Association between tonsillectomy and oropharyngeal cancer risk: a retrospective cohort study

BACKGROUND

The purpose of this retrospective cohort study is to describe the association between the history of tonsillectomy and the risk of oropharyngeal squamous cell carcinoma (OPSSC), using a large cohort of patients.

MATERIALS AND METHODS

We performed a retrospective cohort study with 3620 patients diagnosed with OPٍSCC from 2010 to 2021. We utilized the University of Florida patients' registry i2b2 system. Three subsets of OPSSC were defined, base of tongue(BOT) cancer, tonsillar cancer, and other OPSSC. Tumor demographics and history of tonsillectomy were collected. Odds ratio for OPSSC were assessed utilizing a logistic regression model with adjusting for gender, race, and age. P < 0.05 was deemed significant.

RESULTS

Of the 3620 OPSSC patients were BOT cancer (N = 964), tonsillar cancer (N = 995), and other OPSSC (N = 1661). There was a statistically significant reduction in tonsillar cancer and BOT cancer odds ratio in patients with a history of tonsillectomy vs. patients without tonsillectomy (0.086 and 0.117), respectively, with a P value < .0001. The odds ratio of OPSSC in patients with a history of tonsillectomy vs. patients without tonsillectomy is 1.031.

CONCLUSION

This study showed that the OPSSC and previous history of tonsillectomy are associated. Our results showed a significant reduction in BOT and tonsillar cancer risk in patients with a history of tonsillectomy and an insignificant decrease in other OPSSC. This study could emphasize the importance of the development of future clinical trials to investigate the role of prophylactic tonsillectomy as a secondary preventive strategy to reduce OPSSC.

Increased prevalence of erythema multiforme in patients with COVID-19 infection or vaccination

Several reports stated that erythema multiforme (EM) was associated with COVID-19 with detrimental outcomes in patients. However, since most of these are case reports, it is challenging to quantitively assess their associations. Therefore, our study aims to determine the prevalence of EM in the context of COVID-19. The study was designed as a retrospective cross-sectional hospital-based study of registered patients at the University of Florida Health Hospital. The ICD-10 codes for EM, COVID-19 infection, and COVID-19 vaccines were searched in the database. The odds ratio was calculated to assess the risk of EM after COVID-19 infection or vaccination. Our study included 43,547 patients with a history of COVID-19 infection, of whom 92 developed EM. Patients with COVID-19 infection were 6.68 times more likely to have EM than those without COVID-19 (P < 0.0001). Similarly, the risk of developing EM after COVID-19 vaccination was 2.7, significantly higher than the general population (P < 0.0001). The prevalence of EM following COVID-19 infection or vaccination significantly differs from the general population, highlighting the importance of monitoring patients for EM after COVID-19 infection and/or vaccination. It is imperative to disseminate awareness to clinicians and patients regarding the impact of COVID-19 on EM.

Efficacy of amniotic membrane with coronally advanced flap in the treatment of gingival recession: an updated systematic review and meta-analysis

OBJECTIVES

This systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR).

METHODS

The protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct.

RESULTS

Two independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009).

CONCLUSION

With the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities.

CLINICAL SIGNIFICANCE

While AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR.

Walking against traffic and pedestrian injuries in the United Kingdom: new insights

BACKGROUND

Studies from Finland and Taiwan have shown that walking against traffic was beneficial for reducing pedestrian crashes and fatalities. This study examined whether such beneficial effects are consistent across various circumstances.

METHODS

This study aimed to investigate pedestrian fatalities in walking-against or with-traffic crashes by analysing the UK STATS19 crash data for the period between 1991 and 2020. We firstly employed Chi-square tests to examine risk factors for pedestrian injury severity. These variables were then incorporated into stepwise logistic regression models with multiple variables. We subsequently conducted joint effect analysis to investigate whether the beneficial effects of walking against traffic on injury severity vary across different situations.

RESULTS

Our data contained 44,488 pedestrian crashes, of which 16,889 and 27,599 involved pedestrians walking against and with traffic, respectively. Pedestrians involved in with-traffic crashes were more likely to sustain fatalities (adjusted odds ratio [AOR] = 1.542; confidence interval [CI] = 1.139-1.927) compared with those in walking against-traffic crashes. The detrimental effect of walking with traffic on fatalities appeared to be more pronounced in darkness-unlit conditions (AOR = 1.48; CI = 1.29-1.70), during midnight hours (00:00-06:59 am) (AOR = 1.60; CI = 1.37-1.87), in rural areas (AOR = 2.20; CI = 1.92-2.51), when pedestrians were elderly (≥ 65 years old) (AOR = 2.65, CI = 2.16-3.26), and when heavy goods vehicles were crash partners (AOR = 1.51, CI = 1.28-1.78).

CONCLUSIONS

Walking against traffic was beneficial in reducing pedestrian fatalities compared with walking with traffic. Furthermore, such a beneficial effect was more pronounced in darkness-unlit conditions, at midnights (00:00-06:59 am), in rural areas, when pedestrians were elderly, and when heavy goods vehicles struck pedestrians.

