Mucosal Color Research Articles

Simple endoscopic estimation to predict anastomotic complications after bronchoplastic procedures.

Endoscopic evaluation of anastomosis is effective for the early detection of anastomotic complications after a bronchoplastic procedure. Herein, we aimed to clarify important findings for predicting anastomotic complications. This single-centre retrospective study included patients who underwent bronchoplastic surgery between April 2013 and September 2023. Only cases in which bronchoscopy was performed both 1 and 2 weeks after surgery were included. Endoscopic findings (classification by Ludwig and Stoelben, mucosa colour, oedema, slough area and colour and depression) were reviewed for all cases. The accuracy of these findings for predicting anastomotic complications was evaluated. Of the 190 patients included in this study, 14 (7.4%) experienced anastomotic abnormalities, 11 had fistulas (5.8%) and 7 had stenosis (3.7%). The onsets of fistula and stenosis were 20-28 and 20-44 days after surgery, respectively. In 102 patients (53.7%), the slough worsened from the first to the second week postsurgery. Therefore, it was easier to evaluate slough 2 weeks postsurgery rather than 1-week postsurgery. The positive/negative predicted values of anastomotic complications in endoscopic findings 2 weeks postsurgery were circular slough, 34.2%/99.3%; slough with dark colour, 39.3%/98.1%; and depression, 54.2%/99.4%. The incidence of anastomotic abnormalities was 0% in cases without the 3 findings, 10% in cases with at least 1 finding and 67% in cases with all 3 findings. The endoscopic findings of slough on the anastomosis 2 weeks after bronchoplasty can be easily evaluated and accurately predict complications. Three important endoscopic findings were circular slough, dark colour and depression.

Blood flow assessment of gastric tube with indocyanine green fluorescence angiography and postoperative endoscopy during esophagectomy: indocyanine green enhancement time indicated congestion

BackgroundDuring esophagectomy, evaluation of blood supply to the gastric tube is critically important to estimate and avoid anastomotic complications. This retrospective study investigated the relationship between indocyanine green (ICG) fluorescence angiography during esophagectomy and postoperative endoscopy findings, especially mucosal color change.MethodsThis study retrospectively collected data from 86 patients who underwent subtotal esophagectomy and reconstruction using a gastric tube for esophageal cancer at the Tokyo Medical and Dental University between 2017 and 2020. The flow speed of ICG fluorescence in the gastric tube was evaluated during the operation. Additionally, the main root of ICG enhancement and pattern of ICG distribution in the gastric tube were evaluated. On postoperative day 1 (POD1), the change in the mucosal color to white, thought to reflect ischemia, or black, thought to reflect congestion of the proximal gastric tube, was evaluated. The correlations between these factors, clinical parameters, and surgical outcomes were evaluated. Univariate and multivariate analyses used logistic regression to identify the risk factors affecting mucosal color change.ResultsMultivariate analyses revealed that the only independent significant predictor of mucosal congestion on POD1 was the ICG enhancement time of the right gastric tube tip (odds ratio, 14.49; 95% confidential interval, 2.41–87.24; P = 0.004).ConclusionsThis study indicated that the ICG enhancement time is related to venous malperfusion and congestion rather than arterial malperfusion and ischemia.

Electromyography Analysis of the Masseter Muscle's Activity in the Management of Oral Submucous Fibrosis.

