Evaluation of Salivary Function Post-Partial Superficial Parotidectomy

Introduction

Parotid pleomorphic adenomas necessitate surgical intervention, with a growing emphasis on preserving salivary function post-surgery due to its critical role in maintaining oral health and overall quality of life. This study aims to evaluate a surgical method meticulously designed to preserve salivary function following partial superficial parotidectomy, utilizing Technetium-99m scintigraphy.

Materials and Methods

This single-center prospective cohort study was conducted in Mashhad, Iran, between 2022 and 2023. The study encompassed 40 patients diagnosed with parotid pleomorphic adenomas, ages 20 to 64, undergoing partial superficial parotidectomy. The salivary function was evaluated using Technetium-99m scintigraphy three weeks post-operation.

Results

Most participants underwent right parotid surgery (62.5%, n=25) instead of left parotid surgery (37.5%, n=15). The outcomes of the partial superficial parotidectomy indicated no complications during the three-week post-operative period. Saliva secretion rates on the operated side were preserved across the cohort. A significant difference in saliva secretion rates was observed between the operated and contralateral sides (P<0.01) for both right and left parotid surgery groups. No significant correlation was found between the time elapsed post-surgery and saliva secretion rates (P=0.48).

Conclusion

Our study demonstrated that the superficial parotidectomy technique is notably effective when focused on preserving the salivary function of the deep parotid gland. Not only does it maintain saliva secretion on the operated side, but it also boasts an admirable safety profile. There were no recorded complications, and duct preservation was achieved in most instances.

An Evaluation of Antibacterial Effects of Human Amniotic Fluid on Pathogenic and Probiotic Bacteria In Vitro

Background

Amniotic fluid in the uterus is beneficial for the fetus growth and protection due to its nutritional elements as well as its antibacterial and anti-inflammatory properties. Today, body membranes are increasingly being used in multiple fields. The purpose of the current study was evaluation of the antibacterial effects of amniotic fluid and comparison of its effects on pathogenic and probiotic bacteria.

Methods

This experimental study was conducted on amniotic fluid obtained from 43 healthy mothers who gave birth by selective cesarean section. Then, antibacterial effects of amniotic fluids were investigated on 8 standard bacterial strains, including Bacillus cereus, Escherichia coli, Staphylococcus aureus, Shigella flexneri, Pseudomonas aeruginosa, Klebsiella pneumoniae, Bacillus cereus, and Lactobacillus plantarum by agar well-diffusion method. Data analysis was performed by SPSS software, vs. 22 (IBM, US).

Results

Amniotic fluid revealed an inhibitory effect on the growth of bacterial strains. Staphylococcus aureus and Streptococcus pyogenes strains showed growth inhibition in 39% and 17% of samples, respectively. In other bacterial strains, there was growth inhibition in less than 5% of the samples. Also, the zone of growth inhibition for Staphylococcus aureus and Streptococcus pyogenes was significantly higher than the other strains. Amniotic fluid samples had an antibacterial effect on all pathogen strains in general, but not on the Lactobacillus plantarum probiotic strain.

Conclusion

Our findings suggest that the antibacterial effect of amniotic fluid on pathogenic bacteria is significantly higher than the Lactobacillus plantarum as a probiotic one. Overall, the findings support the use of natural substances as alternative therapeutic agents to combat antibiotic resistance.

Remarkable FDG Uptake in Numerous Granulomatous Panniculitis Lesions: A Case Report

ABSTRACT

A 42-year-old woman with history of rheumatoid arthritis and erythema nodosum from 8 years ago, who was treated with CellCept and prednisolone, was admitted to the rheumatology service due to skin lesions in the upper and lower extremities. Skin excisional biopsy was performed, and the results suggested panniculitis. FDG PET/CT was performed for malignancy workup. The scan images revealed intensely increased FDG uptake in all numerous subcutaneous nodules. FDG uptake in the panniculitis lesion is rarely reported in the literature.

Case Report: Regaining radioiodine uptake following PRRT in radioiodine-refractory thyroid cancer: A new re-differentiation strategy?

A 61-year-old woman with a history of metastatic follicular thyroid carcinoma became radioiodine-refractory following two doses of radioiodine (RAI) therapy (cumulative = 230 mCi). While no RAI-avid lesion was noticed in the last post-ablation whole-body radioiodine scan (WBIS), she reported sternal pain, which was accompanied by rapidly rising thyroglobulin levels. 18F-FDG and 68Ga-DOTA-TATE PET/CT was performed, showing metastatic pulmonary nodules and a lytic sternal lesion with acceptable avidity (i.e. uptake ≥ liver). Following four cycles of peptide receptor radionuclide therapy (PRRT) with 177Lu-DOTA-TATE, the thyroglobulin levels dropped significantly, and the sternal pain was partially alleviated. Despite only experiencing grade I thrombocytopenia, the treating physician decided to discontinue PRRT and repeat the diagnostic WBIS. Surprisingly, the scan revealed significantly increased tracer uptake in the sternum. The patient received 200 mCi 131I, and WBIS showed increased RAI uptake in all pulmonary nodules as well as bone metastases. We report a case of RAI-refractory thyroid carcinoma with a somatostatin-receptor expression that re-differentiated and gained significant RAI uptake capacity after PRRT.

