The aim of this retrospective study is to evaluate the volumetric and histogram-based characteristics of the parotid and submandibular salivary glands in patients with hypertension compared with healthy controls. Magnetic Resonance images of a total of 94 patients, including 42 hypertensive and 52 control subjects, were included in the study. The volumes of the right and left parotid and submandibular glands were manually measured on images obtained using a 1.5 Tesla Magnetic Resonance scanner. For volumetric assessment of the parotid and submandibular glands, T1-weighted MR images were analyzed using the Sectra IDS7 software program on a full HD display. In addition, histogram analysis was performed on manually defined regions of interest to calculate mean, skewness, and kurtosis values. A total of 94 participants were included. Submandibular gland volumes were significantly higher in hypertensive patients (right: 8.58 ± 2.0; left: 8.61 ± 2.1 ) compared to controls (right: 7.81 ± 2.1; left: 7.73 ± 1.9), while parotid gland volumes showed no significant difference (p < 0.05). Histogram analysis revealed significantly lower mean grayscale values in the parotid glands in the hypertension group (right: 113.73 ± 27.9; left: 113.81 ± 25.6) compared to healthy controls (right: 145.91 ± 31.1; left: 148.89 ± 32.6)(p < 0.001), whereas skewness and kurtosis values were not significantly different (p > 0.05). Hypertension may be associated with gland-specific volumetric changes and diffuse microstructural alterations in salivary glands. Histogram-based analysis provides complementary information beyond volumetric measurements and may improve the detection of subtle tissue changes. MRI is an effective method for quantitative evaluation of salivary glands.

Type 2 diabetes causes changes in the structure and functions of the major salivary glands. The aim of this study is to evaluate the dimensional measurements, echogenicity, and fractal dimension (FD) of bilateral major salivary glands in patients with type 2 diabetes mellitus (DM) on ultrasonography (US) and compare them with healthy individuals. The study included US images of 36 patients with type 2 DM and 36 healthy individuals. The superoinferior (SI), anteroposterior (AP), and mediolateral (ML) dimensions of the major salivary glands were measured, echogenicity was classified, and FD was calculated. Dimensional measurements, FD, and echogenicity comparisons between groups were analyzed. Dimensions of SI, AP, and ML were found statistically higher in the patient group than in the control group (p < 0.05). In the parotid gland, the isoechoic type was significantly more common in the patient group (p < 0.05). Although no statistically significant relationship was observed, in the submandibular and sublingual glands, isoechoic type was more frequent in the patient group. FD values were found to be higher in the patient group compared with the control group for all glands and a statistically significant relationship was observed in the sublingual gland (p < 0.05). Type 2 DM is a disease that changes the salivary gland structure, but to confirm these results, new studies are needed in which disease severity/HbA1c levels, drug doses and disease duration are known and can be associated with clinical data.

Primary Sjögren's disease (SjD) is characterized by lymphocyte infiltration into exocrine glands. Mitochondrial dysfunction is a critical pathological mechanism underlying SjD, and mitophagy plays a vital role in clearing damaged mitochondria. This study used bioinformatic analysis to explore the potential roles of mitophagy-related genes in SjD pathogenesis and immune infiltration. Bioinformatic analysis was performed on the SjD microarray datasets to identify differentially expressed genes (DEGs). Mitophagy-related DEGs were selected and analyzed using functional enrichment, protein-protein interaction (PPI) networks, and machine learning (Least Absolute Shrinkage and Selection Operator [LASSO] and Random Forest) to identify hub genes. Their diagnostic value was assessed by receiver operating characteristic (ROC) curves. Immune infiltration and its correlation with hub genes were also evaluated. Hub gene expression in the salivary glands of patients was validated using qRT-PCR. Regulatory networks were also predicted. Three hub genes (GABARAPL1, PINK1, and SQSTM1) were identified. They showed high diagnostic specificity and were downregulated in SjD salivary glands. Immune infiltration analysis revealed increased levels of activated natural killer (NK) cells, memory B cells, plasma cells, CD8+ T cells, Tfh cells, and M1 macrophages, but decreased levels of Tregs and M2 macrophages. Hub gene expression was correlated with specific immune cell subsets. Regulatory network predictions highlighted potential upstream regulators and therapeutic compounds. This study identified three mitophagy-related hub genes linked to immune dysregulation in SjD, providing novel insights into disease mechanisms and potential therapeutic targets.