A lower prevalence of malignant lymphoma in Sjögren's syndrome patients: A cross-sectional study

OBJECTIVE

This study aims to determine the prevalence and risk factors associated with lymphoma in primary Sjögren's syndrome (pSS).

METHODS

We conducted a cross-sectional study on pSS patients who were registered into the Integrated Data Repository (IDR) at the University of Florida (UF) Health Shands Hospital. The parameters, such as age, sex, race, and smoking status, were included. Lymphoma types in pSS were categorized. The clinical and laboratory features were compared between pSS patients with and those without lymphoma by utilizing the items in the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI).

RESULTS

Among 1,211,343 patients, we found 6799 patients (0.56%) with lymphomas and 2562 patients (0.21%) with pSS. Out of the 2562 pSS patients, 67 patients (2.6%) were diagnosed with lymphoma. The difference in the clinical and laboratory features listed under the ESSDAI domains between pSS patients with lymphomas and pSS without it was significant (p < 0.05 or 0.01): fever, weight loss, lymphadenopathy, splenomegaly, lacrimal gland diseases, cough, shortness of breath, hematuria, cerebrovascular accident diseases, peripheral nerve involvement due to vasculitis, neutropenia, and thrombocytopenia.

CONCLUSION

We report 2.6% of lymphoma prevalence in pSS, lower than previously reported in the literature.

Localization and characterization of human papillomavirus-16 in oral squamous cell carcinoma

OBJECTIVES

The role of Human papillomavirus (HPV) in the oral squamous cell carcinoma (OSCC) has not been completely elucidated. The purpose of the present study was to investigate the prevalence and localization of HPV-16 virus in OSCC and to correlate HPV-16 positivity and p16INK4A expression with the clinical and pathological features of OSCC.

METHODS

The archives of Oral Pathology at the University of Florida, College of Dentistry were accessed for demographic, clinical, histopathological data, and slides of 114 OSCC patients. HPV-16 positivity of OSCC was evaluated by p16INK4A immunohistochemistry (IHC) and HPV-16 E6/E7mRNA by in situ hybridization (ISH).

RESULTS

Out of 114 consecutive pathological slides of OSCC, 16 samples (14%) showed positivity for p16INK4A by IHC and 14 samples (12%) were positive for HPV-16 E6/E7mRNA ISH and the Positivity showed a significant correlation with the patients' age, alcohol consumption, and the degree of OSSC differentiation. The hard palate showed the highest positivity of p16INK4A IHC and HPV-16 mRNA ISH (38%, 36% respectively).

CONCLUSION

HPV-16 is a significant factor in oral carcinogenesis. We recommend using p16INK4A as a surrogate marker for HPV detection in OSCC, which can be complemented by RNA ISH for the identification of HPV subtypes.

A rare presentation of a mucocele in a separate compartment of maxillary sinus

Maxillary sinus is frequently presented as a single space within each maxilla. It drains directly into the nose through the middle meatus. We are reporting the second rare case of a mucocele in a separate compartment of maxillary sinus in a 26-year-old patient without a history of facial trauma. The non-contrast computed tomography of paranasal sinuses showed an expansile right infraorbital cystic lesion developed in an upper lateral position of the maxillary sinus. An excision biopsy was performed, which showed histopathological findings of a maxillary sinus mucocele.

Unhelmeted Riding, Drunk Riding, and Unlicensed Riding among Motorcyclists: A Population Study in Taiwan during 2011-2016

This study aimed to investigate the association between drunk riding, unhelmeted riding, unlicensed riding, and running-off-road (ROR) crashes. Multiple logistic regression was used to calculate the adjusted odds ratio (AOR) by using the National Taiwan Traffic Crash Dataset for 2011-2016. The results revealed that unhelmeted riding was associated with 138% (AOR = 2.38; CI (confidence interval) = 2.34-2.42) and 47% (AOR = 1.47; CI = 1.45-1.49) higher risks of drunk riding and unlicensed riding, respectively. The risk of unhelmeted riding increased with blood alcohol concentrations (BACs), and riders with the minimum BAC (0.031-0.05%) had nearly five times (AOR = 4.99; CI = 4.74-5.26) higher odds of unlicensed riding compared with those of riders with a negative BAC. Unhelmeted riding, drunk riding, and unlicensed riding were associated with 1.21 times (AOR = 1.21; CI = 1.13-1.30), 2.38 times (AOR = 2.38; CI = 2.20-2.57), and 1.13 times (AOR = 1.13; CI = 1.06-1.21) higher odds of ROR crashes, respectively. The three risky riding behaviours (i.e., unhelmeted riding, drunk riding, and unlicensed riding) were significantly related to ROR crashes. The risk of unhelmeted riding and ROR crashes increased with BACs.

