Carmellose mucoadhesive oral films containing vermiculite/chlorhexidine nanocomposites as innovative biomaterials for treatment of oral infections

Infectious stomatitis represents the most common oral cavity ailments. Current therapy is insufficiently effective because of the short residence time of topical liquid or semisolid medical formulations. An innovative application form based on bioadhesive polymers featuring prolonged residence time on the oral mucosa may be a solution to this challenge. This formulation consists of a mucoadhesive oral film with incorporated nanocomposite biomaterial that is able to release the drug directly at the target area. This study describes the unique approach of preparing mucoadhesive oral films from carmellose with incorporating a nanotechnologically modified clay mineral intercalated with chlorhexidine. The multivariate data analysis was employed to evaluate the influence of the formulation and process variables on the properties of the medical preparation. This evaluation was complemented by testing the antimicrobial and antimycotic activity of prepared films with the aim of finding the most suitable composition for clinical application. Generally, the best results were obtained with sample containing 20 mg of chlorhexidine diacetate carried by vermiculite, with carmellose in the form of nonwoven textile in its structure. In addition to its promising physicomechanical, chemical, and mucoadhesive properties, the formulation inhibited the growth of Staphylococcus and Candida; the effect was prolonged for tens of hours.Web of Scienceart. no. 58014

Role of orthoptics and scoring system for orbital floor blowout fracture: surgical or conservative treatment

AIM: To assess the role of orthoptics in referring patients with orbital floor blowout fracture (OFBF) for conservative or surgical treatment and based on the results, to propose a scoring system for such decision making. METHODS: A retrospective analysis of 69 patients with OFBF was performed (35 treated conservatively, 34 surgically). The role of orthoptics in referring to surgery or conservative treatment was retrospectively evaluated, the factors with the highest significance for decision making were identified, and a scoring system proposed using Logistic regression. RESULTS: According to defined criteria, the treatment was unsuccessful in 2 (6%) surgically treated and only in one (3%) conservatively treated patient. The proposed scoring system includes the defect size and several values resulting from the orthoptic examination, the elevation of the eyebulb measured on Lancaster screen being the most significant. CONCLUSION: The study demonstrates the benefits of orthoptic examination when making decisions on conservative or surgical treatment and for diagnosing ocular motility disorder (with or without binocular diplopia) in OFBF patients. The proposed scoring system could, following verification in a prospective study, become a valuable adjunctive tool.Web of Science14121934192

The use of a battery of examination methods for detection of cervical metastases in squamous cell carcinoma of the oral cavity

Introduction. In patients with squamous cell carcinoma of the orofacial area, the presence of cervical metastases represents a single most significant prognostic factor. This fact underlines the importance of thorough examination of the cervical lymph nodes for potential tumor involvement. To verify this, the most common investigative methods are physical examination (PE), sonography (US) and computed tomography (CT), which have also been used to assess the stage of the disease in the patients in our research. Objective. To evaluate the performance of individual methods (physical examination, sonography, computed tomography) and combinations. Method. Patients with squamous cell carcinoma of the oral cavity, who had undergone physical, US and CT examinations at our department followed by radical neck dissection were included in this retrospective study. A total of 57 patients were included. Results. The sensitivity of PE, US and CT were 38%, 69% and 61%, respectively, however CT+US combination yielded 83% sensitivity and combination of all these methods 86% sensitivity. The number of false positives was however relatively high with specificity of the 3-way combination at 65%. Conclusion. A combination of our three widely available inexpensive methods detected 86% of metastases in cervical nodes. The large number of false positives however indicates that the method should rather be used for screening in selecting patients who need additional and more expensive imaging than for diagnosing cervical metastases. Also, as 14% of cervical metastases pass undetected using our method, we would recommend an additional examination at least by US+PE several weeks to a few months after the initial examination.Web of Science165222822

Antibacterial efficiency of vermiculite/chlorhexidine nanocomposites and results of the in vivo test of harmlessness of vermiculite

Clay minerals have been proposed as very useful materials for modulating drug delivery. These are the commonly used materials in pharmaceutical production both as inorganic carriers or active agents. We focused on the development of suitable long-acting material for local treatment of oral infection where clay minerals act as inorganic drug carriers. Organovermiculites with antibacterial activity were prepared by ion exchange reactions using different concentrations of chlorhexidine diacetate. The samples were characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and thermal analysis (TGA). The antibacterial activity was evaluated by finding the minimum inhibitory concentration (MIC). All studied organoclays possessed good antibacterial activity after 24 h exposure against Escherichia coli, Enterococcus faecalis and particularly against Staphylococcus aureus. Pseudomonas aeruginosa however proved very resistant as only the sample with the highest concentration of CA that successfully inhibited bacterial growth. Furthermore, clay mineral vermiculite was subjected to in vivo toxicological analysis and its influence on gastrointestinal tract during its oral application was investigated. Tissue samples from buccal mucosa, tongue, esophagus, stomach, terminal duodenum, small intestine, caecum, distal colon and liver were subjected to histological examination, both macroscopically and microscopically. Neither systemic nor local reactions were observed. Therefore the toxicity of vermiculite to a mammal model organism can be excluded.Web of Science4247346