Complete congenital agenesis of major salivary glands: case report and systematic review of the literature.

ObjectivesSaliva, like other body fluids, has been investigated as a source of biomarkers for Alzheimer's disease (AD) due to its accessibility. Recently, decreased amyloid‐PET uptake in the salivary glands of patients with AD was reported, prompting interest in the potential clinical relevance of that finding. This study evaluates the association between salivary gland uptake on 18F‐florbetaben PET and cortical amyloid burden and assesses its diagnostic value.MethodsWe retrospectively analyzed 73 patients who underwent 18F‐florbetaben PET imaging. Salivary gland uptake (SUVRSG) was measured and compared with the cortical amyloid burden, severity of dementia, and clinical diagnoses (cognitively normal, mild cognitive impairment, and dementia). Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analyses.ResultsThe mean SUVRSG was 1.43 ± 0.29, with no significant differences based on the cortical amyloid burden, severity of dementia, or clinical diagnosis. SUVRSG did not correlate with the cortical amyloid burden (ρ = −0.103, p > 0.05). The area under the ROC curve and volume under the ROC surface indicated that SUVRSG had poor diagnostic performance.ConclusionsSalivary gland uptake on 18F‐florbetaben PET was not associated with the cortical amyloid burden or clinical stage of AD, and it did not demonstrate diagnostic value. Further research is needed to explore its biological significance and standardization methods.

Background. Primary Sjögren’s syndrome (pSS) is a chronic autoimmune inflammatory disease that typically develops in the absence of another systemic autoimmune disorder. Interstitial lung disease (ILD) represents the most frequent pulmonary manifestation of pSS and is associated with impaired lung function and potentially severe complications. Stratifying patients according to their risk of developing pSS-associated ILD (pSS-ILD) and identifying those at increased risk at an early stage may enable timely therapeutic intervention. Therefore, transcriptomic studies aimed at identifying differentially expressed genes across the three study groups may prove useful for the characterization of predictive disease factors. Materials and Methods. Transcriptomic analyses of inflammatory and immune-related gene panels were performed on patients with ILD, pSS, and pSS-ILD using the NanoString nCounter platform. RNA was extracted from FFPE-embedded minor salivary gland samples obtained from eight patients in each group. Only RNA samples with the highest DV200 values, as assessed by Bioanalyzer, were used for further analysis. Data were processed using the nSolver software, and genes showing significant up- or down-regulation with p &lt; 0.05 were considered differentially expressed. Results. Gene expression analysis in patients with ILD revealed significant differences in immune and inflammatory responses compared to patients with isolated pSS. The up-regulation of TSLP, IL1RN, MAP2K6, JUN, IL1RL1, TNFRSF14, CXCL10, and IL7, along with the down-regulation of PIGR and ITGA6, signifies modified immunologic activity that may aid in clarifying the pathophysiology associated with ILD. Moreover, substantial gene expression variations were observed between pSS-ILD and isolated ILD. Elevated expression of HIF1A, NFATC3, FLT1, APP, and CD14, alongside diminished expression of transcription factors like MYC and FOS, indicates significant modifications in intracellular signaling pathways that may be involved in the pathogenesis of ILD. In addition, upregulation of HDAC4, C4A, and C7 in pSS-ILD patients compared to those with isolated pSS highlights further dysregulation of immune and inflammatory processes, suggesting the emergence of a profibrotic microenvironment capable of exacerbating lung injury. Conversely, down-regulation of CCL21 implies possible disturbances in lymphocyte trafficking and immune surveillance, further complicating disease pathogenesis. Conclusions. It is noteworthy that not all patients with pSS develop ILD, suggesting the possible contribution of genetic or environmental factors to disease manifestation and progression. In summary, the transcriptomic landscape distinguishing ILD, pSS, and their comorbidity provides crucial insights into disease pathogenesis. The differential expression of genes—particularly HDAC4, C4A, C7, and CCL21—offers valuable clues for future research focused on targeted therapies and precision medicine approaches for these complex clinical phenotypes.

