Porphyromonas gingivalis, a bridge between oral health and immune evasion in gastric cancer.

Porphyromonas gingivalis (P. gingivalis) is a gram-negative oral pathogen associated with chronic periodontitis. Previous studies have linked poor oral health and periodontitis with oral cancer. Severe cases of periodontal disease can result in advanced periodontitis, leading to tissue degradation, tooth loss, and may also correlate with higher gastric cancer (GC) risk. In fact, tooth loss is associated with an elevated risk of cancer. However, the clinical evidence for this association remains inconclusive. Periodontitis is also characterized by chronic inflammation and upregulation of members of the Programmed Death 1/PD1 Ligand 1 (PD1/PDL1) axis that leads to an immunosuppressive state. Given that chronic inflammation and immunosuppression are conditions that facilitate cancer progression and carcinogenesis, we hypothesize that oral P. gingivalis and/or its virulence factors serve as a mechanistic link between oral health and gastric carcinogenesis/GC progression. We also discuss the potential impact of P. gingivalis' virulence factors (gingipains, lipopolysaccharide (LPS), and fimbriae) on inflammation and the response to immune checkpoint inhibitors in GC which are part of the current standard of care for advanced stage patients.

MONAI Label: A framework for AI-assisted interactive labeling of 3D medical images.

The lack of annotated datasets is a major bottleneck for training new task-specific supervised machine learning models, considering that manual annotation is extremely expensive and time-consuming. To address this problem, we present MONAI Label, a free and open-source framework that facilitates the development of applications based on artificial intelligence (AI) models that aim at reducing the time required to annotate radiology datasets. Through MONAI Label, researchers can develop AI annotation applications focusing on their domain of expertise. It allows researchers to readily deploy their apps as services, which can be made available to clinicians via their preferred user interface. Currently, MONAI Label readily supports locally installed (3D Slicer) and web-based (OHIF) frontends and offers two active learning strategies to facilitate and speed up the training of segmentation algorithms. MONAI Label allows researchers to make incremental improvements to their AI-based annotation application by making them available to other researchers and clinicians alike. Additionally, MONAI Label provides sample AI-based interactive and non-interactive labeling applications, that can be used directly off the shelf, as plug-and-play to any given dataset. Significant reduced annotation times using the interactive model can be observed on two public datasets.

The Patient Faints in the Waiting Area with a Suspected Hypoglycemic Event.

An older adult with diabetes is taking glipizide, a sulfonylurea class drug. Subsequently, she experiences a hypoglycemic episode in the dental office. Prompt recognition of hypoglycemia and administration of glucose or sugar is vital. Patient and provider education about the risks of hypoglycemia in older adults may help to prevent future hypoglycemic episodes.

An Elderly Patient with Undiagnosed Type 2 Diabetes Mellitus Presenting for an Emergency Extraction.

In this case a patient has multiple risk factors for diabetes including periodontal disease, family history positive for diabetes, and body mass index of 24 in an Asian American. He has no medical or dental home and upon presenting to the dental office would be a good candidate for diabetes screening.

A Diabetic Patient with a Recent History of Flap and Osseous Surgery Presents Back with Bleeding and Infection.

A patient with type II diabetes and renal disease developed infection and bleeding after periodontal osseous surgery. The clinician did not adequately assess the patient's long-term glycemic status or stage of chronic kidney disease (CKD) before initiating osseous surgery. Preoperative assessment of patients with diabetes should include at a minimum an Hba1c within 3 months and estimated glomerular filtration rate for CKD.

Patient with Type I Diabetes Mellitus Develops Post-Operative Hyperglycemia After Osseous Surgery.

A patient with type I diabetes withheld her diabetes medications without consulting her physician and was not able to resume her normal diet after extensive dental surgery resulting in hyperglycemia postoperatively. Clear communication between clinicians and patient about the expected postoperative course and changes to factors that may influence glycemic control could prevent hyperglycemia in the postoperative period.

A Patient with Refractory Trigeminal Neuralgia was Referred for Suspected Odontogenic Pain.