Evaluating the effect of drunk driving on fatal injuries among vulnerable road users in Taiwan: a population-based study

Background

Most studies have focused on injuries sustained by intoxicated drivers themselves, but few have examined the effect of drunk driving on injury outcomes among VRUs (vulnerable road users) in developing countries. This study aims to evaluate the effect of drunk driving on fatal injuries among VRUs (pedestrians, cyclists, or motorcyclists).

Methods

The data were extracted from the National Taiwan Traffic Crash Dataset from January 1, 2011, to December 31, 2019. Crashes involving one motorized vehicle and one VRU were considered. This study examines the effect of drunk driving by estimating multivariate logistic regression models of fatal injuries among VRUs after controlling for other variables.

Results

Among 1,416,168 casualties, the fatality rate of VRUs involved in drunk driving was higher than that of general road users (2.1% vs. 0.6%). Drunk driving was a significant risk factor for fatal injuries among VRUs. Other risk factors for fatal injuries among VRUs included VRU age ≥ 65 years (adjusted odds ratio [AOR]: 5.24, 95% confidence interval [CI]: 5.53–6.07), a nighttime accident (AOR: 4.52, 95% CI: 4.22–4.84), and being hit by a heavy-duty vehicle (AOR: 2.83, 95% CI: 2.26–3.55). Subgroup analyses revealed a linear relationship between driver blood alcohol concentration (BAC) and the risk of fatal injury among motorcyclists. Motorcyclists exhibited the highest fatality rate when they had a BAC ≤ 0.03% (AOR: 3.54, 95% CI: 3.08–4.08).

Conclusion

Drunk driving was associated with a higher risk of fatality for all VRUs. The risk of fatal injury among motorcyclists was linearly related to the BAC of the drunk drivers. Injuries were more severe for intoxicated motorcyclists, even those with BAC ≤ 0.03%, which is within the legal limit.

Joint Effect of Heavy Vehicles and Diminished Light Conditions on Paediatric Pedestrian Injuries in Backover Crashes: A UK Population-Based Study

Backover crashes cause considerable injuries especially among young children. Prior research on backover crashes has not assessed the joint effect of heavy vehicles and diminished light conditions on injuries. By analysing the United Kingdom STATS19 crash dataset from 1991 to 2020, this study focused on backover crashes involving paediatric cyclists or pedestrians aged ≤17 years and other motorised vehicles. By estimating the adjusted odds ratio (AOR) of multiple logistic regression models, pedestrians appeared to have 82.3% (95% CI: 1.78-1.85) higher risks of sustaining killed or serious injuries (KSIs) than cyclists. In addition, casualties involved in backover crashes with heavy vehicles were 39.3% (95% CI: 1.35-1.42) more likely to sustain KSIs than those involved in crashes with personal cars. The joint effect of heavy vehicles and diminished light conditions was associated with a 71% increased probability of sustaining KSIs (AOR = 1.71; 95% CI: 1.60-1.83). Other significant joint effects included young children (aged 0 to 5 years) as pedestrian (AOR = 1.92; 95% CI: 1.87-1.97), in diminished light conditions (AOR = 1.23; 95% CI: 1.15-1.31), and with heavy vehicle (AOR = 1.37; 95% CI: 1.28-1.47).

Injury in Children with Developmental Disorders: A 1:1 Nested Case-Control Study Using Multiple Datasets in Taiwan

Although past studies have identified predictors related to child injuries with developmental disorders, national-level research in Asia is limited. The objective of this study was to explore the risk factors for child injuries with developmental disorders in Taiwan using a national-level integrated database for the period between 2004-2015 (The Maternal and Child Health Database, National Health Insurance Research Database, Census Registry, and Indigenous Household Registration). Children younger than 12 years old who had records of visiting the ER or being hospitalized due to injury or without injury were included in this study. A 1:1 nested case-control study (injury vs. noninjury) to examine the risk factors for child injury with developmental disorder was performed. A total of 2,167,930 children were enrolled. The risk factors were associated with repeated ER visits or hospitalization: being indigenous (adjusted odds ratio [AOR]: 1.51; CI: 1.45-1.57); having a developmental disorder (AOR: 1.74; CI: 1.70-1.78); and having parents with illicit drug use (AOR: 1.48; CI: 1.32-1.66), alcohol abuse (AOR: 1.21; CI: 1.07-1.37), or a history of mental illness (AOR: 1.43; CI: 1.41-1.46). Being indigenous, having developmental disorders, and having parents with history of illicit drug use, alcohol abuse, or mental illness were predictors related to injuries in children.

Clinical responses of patients with systemic diseases to the photodynamic therapy of oral lichen planus

BACKGROUND

 Oral lichen planus (OLP) is a chronic disease commonly detected in older aged patients with female predominance. Treatment of OLP in diabetic and hypertensive patients usually shows some difficulties which require a more safe and effective treatment modality such as Photodynamic therapy (PDT). The current study aims to evaluate the role of PDT in treating OLP in diabetic and hypertensive patients.

METHODS

We evaluated the role of PDT in treating erosive OLP of type 2 diabetic and hypertensive patients. The following parameters were evaluated for each case at the time zero, after2 weeks, and 4 weeks of the study: subjective responses, objective responses, and the size of the lesion.

