Value of Tongue Color Combined with Sublingual Microcirculation in Predicting the Severity of Mild to Moderate Acute Cerebral Infarction

Objective:To explore the value of tongue color combined with sublingual microcirculation in predicting the severity of mild to moderate acute cerebral infarction(ACI).Methods:From January to December 2022,90 patients with ACI were admitted to the Department of Neurology of Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine.According to the NHISS score on the 5th day of admission,the patients were divided into mild group(35 cases)and moderate group(55 cases).The changes of tongue color and arterial lactate on the 5th day of admission were observed and monitored.Side-stream dark field imaging(SDF)was used to determine the total vascular density(TVD),perfused vascular density(PVD),perfused vascular ratio(PPV)and microvascular flow index(MFI).The multivariate logistic regression analysis was used to screen the risk factors for the severity of ACI,and the receiver operating characteristic curve(ROC)to evaluate their values in predicting ACI severity.Results:There was no significant difference in lactate between the two groups(P>0.05),and the frequency of red tongue in the mild group was higher,and the frequency of red tongue in the moderate group was significantly higher in the dark tongue group(P<0.05).The multivariate logistic regression analysis showed that PVD and PPV were independent risk factors for the severity of mild to moderate ACI(P<0.05).The ROC curve analysis showed that an area under the curve of 0.832 was achieved by the combination of PVD and PPV,which was larger than that of a single factor.Conclusion:Tongue color combined with sublingual microcirculation can be combined to predict the severity of mild to moderate ACI.

Single-allergen Sublingual Immunotherapy versus Multi-allergen Subcutaneous Immunotherapy for Children with Allergic Rhinitis

It has always been controversial whether a single allergen performs better than multiple allergens in polysensitized patients during the allergen-specific immunotherapy. This study aimed to examine the clinical efficacy of single-allergen sublingual immunotherapy(SLIT) versus multi-allergen subcutaneous immunotherapy(SCIT) and to discover the change of the biomarker IL-4 after 1-year immunotherapy in polysensitized children aged 6–13 years with allergic rhinitis(AR) induced by house dust mites(HDMs). The AR polysensitized children(n=78) were randomly divided into two groups: SLIT group and SCIT group. Patients in the SLIT group sublingually received a single HDM extract and those in the SCIT group were subcutaneously given multiple-allergen extracts(HDM in combination with other clinically relevant allergen extracts). Before and 1 year after the allergen-specific immunotherapy(ASIT), the total nasal symptom scores(TNSS), total medication scores(TMS) and IL-4 levels in peripheral blood mononuclear cells(PBMCs) were compared respectively between the two groups. The results showed that the TNSS were greatly improved, and the TMS and IL-4 levels were significantly decreased after 1-year ASIT in both groups(SLIT group: P<0.001; SCIT group: P<0.001). There were no significant differences in any outcome measures between the two groups(for TNSS: P>0.05; for TMS: P>0.05; for IL-4 levels: P>0.05). It was concluded that the clinical efficacy of single-allergen SLIT is comparable with that of multi-allergen SCIT in 6–13-year-old children with HDM-induced AR.

Effect of Sublingual Immunotherapy on Level of Cytokines in PBMCs of Patients with Allergic Asthma

This study examined the possible mechanism of sublingual immunotherapy（SLIT） in the treatment of allergic asthma.Forty asthma patients allergic to dust mite were enrolled.They received SLIT with dermatophagoides farinae（Der.f） drops for one year.Thirty healthy subjects served as controls.The levels of IL-4 and IFN-γ of peripheral blood mononuclear cells（PBMCs） were determined in allergic asthma patients before and after the SLIT as well as the healthy subjects.The results showed that the level of IL-4 was substantially increased and that of IFN-γ remarkably decreased in the patients before the SLIT as compared with those in the healthy subjects（P0.05）.After the SLIT,the level of IL-4 was significantly reduced and that of IFN-γ elevated in these allergic asthma patients.It was concluded that sublingual immunotherapy is effective for patients with allergic asthma.And it may work by regulating the balance of Th1/Th2 through changing the expression of IL-4 and IFN-γ in PBMCs.