Introduction Oral submucous fibrosis (OSMF) is a persistent, collagen metabolic disorder distinguished by the presence of fibrosis of the connective tissue stroma in the oral mucosa with a higher malignant potential rate for oral cancer. This study aimed to analyze the utility of electromyography (EMG) as the prognostic assessment tool in the management of OSMF with conventional intralesional corticosteroid therapy. Materials and methods This study included 20 OSMF cases of age range 20 to 80 years without systemic comorbidities to assess pre-treatment and post-treatment changes with intralesional corticosteroid therapy as an intervention and to determine if it could be assessed using electromyographic study. Clinical and histopathological grading of OSMF was done. The five clinical parameters were evaluated for measuring treatment prognosis. Among them, mouth opening, tongue protrusion, and burning sensation assessments were quantitative parameters, and palpable fibrotic bands and mucosa colour were qualitative parameters. As OSMF involves changes in muscle plane in moderately advanced and advanced cases, EMG was used as an assessment tool for measuring muscle activity. Among the muscles of mastication, the masseterand temporalis were selected for evaluation. Twenty age and gender-matched healthy controls were required for this study as there are no standardized normal values for amplitude and onset of activity in muscle analysis. The EMG activity of the right and left temporalis and masseter muscles were recorded using surface electrodes and were correlated with five clinical assessment parameters. Results In the right masseter, the rest amplitude of 1.6010 µV of the OSMFwas statistically significant (p-value: 0.050) when compared with 4.1275 µV of the control. The clench amplitude of 133.370 µV of the OSMFwas statistically significant (p-value: 0.062) when compared with 94.310 µV of the control. In the left masseter, the rest amplitude of 1.6695 µV of the OSMFwas statistically significant (p-value 0.066) when compared with 2.5735 µV of the control. In the left masseter, the onset of muscle action of 62.670 ms of the OSMFwas statistically significant (p-value: 0.017) when compared with 131.835 ms of the control. The clench amplitude differences in the right masseter of 133.370 µV pre-treatment, and 102.775 µV post-treatment were statistically significant (p-value: 0.007). The clench amplitude in the left masseter of 102.535 µV pre-treatment, and 92.090 µV post-treatment were statistically significant (p-value: 0.036). The correlation was seen between tongue protrusion and rest amplitude in the right masseter in OSMF (r = 0.376, p-value: 0.023). Conclusion There was a correlation between tongue protrusion and rest amplitude in the right masseter muscle in OSMF patients before treatment. In the right and left masseter, during rest, the amplitude of the OSMF group was lesser than that of the control group. During clench, in the right masseter, the amplitude of the OSMF group was higher than that of the control group. During clench in the left masseter, the onset of muscle action was lesser in the OSMF group than in the control group. After treatment, there was a reduction in clench amplitude in OSMF patients from their pretreatment values signifying muscle relaxation and a better onset of muscle action.

Analysis of the detection rate and clinical characteristics of early gastric cancer by painless gastroscopy and ordinary gastroscopy.

To investigate the difference of early gastric cancer (EGC) detection rate and endoscopic characteristics between painless and ordinary electronic gastroscopy, and summarize the clinical data of gastric cancer (GC) patients. Clinical data of 72,000 patients who underwent gastroscopy in the First People Hospital of Huzhou (Zhejiang, China) from January 2016 to December 2021 were retrospectively analyzed. The patients were divided into painless gastroscopy group (observation group, 36,000 cases) and ordinary gastroscopy group (control group, 36,000 cases) according to the examination methods. The detection rate of EGC between the 2 groups and the endoscopic characteristics of EGC lesions between the 2 groups were compared, and the clinical data of GC were summarized. Painless gastroscopy is safer than ordinary gastroscopy. The detection rate of GC and EGC in the observation group was significantly higher than that in the control group (P < .05); the difference between the 2 groups in the detection rate of advanced GC was not statistically significant. The average length of EGC lesions in the observation group was significantly shorter than that in the control group (P < .05). The proportion of EGC with lesion length <2.0 cm in the observation group was significantly higher than that in the control group (P < .05). The proportion of EGC lesions with type II morphology, normal or pallor mucosal color, and no rupture in mucosa in the control group were significantly lower than that in the observation group, respectively (P < .05). The proportion of EGC distributed in the cardia, fundus and corpus was higher in the observation group than in the control group (P < .05). The incidence of helicobacter pylori (HP) infection, precancerous diseases, first-degree relatives of GC patients, and risk factors in patients with GC was significantly higher than that in non-GC patients (P < .05), multivariate logistic regression analysis showed that these were independent influencing factors for the occurrence of GC. Painless gastroscopy can effectively improve the screening and diagnostic efficiency of EGC, especially for EGC lesions that are not easy to expose the site, small in size, superficial, without obvious mucosal color change or without mucosal breakage. Therefore, the value of painless gastroscopy in EGC screening is worth further promotion and research.