RESULTS

 Our study included 9 diabetic and 7hypertensive patients with an age range of 30:60 years old. There were statistically significant differences between the diabetic and hypertensive patients in the objective response, area of ulceration, and the area of erythema at the end of the 4th week of the study (p<0.05).

CONCLUSION

 PDT is an effective treatment modality for diabetic and hypertensive patients with no side effects or patient discomfort.

Multiple oral squamous cell carcinoma 6 years after allogeneic stem cell transplantation complicated with chronic graft-versus-host disease: A case report

Oral squamous cell carcinoma is a potential long-term complication after hematopoietic stem cell transplantation. This may be related to mechanisms including radiation and chemotherapy regimens, chronic graft-versus-host disease, inflammation, and prolonged immunosuppression. The current case describes the development of multiple oral white thick keratotic lesions in the floor of the mouth and the tongue 6 years after hematopoietic stem cell transplantation complicated with chronic graft-versus-host disease. A biopsy performed with histopathological analysis revealed a well-differentiated squamous cell carcinoma. The patient was treated by subtotal glossectomy, bilateral neck dissection, and flap reconstruction. This report highlights the significance of the routine oral examination of long-term surveillance post hematopoietic stem cell transplantation to ensure early detection of these tumors at potentially treatable stage.

Is COVID-19 infection triggering oral herpes zoster? A case report

Patients affected with COVID-19 are at risk of developing serious and life-threatening conditions. The clinical manifestations of COVID-19 were detected in asymptomatic cases to severe clinical symptoms with a major impact on the respiratory system. A few cases of cutaneous as well as an oral lesion of herpes zoster in patients with COVID-19 were reported in the literature. We present a case of the rapid appearance of the oral lesion as a manifestation of herpes zoster associated with COVID-19 infection. Our case highlights the importance of oral examination as well as oral care in patients with COVID-19 infection.

Oral lichen planus after COVID-19, a case report

Introduction

The COVID-19 is a global pandemic that is now responsible for more than 3 million deaths around the world. The oral and dermatological manifestations of COVID-19 are being remarkably reported. This report aims to describe a unique case of oral presentation of erosive lichen planus after COVID-19 infection.

Case presentation

We present a case of oral lichen planus manifested in the buccal mucosa and the tongue. The lesions were detected one month after COVID-19 infection. Clinical, as well as the histopathological diagnosis, was performed on the oral lesion to confirm oral lichen planus.

Clinical discussion

Despite viruses being reported as a triggering factor in oral lichen planus, very few cases of oral lichen planus after COVID-19 infection were noticed. The immunological and psychological changes induced by COVID-19 infection may explain the tendency to find lichen planus lesions in COVID-19 patients.

Conclusion

Our case suggests the possible association between COVID-19 and oral lichen planus. This report highlights the role of health practitioners to be concerned about the probably rising incidence of lichen planus during the COVID-19 pandemic and consider appropriate therapeutic and protective measures against infection.

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Coronavirus disease 2019 (Covid 19) causes pandemics all over the world.

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Oral and cutaneous manifestations of COVID-19 are emerging every day.

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Lichen planus is a new pattern of COVID‐19 associated lesion.

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Identification and diagnosis of lichen planus after COVID-19 need conducting entire clinical and laboratory investigation.

First report of oral angiokeratoma in a xeroderma pigmentosum

Introduction and importance

Xeroderma pigmentosum is an autosomal recessive genetic disorder with impaired ability to repair DNA damage. Detection of the intraoral benign and malignant lesion in Xeroderma pigmentosum is uncommon, and the reported few cases were in the lip and tip of the tongue which are related to ultraviolet light exposure.

Case presentation

We present a case of 20 years old male with erythematous to violet, painless and shiny papule at the right side of the tongue. The lesion was surgically excised while the histopathological examination of the lesion showed focally eroded and hyperplastic stratified squamous epithelial covering with underlying capillary sized blood vessel filled with RBCs and lined by endothelium with no atypia or malignancy.

Clinical discussion

Oral angiokeratoma is a rare disease in patient with Xeroderma pigmentosum that should be early detected and diagnosed to decrease the liability for malignant transformation.

Conclusion

Health case workers should be aware of the nature of the disease, protection of the patient from ultraviolet light as well as Frequent follow up of the patients for a better quality of life.

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The management of XP complications, especially orofacial manifestations, represents a considerable challenge to healthcare providers.

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Angiokeratomas are vascular malformations of capillaries in the form of single or multiple keratotic papules and/or plaques.

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Health case workers should be aware of disease’s nature and the follow up of the patient for a better of life.