Sublingual immunotherapy for pediatric allergic rhinitis: The clinical evidence

Allergic rhinitis affect 10%-20% of pediatric population and it is caused by the Ig E-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence patient's daily activity severely and may precede the development of asthma, especially if it is not diagnosed and treated correctly. In addition to subcutaneous immunotherapy, sublingual immunotherapy(SLIT) represents the only treatment being potentially able to cure allergic respiratory diseases, by modulating the immune system activity. This review clearly summarizes and analyzes the available randomized, double-blinded, placebo-controlled trials, which aimed at evaluating the effectiveness and the safety of grass pollen and house dust mite SLIT for the specific treatment of pediatric allergic rhinitis. Our analysis demonstrates the good evidence supporting the efficacy of SLIT for allergic rhinitis to grass pollens in children, whereas trials regarding pediatric allergic rhinitis to house dust mites present lower quality, although several studies supported its usefulness.

Carcinoma ex pleomorphic adenoma of the sublingual gland:a case report

We report a case of carcinoma ex pleomorphic adenoma of a sublingual gland in a 70-year-old man.Under a clinical diagnosis of benign salivary gland tumor,excision of the mass with the sublingual salivary gland in an en bloc fashion via an intraoral approach was performed.Histopathologically,there was a rupture of the fibrous capsule and diffuse cell-rich sheets composed of myoepithelial cells with round nuclei were also seen.Immunohistochemically,the cells that composed of cell rich sheets were positive to smooth muscle actin.Final diagnosis of myoepithelial carcinoma ex pleomorphic adenoma was made.

Liver metastasis as the initial clinical manifestation of sublingual gland adenoid cystic carcinoma: A case report

BACKGROUND Adenoid cystic carcinoma(ACC)is a common malignant tumor of salivary gland.The lung and liver are frequent sites of distant metastasis.Liver metastasis as the initial clinical manifestation of sublingual gland ACC is very rare.CASE SUMMARY A 51-year-old Chinese woman presented with a painless mass in the right lobe of liver.The tumor was composed of ductal cells and myoepithelial cells with a morphology including tubiform and cribriform structures.Immunostaining results showed ductal cells positive for CK7,CK14,CK19,CD117,and 34βE12,and negative for MYB,vimentin,ER,PR,and CEA.The myoepithelial cells were positive for p63,calponin and CK5/6.Metastatic salivary ACC was considered,and a sublingual gland mass was revealed by computed tomography.Histological evaluation confirmed primary sublingual gland ACC.Fluorescence in situ hybridization(FISH)did not find an MYB-NFIB fusion gene in specimens from either the primary or metastatic ACC tumors.The sublingual gland ACC relapsed in 20 mo.The recurrent lesion disappeared following local radiation therapy and computed tomography-guided radioactive seed implantation.The patient remains in good condition until now.CONCLUSION Metastatic sublingual gland ACC with initial clinical manifestation as a liver mass is very rare,and was pathologically confirmed in this patient by its histological appearance.Primary hepatic tumors and metastatic carcinomas should be included in the differential diagnosis.Immunohistochemical detection of MYB protein and MYB-NFIB fusion gene detection by FISH can be helpful,but occasional negative results confuse the diagnosis.

Sublingual epidermoid cyst—a case report

In this article we present the case of an epidermoid cyst of sublingual space along with submental extension in a 35 year old lady who presented with a mass in the oral cavity. On examination a mass was seen on the floor of the mouth displacing the tongue superiorly. Diffuse fullness was noted in the submental region. The lesion was excised under general anaesthesia with nasotracheal intubation. The entire mass was removed intra orally. The histological features were suggestive of epidermoid cyst. The patient did well postoperatively and no recurrence was seen during 8 months follow up.