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.

Clinicopathologic Evaluation and Management of Twenty Cases of Oral Mucoceles

Background: Oral mucoceles are benign minor salivary gland lesions characterized by a single or multiple, soft, fluctuant nodule, ranging from normal oral mucosal color to deep blue depending upon the extent of the swelling in deeper layers. This study evaluated clinicopathological features, including the etiology and management of oral mucoceles. Methods: Twenty cases of oral mucoceles were diagnosed, and parameters such as age, gender, etiology, site, clinical presentation, including size, any symptoms, and treatment mode underwent evaluation. Results: In 20 cases, the lesions were found to be more common in males compared to females (16:4). The most common site was the lower lip, and the etiology of mucocele was lip biting, with 80% of cases normal in color and size ranging between 5 mm and 10 mm. The most common type based on histopathology evaluation was the extravasation type in almost all cases. Conclusion: The non-neoplastic benign lesions of minor or major salivary glands pose a diagnostic challenge because of their close resemblance to other pathologies and iatrogenic responses. Thus, the clinical knowledge and pathogenesis of these lesions are necessary for the correct diagnosis and appropriate treatment.

Mucosa color and size may indicate malignant transformation of chicken skin mucosa-positive colorectal neoplastic polyps.

Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions, including colorectal adenoma. Screening colonoscopy frequently reveals chicken skin mucosa (CSM; white or yellow-white speckled mucosa) surrounding colorectal polyps, caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors. CSM-positive colorectal polyps are associated with various diseases; however, their prognosis varies greatly. Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps. Improved imaging is required to diagnose and treat CSM-positive colorectal polyps. To highlight the clinical significance of CSM surrounding colorectal polyps and clarify the associated treatment for endoscopists. This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy. All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system. Based on the pathological results, patients were classified as non-neoplastic polyps (five juvenile polyps), neoplastic polyps, non-invasive high-grade neoplasia (NHGN), or submucosal invasive carcinoma (SM stage cancer). We analyzed and compared the clinical features, suspected risk factors for malignant transformation of neoplastic polyps, and early infiltration of submucosal carcinoma. The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps. Most NHGN polyps had a deeper red mucosal color. On logistic regression analyses, diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps. Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM; type 2 CSM was more common in neoplastic polyps. Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer. Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months. No tumor recurrence was found during either partial or complete endoscopic resection of the CSM. CSM-positive colorectal polyps > 1 cm in diameter or with deeper red mucosa may be related to NHGN. Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.

Diagnostic performance of linked color imaging for gastric cancer by Helicobacter pylori infection status: A subanalysis of the large-scale, multicenter randomized controlled trial LCI-FIND.

Linked color imaging (LCI) is a new image enhancement technology that facilitates the recognition of subtle differences in mucosal color. In the large-scale, multicenter randomized controlled trial LCI-FIND, LCI demonstrated good diagnostic performance for the detection of tumor lesions in the upper gastrointestinal tract. The aim of the present study was to exploratively evaluate the diagnostic performance of LCI according to H. pylori infection status as a subanalysis of LCI-FIND trial. The patients were randomly allocated to receive white light imaging (WLI) first, followed by LCI (WLI group), or vice versa (LCI group), and the two groups were compared for the detection of tumors. Data from this trial were analyzed by the presence/absence of H. pylori infection and further analyzed by successful or unsuccessful eradication in the H. pylori infection group. The 752 patients in the WLI group and 750 patients in the LCI group who had participated in the LCI-FIND trial were included. In the successful eradication group, more gastric lesions were detected by primary mode in the LCI group than in the WLI group, indicating that more lesions were missed by WLI. Fisher's exact probability test for the comparison of the WLI and LCI groups yielded a p-value of 0.0068, with missed gastric lesions being detected 0.136 times (95% confidence interval: 0.020-0.923), significantly less with LCI than with WLI. The current study suggests that LCI should be used for gastric cancer screening, particularly in patients with successful H. pylori eradication.

