History and evolution of the use of oral mucosa for urethral reconstruction

We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute material.Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias.The use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in 1993.Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996.Today,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery.As the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a scaffold.However,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.

Micronuclei in Nasal Mucosa, Oral Mucosa and Lymphocytes in Students Exposed to Formaldehyde Vapor in Anatomy Class

The frequency of micronuclei (MN) in cells of the nasal mucosa, oral mucosa and in lym-phocytes was evaluated for 25 students in anatomy classes exposed to formaldehyde (FA) overan 8-week period. Each student served as his or her own control. The time-weighted averageconcentration (TWA) of fOrmaldehyde in anatomical laboratories and in students' dormitorieswas 0. 508 ± 0. 299 mg/m3 and 0. 012 ± 0. 0025mg/m3, respectively. A higher frequency ofmicronuclei was observed in nasal and oral exfoliative cells after formaldehyde exposure (3. 85± 1. 48 vs 1 .20± 0. 676 and 0. 857 ± 0. 558 vs 0. 568 ± 0. 317, paired-t test: P< 0. 001and P < 0. 01, respectively). No significant increase in the frequency of lymphocyte micronu-clei was found after formaldehyde exposure (P >0. 05 ). The present study shows that nasalmucosa cel1s exposed through respiration are the chief target of FA-induced genotoxic effects

Bacterial-killing Effect of Atmospheric Pressure Non-equilibrium Plasma Jet and Oral Mucosa Response

Recently, plasma sterilization has attracted increasing attention in dental community ibr the atmospheric pressure non-equilibrium plasma jet （APNPs）, which is driven by a kilohertz pulsed DC power, may be applied to the dental and oral diseases. However, it is still in doubt whether APNPs can effectively kill pathogenic bacteria in the oral cavity and produce no harmful effects on normal oral tissues, especially on normal mucosa. The aim of this study was to evaluate the bacterial-killing effect of APNPs in the biofilms containing a single breed of bacteria （Porphyromonas gingivalis, Pg.）, and the pathological changes of the oral mucosa after treatment by APNPs. P.g. was incubated to form the biofilms in vitro, and the samples were divided into three groups randomly： group A （blank control）; group B in which the biofilms were treated by APNPs （the setting of the equipment： 10 kHz, 1600 ns and 8 kV）; group C in which the biofilms were exposed only to a gas jet without ignition of the plasma. Each group had three samples and each sample was processed for up to 5 min. The biofilms were then fluorescently stained, observed and photographed under a laser scanning confocal microscope. In the animal experiment, six male Japanese white rabbits were divided into two groups randomly （n=3 in each group） in terms of the different post-treatment time （1-day group and 5-day group）. The buccal mucosa of the left side and the mucosa of the ventral surface of the tongue were treated by APNPs for 10 min in the same way as the bacterial biofilm experiment in each rabbit, and the corresponding mucosa of the other sides served as normal control. The clinical manifestations of the oral mucosa were observed and recorded every day. The rabbits were sacrificed one or five day（s） after APNPs treatment. The oral mucosa were harvested and prepared to haematoxylin and eosin-stained sections. Clinical observation and histopathological scores were used to assess mucosal changes. The results showed the obvious P.g. biofilms were formed at 10 days, and most of the bacteria in groups A and C were alive under a laser scanning confocal microscope, but the bacteria in the group B were almost all dead. In animal experiment, no ulcers, anabrosis and oral mucositis were found in both the 1-day and 5-day groups. The aver- age mucous membrane irritation index was -0.83 and -0.67 in the 1-day and 5-day groups, respectively, suggesting that no intense mucosal membrane irritation responses occurred. It was concluded that APNPs could effectively kill Pg. in the biofilms and did not cause any pathological changes in the normal mucosa, suggesting that the plasma jet （APNPs） may be applied to oral diseases as a novel sterilization device in the future.

The mucosal immune system in the oral cavity——an orchestra of T cell diversity

The mucosal immune system defends against a vast array of pathogens, yet it exhibits limited responses to commensal microorganisms under healthy conditions. The oral-pharyngeal cavity, the gateway for both the gastrointestinal and respiratory tracts, is composed of complex anatomical structures and is constantly challenged by antigens from air and food. The mucosal immune system of the oral-pharyngeal cavity must prevent pathogen entry while maintaining immune homeostasis, which is achieved via a range of mechanisms that are similar or different to those utilized by the gastrointestinal immune system. In this review, we summarize the features of the mucosal immune system,focusing on T cell subsets and their functions. We also discuss our current understanding of the oral-pharyngeal mucosal immune system.

