) showed the highest specificity in detecting ENE. Clinical nodal size ≥ 3 cm ( p ≤ 0.001), fixity ( p ≤ 0.001), and clinical number of nodes ( p ≤ 0.001) had significant association with ENE. The presence of thick nodal walls on CECT increased the probability of predicting ENE 15 times ( p  = 0.180, confidence interval: 0.3-765.4). After a mean follow-up of 18 months, subjects without nodal positivity had a survival advantage over patients with positive lymph nodes (86.4% vs. 53.3%) and those with ENE (86.4% vs. 23.2%), respectively. Conclusion  The results demonstrated that clinical examination can be used as an adjuvant to radiological imaging for prediction of ENE preoperatively. Clinical finding suggesting size of node ≥ 3 cm and ≥ 2 nodes are strong predictor of ENE, in addition to other known predictors. Patients with ENE had an unfavorable prognosis when compared with subjects with metastatic nodes without ENE. Presence of ENE remains one of the strongest factors predicting recurrence and thus poor prognosis.

A Study on the Time-Effect and Dose-Effect Relationships of Polysaccharide from Opuntia dillenii against Cadmium-Induced Liver Injury in Mice

The purpose of this study was to evaluate the protective effect of Opuntia dillenii (Ker-Gaw) Haw. polysaccharide (ODP) against cadmium-induced liver injury. Cadmium chloride (CdCl2) was used to construct a mice evaluation model, and the indicators chosen included general signs, liver index, biochemical indicators, blood indicators, and pathological changes. A dose of 200 mg/kg ODP was applied to the mice exposed to cadmium for different lengths of time (7, 14, 21, 28, and 35 days). The results showed that CdCl2 intervention led to slow weight growth (reduced by 13−20%); liver enlargement; significantly increased aspartate aminotransferase (AST, 45.6−52.0%), alanine aminotransferase (ALT, 26.6−31.3%), and alkaline phosphatase (ALP, 38.2−43.1%) levels; and significantly decreased hemoglobin (HGB, 13.1−15.2%), mean corpuscular hemoglobin (MCH, 16.5−19.3%), and mean corpuscular hemoglobin concentrations (MCHC, 8.0−12.7%) (p < 0.01). In addition, it led to pathological features such as liver cell swelling, nuclear exposure, central venous congestion, apoptosis, and inflammatory cell infiltration. The onset of ODP anti-cadmium-induced liver injury occurred within 7 days after administration, and the efficacy reached the highest level after continuous administration for 14 days, a trend that could continue until 35 days. Different doses (50, 100, 200, 400, and 600 mg/kg) of ODP have a certain degree of protective effect on cadmium-induced liver injury, showing a good dose−effect relationship. After 28 days of administration of a 200 mg/kg dose, all pathological indicators were close to normal values. These findings indicated that ODP had positive activity against cadmium-induced liver injury and excellent potential for use as a health food or therapeutic drug.