Sjögren’s disease (SjD) is a systemic auto-immune disease characterized by salivary gland inflammation and glandular dysfunction. Diagnosis is challenging due to its heterogeneity and currently relies on a variety of tests that are present in the ACR-EULAR classification criteria. These include invasive and resource-intensive tests, highlighting the unmet need for a single, accurate, non-invasive diagnostic modality. Multispectral optoacoustic tomography (MSOT), enabling functional imaging of hemoglobin-related parameters, may address this gap. This pilot study evaluates MSOT's potential for salivary gland imaging in patients suspected of SjD. This study included 20 patients clinically suspected of SjD. Which underwent MSOT imaging of the major salivary glands, alongside the full ACR-EULAR diagnostic workup, including serology, salivary gland biopsy, and sialometry, alongside salivary gland ultrasound. MSOT parameters were compared to standard of care diagnostic modalities and ultrasound scoring systems. A novel MSOT scoring system based on 800 nm hemoglobin signals was developed to evaluate diagnostic performance. Patients classified as SjD (n = 13) show significantly higher hemoglobin-related signals compared to non-SjD patients (n = 7). When ≥ 2 salivary glands, either submandibular or parotid, exceeded their predefined MSOT cut-off values of 371.6 a.u. and 374.2 a.u., respectively, MSOT achieved 92 % sensitivity and 100 % specificity for SjD classification, outperforming other diagnostic tests and established ultrasound scoring systems. MSOT shows promise as non-invasive imaging modality for SjD classification, and may offer higher sensitivity compared to established ultrasound scoring systems and other diagnostic tests. These explorative findings support further investigation of MSOT as non-invasive diagnostic tool in SjD.

Sjögren's disease (SjD) is a systemic autoimmune disorder characterised by chronic lymphocytic inflammation of the salivary and lacrimal glands, leading to progressive dysfunction and tissue damage. Salivary gland ultrasonography (SGUS) enables standardised, semiquantitative evaluation of glandular structure. While grey-scale (B-mode) scoring systems such as De Vita et al. and OMERACT are widely used, the recently validated colour Doppler (CD) OMERACT scoring system allows assessment of glandular vascularisation. However, its relationship with structural imaging and clinical disease activity remains uncertain. The aim of the study is to assess the correlation between CD ultrasonography and established B-mode scores, and to explore the clinical significance of vascular assessment in patients with SjD. Sixty-three consecutive patients fulfilling the 2016 ACR/EULAR criteria for SjD underwent standardised SGUS of parotid and submandibular glands using De Vita et al., B-mode OMERACT, and CD OMERACT semiquantitative scores (0-3). Clinical, serological, and disease activity parameters were recorded and correlated using Spearman's rank coefficient. Most patients exhibited moderate to severe B-mode alterations, while higher CD grades (2-3) were less frequent. CD OMERACT scores correlated moderately with De Vita et al. (ρ=0.44, p<0.001), B-mode OMERACT (ρ=0.48, p<0.001), and glandular ESSDAI (ρ=0.43, p<0.001). SjD-related lymphoma showed weak but significant correlation with CD OMERACT and moderate correlation with both B-mode scores. Colour Doppler ultrasonography reflects inflammatory vascular changes paralleling structural and clinical disease activity in SjD. Although it does not yet provide independent diagnostic value, further studies are needed to define the role of Colour Doppler as a complementary tool in salivary gland ultrasonography for assessing glandular inflammation and lymphoproliferative risk.

A cross-sectional observational study of patients with sicca with salivary autoantibodies defines a potential new phenotype of Sjögren's disease.

Activated T cells play a pivotal pathogenic role in the progression of Sjögren disease (SjD); however, there are currently no targeted therapies specifically designed to address them. This study aims to identify pathogenic CD8+ T cells in SjD and develop targeted therapeutic strategies. Il12b-/-Il2ra-/- mice, a murine model for overlapping primary biliary cholangitis and SjD, were employed in this study. Pathogenic CD8+ T cells were identified through single-cell RNA sequencing and flow cytometry analyses of samples from both patients with SjD and relevant murine models. Shared T cell receptor analysis was conducted to trace the potential precursors of pathogenic CD8+ T cells. The efficacy of PD-1-targeted chimeric antigen receptor (CAR)-T cell therapy was evaluated through the assessment of salivary gland secretory function, immunologic profiles, and histopathological changes in the murine model. We identified PD-1 as a comprehensive marker of clonally expanded and activated pathogenic CD8+ T cells in the salivary glands and peripheral tissues. Flow cytometry further confirmed the activation phenotype and cytotoxicity of PD-1+CD8+ T cells in the salivary glands of patients with SjD. Notably, the number of PD-1+CD8+ T cells in the labial glands positively correlated with disease activity in patients with SjD. These findings highlight the therapeutic potential of depleting PD-1+CD8+ T cells in SjD. Furthermore, PD-1-targeted CAR-T cell therapy significantly alleviated SjD symptoms in a murine model. We identified the pathogenic role of PD-1+CD8+ T cells in both patients with SjD and a murine model and demonstrated the efficacy of PD-1-targeted CAR-T cell therapy in SjD model mice. Our findings suggest a promising avenue for developing clinical therapeutic strategies for patients with SjD.

