Natural image noise removal using nonlocal means and hidden Markov models in transform domain

Nonlocal means (NLM) which utilizes the self-similarity is considered as one of the most popular denoising techniques. Although NLM can attain significant performance, it shows a few loopholes, such as its computational complexity when it comes to similarity measurements, and the small number of sufficient candidates that use to choose the target patches which have complicated textures. In this paper, the use of clustering based on moment invariants and the hidden Markov model (HMM) is proposed to achieve preclassification and thus capture the dependency between additive white Gaussian noise pixel and its neighbors on the wavelet transform. The HMM also allows hidden states to connect to one another to capture the dependencies among coefficients in the transform domain. In the practical part, the experimental results present that the proposed algorithm has the ability to show denoised images better than the results of state-of-the-art denoising methods both objectively in peak signal-to-noise ratio and structural similarity and subjectively using visual results, especially when the noise level is high

The role of matrix metalloproteinases and their inhibitors in irinotecan-induced oral mucositis: an animal model.

Background: Chemotherapy-induced oral mucositis is defined as damage of oral mucosa caused by unwanted detrimental effects of the cytotoxic chemotherapy. Oral mucositis presents as widespread painful ulcerations and erythematous eruptions and occurs in between 40-100% of all patients undergoing chemotherapy. Currently, there are no standard treatments available to prevent oral mucositis and the consequences on health care systems remain extensive. Research into the pathogenesis of oral mucositis has shown a complex underlying process, involving several overlapping biological events in the epithelium and submucosal layers. However, this pathogenesis is still not fully understood. A group of proteolytic enzymes called matrix metalloproteinases (MMPs) have been recently postulated to play a part in mediating the damaging process seen in oral mucositis. It is well established that MMPs and their naturally existing inhibitors (tissue inhibitors of metalloproteinases; TIMPs) maintain a balanced level in normal physiological status of oral mucosa. Their dysregulated balance underlies some pathophysiological aspects of several diseases including some diseases of the oral and gastrointestinal mucosae. These mucosal diseases include ulcerative colitis, Crohn‟s disease, recurrent aphthous stomatitis and oral lichen planus. However, as MMPs and TIMPs have not been well studied in oral mucositis, this formed the basis of this thesis. Hypothesis and Aims of the thesis: If MMPs and TIMPs are involved in the pathogenesis of oral mucositis, their tissue levels will change following the administration of cytotoxic chemotherapy. This may correlate to any histopathological changes in the oral mucosa. This thesis aimed to investigate the morphological changes and the tissue expression levels of MMP-2, -3 -9 and TIMP-1 within the oral cavity in a well-established pre-clinical animal model of chemotherapy-induced oral mucositis. Results and Discussion: The findings presented in this thesis demonstrate epithelium thickness reduces without obvious ulceration in the oral mucosa very early after chemotherapy administration. Maximum atrophy is observed 60 min following chemotherapy in both dorsal and ventral surfaces of the tongue. This reduction in epithelial thickness is associated with significant up-regulation of MMP-2, -3 and -9 and down-regulation of TIMP-1 in all layers of the oral mucosa. MMP-9 is also up-regulated at later time point. These findings support previous evidence that oral mucositis involves changes in the submucosa before it is clinically evident. The early reduction in epithelial thickness confirms similar findings reported in earlier studies of oral mucositis in rat buccal mucosa. The up-regulation of MMP-2, -3, -9 and down-regulation of TIMP-1 coincided with the previously described early up-regulation of transcription factors and pro-inflammatory cytokines in oral mucosa, suggesting a relationship between their up-regulation/down-regulation and the release of these factors and cytokines. Furthermore, the different patterns of expression demonstrated by MMP-2, -3, -9 suggest that these MMPs are involved in various aspects of the 5-phase model of OM pathophysiology including initiation of inflammatory response and tissue injury, recruitment of other mediators of OM and restoration of oral mucosa to normal physiological status. Conclusion: This thesis has provided evidence that MMPs play a key role in the aetiology of oral mucositis. Research in this area needs to be directed towards studying other relevant MMPs and also towards interventional therapies aiming to target MMP-2, -3 and -9 to prevent or reduce the severity of oral mucositis, as well as to promote faster healing of OM lesions. This will help provide an optimum treatment outcomes provided to cancer patients and improve the quality of life during and after their treatment.Thesis (D.Clin.Dent.) -- University of Adelaide, School of Dentistry, 201

Temporomandibular disorders in patients with mandibular fractures: A preliminary comparative case-control study between South Australia and Oman