Pediatric Traffic Injuries on Halloween in the United Kingdom: Prevalence and Injury Severity

The study results serve as a reminder for parents, children, and drivers to be alert to the danger of traffic crashes on Halloween. The aim of this study was to examine whether Halloween is associated with a higher incidence of traffic injuries and whether traffic injuries sustained on Halloween are more severe than those sustained on other days. The U.K. STATS19 database, including the data of all road traffic crashes occurring from 1990 to 2017, was employed. A total of 73,587 pediatric traffic casualties (involving pedestrians, cyclists, and moped riders) were included. Between 17:00 and 19:00 (17:00~18:59) on Halloween, the number of casualties was higher than that on other public holidays and usual days. The logistic regression model revealed that, between 17:00 and 18:00 (17:00~17:59), the risk of being killed or seriously injured on Halloween was 34.2% higher (odds ratio = 1.342; 95% CI = 1.065–1.692) than that on other days. Pediatric crashes occurring on Halloween are associated with a higher number of injuries and increased injury severity.

Differentiation of Posterior Fossa Brain Tumors by Diffusion Weighted Imaging

Background:

Diffusion Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) map provide information on Magnetic Resonance Imaging (MRI) about the cellularity of the tumor and have an important role in the pre-operative differentiation of different tumor types. The aim of the current study is to differentiate between pediatric and adult posterior fossa brain tumours using DWI calculation of ADC value of these tumours and correlate our findings with the histopathological reported data.

Methods:

Our study included a total of 34 patients with posterior fossa brain tumours. Conventional MRI and MRI DWI were applied for each patient. The calculation of the ADC value was performed for the pediatric and adult posterior fossa brain tumours.

Results:

This study included 34 patients with posterior fossa brain tumours,19 males and 15 females while the cases were selected randomly from the neurosurgery department. Our study has been divided into pediatric group which included 11 patients and adult group with 23 patients. We found a significant difference in 1 (regions of interest) ROI ADC values between all types of pediatric posterior fossa brain tumours (p<0.001). Furthermore, there was a significant difference in 3 ROIs ADC values between all types of pediatric posterior fossa brain tumours (p<0.001). There were no significant differences in 1 ROIs ADC values as well as 3 ROIs ADC values between the adult posterior fossa brain tumors (p value> 0.05).

Conclusion:

ADC values are simple and readily available techniques for preoperative differentiation of the most common posterior fossa.

Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin‐converting enzyme 2 (ACE2). As a result of SARS‐CoV‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT₁R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT₁R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects, helpful in mitigating COVID‐19 severity.

Secretome Analysis of Inductive Signals for BM-MSC Transdifferentiation into Salivary Gland Progenitors

Severe dry mouth in patients with Sjögren's Syndrome, or radiation therapy for patients with head and neck cancer, significantly compromises their oral health and quality of life. The current clinical management of xerostomia is limited to palliative care as there are no clinically-proven treatments available. Previously, our studies demonstrated that mouse bone marrow-derived mesenchymal stem cells (mMSCs) can differentiate into salivary progenitors when co-cultured with primary salivary epithelial cells. Transcription factors that were upregulated in co-cultured mMSCs were identified concomitantly with morphological changes and the expression of acinar cell markers, such as α-amylase (AMY1), muscarinic-type-3-receptor(M3R), aquaporin-5(AQP5), and a ductal cell marker known as cytokeratin 19(CK19). In the present study, we further explored inductive molecules in the conditioned media that led to mMSC reprogramming by high-throughput liquid chromatography with tandem mass spectrometry and systems biology. Our approach identified ten differentially expressed proteins based on their putative roles in salivary gland embryogenesis and development. Additionally, systems biology analysis revealed six candidate proteins, namely insulin-like growth factor binding protein-7 (IGFBP7), cysteine-rich, angiogenetic inducer, 61(CYR61), agrin(AGRN), laminin, beta 2 (LAMB2), follistatin-like 1(FSTL1), and fibronectin 1(FN1), for their potential contribution to mMSC transdifferentiation during co-culture. To our knowledge, our study is the first in the field to identify soluble inductive molecules that drive mMSC into salivary progenitors, which crosses lineage boundaries.

Evaluating the combined effect of alcohol-involved and un-helmeted riding on motorcyclist fatalities in Taiwan

BACKGROUND

Alcohol-involved riders tend to engage in other risk-taking behaviours such as un-helmeted riding which could further increases injury severity. The combined effect of alcohol-involved and un-helmeted riding on fatal injuries is rarely investigated. This study investigated the interaction effect between blood alcohol concentration and helmet use on fatal injuries.

METHODS

This study used the National Taiwan Traffic Crash Dataset for the period from 2011 to 2015. Data on road crashes involving a motorcycle and an automobile were extracted and analysed. Multiple logistic regression models were used to calculate the adjusted odds ratio (AOR). We calculated an interaction effect for blood alcohol concentration and helmet use based on STROBE guidelines.

RESULTS

There were a total of 669,292 motorcyclist casualties; among these casualties, 3459 (0.5 %) motorcyclists sustained fatal injuries. Alcohol-involved riders were 9.47 times (AOR = 9.47; 95 % CI = 8.75-10.25) more likely than sober ones to sustain fatal injuries. Alcohol-involved and un-helmeted riders were approximately 18 times (AOR = 18.1; CI: 15.9-20.4) more likely to sustain fatal injuries than sober and helmeted riders. Riders involved in head-on crashes and approach-turn motorcycle crashes had an increased probability of sustaining fatal injuries by 240 % (AOR = 3.4; 95 % CI = 2.91-4.09) and 132 % (AOR = 2.3; 95 % CI = 2.016-2.67), respectively.