Introduction: Dysfunction of salivary glands in patients with a history of coronavirus disease (COVID-19) infection are a prevalent clinical finding. However, the impact of these salivary disorders on the clinical experience of xerostomia has been less frequently investigated. This study aimed to investigate the prevalence of xerostomia in patients recovered from COVID-19. Methods: In this retrospective cross-sectional study, data were collected through interviews with 350 patients referred to the Department of Dentistry at Urmia from March to August 2023 who had a history of COVID-19 infection. Demographic information, previous systemic diseases, medication history, and history of COVID-19 infection were provided by patients through a checklist of preliminary descriptive information. The Persian version of the Fox et al questionnaire was used to assess xerostomia, and the Thomson et al questionnaire was used to assess the severity of xerostomia. The total scores were used to evaluate the severity of xerostomia. The final data were entered into SPSS version 29 for analysis. Results: Participants were 211 males and 139 females with a mean age of 32.19±12.14 years. The mean xerostomia score in patients based on the Thomson Index was 21.7±7.50 out of 44. No significant difference in xerostomia severity was observed between males and females (P=0.278), but with increasing age, the likelihood of xerostomia occurrence increased (P=0.009). The severity of xerostomia was significantly higher in recipients of the Sinopharm vaccine compared to recipients of the AstraZeneca vaccine (P=0.028). Still, no difference was observed between the frequency of vaccinations and the severity of xerostomia (P=0.757). Conclusion: Based on the results of this study, age and type of vaccine can have an impact on the severity of xerostomia after contracting COVID-19 infection. Therefore, the type of received vaccine and the age of the patient during vaccination and assessments of patients should be considered.

Background/Objectives: Primary Sjogren's syndrome (pSS) is an autoimmune disease caused by chronic inflammation of the exocrine glands. We aimed to determine the immunohistochemical parameters that may help in the diagnosis of pSS and to determine histopathological markers for the early diagnosis of patients. Methods: Hematoxylin-eosin-stained preparations of salivary gland tissue samples of a control group consisting of 9 healthy patients and 12 patients diagnosed with non-specific chronic sialadenitis (NSCS) and a study group consisting of 39 patients diagnosed with pSS were evaluated. SSA/Ro (TRIM21), SSB/la, BAFF, enolase (ENO1), and MMP-9 antibodies were applied to the samples to assess the presence of staining in the ductal, acini, and inflammation regions. Results: In our study, mild staining with the SSA/Ro (TRIM21) antibody was observed in the ductal areas of all pSS cases, while no staining was detected in the healthy and NSCS cases (p < 0.01). Additionally, stronger staining was identified in the ductal and inflammatory areas of the pSS cases with BAFF compared to the control group. The staining for the ENO1 antibody was higher and more intense in the NSCS and pSS cases compared to those with normal salivary glands, and this difference was found to be statistically significant (p < 0.01). While mild staining was detected in the ductal areas with MMP-9 antibody in most of the NSCS and pSS cases, it was detected in 11% of the healthy cases. Conclusions: Our study suggests that SSA/Ro (TRIM21), ENO1, MMP9, and BAFF can be used to confirm the diagnosis in cases of suspicion.