Risk Factors for Mucosal Redness in the Duodenal Bulb as Detected via Linked Color Imaging.

Linked color imaging (LCI) for image-enhanced endoscopy (IEE) highlights mucosal color differences. We investigated risk factors associated with mucosal redness of the duodenal bulb using LCI. Consecutive patients were retrospectively selected after their duodenal bulbs were observed via LCI. A symptom questionnaire (Izumo scale) was completed. The LCI of the duodenal bulb was subjectively evaluated on whether redness was present and objectively evaluated based on L* a* b* color values. The clinical characteristics of the 302 study participants were: male/female, 120/182; mean age, 70.9 years. Twenty-one cases (7.0%) were in the redness (+) group. After multiple regression analysis, independent predictors for the red component (a*) of the duodenal bulb using LCI were: age (β = -0.154, p < 0.01), female (β = -0.129, p < 0.05), body mass index (BMI; β = -0.136, p < 0.05), Helicobacter pylori eradication (β = 0.137, p < 0.05), endoscopic gastric mucosal atrophy score (EGAS; β = -0.149, p < 0.05), and constipation-related quality of life (QOL) (β = -0.122, p < 0.05) scores. Lower age, lower BMI, lower EGAS, a constipation-related QOL score, post-H. pylori eradication, and being male were associated with mucosal redness in the duodenal bulb with IEE using LCI.

Clinical usefulness of image-enhanced endoscopy for the diagnosis of ulcerative colitis-associated neoplasia.

Patients with a long history of ulcerative colitis (UC) are at risk of developing a significant complication known as UC-associated neoplasia (UCAN). To reduce the risk of UCAN and the associated mortality, the current guidelines recommend initiating surveillance colonoscopy 8-10 years after confirmation of UC diagnosis. In recent years, advancements in endoscopic diagnostic technologies, including magnifying and image-enhancing techniques, have allowed for the production of high-contrast images that emphasize mucosal structures, vascular patterns, and color tones. Recently, image-enhanced endoscopy technologies have become available and offer the potential to improve the qualitative endoscopic assessment of UCAN. The use of high-definition chromoendoscopy enables the evaluation of subtle mucosal patterns in the colon. Magnifying narrow-band imaging facilitates the visualization of mucosal vascular structures. Texture and color enhancement imaging processes structure, color tone, and brightness aspects more appropriately, whereas linked color imaging optimizes the emphasis on mucosal and vascular redness. Both techniques are expected to excel in the depiction of subtle color variations and mucosal changes characteristic of UCAN. This article provides an overview of the current status and future challenges regarding the use of various image-enhanced endoscopytechniques in the diagnosis of UCAN.

Strongyloidiasis in Bornean Orangutan: A Case Report

This study reported the diagnosis and treatment of Strongyloidiasis in two Bornean orangutans (Pongo pygmaeus); adult male aged 23 years, weighing 100 kg and an infant female orangutan, 4 years old, weighing 13,6 kg. Samples were physically and laboratory examined for faeces using the Mini-FLOTAC method. Therapy was performed on the adult orangutan using albendazole at a dose of 400 mg individual twice a day for 4 days, orally. The infant orangutan was administered albendazole at a dose of 10 mg/kg BW once a day for 3 days orally. From several physical examinations, both orangutans looked active, body temperature and oral mucosa color were normal, green feces with solid consistency in the adult orangutan and brown with solid consistency in the infant orangutan. Microscopic faeces examination of the adult orangutan showed Strongyloides sp. as many as 1005 eggs per gram (EPG) of feces, and the infant orangutan as many as 2490 larvae per gram of feces. Both orangutans were diagnosed with severe Strongyloidiasis based on those examinations. Three days after starting treatment, the adult orangutan's EPG decreased to 890, and a week later, no Strongyloides sp. eggs or larvae were discovered. A week following treatment, no Strongyloides sp. was discovered in an infant orangutan. In conclusion, albendazole was an effective treatment for severe Strongyloidiasis in adult and infant orangutans. Strongyloidiasis can be a threat to both infant and adult orangutans without distinct clinical symptoms.