Prostatic bed calcification with MDP uptake: Easy to miss on planar images

A 65 years old man with high-risk prostate adenocarcinoma underwent bone scintigraphy with 99mTc-methylene diphosphate (99mTc-MDP). The scan revealed a focus of radiotracer uptake in the left pubic region, which was suspicious for metastatic involvement. Additional imaging with single photon emission computed tomography (SPECT/CT) confined the uptake to be extra-osseous and contributed to the calcified zone in the prostate bed. Prostatic bed calcification with 99mTc-MDP uptake mimics metastasis and can be easily missed on planar images.

Prostate-Specific Membrane Antigen Radioguided Surgery for Salvage Pelvic Lymph Node Dissection in a Man With Prostate Cancer

ABSTRACT

A 75-year-old man with evidence of recurrent prostate cancer on 68Ga-prostate-specific membrane antigen (PSMA) PET/CT after radical prostatectomy was referred to our department for 99mTc-PSMA radioguided surgery. Intraoperatively, lymph nodes with high count rates were localized using a handheld gamma probe. High-count specimens were resected from the exact locations as reported by 68Ga-PSMA PET/CT. The total prostate-specific antigen value decreased 6 weeks after surgery. Our case shows the feasibility of radioguided surgery with 99mTc-PSMA for salvage lymphadenectomy in prostate cancer.

Antimicrobial Properties of Amniotic and Chorionic Membranes: A Comparative Study of Two Human Fetal Sacs

BACKGROUND

There is evidence of antibacterial properties of human chorioamniotic layer. However, the distinctive contribution of its individual parts, amniotic and chorionic membranes, to these effects is still unknown. The aim of present study was comparison of the antibacterial effects between amniotic and chorionic membranes.

METHODS

Chorioamniotic layer was removed from placenta belonging to 43 healthy mothers whose infants were delivered by caesarean section. Their amniotic and chorionic fetal tissues were manually peeled in sterile conditions. The antibacterial effects of all membrane samples were evaluated on 8 standard strains of bacterial collection using disk diffusion method on bacteriologic media. Results of bacterial growth inhibition in the presence of amniotic or chorionic membranes were measured and recorded as median±IQR. For data analysis and statistical comparison of samples, Kruskal-Wallis and Mann-Whitney U-test were applied using SPSS (v. 18).

RESULTS

Amniotic and chorionic membranes significantly showed different level of growth inhibitory effects on 8 bacterial strains including seven pathogens: E. coli, Bacillus cereus, Klebsiella pneumonia, Streptococcus pyogenes, Pseudomonas aeruginosa, Staphylococcus aureus, Shigella flexneri and one probiotic: Lactobacillus plantarum (p=0.018 and p<0.001, respectively). The number of bacterial growth inhibition zones around chorionic membranes was more than of what found around amniotic membranes.

CONCLUSION

The superiority of antibacterial effects of the chorionic membrane compared with the amniotic membrane can represent the key role of maternal part in placenta in protecting the fetus against possible infections. The antimicrobial effect of amniotic and chorionic membranes is significantly different on various bacteria.

Neuroprotective Effects of Exercise on Brain Edema and Neurological Movement Disorders Following the Cerebral Ischemia and Reperfusion in Rats

Introduction:

Cerebral ischemia and reperfusion causes physiological and biochemical changes in the neuronal cells that will eventually lead to cell damage. Evidence indicates that exercise reduces the ischemia and reperfusion-induced brain damages in animal models of stroke. In the present study, the effect of exercise preconditioning on brain edema and neurological movement disorders following the cerebral ischemia and reperfusion in rats was investigated.

Methods:

Twenty-one adult male wistar rats (weighing 260–300 g) were randomly divided into three groups: sham operated, exercise plus ischemia, and ischemia group (7 rats per group). The rats in exercise group were trained to run on a treadmill 5 days a week for 4 weeks. Transient focal cerebral ischemia and reperfusion were induced by middle cerebral artery occlusion (MCAO) for 60 minutes, followed by reperfusion for 23 hours. After 24 hours ischemia, movement disorders were tested by a special neurological examination. Also, cerebral edema was assessed by determining the brain water content.