Urothelial or oral mucosa cells for tissue-engineered urethroplasty: A critical revision of the clinical outcome

Objective:To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty.Methods:We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase(OvidSP)through January,1990 to June,2018.We excluded studies based on titles that clearly were not related to the subject,studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals,and in the absence of autologous cultured epithelial cells.Studies were also excluded if they were not published in English,had no disease background and adequate follow-up.Finally,we search all relevant abstract presented at two of the main urological meetings in the last 10 years:European Association of Urology(EAU)and American Urological Association(AUA).Results:A total of six articles,reporting the clinical use of tissue-engineered techniques in humans,were fully reviewed in our review.The epithelial cells were harvested from the urethra(10 patients),the bladder(11 patients)and the mouth(104 patients).The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases,and in adults for posterior and anterior urethral strictures repair in 109 cases.Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair.Conclusion:One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair.The studies demonstrate a high degree of heterogeneity respect to epithelial cells(from urethra,bladder,and mouth),type of scaffold,etiology,site of urethral stricture,number of patients,follow-up and outcomes.

Characteristics of benign lymphoadenosis of oral mucosa

AIM: To investigate the pathological characteristics and carcinogenesis mechanism of benign lymphoadenosis of oral mucosa (BLOM).METHODS: The expressions of Ki-67, CD34 and apoptosis were evaluated by immunohistochemical SP staining in 64 paraffin-embedded tissue samples. Of them, 9 were from BLOM with dysplasia, 15 from BLOM without dysplasia,15 from oral squamous cell carcinoma (OSCC), 15 from oral precancerosis, and 10 from normal tissues. Cell proliferation, apoptosis and angiogenesis of tissue samples were also analyzed.RESULTS: The expression of Ki-67 in BLOM with dysplasia,oral precancerosis and OSCC was significantly higher than in BLOM without dysplasia and normal mucosa. The microvascular density (MVD) in BLOM with and without dysplasia, oral precancerosis, and OSCC was significantly higher than in normal mucosa. Apoptosis in BLOM and oral precancerosis was significantly higher than in OSCC and normal mucosa.CONCLUSION: Benign lymphoadenosis of oral mucosa has potentialities of cancerization.

Role of Protein Kinase C<i>δ</i>-Mediated Spleen Tyrosine Kinase (Syk) Phosphorylation on Ser in the Amplification of Oral Mucosal Inflammatory Responses to <i>Porphyromonas gingivalis</i>

The signaling events underlying oral mucosal inflammatory responses to P. gingivalis and its key endotoxin, lipopolysaccharide (LPS), relay primarily on the LPS engagement of Toll-like receptor-4 (TLR4), and the activation of IκB-kinase complex (IKK) and mitogen-activated protein kinases (MAPKs that exert their control over transcription factors implicated in the regulation of iNOS and COX-2 proinflammatory genes expression). Since spleen tyrosine kinase (Syk) has emerged recently as a major amplifier in the production of proinflammatory mediators, we investigated the process of recruitment and interaction of Syk with TLR4 in salivary gland acinar cells in response to P. gingivalis LPS. Our findings revealed that stimulation of the acinar cells with the LPS leads to protein kinase Cδ (PKCδ)-mediated phosphorylation of Syk on Ser which results in its localization with the membrane associated TLR4 complex and the activation through phosphorylation on Tyr. Further, our results support the involvement of Syk in the amplification of transcription factors involved in the assembly and expression of transcription complexes associated with the induction in COX-2 and iNOS genes. Therefore, our data suggest that PKCδ is a primary linchpin affecting the Syk recruitment to the membrane localized TLR4, and hence affects the efficiency of the kinase activation and the magnitude of oral mucosal inflammatory response to P. gingivalis.