Endoscopic Manifestations and Clinical Characteristics of Localized Gastric Light-Chain Amyloidosis.

To determine the endoscopic and clinical features of localized gastric amyloid light-chain (AL) amyloidosis, we retrospectively examined the characteristics of nine patients (eight men and one woman) encountered by the hospitals in our network. Lesions were predominantly flat and depressed with surface vascular dilatation (n=5); others were characterized by subepithelial lesions (n=2), mucosal color change (n=1), and a mass-like morphology with swollen mucosal folds (n=1). Colonoscopy (n=7), video capsule enteroscopy (n=2), serum (n=5) and urine immunoelectrophoresis (n=4), and bone marrow examination (n=3) were performed to exclude involvement of organs other than the stomach. As treatment for gastric lesions of AL amyloidosis, one patient each underwent endoscopic submucosal dissection (n=1) and argon plasma coagulation (n=1), while the remaining seven patients underwent no specific treatment. During a mean follow-up of 4.2 years, one patient died 3.2 years after diagnosis, but the cause of death, which occurred in another hospital, was unknown. The remaining eight patients were alive at the last visit. In conclusion, although localized gastric AL amyloidosis can show various macroscopic features on esophagogastroduodenoscopy, flat, depressed lesions with vascular dilatation on the surface are predominant.

Salivary Interleukin-6 Level in Iraqi Patients with Oral Lichen Planus receiving Platelet-Rich Plasma Injections

Background: Interleukin-6 (IL-6) is a cytokine that has several functions, including stimulating growth and inhibiting cell death. It has the potential to operate as a biomarker for the accurate prediction of disease severity and activity, platelets-rich plasma was used in the treatment of oral lichen planus and can change the salivary IL-6 level. Objectives: To study the clinical outcome of intralesional platelets-rich plasma in patients with oral lichen planus and to measure salivary IL-6 levels before and after the treatment with platelets-rich plasma were the aims of this study. Subjects and Methods: In this clinical trial, for each patient a standardized case sheet was filled including demography, social, medical, and medication history. Before receiving, each patient was examined for phenotype, color, size, and site of oral lichen planus lesions. Patient's salivary samples were taken between 8 and 11 a.m. Three to four milliliters of saliva was obtained from each patient. The ELISA kit for IL-6 using sandwich-ELISA technique, to measure salivary IL-6 before and after PRP injections. Results: Thirteen oral lichen planus patients were took part in this study, six males (46.2%) and seven females (53.8%). The patients were between 32 and 91 years of age, with a mean age of 60.2(±13.9) years. All symptomatic and most of the hyperemic ones showed improvement after PRP injections, while the size of the lesions was resistant to change. Mean salivary IL-6 was 44.27 pg/mL (±43.24) before PRP injections and (69.74±59.86 pg/mL) after PRP injections. No significant difference was found, however IL-6 was higher after PRP injections. In relation to color changes after PRP, there was a significant changes in IL-6 level compared with that before PRP injections. Similarly, a significant relation was found between IL-6 level and signs and symptoms; pain and burning sensation. No association was found in salivary IL-6 level in relation to lesion phenotype, size, and location. Conclusion: All symptomatic OLP lesions that were treated with intralesional PRP responded very well, similarly almost all hyperemic lesions turned into normal mucosal color after completing the course of treatment. The majority of OLP lesions showed an increased salivary IL-6 levels after PRP treatment.

Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials.

Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.

Comparison of Intralesional Placentrex Versus Hyaluronidase and Dexamethasone Injection in the Symptomatic Management of Stage II Oral Submucous Fibrosis - a Prospective Study.