CONCLUSIONS

This study found that alcohol-involved riding acts synergistically with un-helmeted riding to increase motorcyclist injury severity.

Could photodynamic therapy be utilized as a treatment modality for oral lichen planus?

BACKGROUND

Oral lichen planus (OLP) is a chronic inflammatory disease. There is no standard treatment modality for OLP. Recently, photodynamic therapy (PDT) has been advocated as a new treatment modality for OLP.

AIM

The aim of the present study is to compare the effect of PDT using methylene blue (MB) as a photosensitizer to the effect of topical corticosteroids in the treatment of erosive OLP lesions.

MATERIALS AND METHODS

Our study included 20 patients with erosive OLP. Patients were divided into two groups. The study group included 10 patents which received MB-PDT. Patients were instructed to use MB as mouth path for 5 min. After 10 min, we applied focal red light on OLP lesions (wavelength 660 nm, Intensity 100-130 m W/cm2) for 2 min. The PDT was applied twice a week for four weeks. In the control group, 10 patients were instructed to apply topical betamethasone valerate ointment 100 mg on OLP lesion three times per day for four weeks. Subjective, objective scores and lesion size were recorded at time zero, after 2 weeks and after 4 weeks from the start of treatments.

RESULTS

Both groups showed statistically significant differences between time zero and the 4^th week of treatment in subjective, objective scores and the area of the lesions. MB-PDT showed a higher degree of improvement than topical corticosteroids between time zero and the 4^th week of treatment.

CONCLUSION

Photodynamic therapy can be used as a treatment for erosive OLP. PDT offers improvement of OLP subjective and objective scores without major side effects.

Pedestrian crashes at priority-controlled junctions, roundabouts, and signalized junctions: The UK case study

Objectives: Over half of pedestrians killed and seriously injured in Great Britain in 2015 were involved in crashes at junctions. This study investigates the nature of these crashes. Methods: A study was conducted into pedestrian casualty crashes at priority controlled junctions, roundabouts and signalised junctions in England between 2005 and 2015 using information from the UK STATS19 accident database, the UK National Travel Survey and the UK National Census. Consideration was given to coding frequencies of contributory factors, exposure (in terms of miles walked or driven) as well as age, gender and the resident deprivation index of the road users involved. Results and Conclusions: In terms of indicative blame, the coding frequencies of subjectively determined pedestrian actions and behaviour factors which might have contributed to pedestrian casualty crashes were found to be between 1.6 and 2.8 times the frequencies of driver actions and behavioural factors. Substantial social gradients were found in pedestrian casualty rates per miles walked and in the driver involvement rates per mile driven with those from the most deprived quintile having higher rates. In addition, it was found that female pedestrians, aged 60 years and over, had higher pedestrian casualty rates, per billion miles walked, for all three junction types, when compared with males and females under the age of 60 years, apart from male pedestrians aged 16 years and younger at priority controlled junctions.

HPV-related oral dysplasia in a multiple myeloma patient after stem cell transplantation

The development of dysplastic changes in oral epithelial lesions is a potential long-term complication after hematopoietic stem cell transplantation (HSCT). This may be related to mechanisms including radiation and chemotherapy regimens, chronic graft-versus-host disease (cGVHD), inflammation, and prolonged immunosuppression. The current case describes a 54-year-old male with multiple myeloma treated by autologous and allogenic HSCT followed by development of cGVHD (mouth, skin and the eyes) with the complaint of diffuse white lesions on the buccal mucosa, tongue, and palate. A biopsy performed with histopathological analysis revealed moderate to severe epithelial dysplasia with hyperkeratosis, positive for p16INK4A as a surrogate marker for human papillomavirus (HPV). Our finding suggests a possible association of oral dysplasia and HPV in patients after receiving allogenic HSCT with the necessity of more clinical follow-ups for those patients that may be at a higher risk for the development of oral dysplasia associated with HPV.

Exploring motorcycle red-light violation in response to pedestrian green signal countdown device

Literature has suggested that angle/rear-end collisions would arise from the reality that motorists and motorcyclists tended to accelerate aggressively in response to the remaining seconds of green signal countdown device (GSCD). One safety concern, while GSCD has gradually been removed for safety in Taiwan, is pedestrian green signal countdown device (PGSCD) that is used by approaching motorists and motorcyclists that may adopt the information to travel aggressively - an unintended consequence that is detrimental to safety. Research has reported that there appeared no negative effect of PGSCD on motorist behaviours but the effect on motorcyclists' behaviours has been rarely investigated. Using video/speed cameras, the current research investigates motorcyclists' RLV (red-light violation) behaviours. The descriptive analyses indicate that the percentage of RLV at PGSCD intersection is higher than that at typical intersection, and the violating motorcycles appear to have higher travelling speeds at PGSCD intersection. Several interaction terms were examined with the binary logit framework, and the results reveal that several factors are associated with RLV, notably male/young riders, moped/large motorcycle users, higher approaching speeds of motorcycles, those with tropical helmets, and lower traffic volume. Similar determinants of early-start behaviours (for those waiting at reds and could view the PGSCDs for the crossing pedestrians at the same time) were identified. Implications of the research findings, the concluding remarks, and recommendations for future research are finally provided.