Chronic pain of the face with a sudden, unilateral, and electric shock-like pain in the distribution of the trigeminal nerve is known as Trigeminal neuralgia (TN). This case report presents a patient with TN symptoms, along with concomitant tooth pain. The diagnostic process and management of the patient are discussed, emphasizing the importance of interdisciplinary collaboration for optimal patient care.

A Pregnant Patient with Gestational Diabetes Reports for Scaling and Root Planning.

In this case a woman with gestational diabetes and otherwise healthy pregnancy needs scaling and root planning for the treatment of stage I periodontal disease during pregnancy. Her daily blood sugars are in the target range, and there are no contraindications to providing necessary dental treatment under local anesthesia with vasoconstrictors in her case.

Dental Management of the Human Papilloma Virus-Related Oropharyngeal Cancer Patient.

Human papilloma virus (HPV)-attributable head and neck cancers (HNCs) are on the rise, impacting younger patients compared with HPV (-) HNC. Fortunately, HPV (+) HNCs are associated with favorable prognoses and tend to be radiosensitive. However, radiation therapy for the treatment of HNC is associated with acute and chronic normal tissue toxicity to salivary glands, muscles, bone, and the oral cavity and presents a treatment challenge. Thus, the prevention of normal tissue injury and optimization of oral health are key. Dental teams are important members of the multidisciplinary cancer team.

An Adolescent Patient Reports to Dental Office for Pain in Relation to Mandibular Molar with an Incidental Palpable Thrill in the Submandibular Region.

A young female patient presents to a dental clinic for treatment of swelling and pain. Clinical examination and testing are completed revealing concomitant, suspected vascular pathology of the head and neck area. An endodontic diagnosis is made, but an unusual clinical finding of a vascular entity, not typically considered by dentists, requires interdisciplinary assessment and management with vascular surgery before surgical intervention of the oral cavity.

Mönckeberg's medial arteriosclerosis in the oral and maxillofacial region: A pilot study.

OBJECTIVE: To evaluate the prevalence of medial vascular calcifications in the oral and maxillofacial region and their association with systemic diseases. MATERIALS AND METHODS: The study included 211 consecutive patients with systemic diseases (January 2015-May 2016). Medical history and radiographic images were evaluated. Univariate analysis (t-test) was performed for continuous variables (age). The Chi square test was applied for the categorical variables (Mönckeberg medial arteriosclerosis [MMA], gender). RESULTS: There was a 6.2% prevalence of MMA. The mean age of patients with MMA was 65.46 ± 13.38. The prevalence of kidney disease in patients with MMA was significantly higher than in those without MMA (p < 0.001). This finding was maintained even after adjusting for other systemic diseases (OR = 31.84 [8.63-136.78]). CONCLUSION: A significant prevalence of MMA in kidney disease patients was observed in this pilot study.

Shape registration with learned deformations for 3D shape reconstruction from sparse and incomplete point clouds.

Shape reconstruction from sparse point clouds/images is a challenging and relevant task required for a variety of applications in computer vision and medical image analysis (e.g. surgical navigation, cardiac motion analysis, augmented/virtual reality systems). A subset of such methods, viz. 3D shape reconstruction from 2D contours, is especially relevant for computer-aided diagnosis and intervention applications involving meshes derived from multiple 2D image slices, views or projections. We propose a deep learning architecture, coined Mesh Reconstruction Network (MR-Net), which tackles this problem. MR-Net enables accurate 3D mesh reconstruction in real-time despite missing data and with sparse annotations. Using 3D cardiac shape reconstruction from 2D contours defined on short-axis cardiac magnetic resonance image slices as an exemplar, we demonstrate that our approach consistently outperforms state-of-the-art techniques for shape reconstruction from unstructured point clouds. Our approach can reconstruct 3D cardiac meshes to within 2.5-mm point-to-point error, concerning the ground-truth data (the original image spatial resolution is ∼1.8×1.8×10mm3). We further evaluate the robustness of the proposed approach to incomplete data, and contours estimated using an automatic segmentation algorithm. MR-Net is generic and could reconstruct shapes of other organs, making it compelling as a tool for various applications in medical image analysis.