STUDY OF ESTROGEN RECEPTOR AND PROGESTERONE RECEPTOR IN SQUAMOUS CELL CARCINOMA TISSUE OF ORAL MUCOSA

By means of the enzyme linked affinity histothemical method, 45 cases of squamous cell carcinoma(SCC) of the oral mucosa and 15 cases of the approximately normal oral mucosal tissue were detected for estrogen receptor(ER) and progesterone receptor(PR). The results indicated that In the SCC tissue of the oral mucosa there were 5 cases of ER+ and PR- and 32 cases of both ER+ and PR+. Thirty-seven cases, the summation of the above two items, were considered as receptor(+),therefore the rate of the receptor(+) being 82.22%. ER+ and PR+ were cd related to the sex and age of patients, the neck lymph nodes' metastasizing or not and affected parts of the tumor, while they were related to the differentiation degree of the tumor. The rate of receptor(+) decreased with the decrease of the differentiation degree of the tumor. By X2 test a remarkable difference between grade Ⅰand grade Ⅲ of SCC of the oral mucosa was shown. It is suggested that SCC of the oral mucosa may probobly be hormone dependent tumor. The authors consider that the SCC detection for ER and PR could not only be one of the indices of biologic characteristics for that tumor but also as bases of anti-hormone treatment.

ORAL TRANSMUCOSAL BACK PERMEATION OF ALFENTANIL IN DOGS──A NOVEL METHOD TO DETERMINE BLOOD ALFENTANIL CONCENTRATION

This study explores a novel noninvasive method for monitoring blood alfentanil concentrations using a dog model. Alfentanil which 'back', permeated across the oral mucosa from the systemic circulation was collected from the oral mucosal surface and quantitated. The levels of the 'back' permeated alfentanil were found to closely reflect real time serum alfentanil concentrations. With further work, this finding may lead to a novel noninvasive method for monitoring real time serum alfentanil concentrations in its clinical applications.

Electron Probe Microanalysis of Exogenous Pigmentation of Oral Mucosa Originating from Dental Alloy: Two Case Reports

Pigmentation of the oral mucosa is relatively common and has a wide variety of etiologies. Although most pigmented lesions of the oral mucosa are associated with deposition of melanin and accidental displacement of a dental alloy, accurate differential diagnosis of a pigmented lesion is important, especially in the case of malignant melanoma. We report two cases of oral mucosal pigmentation associated with accidental displacement of a dental alloy in which malignant melanoma was suspected. Excisional biopsy was carried out in these cases with the incision line set at approximately 5 mm from the lesions. Histopathologically, brownish foreign substances were observed in the lamina propria. Metal quantitative analyses of the extracted specimens were carried out by electron probe microanalysis (EPMA). The metal components and the mass concentration revealed that the metals were derived from a dental casting silver alloy in Case 1 and from a gold-silver palladium alloy in Case 2. Although exogenous pigmentation originating from a dental alloy is not rare, differential diagnosis of oral pigmented lesions is sometimes very difficult. In such cases, histopathological examination may be necessary for the diagnosis to exclude melanocytic lesions and EPMA may be effective to identify the causative dental alloy.

P^（53） PROTEIN OVEREXPRESSION IN PREMALIGNANT AND MALIGNANT LESIONS OF ORAL MUCOSA：IMMUNOHISTOCHEMICAL OBSERVATION

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A Case of Exfoliation of Oral Mucosal Epithelium in a Patient with Anti-Desmoglein 1 Antibody-Positive and Anti-Desmoglein 3 Equivocal Antibody

Pemphigus is an autoimmune bullous disease observed with lesions in the skin and mucosa. Pemphigus is classified by antibodies against desmogleins, which is cadherin type intercellular adhesion factors involved in adhesion between epidermal cells. In this case, because erosion of the oral mucosa was the primary symptom, a relationship with membrane-dominant pemphigus vulgaris was strongly suspected. And in terms of histopathology, findings not conflicted with pemphigus vulgaris were observed, but given all these different findings, the results did not correspond with bullous pemphigoid in clinical findings, and with pemphigus foliaceus and pemphigus vulgaris in various testing results, leading us to believe this represented a very rare case. We started oral health care, and when application of steroid ointment to the entire surface of the mucosa was continued, symptoms disappeared within approximately 2 months. In this case, relapse has not yet occurred and periodic follow-up was continued.