Results:

The results showed that pre-ischemic exercise significantly reduced brain edema (P<0.05). In addition, exercise preconditioning decreased the neurological movement disorders caused by brain ischemia and reperfusion (P<0.05).

Conclusion:

Preconditioning by exercise had neuroprotective effects against brain ischemia and reperfusion-induced edema and movement disorders. Thus, it could be considered as a useful strategy for prevention of ischemic injuries, especially in people at risk.

Chemoprotection of MNNG-initiated gastric cancer in rats using Iranian propolis

BACKGROUND

Iranian propolis is a natural product of honeybees that has significant and varied anti-cancer benefits. The present study was designed to investigate the protective effects of Iranian propolis on gastric tissue carcinogenesis in an animal model. 

METHODS

Propolis samples were collected from Hamadan and Taleghan districts of Iran, followed by ultra performance liquid chromatography mass spectrometry analysis. Fifty-five rats were divided into three groups; control, Taleghan propolis and Hamadan propolis. All the animals received N-methyl-N-nitro-N-nitrosoguanidine (MNNG, 100 μg/ml) in drinking water ad libitum for 34 weeks. In the treated groups, nutrition with propolis was started two weeks before MNNG administration. At the end of the study, the entire gastrointestinal tract was scrutinized for tumors, and the rest of the body was assessed for metastatic deposits. 

RESULTS

Results indicated that the incidence and number of tumors were significantly decreased by propolis in comparison with the control group (P < 0.05). The nuclear/cytoplasmic ratio, epithelial stratification, nuclear dispolarity, structural abnormality, and Beta-catenin and Bcl-2 proteins expression were significantly reduced in the propolis group compared to the control group (P < 0.05). In addition, Bax protein expression was significantly increased in the propolis group in comparison with the control group (P < 0.05). 

CONCLUSION

The present study demonstrated the potential chemoprotective effects of the Iranian propolis against gastric cancer in a typical animal model. The results provide evidence for the hypothesis that Iranian propolis may exert a chemoprotective effect on MNNG-initiated gastric cancer through inhibition of cell proliferation and apoptosis induction.

Cyproheptadine in the treatment of autistic disorder: a double-blind placebo-controlled trial

OBJECTIVE

Autism is a childhood-onset disorder of unknown, possibly of multiple aetiologies. The core symptoms of autism are abnormalities in social interaction, communication and behaviour. The involvement of neurotransmitters such as 5-HT has been suggested in neuropsychiatric disorders and particularly in autistic disorder. Increased platelet 5-HT levels were found in 40% of the autistic population, suggesting that hyperserotonaemia may be a pathologic factor in infantile autism. Therefore, it is of interest to assess the efficacy of cyproheptadine, a 5-HT2 antagonist in the treatment of autistic disorder. In this 8-week double-blind, placebo-controlled trial, we assessed the effects of cyproheptadine plus haloperidol in the treatment of autistic disorder.

METHODS

Children between the ages 3 and 11 years (inclusive) with a DSM IV clinical diagnosis of autism and who were outpatients from a specialty clinic for children at Roozbeh Psychiatric Teaching Hospital were recruited. The children presented with a chief complaint of severely disruptive symptoms related to autistic disorder. Patients were randomly allocated to cyproheptadine + haloperidol (Group A) or haloperidol + placebo (Group B) for an 8-week, double-blind, placebo-controlled study. The dose of haloperidol and cyproheptadine was titrated up to 0.05 and 0.2 mg/kg/day respectively. Patients were assessed by a third-year resident of psychiatry at baseline and after 2, 4, 6 and 8 weeks of starting medication. The primary measure of the outcome was the Aberrant Behaviour Checklist-Community (ABC-C) and the secondary measure of the outcome was the Childhood Autism Rating Scale (relating to people and verbal communication). Side effects and extrapyramidal symptoms were systematically recorded throughout the study and were assessed using a checklist and the Extrapyramidal Symptoms Rating Scale, administered by a resident of psychiatry during weeks 1, 2, 4, 6 and 8.

RESULTS

The ABC-C and the Childhood Autism Rating Scale scores improved with cyproheptadine. The behaviour of the two treatments was not homogeneous across time (groups-by-time interaction, Greenhouse-Geisser correction; F = 7.30, d.f. = 1.68, P = 0.002; F = 8.21, d.f. = 1.19, P = 0.004 respectively). The difference between the two treatments was significant as indicated by the effect of group, and the between-subjects factor (F = 4.17, d.f. = 1, P = 0.048; F = 4.29, d.f. = 1, P = 0.045 respectively). No significant difference was observed between the two groups in terms of extrapyramidal symptoms (P = 0.23). The difference between the two groups in the frequency of side effects was not significant.

CONCLUSION

The results suggest that the combination of cyproheptadine with a conventional antipsychotic may be superior to conventional antipsychotic alone for children with autistic disorder. However the results need confirmation by a larger randomized controlled trial.