The present study aimed to compare the effectiveness of intralesional placentrex versus hyaluronidase + dexamethasone injection in the symptomatic management of stage II OSMF. This was a non-randomized prospective study conducted over a period of 14 months at a tertiary referral center. Patients with clinical stage II OSMF were randomly grouped into A(n = 18) and B(n = 17). These patients were treated with weekly intralesional injection of placentrex and hyaluronidase + dexamethasone respectively, over a period of six weeks. Variables such as mouth opening, burning sensation and colour of mucosa were evaluated at baseline(T0), second week(T1), fourth week(T3), sixth week(T4) of follow up. A p-value < 0.05 was considered statistically significant. A total of 15 patients completed the study in each group with regular follow up. The mean improvement in mouth opening was 4.3 ± 0.57 mms in group A(p-value < 0.001) and 7.2 ± 0.76 mms in group B(p-value < 0.001) which were significant at the end of six weeks. Mean change in burning sensation at the end of six weeks in group A was 1.2 ± 0.73(p-value < 0.001), and 3.6 ± 0.63(p-value < 0.001) in group B. Mean change in colour of mucosa at the end of six weeks was 1.4 in group A(p-value > 0.05) and 2 in group B(p-value > 0.05). On comparison between both groups, patients in group B exhibited better mouth opening and reduction of burning sensation than patients in group A(p-value < 0.001). Both intralesional placentrex and hyaluronidase + dexamethasone injection are effective in alleviating the symptoms of stage II OSMF. However, hyaluronidase + dexamethasone injection showed slightly better improvement in mouth opening and burning sensation after six weeks.

Effects of intralesional platelets-rich plasma injections on oral lichen planus lesions and salivary interleukin-8

Abstract Background: Oral lichen planus (OLP) is a chronic inflammatory disease of oral mucosal surfaces. Objective: The aim of this study was to determine if salivary IL-8 levels changed after autologous platelet-rich plasma (PRP) therapy and to assess its therapeutic effects on OLP. Materials and Methods: For each patient, demography, social, medical, and medication history was recorded. Before receiving 0.5 mL of PRP for each square centimeter of lesion, each patient was examined for phenotype, color, size, and site of OLP lesions. Patient’s salivary samples were taken between 8 and 11 AM. Three to four milliliters of saliva was obtained from each patient. ELISA kit for IL-8 using a sandwich-ELISA technique, to measure salivary IL-8 before and after PRP injections. Each patient had signed a consent form to participate in this study. Results: Thirteen OLP patients took part in this study, six males (46.2%) and seven females (53.8%). Patients were between 32 and 79 years of age, with a mean age of 60.2 ± 13.9 years. Mean salivary IL-8 was (459.94 ± 233.74 pg/mL) before PRP injections and (465.68 ± 158.30 pg/mL) after PRP injections with no significant difference; however, IL-8 was higher after PRP injections. No association was found in salivary IL-8 level in relation to color changes, signs, and symptoms; pain and burning sensation, lesion phenotype, size, and location. Conclusion: Majority of OLP lesions showed an increased salivary IL-8 level after PRP treatment. PRP injections relieved OLP lesions’ signs and symptoms, and turned hyperemic lesions into normal mucosal color, but lesions’ dimensions were resistant to change.

Comparison Between Clinical Outcome of Intralesional Human Placental Extract Alone and Topical Application of Placental Extract Gel After Fibrotomy in Oral Submucous Fibrosis.

Oral submucous fibrosis (OSMF) is a premalignant condition prevalent in our country. Juxtaepithelial inflammation with progressive hyalinization of the lamina propria results in stiffness and fibrosis of the oral mucosa, characterised by trismus, ankyloglossia, and a burning sensation. Various methods of treatment have been tried in these cases, which include placental extract injections and the cutting of fibrous bands. In this study, we aim to compare the outcome of intra-lesional placental extract injection with fibrotomy and placental extract gel application in OSMF. This prospective interventional study included 58 patients clinically diagnosed with OSMF grades II and III at a rural tertiary care hospital between January 2021 and August 2022. The patients were randomised into two groups: group I received 1 ml of intra-lesional human placental extract injection in the submucosal plane of the buccal mucosa and retro-molar trigone (RMT) once a week for five consecutive weeks, and group II was subjected to a transverse division of fibrotic bands in the submucosal plane under general anaesthesia. The surgical wound was left open, and swabs soaked in human-purified placental extract gel were placed in the wound for two hours twice daily until the surgical wound was epithelialized and healed. The patients in both groups I and II were advised to do jaw opening exercises, and weekly follow-up was done. Findings with regard to maximum mouth opening, colour of mucosa, and burning sensation in the oral cavity based on a Likert scale were documented. At the end of five months, the pre-treatment and post-treatment results documented were compared. All patients were between 20 and 60 years of age and were addicted to chewing areca nuts with tobacco. Bilateral involvement was present in all patients, with extension into the RMTand soft palate seen in 31%. Improvement in mouth opening was between 4 mm and 6 mm in group II, and relief of burning sensation and mucosal colour was better in group I. Intra-lesional placental extract injections help in the improvement of the mucosa and relief from the burning sensation. Fibrotomy with placental extract gel application is better at relieving trismus in OSMF. Aggressive mouth-opening exercises may improve mouth opening following the above procedures.