CXCL1-CXCR2 axis mediates neutrophils recruitment in rat oral mucosa

A lot of researches have shown that besides acting as essential contributors in innate immune response, neutrophils involved in the interaction between innate and adaptive immune responses by generation of a cascade of chemokines. But the data on relationship between chemokines and neutrophils recruitment in oral mucosa have been little available. In the present study, on a rat model characterized by neutrophils infiltration, a distinct profile of cytokines and receptors in oral mucosa was presented by the techniques of PCR array. Moreover, among these cytokines, upexpression of CXCL1 and its receptor, CXCR2, was found to correlate with the level of myeloperoxidase (MPO), a biomarker of neutrophils infiltration, and the up-expression of CXCL1-CXCR2 was suppressed by FK506, an immunosuppressive agent. Our results indicated that CXCL1-CXCR2 axis might play an important role in mediating neutrophils recruitment in oral mucosa, which will give new insights into the mechanisms of innate and adaptive immune responses of oral mucosa.

A Blackish Gingiva Revealing a Metastatic Melanoma of the Oral Mucosa

Background and Objective: Malignant melanoma is the most aggressive skin cancer because it has very strong metastatic power. Endobuccal localization is very rare. Its discovery is often made in the late stage, which leads to a consistently pessimistic diagnostic. We report a case of palatal melanoma at the metastatic stage. Case Report: A 43-year-old woman presented left lateral cervical swelling associated with dyspnea for 5 months. She had regularly taken chewing tobacco for 4 years and had developed blackish gums. The endobuccal examination showed a blackish non-haemorrhagic swelling of 5 cm of the long axis, located at the level of the palatal vault, associated with pigmentation in teeth 21, 22, and 23. The anatomopathological examination confirmed the melanoma. The spreading assessment revealed pleural and hepatic metastasis. The proposed treatment was palliative treatment. The patient died 2 months later. Conclusion: Melanoma of the oral mucosa is a very aggressive tumor. The scarcities of dental care among the Malagasy people exacerbate the delay in diagnosis. Its management is still challenging in Madagascar.

Studies on Biological Characteristics of Rabbit Oral Mucosal Epithelial Cells

Objective:The biological characteristics of rabbit oral mucosal epithelial cells(OMECs) were studied and the suitable procedure for the culture of OMECs was explored.Methods:Cultured OMECs by different surface disinfection,by different Dispase Ⅱ preparation,in different medium,in different calciumion concentration of K-SFM medium.Results:Microbial contamination of cell culture could significantly reduce with 2% iodine solution used for sterilization of oral cavity before cell culture.The OMECs digested with Dispase Ⅱin K-SFM could attach to the culture flask quickly,the OMECs digested with Dispase Ⅱ in PBS rare attached to the culture flask.The proliferations of OMECs cultured in 0 or 0.09 mmol/L calcium concentrations of K-SFM medium showed not statistically significant.the OMECs grew fast with serum,but it was easy to differentiate into fibroblast-like cells.Conclusion:OMECs could grow well and had the typical oral mucosal epithelial cell morphology by the procedure that described in this experiments.

口腔黏膜黑色素瘤冷冻消融治疗专家共识

冷冻消融治疗有着悠久的历史,其抗肿瘤机制、组织病理变化已较明确,且大量临床实践表明冷冻消融治疗安全有效,理论上是一种理想的肿瘤治疗手段。以往一直受冷媒和冷冻设备的限制,制约了其疗效和临床应用。随着以氩氦刀为代表的新一代冷冻消融设备的出现,在制冷效率、消融范围、精准测温等方面取得了长足的进步,极大地推动了肿瘤冷冻消融技术的推广。该共识系统性地总结了冷冻消融技术的机制、口腔黏膜黑色素瘤冷冻治疗的适应证、临床治疗流程、不良反应及处理、冷冻联合治疗等,旨在为口腔黏膜黑色素瘤冷冻消融治疗的规范化开展提供参考。