Sucesión de entomofauna de interés criminalista en modelo experimental de Cavia porcellus / Succession of entomofauna of criminal interest in experimental model of Cavia porcellus

La Entomología Forense (EF) es una rama de las ciencias médico-legales (Ortloff et al. 2012), que utiliza como herramienta clave a insectos y otros artrópodos que interactúan con un cuerpo en descomposición (Gennard, 2007). El presente estudio se basó en un diseño observacional descriptivo de tipo poblacional, en el que se evaluó la diversidad de dípteros de la familia Calliphoridae y Muscidae en la parroquia rural de Posorja, Guayaquil. En el proceso experimental en los biomodelos A y B, se obtuvo que las temperaturas mínimas diarias presentaron un promedio de 21 °C (entre 20 °C y 22 °C) en lo que respecta a las temperaturas máximas diarias presentaron un promedio de 29,50 °C (entre 26 y 31 °C). En ambos biomodelos experimentales A y B, la exposición directa a los rayos solares y el espacio de liberación abierto contribuyo con el desarrollo de los cambios post mortem de descomposición cadavérica, como son el cromatismo, hinchado, licuefacción y reducción. A la par, de la ocurrencia de la sucesión de dípteros de interés criminalisticos, pertenecientes a las familias Calliphoridae y Muscidae. La importancia de de este acercamiento a la fauna de interés forense dentro de la provincia de Posorja, se muestra en el abanico de oportunidades que abre, con miras a la futura incorporación de la entomología forense en investigaciones criminalísticas en casos de homicidios y negligencias. Sin embargo, todavía eisten numerosas dificultades dificultades para este tipo de estudio en el Ecuador, por lo que se propone divulgar la escala estacional y espacial de de estas investigaciones, a través de convenios que permitan replicarlos en diversas partes del país en distintos ecosistemas y bajo distintas condiciones climáticas(AU)

Forensic Entomology (PE) is a branch of the medico-legal sciences (Ortloff et al. 2012), which uses insects and other arthropods that interact with a decomposing body as a key tool (Gennard, 2007). The present study was based on a descriptive observational design of a population type, in which the diversity of diptera of the Calliphoridae and Muscidae families in the rural parish of Posorja, Guayaquil was evaluated. In the experimental process in biomodels A and B, it was obtained that the minimum daily temperatures presented an average of 21 ° C (between 20 ° C and 22 ° C) with regard to the maximum daily temperatures presented an average of 29, 50 ° C (between 26 and 31 ° C). In both experimental biomodels A and B, direct exposure to sunlight and the open release space contributed to the development of post-mortem changes in cadaveric decomposition, such as chromaticism, swelling, liquefaction and reduction. At the same time, the occurrence of the succession of diptera of criminalistic interest, belonging to the Calliphoridae and Muscidae families. The importance of this approach to the fauna of forensic interest within the province of Posorja is shown in the range of opportunities that it opens up, with a view to the future incorporation of forensic entomology in criminal investigations in cases of homicides and negligence. However, there are still numerous difficulties for this type of study in Ecuador, so it is proposed to disclose the seasonal and spatial scale of these investigations, through agreements that allow replication in different parts of the country in different ecosystems and under different weather conditions(AU)

Harmful chemicals emitted from electronic cigarettes and potential deleterious effects in the oral cavity.

Use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes (e-cigs), is increasing across the US population and is particularly troubling due to their adoption by adolescents, teens, and young adults. The industry's marketing approach for these instruments of addiction has been to promote them as a safer alternative to tobacco, a behavioral choice supporting smoking cessation, and as the 'cool' appearance of vaping with flavored products (e.g. tutti frutti, bubble gum, and buttered popcorn etc.). Thus, there is a clear need to better document the health outcomes of e-cig use in the oral cavity of the addicted chronic user. There appears to be an array of environmental toxins in the vapors, including reactive aldehydes and carbonyls resulting from the heating elements action on fluid components, as well as from the composition of chemical flavoring agents. The chemistry of these systems shows that the released vapors from the e-cigs frequently contain levels of environmental toxins that considerably exceed federal occupational exposure limits. Additionally, the toxicants in the vapors appear to be retained in the host fluids/tissues at levels often approximating 90% of the levels in the e-cig vapors. These water-soluble reactive toxins can challenge the oral cavity constituents, potentially contributing to alterations in the autochthonous microbiome and host cells critical for maintaining oral homeostasis. This review updates the existing chemistry/environmental aspects of e-cigs, as well as providing an overview of the somewhat limited data on potential oral health effects that could occur across the lifetime of daily e-cig users.