Clinical Usefulness of Linked Color Imaging for Detection and Characterization of UndifferentiatedType Early Gastric Cancer.

Linked color imaging is based on the bioluminescent imaging technique, which enhances differences in mucosal color allowing for contrast-based detection of lesions. There have been reports which have investigated the usefulness of linked color imaging for assessing color values in endoscopy for early gastric cancer cases. However, these primarily focused on differentiated early gastric cancer. This study aimed to assess the efficacy of linked color imaging in analyzing the color differences between cancerous and noncancerous areas in undifferentiated-type early gastric cancer patients compared with conventional white light imaging. Forty-six patients were prospectively enrolled with undifferentiated-type early gastric cancer from 3 academic hospitals. All lesions were observed first by white light imaging followed by linked color imaging. An additional biopsy was taken from the surrounding mucosa to check for intestinal metaplasia, and test for Helicobacter pylori was performed. Color difference was measured in accordance with the International Commission on Illumination details. The color difference value with linked color imaging was significantly higher, being more than twice that of white light imaging (26.82 ± 14.18 and 12.60 ± 6.42, P < .001), and this difference appeared to be similar in cases of accompanying Helicobacter pylori infection or intestinal metaplasia. In the subgroup analysis, color difference of poorly differentiated adenocarcinoma was notable in linked color imaging compared to white light imaging. Conversely, no statistically significant finding was present in signet ring cell carcinoma or mixed-type histology. Linked color imaging provides a significantly greater color difference between cancerous lesions and background noncancerous mucosa in undifferentiated-type early gastric cancer. Moreover, linked color imaging may differentiate between pathologic subgroups of undifferentiated-type early gastric cancer possibly due to characteristic cellular growth pattern.

Demarcating Z-line and Gastric Folds Boundary Based on the Segmentation of the Lower Esophageal Sphincter Images.

The endoscopic diagnosis of pathological changes in the gastroesophageal junction including esophagitis and Barrett's mucosa is based on the visual detection of two boundaries: mucosal color change between esophagus and stomach, and top endpoint of gastric folds. The presence and pattern of mucosal breaks in the gastroesophageal mucosal junction (Z line) classify esophagitis in patients and the distance between the two boundaries points to the possible columnar lined epithelium. Since visual detection may suffer from intra- and interobserver variability, our objective was to define the boundaries automatically based on image processing algorithms, which may enable us to measure the detentions of changes in future studies. To demarcate the Z-line, first the artifacts of endoscopy images are eliminated. In the second step, using SUSAN edge detector, Mahalanobis distance criteria, and Gabor filter bank, an initial contour is estimated for the Z-line. Using region-based active contours, this initial contour converges to the Z-line. Finally, by applying morphological operators and Gabor Filter Bank to the region inside of the Z-line, gastric folds are segmented. To evaluate the results, a database consisting of 50 images and their ground truths were collected. The average dice coefficient and mean square error of Z-line segmentation were 0.93 and 3.3, respectively. Furthermore, the average boundary distance criteria are 12.3 pixels. In addition, two other criteria that compare the segmentation of folds with several ground truths, i.e., Sweet-Spot Coverage and Jaccard Index for Golden Standard, are 0.90 and 0.84, respectively. Considering the results, automatic segmentation of Z-line and gastric folds are matched to the ground truths with appropriate accuracy.