Oral appliance effectiveness and patient satisfaction with obstructive sleep apnea treatment in adults

Background: Indication of oral appliances for the treatment of an obstructive sleep apnea (OSA) includes both patients with primary snoring and mild OSA, as well as patients with moderate to severe OSA who refuse other treatment or in whom such treatment failed. The aim of this study was to verify the effectiveness of current OSA treatment by objective measurements, and to assess by means of a questionnaire patients' satisfaction with oral appliances manufactured in our laboratory. Material/Methods: The study enrolled 58 adult patients (40 men, 18 women) with mean age of 50.5 years; most were overweight or had class I obesity; mean baseline apnea-hypopnea index (AHI) value prior to the beginning of treatment was 31.3, range 0.6-71. Results: Average AHI reduction in the entire group was 10.4; 31% of patients experienced AHI reduction by at least 50%. Significant AHI reduction was proven when using the appliance. Appliances affect the reduction of AHI and patients tolerate the appliances well. Conclusions: Oral appliances complement positive-pressure treatment and do not interfere with it in any way. Craniometric parameters seem to be applicable as predictors of success or failure of appliance treatment.Web of Science2552451

Medical image processing tools for blender with HPC support

We present a medical image processing plug-in in this paper. Our plug-in uses Blender’s environment and adds tools for the medical image processing and 3D model reconstructions and measurements. There are several software solutions to provide these tasks, two of which are used for comparison with our tool in this paper. However, there is not a single application that can perform medical image processing and subsequent 3D model reconstruction and post-processing with possible utilization of High Performance Computing (HPC) resources. In our plug-in we aim to use HPC resources to speed up the most computationally extensive tasks. The plug-in is written in Python and C++. The basic functionality and additional tools are implemented in Phyton. Blender has built-in Python interface, thus the development of the tools is quite fast. The C++ language is used for all time critical functions as it has unrestricted potential in parallel programming that can utilize available HPC resources. In the paper we present two examples, where we demonstrate possibilities of our Blender plug-in. We provide 3D reconstruction of human airway and human orbital floor and compare the results with those provided by 3D Slicer and Osirix

Age-related changes in the tooth-bone interface area of acrodont dentition in the chameleon

Chameleon teeth develop as individual structures at a distance from the developing jaw bone during the pre-hatching period and also partially during the post-hatching period. However, in the adult, all teeth are fused together and tightly attached to the jaw bone by mineralized attachment tissue to form one functional unit. Tooth to bone as well as tooth to tooth attachments are so firm that if injury to the oral cavity occurs, several neighbouring teeth and pieces of jaw can be broken off. We analysed age-related changes in chameleon acrodont dentition, where ankylosis represents a physiological condition, whereas in mammals, ankylosis only occurs in a pathological context. The changes in hard-tissue morphology and mineral composition leading to this fusion were analysed. For this purpose, the lower jaws of chameleons were investigated using X-ray micro-computed tomography, laser-induced breakdown spectroscopy and microprobe analysis. For a long time, the dental pulp cavity remained connected with neighbouring teeth and also to the underlying bone marrow cavity. Then, a progressive filling of the dental pulp cavity by a mineralized matrix occurred, and a complex network of non-mineralized channels remained. The size of these unmineralized channels progressively decreased until they completely disappeared, and the dental pulp cavity was filled by a mineralized matrix over time. Moreover, the distribution of calcium, phosphorus and magnesium showed distinct patterns in the different regions of the tooth-bone interface, with a significant progression of mineralization in dentin as well as in the supporting bone. In conclusion, tooth-bone fusion in chameleons results from an enhanced production of mineralized tissue during post-hatching development. Uncovering the developmental processes underlying these outcomes and performing comparative studies is necessary to better understand physiological ankylosis; for that purpose, the chameleon can serve as a useful model species

Metastasising ameloblastoma or ameloblastic carcinoma? A case report with mutation analyses

Abstract Background Ameloblastic carcinoma and metastasising ameloblastoma are rare epithelial odontogenic tumours with aggressive features. Distinguishing between these two lesions is often clinically difficult but necessary to predict tumour behaviour or to plan future therapy. Here, we provide a brief review of the literature available on these two types of lesions and present a new case report of a young man with an ameloblastoma displaying metastatic features. We also use this case to illustrate the similarities and differences between these two types of tumours and the difficulties of their differential diagnosis. Case presentation Our histopathological analyses uncovered a metastasising tumour with features of ameloblastic carcinoma, which developed from the ameloblastoma. We profiled the gene expression of Wnt pathway members in ameloblastoma sample of this patient, because multiple molecules of this pathway are involved in the establishing of cell polarity, cell migration or for epithelial–mesenchymal transition during tumour metastasis to evaluate features of tumor behaviour. Indeed, we found upregulation of several cell migration–related genes in our patient. Moreover, we uncovered somatic mutation BRAF p.V600E with known pathological role in cancerogenesis and germline heterozygous FANCA p.S858R mutation, whose interpretation in this context has not been discussed yet. Conclusions In conclusion, we have uncovered a unique case of ameloblastic carcinoma associated with an alteration of Wnt signalling and the presence of BRAF mutation. Development of harmful state of our patient might be also supported by the germline mutation in one FANCA allele, however this has to be confirmed by further analyses