Effect of type of lead vehicle on following headway behaviour in mixed traffic

Purpose

– There is gap in literature on understanding of the issues of following headway behaviour of the driver and a lack of sufficient data in different traffic conditions. The purpose of this paper is to find the effects of type of lead vehicle on following headway in mixed traffic condition in India on different category of roads and flow.

Design/methodology/approach

– Real-world headway data were collected through video and extracted. Data were analysed using tools and statically approach was adopted to present the results in detail.

Findings

– Results shows the impact of type of lead vehicle on driver following time headway behaviour under different level of traffic and types of road characteristics. It was found that driver following behaviour is affected by the type of lead vehicle. It also shows that drivers are inconsistent in their choice of headway.

Research limitations/implications

– This research has special strategic study area of India in typical two cities Silchar and Shillong of northeast region of India. The traffic characteristic and composition is quite different as compared to other cities of India. Therefore the study results cannot be generalized for whole India.

Practical implications

– The result of the study has focused on impact of type of lead vehicle on following behaviour. This can be useful to safety reduction and changing the driver behaviour through education and display of information. However, the real application of this result is to be implemented by local transport and road managing authority to reduce accidents and increase safety of drivers.

Originality/value

– In mixed traffic conditions, the impact of type of lead vehicle on following behaviour affects the safety of drivers and the accounting for such behaviour is never been explored in mixed traffic condition. If the study is implemented, it can be useful to simulation modeller and intelligent transport systems (ITS) to design and operate many in-vehicle systems for smooth traffic processes.

Maternal mortality at the State Specialist Hospital Bauchi, Northern Nigeria

OBJECTIVE

To analyse and document our experiences with maternal mortality with the view of finding the trends over the last seven years, common causes and attributing socio-demographic factors.

DESIGN

A prospective analysis of maternal mortality.

SETTING

State Specialists Hospital Bauchi, Bauchi Northeastern Nigeria.

MAIN OUTCOME MEASURES

These include maternal mortality ratio for the period under review and the annual trends, age and parity most affected the direct and indirect causes of maternal mortality in our environment.

RESULTS

The Maternal Mortality Ratio (MMR) for the period under review was 1,732 per 100, 000 live births. Six hundred and twenty one of the deaths (81.0%) occurred in 12,067 unbooked deliveries giving a maternal mortality ratio of 5,146 per 100,000 for unbooked mothers. This ratio is approximately eleven times that obtained in booked live deliveries. Age range was 14-44 years and the mean age was 27.8 years. The highest maternal death was in the adolescent mothers. The primigravidas had the highest maternal mortality of 28.9%. The direct obstetric causes of maternal death accounted for 79.4% of the deaths. The major causes of deaths were eclampsia 31.9%, haemorrhage 19.2% and sepsis 10.4%. Amongst the indirect causes of maternal death, anaemia was the leading cause accounting for 12.1%. The annual MMR was highest for the year 2006 (2,586 per 100,000).

CONCLUSION

Maternal mortality is unacceptably high in our environment. The provision of more health facilities where basic and comprehensive antenatal care are provided, skilled attendants at birth, community mobilisation to improve antenatal attendance and the use of TBAs as a link between the pregnant women, families and communities providing important messages for a healthy pregnancy, and safe birth remain the bedrock of containing maternal mortality in our environment.

A mixed logit analysis of motorists' right-of-way violation in motorcycle accidents at priority T-junctions

Research suggested that motorists' right-of-way (ROW) violation in automobile-motorcycle gap-acceptance accidents at priority (i.e., stop-/yield-controlled) T-intersections has been a safety concern to motorcyclists. This study examines the characteristics of automobile-motorcycle gap-acceptance accidents that occurred at such locations. British Stats19 accident injury database during 1991-2005 are examined in detail. Automobile-motorcycle gap-acceptance accidents are classified into three crash scenarios: approach-turn, angle crossing, and angle merging crashes. Mixed (random parameters) logit models are estimated to investigate the contributory factors to motorists' ROW violation in these three crash types. Crash features are also compared among gap-acceptance accidents and other crash scenarios. The methodological approach adopted allows for the individuals within the observations to have different parameter estimates as opposed to a single parameter representing all observations (i.e., accounts for unobserved heterogeneity potentially relating to roadway/environmental characteristics, and motorist behaviours). It was found that motorcycles' ROW was more likely to be violated on non-built-up roads, and in diminished light conditions, with non-uniform effects across the observations. Elderly/female motorists appeared to be over-represented in gap-acceptance crashes. Implications of the findings are discussed.