BackgroundEndoplasmic reticulum stress (ERS) and the unfolded protein response (UPR) are adaptive mechanisms for conditions of high protein demand, marked by an accumulation of misfolded proteins in the endoplasmic reticulum (ER). Rheumatic autoimmune diseases (RAD) are known to be associated with chronic inflammation and an ERS state. However, the activation of UPR signaling pathways is not completely understood in Sjögren’s disease (SD). This study evaluated the expression of ERS-related genes in glandular tissue of patients with primary SD (pSD), associated SD (aSD) with other autoimmune diseases, and non-Sjögren sicca syndrome (NSS).MethodsIn a cross-sectional study, minor salivary gland biopsies were obtained from 44 patients with suspected SD and 13 healthy controls (HC). Patients were classified as pSD, aSD, or NSS based on clinical, serological, and histological assessment. Histopathological analysis and mRNA expression analysis of genes associated with ERS and UPR (PERK, XBP1, ATF-6, ATF-4, CANX, CALR, CHOP, and BIP) were performed on the samples. Differences between groups (pSD, aSD, NSS, and HC) were assessed. The influence of chloroquine (CQ) on the ER was also investigated.ResultsTwenty-eight SD patients showed increased expression of PERK (p = 0.0117) and XBP1 (p = 0.0346), and reduced expression of ATF-6 (p = 0.0003) and CHOP (p = 0.0003), compared to the HC group. Increased expression of BIP (p < 0.0001), PERK (p = 0.0003), CALR (p < 0.0001), and CANX (p = 0.0111) was also observed in the SD group compared to the NSS group (n = 16). Patients receiving CQ (n = 16) showed a significant increase in ATF-6 (p = 0.0317) compared to patients not taking the medication (n = 29).ConclusionsAltogether, the results suggest a greater activation of the ERS and UPR genes in patients with SD, especially in the pSD group. Antimalarial drugs, like CQ, used to treat RAD, may affect the ER function in exocrine glands.

To use shear wave elastography (SWE) in the evaluation of salivary glands in patients with ankylosing spondylitis (AS) who present with sicca symptoms. This was a prospective controlled study of patients diagnosed with AS and exhibiting sicca symptoms (study group) and of healthy volunteers (control group). The levels of antinuclear, anti-Ro, and anti-La antibodies were determined in blood samples. In both groups, parotid and submandibular glands were evaluated by ultrasound and tissue stiffness was determined by SWE. Intraclass correlation coefficients were used in order to assess reliability. The differences between the two groups were assessed by statistical methods, and a ROC curve analysis was performed to determine the predictive values. A total of 66 patients with AS and 71 healthy volunteers were included in the study. There were no significant differences between the groups in terms of age or sex (p > 0.05). The intraand inter-rater reliability of SWE were good for the parotid gland (0.81-0.85 and 0.80, respectively) and for the submandibular gland (0.85-0.88 and 0.80, respectively). Statistically significant differences were found. Tissue stiffness in the parotid and submandibular glands, as determined by SWE, was significantly greater in the study group than in the control group (p < 0.05). Although there was no histopathological correlation in the parotid and submandibular salivary glands of patients with AS and sicca symptoms compared with the healthy volunteers, quantitative measurements showed greater tissue stiffness in the former group. In patients with AS, SWE guides salivary gland biopsy, which is the gold standard for diagnosing Sjögren's syndrome.

The pathogenesis of Sjögren's disease (SjD) is still elusive; however, the disease is widely recognised as a multistep disorder triggered by the interplay of environmental, hormonal and genetic factors. Innate immune system plays a crucial role in the initiation of the inflammatory process, but the amplification and the perpetuation of the autoimmune process require a continual interaction between the innate and adaptive immune systems. Several important contributions elucidating SjD pathogenesis have been recently published due to emerging technologies. This review provides an overview of the recent literature focusing, in the first part, on new insights into genetic and epigenetics studies. In the second part, we will discuss new findings related to salivary epithelial glandular cells and their interaction with other immune cells, type I interferon signature and innate immunity. Finally, as ectopic germinal centres like structures in the salivary glands of patients with SjD have been critically involved in autoreactive B cell activation and have been associated with progression towards B cell lymphomas, we will focus on new insights into their regulation in SjD and novel insights into the transition to lymphoma. Hopefully, a better comprehension of SjD complexity will pave the way to highly targeted therapeutic strategies.

Introduction. Radioiodine therapy is a modern method of treating thyroid pathology. Its use is possible both in malignant tumors and in thyrotoxicosis. However, this technique has a complication in the form of impaired salivary gland function, which causes dryness in the oral cavity, its increase and pain syndrome.The aim of our study to identify risk factors for the development of functional disorders of the salivary glands in patients who underwent radioiodine therapy. Material and methods. A retro-prospective open-label, two-center, non-randomized study was conducted, which included 61 patients who received radiotherapy for thyroid diseases. In 33/61 patients, there were no signs of sialadenitis development on the background and after radioiodine therapy. Twenty-eight patients (28/61) who had a lesion of the salivary gland on the background of ongoing therapy. A statistical analysis of data on gender, age, the main clinical diagnosis, the stage of the underlying disease, the received dose of I131, the presence or absence of sialadenitis, the time from the start of radionuclide therapy to the development of sialadenitis was carried out. Results. When analyzing the data obtained, it was revealed that independent adverse factors that increase the risk of developing salivary gland lesions in patients who received at least one session of radioiodine therapy were: female (p = 0.0219; HR 10.38: 95% CI 1.40–76.84) and age 61 years and younger (p = 0.0004; HR 1.04: 95% CI 1.02–1.06). And the median of the total accumulated dose of the radiopharmaceutical did not show its significance in the multifactorial analysis. Conclusion. The development of chronic sialadenitis on the background of radioiodine therapy is a multifactorial pathology. This pathology requires dynamic monitoring and preventive measures, especially the risk group (female and age 61 years and younger).