A. Al-Hashmi, A. Al-Azri, M. Al-Ismaily, A. N. Gos

Systematic review of growth factors and cytokines for the management of oral mucositis in cancer patients and clinical practice guidelines

Purpose: To update the clinical practice guidelines for the use of growth factors and cytokines for the prevention and/or treatment of oral mucositis (OM). Methods: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: recommendation, suggestion, and no guideline possible. Results: A total of 15 new papers were identified within the scope of this section and were merged with 51 papers that were reviewed in the previous guidelines update. Of these, 14, 5, 13, 2, and 1 were randomized controlled trials about KGF-1, G-CSF, GM-CSF, EGF, and erythropoietin, respectively. For the remaining agents there were no new RCTs. The previous recommendation for intravenous KGF-1 in patients undergoing autologous hematopoietic stem cell transplantation (HSCT) conditioned with high-dose chemotherapy and TBI-based regimens is confirmed. The previous suggestion against the use of topical GM-CSF for the prevention of OM in the setting of high-dose chemotherapy followed by autologous or allogeneic stem cell transplantation remains unchanged. Conclusions: Of the growth factors and cytokines studied for the management of OM, the evidence supports a recommendation in favor of KGF-1 and a suggestion against GM-CSF in certain clinical settings

Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients and clinical practice guidelines

Purpose: The aim of this systematic review was to update the clinical practice guidelines for the use of anti-inflammatory agents in the prevention and/or treatment of oral mucositis. Methods: A systematic review was conducted by the Multinational Association of Supportive Care in Cancer/ International Society of Oral Oncology (MASCC/ISOO) subcommittee on mucositis guideline update. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the clinical practice guidelines published in 2014. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guidelines. Results: A total of 11 new papers across five interventions were examined. The recommendation for the use of benzydamine mouthwash for the prevention of radiotherapy-induced mucositis remained unchanged. New suggestion for the use of the same for prevention of mucositis associated with chemoradiotherapy was made. No guideline was possible for any other antiinflammatory agents due to inadequate and/or conflicting evidence. Conclusions: Of the anti-inflammatory agents studied for oral mucositis, the evidence supports the use of benzydamine mouthwash in the specific populations listed above. Additional well-designed research is needed on other (class of agents) interventions and in other cancer treatment settings

MASCC/ISOO clinical practice guidelines for the management of mucositis: sub-analysis of current interventions for the management of oral mucositis in pediatric cancer patients

10.1007/s00520-020-05803-4SUPPORTIVE CARE IN CANCER2973539-356

MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

Background: Mucositis is a significant toxicity of cancer therapy with numerous systemic sequelae. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for the management of mucositis. Methods: The literature was reviewed systematically to identify interventions for mucositis. Studies were rated according to the presence of major and minor flaws according to previously published criteria. The body of evidence for each intervention and in each treatment setting was assigned a level of evidence based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible. Results: The guideline covers evidence from 1197 publications related to oral or gastrointestinal mucositis. Thirteen new guidelines were developed for or against the use of various interventions in specific treatment settings, and 11 previous guidelines were confirmed after aa review of new evidence. Thirteen previously established guidelines were carried over because there was no new evidence for these interventions. Conclusions: The updated MASCC/ISOO Clinical Practice Guidelines for mucositis provide professional health caregivers with a clinical setting-specific, evidence-based tool to help with the management of mucositis in patients who have cancer

Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients

<p>The aim of this project was to review the literature and define clinical practice guidelines for the use of cytokines and growth factor agents for the prevention or treatment of oral mucositis induced by cancer chemotherapy or radiotherapy.</p><p>A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible.</p><p>Sixty-four clinical studies across 11 interventions were evaluated. A recommendation was made for the use of recombinant human KGF-1 (palifermin) at a dose of 60 mu g/kg per day for 3 days prior to conditioning treatment and for 3 days post-transplant for prevention of oral mucositis in patients receiving high-dose chemotherapy and total body irradiation followed by autologous stem cell transplantation for hematological malignancies. A suggestion was made against using granulocyte macrophage colony-stimulating factor mouthwash for the prevention of oral mucositis in the setting of high-dose chemotherapy followed by autologous or allogeneic stem cell transplantation. No guideline was possible for any other cytokine or growth factor agents due to inconclusive evidence.</p><p>Of the cytokine and growth factor agents studied for oral mucositis, the evidence only supports use of palifermin in the specific population listed above. Additional well-designed research is needed on other cytokine and growth factor interventions and in other cancer treatment settings.</p>

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi studyResearch in context

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received