Exploring motorcyclist injury severity in approach-turn collisions at T-junctions: focusing on the effects of driver's failure to yield and junction control measures

Research has suggested that motorcyclists involved in approach-turn crashes were much more injurious than any other crash-type. This paper investigates the determinants of motorcyclist injury severity resulting from such crash types that occurred at T-junctions, with emphasis on the effects of driver's failure to give way and various junction control measures. The ordered probit models of motorcyclist injury severity were estimated using the data extracted from the STATS19 accident injury database (1991-2004). Approach-turn collisions are categorised into two sub-crashes based on the manoeuvres motorcycles and vehicles were making prior to the collisions. The modelling results uncover several important determinants of injury severity: for example, injuries appeared to be greatest when an approaching motorcycle collided with a turning-right vehicle, and such effect was found to exacerbate injury severity when stop, give-way signs and markings controlled the junction. A turning-right driver that was identified to fail to yield to an approaching motorcyclist was also found to severely injure the motorcyclist. The findings of this study may offer guidelines for further research and provide some important preliminary evidence for the development of countermeasures that may help prevent the specific hazards from occurring.

Exploring motorcyclist injury severity resulting from various crash configurations at T-junctions in the United Kingdom--an application of the ordered probit models

OBJECTIVES

The fact that motorcycle users tend to be more vulnerable to injuries than those using other motorized vehicles may act synergistically with the complexity of conflicting movements between vehicles and motorcycles to increase injury severity in a junction-type accident. A junction-type collision tends to be more severe than a non-junction case due to the fact that some of the injurious crashes such as angle-collision commonly occur. Existing studies have applied several statistical modeling techniques to examine influential factors on the occurrences of different crashes among motorized vehicles but surprisingly very little has empirically explored whether a particular crash type, resulting from a junction-type accident, is more injurious to motorcyclists. This article attempts to investigate whether a particular collision is more deadly to motorcyclists conditioned on crash occurrence at T-junctions in the U.K., while controlling for environment, vehicle, and demographic factors.

METHODS

The statistical modeling technique employed is the ordered probit models using the data extracted from the STATS19 accident injury database (1999-2004).

RESULTS

The modeling found determinants of injury severity among motorcyclists at T-junctions in the U.K. For example, an approach-turn/head-on collision is much more injurious to motorcyclists; and, those riding in early morning (i.e., 0000-0659) are more likely to be severely injured.

CONCLUSIONS

This study offers a guideline for future research, as well as insight into potential prevention strategies that might help moderate motorcyclist injuries.

Telesurgical mentoring. Initial clinical experience

BACKGROUND

Minimally invasive surgical techniques yield significant individual, economic, and social benefits when performed by experienced surgeons. Unfortunately, many of these techniques, such as laparoscopy, are associated with steep learning curves, and the incidence of complications has clearly been shown to be inversely related to experience. The initial high complication rate and the dearth of experienced endoscopic surgeons have raised concerns over training, granting of hospital privileges, and most importantly patient safety. The goal of this study was to employ current telecommunications technology in a system for the mentoring of relatively inexperienced surgeons. Therefore, we created a telesurgical system that would allow an endoscopic specialist at a central site to offer guidance and assistance to a surgeon during a laparoscopic procedure.

METHODS

We developed a system that connected a central site and an operative site, a distance of approximately 3.5 miles, via a single T1 (1.54 Mbs) point-to-point communications link. The system provided real-time video display from either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, control of a robotic arm that manipulated the laparoscope, and access to electrocautery for tissue cutting or hemostasis.

RESULTS

Seven patients underwent laparoscopic procedures using the telesurgical consultation system over the communications link. In all cases, the primary surgeon had limited experience with the laparoscopic approach but still had the basic skills required to obtain intraperitoneal access. All seven cases were completed successfully without complications.

CONCLUSION

These initial studies have demonstrated the feasibility, effectiveness, and safety of telementoring. Telesurgical applications have the potential to greatly improve surgical education credentialing, and patient care by offering patients and their surgeons global access to surgical specialists.

Growth factors in reproduction

The changes that occur in the female reproductive tract during the menstrual cycle and in early pregnancy, in preparation for embryo implantation and subsequent placental and fetal development, have long attracted the interest of reproductive biologists. The early embryo expresses growth factors and growth factor receptors that are, in general, temporally expressed. In addition, the oviduct and uterine endometrium also synthesize growth factors and cytokines, and the developing embryo finds itself in a growth-factor-rich milieu during early development. The autocrine, juxtracrine, and paracrine actions of these factors in the development of the early embryo and of the maternal reproductive tract are just beginning to be appreciated, as are their potential roles in cellular proliferation and cell-cell communication within the developing embryo, in the reproductive tract, and at the maternal-trophoblast interface. When detailed mechanisms underlying these interactions are fully understood, it is anticipated that therapies will be rationally designed to treat reproductive disorders associated with abnormal embryonic development and poor placentation.