Strong support has evolved for elastography as a supplement to salivary gland ultrasound assessment.1 We advocate for the clinical value of this tool but offer caution in considering “normal” shear wave velocity (also reported as Young's modulus) to consistently reflect normal gland function. Standard ultrasound assessment of parotid tumors has been reported to identify malignancy with a 91% accuracy.2 Jering et al. reported that additional evaluation with elastography improved the diagnostic accuracy by identifying malignant tumors to be associated with faster shear wave velocities and larger areas of stiff tissue than benign tumors.3 Assessments of non-neoplastic salivary disorders with ultrasound elastography have reported the capacity to discriminate between normal salivary glands with slower shear wave velocity from those in patients with Sjogren's syndrome with faster shear wave velocity.4 Dai et al. through a meta-analysis of 15 articles addressing primary Sjogren's syndrome (pSS) concluded that ultrasound elastography “demonstrates high accuracy in differentiating between pSS and healthy/disease control groups”.5 Chang and Wang identified their experience with ultrasound shear wave elastography to characterize glands affected with sialolithiasis.6 Sequential assessments identified changes to gland stiffness following treatment of obstructive sialadenitis to further support the clinical utility of shear wave elastography as was similarly reported by a group in Munich, Germany.7, 8 We concur with Chang and Wang's contention that the significant decrease in shear wave velocity they identified following stone removal does “imply the diseased gland became softer after removal of sialolithiasis” but offer caution in their interpretation that softening and slower speed reflects “recovery of salivary gland function.”6 Although others have similarly identified the value of elastography to “indirectly reflect organ function,”5 it is important to acknowledge that fatty replacement of diseased glands may dominate the exam to provide a normal shear wave analysis of a poorly functioning or nonfunctioning gland. Takagi et al. employed MR analysis to identify fatty degeneration occurring within the salivary glands of patients with long-standing Sjogren's syndrome.9 Study of patients with post-irradiation xerostomia employing MRI and advanced CT imaging has also correlated poor salivary gland function associated with fat infiltration.10 An elegant study of surgically resected human breast tissue identified a broad range of viscoelastic properties within the tissue subject to elastography analysis.11 These investigators reported the modulus (stiffness) of fat tissue in the specimens to be significantly lower than that of glandular and fibrous tissue. Our experience in examining patients following long-term injury from chronic salivary duct obstruction and from previous irradiation often identifies a slow (“normal”) speed to elastography analysis in a way that correlates with fat replacement identified on CT imaging. This finding is highlighted by our report of a patient who had undergone parotid duct ligation with long-term follow-up identifying an elevated shear wave velocity in an infected tail of one parotid with normal velocity seen in the other parotid regions.12 The normal shear wave velocity measurements correlated with CT assessment identifying parotid gland atrophy with fat replacement. Advances in salivary ultrasound are occurring at a rapid rate and will benefit from efforts to standardize evaluation and reporting.13 The addition of novel approaches to elastography coupled with advances in complementary approaches such as intravenous and intracavitary contrast enhanced ultrasonography (CEUS) will provide greater utility to salivary ultrasound evaluation.14, 15 Multidimensional ultrasound assessment coupled with deep learning offers promise to further enhance diagnostic capabilities.16 This study was supported by Otolaryngology Department, University of Iowa. Henry T. Hoffman: MeiraGtx research study participant; RiboX scientific advisor board; and UpToDate author (no conflicts related to this publication). Harry Quon: MeiraGtx research study participant (no conflicts related to this publication).