Intravascular Papillary Endothelial Hyperplasia: A Rare Vascular Lesion Affecting Submandibular and Sublingual Region

Intravascular papillary endothelial hyperplasia is an unusual benign vascular lesion of the skin and subcutaneous tissue consisting of papillary formations lined with proliferative endothelial cells. The clinical characteristic is not specific and the diagnosis is based on histological examination. The lesion is often mistaken for angiosarcoma and a group of other benign and malignant vascular lesions. IPEH has been relatively rarely described in the head and neck region. An uncommon case located in the submandibular and sublingual region is presented which was misinterpreted as venous malformations and malignant tumors of vascular origin initially. A surgical excision was performed and no recurrences have been found after 5 years of follow-up.

Comparative Study of Sublingual and Vaginal Misoprostol in Second Trimester Induced Abortion

Background: To identify an effective misoprostol-only regime for the termination of second trimester pregnancy. Objectives: To compare the efficacy, safety and acceptability of sublingual and vaginal misoprostol for second trimester pregnancy termination. Methods: In a prospective randomized comparative study, over 138 pregnant women at 13 - 20 weeks (91 - 140 days) of gestation requiring medical abortion were randomly assigned to the sublingual or vaginal route for misoprostol administration with dose schedule of 400 mcg every 3 hours up to 5 doses within 24 hours. The course of misoprostol was repeated if the woman did not abort within 24 hours. Primary outcome was the efficacy of the treatment to terminate pregnancy completely at 24 and 48 hours. Secondary outcomes measured were induction-abortion interval, side effects, failure rate, and women’s perception to these treatments. Results: At 24 h, the complete abortion rate was?87.88% in the vaginal administration group and 79.41% in sublingual group (difference 8.5%, 95%?CI: 3.8 to 13.2). No significant difference in the complete abortion rates was observed at 48 h(90.91% versus 88.24% difference: 2.7%, 95% CI: ?0.04 to 5.4) when vaginal and sublingual?groups were compared. Mean induction-abortion interval in sublingual and vaginal groups was 12.28 h (95% CI of mean 11.019 - 13.541 h) and 13.11 h (95% CI of mean 12.0301 - 14.1899 h) respectively;p = 0.485. The rates of side effects were similar in both groups except for fever, which was more common in vaginal group. Significantly more women in the sublingual group preferred the route as compared to vaginal administration (RR 1.618. 95% CI: 1.277 - 2.050;p < 0.0001). Conclusion: Both sublingual and vaginal routes of misoprostol are equally effective in medical termination of pregnancy in second trimester but sublingual route was preferred by the women.

Challanging Management of a Giant Sublingual Dermoid Cyst Rapidly Enlarged Throughout Pregnancy and Influence of Hormonal Factors

The authors present a case with a sublingual giant dermoid cyst, rapidly enlarged during pregnancy, which showed itself with deglutition and mild respiratory problems. Dermoid cysts (DCs) are benign lesions arising from entrapment of epithelial rests during embryogenesis. They are most frequently located in the ovaries and testes. Up to 6.9% are found in the head and neck and 1.6% within the oral cavity, representing less than 0.01% of all oral cavity cysts. They usually present early in life as asymptomatic masses with slow and progressive growth. However, they may reach a large size with a potential impact on deglutition, speech, and respiration. It is suggested that the rapid growth of DCs during pregnancy is associated with the increase of plasma levels of estrogens and progesterone. In order to eliminate respiratory and deglutition issues, it was decided to perform the surgical excision after a cesarean delivery at 29th week.

Sublingual Immunotherapy Tablets Relieve Symptoms in Adults with Allergic Rhinitis： A Meta-analysis of Randomized Clinical Trials

Background： Sublingual immunotherapy （SLIT） has been proven to be effective against house dust mite-induced allergic rhinitis. However, the efficacy in adults with allergic rhinitis has never been reported on SLIT tablets. The current meta-analysis aimed to illustrate the differentiated efficacy of SLIT tablets on allergic rhinitis. Methods： Our systematic review and meta-analysis were performed on allergic rhinitis patients and aimed to summarize those randomized controlled studies （RCTs）. PubMed, EMBASE, Cochrane library, and MEDLINE were screened for associated articles. We included RCTs on allergic rhinitis patients undergoing SLIT therapy and reporting outcornes on symptom relief and serum-specific lgE levels. The effect of SLIT tablets on the Rhinitis Quality Life Questionnaire Score （RQLQ）, Rhinitis Total Symptom Score （RTSS）, and serum-specific IgE levels was evaluated using RevMan 5.3. Results： Seven studies were included, with 2723 patients identified. All of the studies were RCT. The included seven studies were all conducted on adults. Among the included seven articles, five researches administered patients with SLIT tablets and were eligible for meta-analysis of RTSS, consisting of 1490 patients. Overall, RTSS was significantly reduced in the SLIT tablet group compared with that in the placebo group （standard mean difference = -0.33, 95% confidence interval [-0.54, -0.13], P 〈 0.01 ）. There was no significant difference in specific lgE levels between SLIT and placebo patients. Conclusions： SLIT tablets effectively relieve rhinitis symptoms in adults with allergic rhinitis. Nevertheless, the current evidence may be limited due to sample size and the heterogeneity between studies. Large sample size and multiple center RCTs on the efficacy of different formulations of SLIT drugs are still needed to provide further evidence and a more precise recommendation.

Relationship between Abnormal Characteristics of Sublingual Collateral and Portal Vein Hemodynamic Changes in Patients with Primary Hepatic Carcinoma

Objective： To investigate the relationship between the abnormal characteristics of sublingual collateral （SC） and portal vein hemodynamic changes in patients with primary hepatic carcinoma （PHC）. Methods： A total of 123 patients of PHC with abnormal SC were enrolled. The SC characteristics were classified and evaluated. The principal components （PC） of SC extracted from them by principal component analysis and the relationship between PC and the dynamic changes of portal vein flow were analyzed by correlation analysis. Results： Three groups of PC were extracted, namely PC-1 （length, width, presentation type of visualization）, PC-2 （circuitous, vesicular change）, and PC-3 （color, collateral hemostasis, petechiae, ecchymosis）. Their total accumulative contribution degree reached 56.803%. Correlation analysis shows that PC-1 was significantly positively correlated with the hemodynamic parameters of the portal vein （P〈0.01）, while PC-2 and PC-3 were not （P〉0.05）. Conclusion： Length, width and presentation type of SC could be used for predicting the changes of portal venous pressure in PHC patients.

Sublingual Nodules:Diagnostic Markers of Metastatic Breast Cancer

Objective： To evaluate the diagnostic significance of sublingual nodules for metastasis of patients with breast cancer and further to explore the mechanisms of sublingual nodules. Methods： The image data of 117 in-patients with breast cancer in stage I -IV in Tianjin Medical University Cancer Institute and Hospital from December 2009 to September 2011 were assessed retrospectively. All photos of patients＇ tongue were recorded by the digital camera of uniform type within 1 month after serological examination and regular re-examined by computed tomography （CT）, magnetic resonance imaging and positron emission tomography CT. The presence of sublingual nodules was the positive standard. Chi square test and two-independent-sample test were used to determine the diagnostic value between the status of sublingual nodules and Clinico-pathological characteristics. The optimal cut-off of uric acid （UA） level to diagnose sublingual nodules was determined by receiver operating curve （ROC） analysis. Results： Breast cancer patients with sublingual nodules had a higher risk of recurrence and/or metastasis than patients without it （P〈0.001）. Sublingual nodules was significantly correlated with increased serum UA level （P=0.001）. The optimal cut-off value of UA level to diagnose sublingual nodules was 290 μ mol/L. Furthermore, the elevated serum UA level （ ≥290 μmol/L） was significantly related to breast cancer recurrence and/or metastasis （P〈0.001）. Couclusions： Sublingual nodules were potential diagnostic markers for metastatic breast cancer. The formation of sublingual nodules was associated with elevated level of serum UA.

Role of immunotherapy in the treatment of allergic asthma

Allergen-specific immunotherapy(SIT) induces clinical and immunological tolerance as defined by persistence of clinical benefit and associated long-term immunological parameters after cessation of treatment. Although the efficacy of SIT has been shown in terms of reducing symptoms, medication consumption and ameliorating quality of life in both allergic rhinitis and asthma, there has long been some controversies about effectiveness of SIT in the treatment of allergic asthma. The type of allergen, the dose and protocol of immunotherapy, patient selection criteria, the severity and control of asthma, all are significant contributors to the power of efficacy in allergic asthma. The initiation of SIT in allergic asthma should be considered in case of coexisting of other allergic diseases such as allergic rhinitis, unacceptable adverse effects of medications, patient's preference to avoid long-term pharmacotherapy. Steroid sparing effect of SIT in allergic asthma is also an important benefit particularly in patients who have to use these drugs in high doses for a long-time. Symptomatic asthma is a risk factor for systemic reactions and asthma should be controlled at the time of administration of SIT. Both subcutaneous immunotherapy(SCIT) and sublingual immunotherapy(SLIT) have been found to be effective in patients with allergic asthma. Although the safety profile of SLIT seems to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT may appear better and earlier than SLIT in children with allergic asthma.

Giant Lipoma of the Head and Neck Region: Case Report and Review of the Literature

Head and neck lipomas are fairly common but their presentation in areas like submandibular, submental and sublingual regions are rarely seen. Lipomas are generally asymptomatic and gradually progressive in size, causing aesthetic and functional deficits. Surgical excision remains the mainstay of treatment. Radiological investigations like CECT and MRI play a critical role in diagnosis and management of these lesions. We describe a case of a giant lipoma involving the sublingual, submandibular and submental region, and its management.

Clinical and Histopathological Review of 229 Cases of Ranula

The purpose of this paper was to evaluate the relationship between the thrombosis and secretory duct dilation, lesion size, clinical types, nature （primary or recurrent） and duration of illness in the development of ranula. A total of 229 cases of sublingual gland cysts were treated with surgical resection from Jan. 1990 to Feb. 2010. The patients＇ data were investigated on histopathological findings, size of ranula, the clinical types, nature of ranula （primary or recurrent） and duration of illness. Sections from the paraffinembeded blocks were HE-stained. CK expression was immunohis-tochemically detected. Among 229 cases the incidence of venous thrombosis was 58.52%. The incidence of venous thrombosis with or without duct dilation was 73.25% and 26.39% respectively, with a significant difference between the two groups （P〈0.005）. The incidence of venous thrombosis of ranulas with diameter larger or less than 3 cm was 72.22% and 46.28% （P〈0.005）. The incidence of venous thrombosis of oral ranula, plunging ranula and mixed ranula was 49.37%, 77.19% and 85.71% respectively, with a significant difference found between oral and plunging or mixed ranula （P〈0.01）. The incidence of venous thrombosis in ranula patients with duration of illness longer or less than 3 months was 69.77% and 51.75% （P〈0.01）. The incidence of venous thrombosis with recurrent and primary ranulas was 51.85% and 64.85%, without a significant difference noted between them （P〉0.05）. It is concluded that the formation of venous thrombosis was related to the dilation of secretory duct, lesion size, clinical types, duration of lesion but formation of venous thrombosis was not related to the nature （primary or recurrent） of ranulas.

Massive low-grade myxoid liposarcoma of the floor of the mouth:A case report and review of literature

BACKGROUND Oral liposarcoma is an extremely rare lesion that is often clinically misdiagnosed as a benign tumor due to its asymptomatic and indolent clinical course.Here,we report a case of massive low-grade myxoid liposarcoma(MLS)of the floor of the mouth.CASE SUMMARY A 71-year-old man presented with a huge mass in the left floor of the mouth.A biopsy was performed,and a diagnosis of a myxoid tumor suspicious for lowgrade MLS or myxoma was made.Gadolinium-enhanced T1-weighted magnetic resonance imaging showed an intensely enhanced tumor lesion that occupies the left sublingual space and extends to the submandibular space.Submandibular dissection,tumor resection,and reconstruction with a radial forearm flap were performed.The surgical specimen exhibited histologically low-grade MLS.Fused in sarcoma(FUS,also known as TLS)and DNA damage-inducible transcript 3(DDIT3,also known as CHOP)break-apart was not detected in the fluorescence in situ hybridization analysis.The tumor was completely encapsulated and did not require additional treatment.Furthermore,no recurrence was reported 40 mo after surgery.CONCLUSION We experienced an extremely rare,massive,low-grade MLS emerging from the floor of the mouth.Oftentimes,an MLS of the floor of the mouth lacks significant clinical findings and is often misdiagnosed.Although no FUS-DDIT3 fusion gene was detected,a low-grade MLS was ultimately diagnosed based on the histological findings.

Lingual lymph nodes:Anatomy,clinical considerations,and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes,which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II.There is growing academic data on the metastatic spread of oral cancer,particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes.These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer.Combined information on surgical anatomy,clinical observations,means of detection,and prognostic value is presented.Anatomically obtained incidence of lingual nodes ranges from 8.6%to 30.2%.Incidence of lingual lymph node metastasis ranges from 1.3%to 17.1%.It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control.Extended resection volume,which is required for the surgical treatment of lingual node metastasis,cannot be implied to every tongue cancer patient.As these lesions significantly influence prognosis,special efforts of their detection must be made.Reasonably,every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis.Lymphographic tracing methods,which are currently implied for sentinel lymph node biopsies,may improve the detection of lingual lymph nodes.

Application analysis of pidotimod in the treatment of allergic rhinitis in children accompanied by allergic asthma

Objective:To observe the application effect of pidotimod in the treatment of allergic rhinitis in children accompanied by allergic asthma.Methods:A total of 60 children with allergic rhinitis accompanied by allergic asthma who were admitted in our hospital from January, 2013 to January, 2015 were included in the study and randomized into the treatment group and the control group with 30 cases in each group. The patients in the two groups were given routine treatments in combined with sublingual immunotherapy. On this basis, the patients in the treatment group were given additional pidotimod. The immunological function, inflammatory cytokine level, and pulmonary function improvement in the two groups were observed. Results:The immunological function, inflammatory cytokine level, and pulmonary function improvement in the treatment group were significantly superior to those in the control group. Conclusions:Pidotimod can significantly enhance the immunological function in children with allergic rhinitis in children accompanied by allergic asthma, alleviate the inflammatory reaction, and promote the pulmonary function improvement, with an accurate efficacy.

Current Practices in Prescribing Auto-Injectable Epinephrine during Immunotherapy amongst Otolaryngic Allergists

Purpose: Allergen immunotherapy (AIT) while usually safe, is not without risk. Both sublingual (SLIT) and subcutaneous immunotherapy (SCIT) have the potential for systemic reactions including anaphylaxis. Materials and Methods: A short survey was distributed to fellows of the American Academy of Otolaryngic Allergy (AAOA) (n = 553) in July of 2019 to determine current prescribing practices. Results: A total of 103/553 surveys were completed, giving a response rate of 18.6%. Prescribing patterns for SCIT showed 79.6% prescribed auto-injectable epinephrine (AIE) to all patients, 11.7% prescribed only to high risk patients, while 1.9% did not prescribe AIE at all. SLIT showed similar patterns with 71.8% prescribing AIE to all, 11.7% to high risk or letting patient choose, and 6.8% did not prescribe to anyone. Just under half of the physicians responded affirmatively to giving a written anaphylaxis plan to patients on immunotherapy. 48.5% physicians reported treating in-office anaphylaxis due to SCIT or skin testing in the past year, while 6% reported anaphylaxis due to SLIT. Conclusions: A majority of otolaryngic allergists are still prescribing AIE for both SCIT and SLIT. With the recent higher costs attributed to AIE as well as drug shortages, some physicians are risk-stratifying patients. While SCIT has a higher risk for treatment related systemic reactions, anaphylaxis does occur with SLIT, thus making it imperative to counsel patients on a clear anaphylaxis protocol in all forms of AIT.