An in vitro mouse model of cleft palate: defining a critical intershelf distance necessary for palatal clefting

It is unclear whether cleft palate formation is attributable to intrinsic biomolecular defects in the embryonic elevating palatal shelves or to an inability of the shelves to overcome a mechanical obstruction (such as the tongue in Pierre Robin sequence) to normal fusion. Regardless of the specific mechanism, presumably embryonic palatal shelves are ultimately unable to bridge a critical distance and remain unapproximated, resulting in a clefting defect at birth. We propose to use a palate organ culture system to determine the critical distance beyond which embryonic palatal shelves fail to fuse (i.e., the minimal critical intershelf distance). In doing so, we hope to establish an in vitro cleft palate model that could then be used to investigate the contributions of various signaling pathways to cleft formation and to study novel in utero treatment strategies. Palatal shelves from CD-1 mouse embryos were microdissected on day 13.5 of gestation (E13.5; term = 19.5 days), before fusion. Using a standardized microscope ocular grid, paired palatal shelves were placed on a filter insert at precisely graded distances ranging from 0 (in contact) to 1.9 mm (0, 0.095, 0.19, 0.26, 0.38, 0.48, 0.57, 0.76, 0.95, and 1.9 mm). A total of 68 paired palatal shelves were placed in serum-free organ culture for 96 hours (n = 68). Sample sizes of 10 were used for each intershelf distance up to and including 0.48 mm (n = 60). For intershelf distances of 0.57 mm and greater, two-paired palatal shelves were cultured (n = 8). All specimens were assessed grossly and histologically for palatal fusion. Palatal fusion occurred in our model only when intershelf distances were 0.38 mm or less. At 0.38 mm, eight of 10 palates appeared grossly adherent, whereas six of 10 demonstrated clear fusion histologically with resolution of the medial epithelial seam and continuity of the palatal mesenchyme. None of the 18 palates fused when placed at intershelf distances of 0.48 mm or greater. Using our selected intershelf distances as a guideline, we have established an approximate minimal critical intershelf distance (0.48 mm) at which we can reliably expect no palatal fusion. Culturing palatal shelves at intershelf distances of 0.48 mm or greater results in nonfusion or clefting in vitro. This model will allow us to study biomolecular characteristics of unfused or cleft palatal shelves in comparison with fused shelves. Furthermore, we plan to study the efficacy of grafting with exogenous embryonic mesenchyme or candidate factors to overcome clefting in vitro as a first step toward future in utero treatment strategies.

Immunolocalization of fibroblast growth factor receptors 1 and 2 in mouse palate development

Recent evidence has implicated mutations of fibroblast growth factor receptors (FGF-R) in the pathogenesis of craniosynostotic syndromes. Cleft palate can be a component of such syndromes. The expression of FGF-R1 and FGF-R2 has been delineated in normally developing cranium, where they seem to regulate cellular differentiation and proliferation, respectively. The specific role of fibroblast growth factor signaling in mammalian palate development is unclear. The authors investigated the patterns of expression of FGF-R1 and FGF-R2 throughout mouse palatal development in the embryo. Time-dated CD-1 mouse heads (n = 135) were harvested at embryonic ages 12.5, 13.5, 14.5, 15.5, and 16.5 days (term gestation = 19.5 days), fixed in paraformaldehyde, embedded in paraffin, and sectioned. In addition, paired palatal shelves (n = 30) were isolated by means of microdissection from embryonic day--13.5 embryos, grown on Millipore filters in serum-free medium in vitro for 24, 48, 72, or 96 hours and processed for histological analysis. Immunohistochemical analysis for FGF-R1 and FGF-R2 was performed on the in vivo and in vitro specimens. FGF-R1 and FGF-R2 were found to be specifically expressed in the epithelium of the developing palatal shelves from the time of their outgrowth from the maxillary processes through completion of fusion in vivo and in vitro. Expression of both receptors was particularly strong during the phases of medial epithelial-medial epithelial contact between the individual shelves, through the formation of the medial epithelial seam, to the ultimate dissolution of the seam. Such a pattern of expression seems to implicate fibroblast growth factor signaling in the regulation of the critical phase of fusion of the bilateral shelves. The expression of both FGF-R1 and FGF-R2 in the lateral palatal mesenchyme, where such secondary structures as tooth primordia and bone begin to appear, also suggests a role for fibroblast growth factor signaling in the induction of ongoing differentiation and maturation of the palate after fusion. These data suggest that fibroblast growth factor signaling may play a role in the epithelial-mesenchymal interactions that dictate fusion and maturation of the developing palate. Furthermore, the data are consistent with the correlation of cleft palate formation with aberrant fibroblast growth factor signaling.