Background and aim Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Impaired salivary gland function has been previously reported in children with JIA. Our study explores the possible subclinical lesions of major salivary glands in children with JIA by musculoskeletal ultrasound (US) and correlates the findings with disease activity and inflammatory indices. Patients and methods Major salivary glands of 28 children with JIA (according to International League of Associations for Rheumatology criteria) and 20 healthy controls were evaluated by ultrasound. The findings were correlated with other disease parameters. Ages of participants ranged from 5 to 16 years, with a mean of 11.04± 2.968 years and 33 (68.75%) participants were females. Results According to the Grey-scale score, there were 16 (57.1%) patients with normal parenchyma (grade 0), four (14.3%) patients with minimal change (grade 1), two (7.1%) patients with moderate change (grade 2), and six (21.4%) patients with severe change (grade 3). Power Doppler signal has been detected in the submandibular glands of only two patients with systemic-onset JIA. No abnormality has been detected in the healthy control group. There was a significant positive correlation between Grey-scale total score with erythrocyte sedimentation rate (r=0.694, P&lt;0.001), juvenile arthritis disease activity score (r=0.713, P&lt;0.001), and parents’ disease assessment (r=0.678, P&lt;0.003). Conclusion Ultrasound detected subclinical salivary gland abnormalities are frequent in JIA patients and are associated with disease activity. However, more studies are needed to support these preliminary results.

ObjectiveThis study assessed the effect of cevimeline and different concentrations of gum arabic on the parotid gland of rats being given xerostomia-inducing methotrexate.MethodsOne hundred twenty-five rats were divided into five equal groups of twenty-five each. The rats in Group I received basic diets, while those in Groups II, III, IV, and V received 20 mg/kg MTX as a single intraperitoneal dose on day one. Group III received 10 mg/kg CVM dissolved in saline orally and daily, and the other two groups received a 10% W/V aqueous suspension of GA. Therefore, Group IV received 2 ml/kg suspension orally and daily, while Group V received 3 ml/kg suspension orally and daily. After 9 days, the parotid glands were dissected carefully and prepared for hematoxylin and eosin (H&E) staining as a routine histological stain and caspase-3 and Ki67 immunohistochemical staining. Quantitative data from α-Caspase-3 staining and Ki67 staining were statistically analysed using one-way ANOVA followed by Tukey’s multiple comparisons post hoc test.ResultsRegarding caspase-3 and Ki67 immunohistochemical staining, one-way ANOVA revealed a significant difference among the five groups. For Caspase-3, the highest mean value was for group II (54.21 ± 6.90), and the lowest mean value was for group I (15.75 ± 3.67). The other three groups had mean values of 31.09 ± 5.90, 30.76 ± 5.82, and 20.65 ± 3.47 for groups III, IV, and V, respectively. For Ki67, the highest mean value was for group I (61.70 ± 6.58), and the lowest value was for group II (18.14a ± 5.16). The other three groups had mean values of 34.4 ± 9.27, 48.03 ± 8.40, and 50.63 ± 8.27 for groups III, IV, and V, respectively.ConclusionGA, rather than the normally used drug CVM, had a desirable effect on the salivary glands of patients with xerostomia.

To investigate the effectiveness of botulinum toxin in the salivary glands of patients with neurological impairment and drooling and its impact on the quality of life. This systematic review was registered with the International Prospective Register of Systematic Reviews (CRD 42,023,435,242) and conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic search was performed in the PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and clinical trial databases until August 2023, no language restriction. Cohort studies and randomized clinical trials of patients diagnosed with drooling and neurological impairment who used botulinum toxin on the salivary gland were included, which evaluated subjective quality of life parameters. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and Risk of Bias 2 tools. The certainty of the evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Eight studies involving 317 patients were included. All studies, through subjective parameters, suggested the effectiveness of botulinum toxin in reducing drooling, resulting in an improvement in the quality of life. Three studies demonstrated improvements in swallowing and four in cases of respiratory diseases. Two clinical trials had a high risk of bias, whereas one had low risk. The five cohort studies that were evaluated had a high risk of bias. The certainty of the evidence was considered low. Based on the patient/caregivers' perception of improvement in drooling, dysphagia, and respiratory symptoms, it can be inferred that botulinum toxin application reduces subjective drooling in neurologically compromised patients. Its impact contributes to the general well-being and quality of life. Injection of botulinum toxin into the salivary glands can be considered an alternative technique to surgical or medicinal approaches in reducing drooling. It is effective, less invasive and without significant side effects. It promotes a positive impact on the well-being and quality of life of neurological patients.