Novel non-invasive adjunctive techniques for early oral cancer diagnosis and oral lesions examination

Oral cancer is a potentially fatal disease with an increasing incidence and an unchanged 5-year mortality rate. Unfortunately, oral cancer is often still late diagnosed, which leads to an increase in the likelihood of functional impairment due to treatment and mortality rate. Definitive diagnosis of oral cancer must be confirmed by scalpel biopsy and histological assessment. However despite its benefits, scalpel biopsy is invasive and it is burdened by a potential morbidity. Furthermore, previous studies have suggested a high degree of intraobserver and interobserver variability regarding the histological evaluation of malignancy. As a consequence, in recent years there has been a growing and persisting demand towards developing new non-invasive, practical diagnostic tools that might facilitate the early detection of oral cancer. The most investigated non-invasive adjunctive techniques are vital staining, autofluorescence, chemiluminescence, narrow band imaging, and exfoliative cytology. Aim of the review is to critically describe these adjunctive aids and, after considering the literature data, an expert opinion on the effectiveness and the possible use of each technique will be provided

The LEONIDAS-2 study: Long-term Evaluation of the sffectiveness Of a Novel Intra-oral electro-stimulator for the treatment of raDiotherapy-ASsociated xerostomia

Head and neck cancer is the 7th most common cancer worldwide and the 7th leading cause of cancer-related death. The vast majority of head and neck cancers are diagnosed at advanced stage, which is characterised by large volume disease and locoregional metastases. The overall 5-year survival rate of head and neck cancer is 50%, although most patients with advanced stage cancers die within few years from diagnosis because of relapsing incurable disease. Head and neck cancer patients are often managed with radiotherapy, either as main treatment modality or in association with chemotherapy and surgery. Radiotherapy can cause acute and long-term complication, of which chronic xerostomia is one of the most debilitating. Current treatment of radiotherapy-associated xerostomia encompasses systemic and local therapeutic strategies. None of them, however, represent the ideal treatment in terms of efficacy and safety. Neuro-stimulation of salivary glands via electrical stimulation was initially introduced 30 years ago. It is suggested to provide the benefit of increasing natural salivation with no relevant adverse side effects. Studies using the first generation of electrostimulating devices suggested clinical significant benefit in a small cohort of individuals with radiotherapy-associated xerostomia. More recently, the use of a second-generation intra-oral device, as well as facial transcutaneous nerve stimulation, has been associated with an increase in saliva production and reduction in xerostomia symptoms. Although promising, current data do not provide robust evidence and highlight the need of further and better designed clinical trials in order to investigate the real benefit of salivary electrostimulation in the post-radiotherapy setting. We have performed a double-blind randomised clinical trial (The LEONIDAS-2 study) to assess the long-term efficacy of the second generation intraoral electrostimulating device in lessening xerostomia symptoms, increasing salivary gland function and improving quality of life in individuals with radiotherapy-associated xerostomia. The clinical trial took place between January 2012 and January 2015 at the University College London Hospital and Bradford Royal Infirmary (UK). Eighty-four participants were randomised to use an active electrostimulating device (providing mechanical and electrical stimulation) or a sham device (providing mechanical but not electrical stimulation) for 12 months. Randomisation was by computer-generation and analyses were performed on an intention-to-treat basis. Sixty-eight participants completed the trial. At 12 months an improvement in xerostomia symptoms (VAS) compared to baseline was observed, with no significant difference in means between the active and sham group. Salivary flow rate, measured through sialometry, was higher in the active group but the difference between the two groups was not statistically significant. At 12 months there was an improvement in quality of life, with no significant difference between the active and the control groups. The LEONIDAS-2 clinical trial showed that salivary electrostimulation through the second generation intra-oral electrostimulating device is safe but not more effective than mechanical stimulation in relieving dry mouth symptoms, increasing salivary function or improving quality of life in patients with radiotherapy-associated xerostomia

Engineering Polymeric Nanosystems against Oral Diseases

Nanotechnology and nanoparticles (NPs) are at the forefront of modern research, particularly in the case of healthcare therapeutic applications. Polymeric NPs, specifically, hold high promise for these purposes, including towards oral diseases. Careful optimisation of the production of polymeric NPs, however, is required to generate a product which can be easily translated from a laboratory environment to the actual clinical usage. Indeed, considerations such as biocompatibility, biodistribution, and biodegradability are paramount. Moreover, a pre-clinical assessment in adequate in vitro, ex vivo or in vivo model is also required. Last but not least, considerations for the scale-up are also important, together with an appropriate clinical testing pathway. This review aims to eviscerate the above topics, sourcing at examples from the recent literature to put in context the current most burdening oral diseases and the most promising polymeric NPs which would be suitable against them

Engineering polymeric nanosystems against oral diseases

Nanotechnology and nanoparticles (NPs) are at the forefront of modern research, par-ticularly in the case of healthcare therapeutic applications. Polymeric NPs, specifically, hold high promise for these purposes, including towards oral diseases. Careful optimisation of the production of polymeric NPs, however, is required to generate a product which can be easily translated from a laboratory environment to the actual clinical usage. Indeed, considerations such as biocompati-bility, biodistribution, and biodegradability are paramount. Moreover, a pre-clinical assessment in adequate in vitro, ex vivo or in vivo model is also required. Last but not least, considerations for the scale-up are also important, together with an appropriate clinical testing pathway. This review aims to eviscerate the above topics, sourcing at examples from the recent literature to put in context the current most burdening oral diseases and the most promising polymeric NPs which would be suitable against them

Exploring patient satisfaction of a joint-consultation clinic for trigeminal neuralgia: Enabling improved decision-making

Background: Trigeminal neuralgia (TN) is a relatively rare condition which has a profound impact not only on the patient but also on those around them. There is no cure for TN, and the management of the condition is complex. The most effective forms of treatment are either through medication, neurosurgery, or combination of the two. Each option has risks and implications for the patient. As with all clinical decisions, it is important for patients to understand and be fully informed of the treatments available to them. A London UK unit adopted a joint-consultation clinic approach where the patient meets with both physician and neurosurgeon at the same time to discuss treatment options. The purpose of this evaluation is to understand patients’ level of satisfaction with the joint-consultation clinic and evaluate utilisation of a clinical decision-making tool. Method: Patients who had attended the joint-consultation clinic over a period of 12 months were invited to participate in a telephone or paper survey (N = 55). Responses were analysed using descriptive statistics and thematic analysis. Results: Forty-one patients (77% response rate) participated in the survey, and the results were overwhelmingly positive for the joint-consultation clinic regarding satisfaction. The benefits were broad ranging including increased understanding, collaboration and confidence in decision-making. Conclusions: A joint-consultation clinic comprising a neurosurgeon and a physician for the treatment of TN is valued by patients who become better informed and able to make decisions about their care. Positive application of clinical decision-making aids in this situation offers potential across specialities

Emergencies in patients with advanced cancer followed at home.

Abstract CONTEXT: Patients with advanced cancer stay at home for most of their time, and acute problems may occur during home care. Caregivers may call medical services for an emergency, which can result in patients being admitted to the hospital. No data exist on emergencies in patients followed by a home care team. OBJECTIVES: The aim of this multicenter prospective study was to assess the frequency, reasons for, and subsequent course of emergency calls for patients followed at home by a palliative care team. METHODS: A consecutive sample of patients admitted to home care programs was surveyed for a period of seven months. Epidemiological data, and characteristics of emergency calls and outcomes, as well as environmental situations were recorded. RESULTS: Six hundred eighty-nine patients were surveyed; 118 patients (17.1% of the total number of patients surveyed) made one emergency call, 23 made two calls, and four made three calls for a total number of 176 emergency calls. The mean age was 71 years (standard deviation [SD] 13), and the mean Karnofsky status the day before the emergency call was 38 (SD 14). The mean time from admission to the first emergency call was 38.4 days (SD 67), and the mean time from the first emergency call to death was 17.5 days (SD 41.5). No differences were found for age, diagnosis, gender, duration of assistance, and survival between patients making emergency calls and those who did not make a call during an emergency. Twenty-three patients were managed by phone, and 122 were visited at home for the emergency. Calls were prevalently recorded on weekdays and were primarily made by relatives. The most frequent reasons for calling were dyspnea, pain, delirium, and loss of consciousness. Calls were considered justified by home care physicians in most cases. The mean number of relatives present during the emergency home visit was 2.2 (SD 1.5). The intervention was mainly pharmacological and considered satisfactory in the majority of cases. CONCLUSION: Emergency calls are relatively frequent in patients followed at home by a palliative care team. Phone consultation or intervention at home may avoid inappropriate hospital admission

Episodic breathlessness with and without background dyspnea in advanced cancer patients admitted to an acute supportive care unit

Aim: To characterize episodic breathlessness (EB) in patients with advanced cancer, and to determine factors influencing its clinical appearance. Methods: A consecutive sample of advanced cancer patients admitted to an acute palliative care unit was surveyed. Continuous dyspnea and EB were measured by a numerical scale. The use of drugs used for continuous dyspnea and EB was recorded. Patients were asked about the characteristics of EB (frequency, intensity, duration and triggers). The Multidimensional dyspnea profile (MDP), the Brief dyspnea inventory (BDI), the Athens sleep scale (AIS) and the Hospital Anxiety and Depression Scale (HADS) were also administered. Results: From 439 advanced cancer patients surveyed, 34 and 27 patients had EB, without and with background dyspnea, respectively. The mean intensity and the number of episodes were higher in patients with background dyspnea (p < 0.0005 and p = 0.05, respectively). No differences in duration were observed. Most episodes lasted <10 min. A recognizable cause triggering EB was often found. The presence of both background dyspnea and EB was associated with higher values of MDP and BDI. EB was independently associated with frequency and intensity of background dyspnea (OR = 20.9, 95% CI (Confidence interval) 9.1–48.0; p < 0.0005 and OR = 1.97, 95% CI 1.09–3.58; p = 0.025, respectively) and a lower Karnofsky level (OR = 0.96, 95%CI 0.92–0.98, p = 0.05). Discussion: EB may occur in patients with and without continuous dyspnea, and is often induced by physical and psychological factors. EB intensity is higher in patients with continuous dyspnea. The duration was often so short that the use of drugs, as needed, may be too late, unless administered pre-emptively when the trigger was predictable

STAT3-Deficient hyperimmunoglobulin E syndrome: report of a case with orofacial granulomatosis–like disease

Hyperimmunoglobulin E syndrome (HIES) is a rare heterogeneous primary immunodeficiency disorder characterized by infections of the lung and skin, elevated serum immunoglobulin E, and involvement of soft and bony tissues. Autosomal dominant HIES and related disorders are caused by defects in the Janus activated kinase–signal transducer and activator of transcription signaling pathway, leading to reduced numbers of T helper cell type 17 and impaired production of interleukin (IL)-17 A, IL-17 F, and IL-22. In addition, neutrophils have chemotactic defects, resulting in impaired responses at skin and lung sites. We report here a case of orofacial granulomatosis–like disease in a teenage boy ultimately found to have autosomal dominant HIES caused by a heterozygous mutation in the STAT3 gene

New Cases of Universality Theorem for Gravitational Theories

The "Universality Theorem" for gravity shows that f(R) theories (in their metric-affine formulation) in vacuum are dynamically equivalent to vacuum Einstein equations with suitable cosmological constants. This holds true for a generic (i.e. except sporadic degenerate cases) analytic function f(R) and standard gravity without cosmological constant is reproduced if f is the identity function (i.e. f(R)=R). The theorem is here extended introducing in dimension 4 a 1-parameter family of invariants R' inspired by the Barbero-Immirzi formulation of GR (which in the Euclidean sector includes also selfdual formulation). It will be proven that f(R') theories so defined are dynamically equivalent to the corresponding metric-affine f(R) theory. In particular for the function f(R)=R the standard equivalence between GR and Holst Lagrangian is obtained.Comment: 10 pages, few typos correcte

Cancer: New needs, new models. is it time for a community oncologist? another brick in the wall

Over the last few decades, thanks to early detection, effective drugs, and personalized treatments, the natural history of cancer has radically changed. Thanks to these advances, we have observed how survival of cancer patients has increased, becoming an ever more important goal in cancer care. Effective clinical governance of survivorship care is essential to ensure a successful transition between active and post-treatment life, identifying optimization of healthcare outcomes and quality of life for patients as the primary objectives. For these reasons, potential intervention models must consider these differences to rationalize the available resources, including economic aspects. In this perspective, analyzing the different models proposed in the literature to manage this type of patients, we focus on the possible role of the so-called “community oncologist”. As a trained health professional, also focused on longevity, he could represent the right management solution in all those “intermediate” clinical conditions that arise between the hospital specialist, frequently overworked, and the general practitioner, often biased by the lack of specific expertise