微粒口腔黏膜代阴道成形术临床应用效果评价

目的探讨微粒口腔黏膜代阴道成形术的临床应用效果。方法回顾性分析2013年2月-2024年1月甘肃省妇幼保健院收治的149例生殖道畸形(MRKH综合征和阴道闭锁)需要行阴道成形术的患者临床资料。按照手术方式不同分为口腔黏膜代阴道成形术组(n=95)、腹膜代阴道成形术组(n=31),及生物补片代阴道成形术组(n=23),比较手术相关指标、人工阴道相关指标、性生活指标,评价微粒口腔黏膜代阴道成形术的临床应用效果。结果口腔黏膜组及生物补片组在手术时间、出血量方面显著优于腹膜组(P<0.05)。在住院费用上,生物补片组明显高于另外两组,口腔黏膜组花费最低(P<0.05)。术后阴道长度口腔黏膜组及生物补片组优于腹膜组(P<0.05)。阴道弹性、阴道pH值、性满意度、并发症率等指标3组间差异无统计学意义。结论口腔黏膜代阴道成形术简单、微创、无痛。符合患者隐私需求,效果满意,医疗费用低,性价比高,具有临床应用价值。

AIDS合并原发性口腔黏膜恶性黑色素瘤1例

AIDS是严重影响人类健康的慢性传染性疾病之一。原发性口腔黏膜恶性黑色素瘤是一类高度恶性肿瘤,其发病率低、预后极差。本研究报道1例AIDS合并原发性口腔黏膜恶性黑色素瘤的青年男性患者,右下颌牙龈肿物2月余,肿物伴疼痛,并破溃出血,张口受限。经肿物活检,病理学检查诊断为恶性黑色素瘤。临床给予一线化疗方案、联合免疫抑制剂治疗,二线化疗方案联合抗血管生成药物治疗,肿瘤先出现进展、后缩小明显。本研究通过此例患者及相关文献复习,探讨了AIDS合并口腔黏膜恶性黑色素瘤的诊断和治疗,以提高对该疾病的认识。

不同剂量右美托咪定口腔黏膜喷雾或滴鼻用于小儿脑电图检查的镇静效果

目的观察不同剂量右美托咪定(Dex)口腔黏膜喷雾或滴鼻用于小儿脑电图(EEG)检查的镇静效果。方法151例患儿根据Dex口腔黏膜喷雾2.5 ug/kg、3 ug/kg,Dex滴鼻2.5 ug/kg、3 ug/kg,随机分为D1组(38例)、D2组(38例)、D3组(37例)和D4组(38例)。记录患儿给药前(T_(0)),给药后10 min(T_(1))、20 min(T_(2))、30 min(T_(3))、40 min(T_(4))警觉镇静量表(OAA/S)评分、MAP、HR、SpO_(2)。观察患儿镇静一次成功率、诱导时间、检查时间、苏醒时间、不良反应和不同时间点4组患儿的镇静效果和MAP、HR、SpO_(2)。结果D1与D3组、D1与D2组起效时间和D3与D4组的苏醒时间差异有统计学意义(P<0.05);T_(2)时的D1与D2组、D3与D4组和T_(4)时的D3与D4组的OAA/S评分差异有统计学意义(P<0.05);T_(2)时的D1与D2组的MAP差异有统计学意义(P<0.05);T_(1)时的D1与D2组、T_(3)时的D1与D2组和D3与D4组的HR差异有统计学意义(P<0.05)。结论小儿EEG检查前应用Dex 3ug/kg滴鼻,诱导时间快、成功率高、镇静效果好,是一种安全有效的EEG检查前的镇静方法。

男性硬化性苔藓样尿道狭窄的诊治策略

硬化性苔藓样变(LS)是发生于患者生殖器区域的瘢痕性皮肤病,治疗不及时会导致尿道外口狭窄,进而发展至部分或全尿道狭窄,甚至癌变。由于患者及临床医师对该病认识不足,复杂尿道狭窄的病例日益增多,这类患者病情复杂、手术并发症多,治疗决策选择存在诸多争议。本文结合近年相关文献,首先简述了LS的流行病学、典型临床表现、鉴别诊断,并提到本病与阴茎癌的关系。随后详述了LS男性尿道狭窄的主要治疗方式,包括类固醇、免疫调节抑制剂等药物局部治疗,尿道扩张、居家清洁导尿等非手术疗法,以及手术干预方法。在此基础上,本文对于临床上关于LS尿道狭窄手术治疗的争议和进展进行了深入阐述。