Analysis of clinical oral medicine practices at the University of Pennsylvania: a 5-year retrospective study.

OBJECTIVE: The aim of this study was to characterize oral medicine (OM) clinical practices at the University of Pennsylvania (Penn), determine the importance of OM clinical services, and emphasize aspects of training for OM specialists. STUDY DESIGN: Nonprobability sampling of OM resident patient logs for patients receiving clinical care from 2008 to 2013 was conducted. OM resident patient logs included clinical diagnosis, International Classification of Diseases, ninth edition code, medical history, clinical procedure, Current Procedural Terminology code, attending physician, and resident participation notes. RESULTS: Outpatients in OM medical practices (n = 6024) averaged 1.56 diagnoses from OM specialists. Orofacial pain (45.02%) and oral mucosal diseases (34.28%) comprised the majority of OM diagnoses. The most common procedures were tissue biopsies (59.34%) and treatments for temporomandibular disorders (29.9%). Inpatients (n = 313) comprised 3.46% of Penn OM hospital services, and cardiovascular disorders (38.99%) were the most common admitting diagnoses in this group. In the OM dental practice (n = 1648), 42.05% of patients had a median of 3 medical comorbidities (range = 2-11), of which cardiovascular disorders (27.13%) were most prevalent. CONCLUSIONS: Analysis of Penn OM clinical practices emphasizes the breadth and multidisciplinary nature of OM services and importance of comprehensive postdoctoral training in all domains of OM.

REFUGE Challenge: A unified framework for evaluating automated methods for glaucoma assessment from fundus photographs.

Glaucoma is one of the leading causes of irreversible but preventable blindness in working age populations. Color fundus photography (CFP) is the most cost-effective imaging modality to screen for retinal disorders. However, its application to glaucoma has been limited to the computation of a few related biomarkers such as the vertical cup-to-disc ratio. Deep learning approaches, although widely applied for medical image analysis, have not been extensively used for glaucoma assessment due to the limited size of the available data sets. Furthermore, the lack of a standardize benchmark strategy makes difficult to compare existing methods in a uniform way. In order to overcome these issues we set up the Retinal Fundus Glaucoma Challenge, REFUGE (https://refuge.grand-challenge.org), held in conjunction with MICCAI 2018. The challenge consisted of two primary tasks, namely optic disc/cup segmentation and glaucoma classification. As part of REFUGE, we have publicly released a data set of 1200 fundus images with ground truth segmentations and clinical glaucoma labels, currently the largest existing one. We have also built an evaluation framework to ease and ensure fairness in the comparison of different models, encouraging the development of novel techniques in the field. 12 teams qualified and participated in the online challenge. This paper summarizes their methods and analyzes their corresponding results. In particular, we observed that two of the top-ranked teams outperformed two human experts in the glaucoma classification task. Furthermore, the segmentation results were in general consistent with the ground truth annotations, with complementary outcomes that can be further exploited by ensembling the results.

Review of obesity and periodontitis: an epidemiological view.

Obesity and periodontitis are among the most common non-communicable diseases, and epidemiological studies report the influence of obesity in the onset and progression of periodontitis. Data indicate that increased body mass index, waist circumference, percentage of subcutaneous body fat, and serum lipid levels are associated with increased risk to develop periodontitis. The underlying biological mechanisms of this association involve adipose tissue-derived cytokines, such as tumour necrosis factor-α and interleukin-6, which affect whole-body metabolism and contribute to the development of a low-grade systemic inflammation. Multiple studies report a positive association between these two diseases across diverse populations. Obesity does not appear to impair the success of periodontal therapy. However, currently available evidence is variable and therefore inconclusive. Despite the limited evidence about recommendations on treatment planning, oral healthcare professionals need to be aware of the complexity of obesity to counsel their patients about the importance of maintaining healthy body weight and performing good oral hygiene procedures.