Diagnostic and prognostic value of cancer stem cell marker CD44 and soluble CD44 in the peripheral Blood of patients with oral Squamous cell carcinoma

BackgroundHead and neck cancer is a major health problem. Recent studies on the pathobiology of oral squamous cell carcinoma (OSCC) have led to the discovery of a small population of cancer cells with a consistent behavior with the features of cancer stem cells (CSCs).  CSCs are required and responsible for initiation, maintenance and recurrence of disease. Molecular markers are commonly used for the identification of CSCs. CD44 is the most reported CSC marker in OSCC.The aim of the study was to evaluate and correlate the expression of CD44 in different histopathological grades of OSCC, as well as to assess the diagnostic and prognostic value of soluble CD44 (CD44sol) in peripheral blood of patients.Materials and methodsFifteen patients with OSCC were included; biopsies were histologically evaluated using haematoxylin and eosin. Serial sections were immunohistochemically stained by monoclonal antibody to CD44. The intensity of immunostaining of CD44 was calculated. Enzyme-linked immunosorbent assay (ELISA) method was used to determine the concentration of CD44sol in the blood serum.ResultsAll grades of OSCC showed membranous immunosignaling of CD44. The well, moderately and poorly differentiated OSCC cases showed weak, moderate and intense positive membranous immunosignaling of CD44 respectively.CD44sol levels were significantly higher in OSCC patients than they were in control groups. Soluble CD44 serum levels were significantly higher in poorly differentiated than they were in moderately and well differentiated.ConclusionCSCs detection in fixed human tissue and CD44sol detection in peripheral blood using ELISA seemed to be a promising method and may have a diagnostic and prognostic value in management of OSCC

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely