Decreased Circulating Melatonin with Loss of Age-Related Biphasic Change in Patients with Oral Squamous Cell Carcinoma

Background: Melatonin, produced by the pineal gland, is known for its antioxidant, oncostatic, and anti-inflammatory properties. However, studies on serum melatonin levels in different cancer types have yielded conflicting results, and little is known about the clinical significance of serum melatonin in oral squamous cell carcinoma (OSCC) in the Southern Asian population. Therefore, we explored its role in OSCC in this study. Methods: A total of 67 male OSCC patients and 78 healthy controls were enrolled in this case–control study. The serum levels of melatonin were determined by enzyme-linked immunosorbent assay (ELISA) and compared between the two groups. Results: The serum melatonin levels were significantly lower in OSCC patients compared with healthy controls (mean ± standard deviation, 15.0 ± 4.6 vs. 18.5 ± 11.8 pg/mL, p = 0.02). In the subgroup of age less than 55 years (mean age of OSCC), OSCC patients had a significantly decreased melatonin level than healthy controls (mean melatonin, 15.7 ± 12.6 vs. 20.8 ± 3.9 pg/mL, p = 0.02). Decreased serum melatonin (odds ratio (OR): 0.95, 95%CI: 0.91–0.99), alcohol consumption (OR: 29.02, 95%CI: 11.68–72.16), betel quid chewing (OR:136.44, 95%CI: 39.17–475.27), and cigarette smoking (OR:29.48, 95%CI: 11.06–78.60) all increased the risk of OSCC under univariate analyses of logistic regression. Betel quid chewing (OR: 45.98, 95%CI: 10.34–204.49) and cigarette smoking (OR:6.94, 95%CI: 1.60–30.16) were the independent risk factors for OSCC in Taiwan. In addition, a negative correlation between age and melatonin level was observed in healthy controls (Pearson r = −0.24, p = 0.03). However, the negative correlation was lost in patients with OSCC. Melatonin concentration had no association with the severity of OSCC. Conclusion: Overall, our study provides evidence that serum melatonin levels decreased in OSCC patients in Taiwan and the decreased level is much significant in young populations and suggests that the decreased melatonin was associated with OSCC, especially in young populations. Further studies are warranted to investigate whether melatonin can be a useful non-invasive screening tool for OSCC.

Prevalence of Tobacco and Areca-nut Use and Awareness of Its Harmful Effects among Non-academic Staff at Faculty of Dental Sciences, University of Peradeniya

Background: Tobacco and areca nut (AN) are well known risk factors for oral cancer and awareness of these harmful risk habits will reduce the incidence of oral cancer in Sri Lanka. Faculty of Dental Sciences, University of Peradeniya plays a major role in this fight against oral cancer. Hence this study is aimed to evaluate the prevalence of these risk habits among its non-academic staff and their awareness of its harmful effects as they are also responsible stakeholders of the faculty. Method: An institutional based cross sectional study was conducted among 108 non-academic staff members of the faculty using a self-administered questionnaire on risk habit details and their awareness on its harmful effects. Results: Analyzed results revealed that only 4.6% of the sample had tobacco and AN use; betel quid chewing (2.7%) and tobacco smoking (1.8%). However, the awareness on the harmful effects of these products were not very satisfactory as only 48% were overall aware while the unhealthy effects of AN use were known only by 27% of the sample. Contradictorily, 70% of them informed that they have received information regarding the harmful risk habits. Conclusion: It is important to increase awareness among the non-academic staff of the faculty as they become important stakeholders of one of the leading centres in the fight against oral cancer.

Extragingival benign growth-Case report at a rare site

To present a case report of extragingival pyogenic granuloma on lower lip which is an uncommon site for pathological entity and also to emphasize the reason for its occurrence. Pyogenic granuloma (PG) is a benign vascular neoplasm more often appear as lobulated or smooth red nodular lesion commonly in gingiva. Extragingival occurrence of PG is very rare. The present article reports a rare case of 55-year-old female with PG presenting rapid growing mass on the lower lip. This article highlights the possibility on the reason for its occurrence which is important for the diagnosis in this atypical location. The primary etiology of lower lip lesion is trauma and contributory factors being poor oral hygiene and betel quid chewing. Pyogenic granuloma is one of the common lesions in oral cavity. This article highlights the pyogenic granuloma on lip which is an unusual site. Although it can be diagnosed clinically, atypical presentations lead to inappropriate diagnosis. Therefore, further investigation by biopsy confirms final diagnosis upon which treatment is instituted.

Combined Impacts of Genetic Variants of Long Non-Coding RNA MALAT1 and the Environmental Carcinogen on the Susceptibility to and Progression of Oral Squamous Cell Carcinoma

Oral squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity, and long non-coding (lnc)RNA of metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) was recently reported to play a crucial role in OSCC development and progression. However, potential effects of genetic variants of MALAT1 on the development of OSCC are still unclear. Herein, we performed a case-control study in 1350 patients with OSCC and 1199 healthy controls to evaluate the association between functional single-nucleotide polymorphisms (SNPs) of MALAT1 and OSCC susceptibility, as well as its clinicopathologic characteristics. A TaqMan allelic discrimination assay was used to genotype four tagging SNPs, viz., rs3200401 C>T, rs619586 A>G, rs1194338 C>A, and rs7927113 G>A, and results showed that the MALAT1 rs3200401 T allele had a lower risk of OSCC (adjusted odds ratio (AOR): 0.779, 95% confidence interval (CI): 0.632~0.960, p=0.019) and a higher risk of developing moderately (grade II)/poorly (grade III) differentiated OSCC (AOR: 1.508-fold, 95% CI: 1.049~2.169, p=0.027) under a dominant model. According to environmental carcinogen exposure, patients with a betel quid-chewing habit who carried the T allele of rs3200401 more easily developed high-grade (II/III) OSCC (AOR: 1.588, 95% CI: 1.055~2.390, p=0.027), and patients with the same genotype but who did not chew betel quid had a lower risk of developing lymph node metastasis (AOR: 0.437, 95% CI: 0.255~0.749, p=0.003). In addition to rs3200401, the rs619586 AG/GG genotype was associated with increased risks of developing advanced stages (III+IV) and larger tumor sizes (>T2) compared to the AA genotype, especially in the subgroup of betel quid chewers. Furthermore, analyses of clinical datasets revealed that the MALAT1 expression level was upregulated in OSCC compared to normal tissues, especially in the betel quid-chewing population. These results indicated involvement of MALAT1 SNPs rs3200401 and rs619586 in the development of OSCC and support the interaction between MALAT1 gene polymorphisms and the environmental carcinogen as a predisposing factor for OSCC progression.

Effect of MACC1 Genetic Polymorphisms and Environmental Risk Factors in the Occurrence of Oral Squamous Cell Carcinoma

MACC1 (Metastasis Associated in Colon Cancer 1) is found to regulate the hepatocyte growth factor (HGF)/Met signal pathway, and plays an important role in tumor proliferation, angiogenesis, and metastasis. However, the relationships between MACC1 SNPs (single nucleotide polymorphisms) and oral cancer are still blurred. In this study, five SNPs (rs3095007, rs1990172, rs4721888, rs975263, and rs3735615) were genotyped in 911 oral cancer patients and 1200 healthy individuals by real-time polymerase chain reaction (PCR), and the associations of oral cancer with the SNP genotypes, environmental risk factors, and clinicopathological characteristics were further analyzed. Our results showed that individuals who had GC genotype or C-allele (GC + CC) in rs4721888 would have a higher risk for oral cancer incidence than GG genotype after adjustment for betel quid chewing, cigarette smoking, and alcohol drinking. Moreover, the 715 oral cancer patients with a betel quid chewing habit, who had C-allele (TC + CC) in rs975263, would have a higher risk for lymph node metastasis. Further analyses of the sequences of rs4721888 revealed that the C-allele of rs4721888 would be a putative exonic splicing enhancer. In conclusion, MACC1 SNP rs4721888 would elevate the susceptibility for oral cancer, and SNP rs975263 would increase the metastasis risk for oral cancer patients with a betel quid chewing habit. Our data suggest that SNP rs4721888 could be a putative genetic marker for oral cancer, and SNP rs975362 may have the potential to be a prognostic marker of metastasis in an oral cancer patient.

Sociodemographics, lifestyle determinants, and viral infections in patients with head and neck cancer undergoing radiotherapy in Taiwan: A prospective cohort study.

10553 Background: Human papillomavirus (HPV) screening has been implemented to monitor both cervical cancer and head and neck cancer. In this prospective cohort study, we determined sociodemographic, behavioral, and infectious etiology for head and neck squamous cell carcinoma (HNSCC) in Taiwan using data collected from an anonymous sexually transmitted infections screening program. Methods: An anonymous sexually transmitted infections screening program was conducted at a medical center during 2016, in which sociodemographic characteristics including gender, age, marital status, education level, and occupation; medical history regarding underlying comorbidities and history of receiving HPV and other vaccines; lifestyle determinants including betel quid chewing, drug using, and sexual behaviors, were inquired. Blood, anal swab, and penile swab samples were collected to determine viral infections using polymerase chain reaction (PCR). With PCR, 37 HPV genotypes were detected. Regular follow-ups were made for patients enrolled in the screening program until end of 2020, during which all suspected malignancies were recorded upon referrals to oncologists. From this prospective cohort, odds ratios (ORs) of HNSCC for sociodemographic, lifestyle, and infectious variables were derived with logistic regression (R version 4.0.1). P < 0.05 was considered statistically significant. Results: A total of 376 patients were enrolled. Most patients were men (n = 372), with a median age of 27 years. There were 124 (32.98%) HPV-positive patients and 78 (20.74%) HIV-positive patients. Among HPV-positive patients, 20 (25.64%) were of high-risk genotypes. During the follow-up, 44 patients developed HNSCC and all received radiotherapy. Multivariate analysis revealed that patients who were single (OR = 1.43, 95% CI = 1.12-1.83, P = 0.01) or widowed (OR = 2.47, 95% CI = 1.88-3.25, P < 0.001) had higher risk of HNSCC than patients who were married. Patients aged 51-60 (OR = 2.93, 95% CI = 2.10-4.09, P < 0.001) and over 60 (OR = 1.89, 95% CI = 1.45-2.47, P < 0.001) presented higher risks of HNSCC, compared with those aged below 20. Patients addicted to betel quid chewing had high HNSCC risk (OR = 1.29, 95% CI = 1.11 – 1.50, P < 0.001). However, patients with HPV infections did not present with higher HNSCC risks (OR = 0.925, 95% CI = 0.852 – 1.003, P = 0.058). Conclusions: In this prospective cohort study, the elderly, unmarried patients, and patients addicted to betel quid chewing, presented with high HNSCC incidence. On the contrary, the association between HPV infection and HNSCC was insignificant. As both betel nut-chewing and HPV infection could be prevented, we advocate for comprehensive screening and patient education for HNSCC prevention.

A comparison of the risk factors of diabetic retinopathy between type 2 diabetes mellitus patients with and without metabolic syndrome

IntroductionThis study was aimed at analyzing, modeling, and comparing the risk factors of diabetic retinopathy (DR) among type 2 diabetes mellitus (DM) patients with and without metabolic syndrome (MS).Material and methodsA cross-sectional study from July 2017 to July 2019 was performed by tracing type 2 DM patients who received treatment at an out-patient clinic and a mydriatic examination by an ophthalmologist in a single institute in south Taiwan. A total of 802 patients without DR were recruited and divided into two groups based on whether they had MS for this study. We analyzed the impact of DR based on the potential and related factors of these two groups.ResultsThe sample consisted of 802 patients; 282 patients did not have MS, and 520 did. A comparison of the risk factors of DR among the patients with and without MS revealed that the level of glycated hemoglobin (HbA1c) was a co-risk factor of DR. However, female sex, betel quid chewing, family history of DM, and higher total cholesterol were found to be risk factors of DR among the patients who had MS. Betel quid chewing, especially, could exacerbate the disease condition of DM and elevate the risk of DR.ConclusionsOf those risk factors, betel quid chewing may be the main reason for DM deterioration and raised risk of DR. Hence, we recommend that the chewing of betel quid should be avoided to prevent DR.

Frequency of micronuclei in oral mucosal smears of female municipal sweepers with betel quid chewing practice

Background: Oral cancer is common worldwide. Study of micronuclei in exfoliated buccal mucosal cells holds great scope in bio monitoring their carcinogenic potential. Betel quid chewing is one of the most common factors contributing to oral cancers. Ours being a developing country, a study was undertaken among female municipal sweepers, majority of who are betel quid chewers, unaware of the harmful effects of the same. We attempted to cytologically access the presence and compare the proportion of micronuclei in the right, left buccal mucosa and hard palate of female municipal sweepers with and without betel quid chewing practice.Materials and Methods: This was a cross sectional study with purposive sampling. Buccal smears were analysed from 30 betel quid chewers & non chewer females for micronuclei. Mean and standard deviationwere calculated. Independent T test was used for comparison between groups. P value less than 0.05 was considered statistically significant.Results: Frequency of micronuclei in betel quid chewers and non-chewers was 26.80+/-11.96 and 7.76+/-4.73. The frequency of total micronuclei per 250 cells in cases was 9.3+/-5.37 in right buccal mucosa, 9.43+/-5.66 in left buccal mucosa, 9.43+/- 5.66 in hard palate and 3.33+/- 2.88 in right buccal mucosa, 2.96+/-3.31 in left buccal mucosa, and 2.96+/-3.31 in hard palate in controls. Conclusions: The mean number of micronuclei in buccal mucosal cells of female municipal sweepers with betel quid chewing practice was significantly higher compared to controls reaffirming their carcinogenic potential and highlighting the need of early screening for oral cancer in susceptible groups.

Gender difference in betel quid consumption levels and tobacco use among adults in Myanmar

Several small scaled studies in Myanmar investigated determinants of betel quid chewing status but to better understand more complete profiles of betel quid chewing habits, this study investigated the associations of betel quid consumption levels with tobacco and sociodemographic factors using a nationally representative sample in Myanmar. A cross-sectional, secondary data analysis was conducted by using Myanmar demographic and health survey (MDHS) (2015-2016). Chi-square tests and multinomial logistic regression were performed with p-value&lt;0.05 as significance. Men averagely chewed 5.59 (SD=8.229) pieces per day while women chewed 1.25 (SD=3.584) pieces. The prevalence of chewing daily pieces 1-2, 3-5 and 6+ were 7.9%, 17.1% and 34.2% for men and 6.1%, 8% and 7.1 %, respectively, for women. In multivariate analysis, low education, low family wealth, married, and urban were more likely to chew 6+ pieces per day relevant to no consumption in both genders, while a positive association with age was observed only in women. Tobacco use was associated with low consumption level (1-2 pieces), relative to no consumption in both genders. Therefore, this study underlined the need to improve knowledge on the dangers associated with betel quid chewing and tobacco use among socially disadvantaged populations and urban residents.