Recurrent aphthous stomatits (RAS) is also known as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. RAS has been the subject of active investigation along multiple lines of research including epidemiology, immunology, clinical correlations and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MIAU, MJAU, HU) and severity (simple versus complex). In order to properly diagnose and treat a patient with lesions of RAS, the clinician must exclude other causes of acute oral ulcers. Complex aphthosis and complex aphthosis variants associated with systemic disorders should be considered. The aphthous-like oral ulcerations of patients with HIV disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause" which, with appropriate treatment, can result in a remission or substantial lessening of disease activity. Finally, when all of these factors are considered, the evaluation of the patient for Behcet's disease can be continued on firm grounds that one of the major criteria for the diagnosis of Behcet's disease has been met.
Behcet's Syndrome/diagnosis* ; Diagnosis, Differential ; Human ; Recurrence ; Stomatitis, Aphthous/etiology ; Stomatitis, Aphthous/diagnosis* ; Stomatitis, Aphthous/classification

Humans ; Stomatitis, Aphthous ; diagnosis ; etiology ; therapy

OBJECTIVE: To study the clinical features of children with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, a polygenic and multifactorial autoinflammatory disease with unknown pathogenesis. METHODS: A retrospective analysis was performed on the medical data of 13 children with PFAPA syndrome. RESULTS: All 13 children had disease onset within the age of 3 years, with a mean age of onset of (14±10) months. They all had periodic fever, with 8-18 attacks each year. The mean interictal period of fever was (30±5) days. Pharyngitis, cervical adenitis, and aphthous stomatitis were the three cardinal symptoms, with incidence rates of 100% (13/13), 85% (11/13), and 38% (5/13) respectively. There were increases in white blood cells, C-reactive protein, and erythrocyte sedimentation rate during fever. Of all the 13 children, 6 underwent whole exome sequencing and 7 underwent panel gene detection for autoinflammatory disease, and the results showed single heterozygous mutations in the CONCLUSIONS For children with unexplained periodic fever with early onset accompanied by pharyngitis, cervical adenitis, aphthous stomatitis, elevated inflammatory indices, and good response to glucocorticoids, PFAPA syndrome should be considered. This disorder has good prognosis, and early diagnosis can avoid the long-term repeated use of antibiotics.
Child ; Child, Preschool ; Fever/etiology* ; Humans ; Infant ; Lymphadenitis/diagnosis* ; Pharyngitis/drug therapy* ; Pyrin ; Retrospective Studies ; Stomatitis, Aphthous/genetics*

In recent years, more head and neck cancer patients have been treated with radiotherapy. Radiation-induced mucositis is a common and dose limiting toxicity of radiotherapy among patients with head and neck cancers. Patients undergoing radiation therapy for head and neck cancer are also at increased risk of developing oral candidiasis. A number of new agents applied locally or systemically to prevent or treat radiation-induced mucositis have been investigated, but there is no widely accepted prophylactic or effective treatment for mucositis. Topical Aloe vera is widely used for mild sunburn, frostbites, and scalding burns. Studies have reported the beneficial effects of Aloe gel for wound healing, mucous membrane protection, and treatment of oral ulcers, in addition to antiinflammatory, immunomudulation, antifungal, scavenging free radicals, increasing collagen formation and inhibiting collagenase. Herein the author postulates that oral Aloe vera mouthwash may not only prevent radiation-induced mucositis by its wound healing and antiinflammatory mechanism, but also may reduce oral candidiasis of patients undergoing head and neck radiotherapy due to its antifungal and immunomodulatory properties. Hence, Aloe vera mouthwash may provide an alternative agent for treating radiation-induced oral mucositis and candidiasis in patients with head and neck cancers.
Aloe ; chemistry ; Clinical Trials as Topic ; Head and Neck Neoplasms ; radiotherapy ; Humans ; Mouthwashes ; therapeutic use ; Radiation Injuries ; drug therapy ; etiology ; prevention & control ; Stomatitis ; drug therapy ; etiology ; prevention & control

PURPOSE: This study was conducted to determine the risk factors among patients with depression with Crohn's disease. METHODS: Data were collected by questionnaire from 276 patients who were diagnosed with Crohn's disease at a tertiary hospital located in Seoul. Measurements included patients' demographic characteristics, clinical characteristics, depression level, and health-related quality of life. Data were analyzed using t-test, chi2-test, Wilcoxon rank sum test, and logistic regression analyses. RESULTS: The incidence rate of depression (BDI-II> or =14scores) was 31.9% (n=88). Univariate analysis revealed that being a woman, school graduation status, economic status (low), BMI(<18.5Kg/m2), disease duration (> or =3 years), CDAI (> or =150 scores), frequency of hospital admission (> or =2), extra-intestinal manifestation (arthralgia, stomatitis), administration of 5-aminosalicylic acid, and disease related quality of life (SIBDQ<50 scores) were associated with depression. Multivariate analysis revealed that economic status (low), school graduation status, and quality of life (SIBDQ<50 scores) were more likely to report high level of depression. CONCLUSION: Future research should consider managing depression as an essential component of comprehensive care for patients with Crohn's disease. In addition, further research is needed to develop strategies to better improve quality of life among patients with Crohn's disease who are depressed.
Adult ; Arthralgia/etiology ; Body Mass Index ; Crohn Disease/complications/drug therapy/*psychology ; *Depression ; Female ; Humans ; Logistic Models ; Male ; Mesalamine/therapeutic use ; Quality of Life ; Questionnaires ; Risk Factors ; Socioeconomic Factors ; Stomatitis/etiology ; Young Adult

OBJECTIVETo investigate the prevalence and treatment of oral mucositis caused by concurrent chemoradiotherapy and/or molecular targeted therapy in the patients with advanced squamous cell carcinoma of the head and neck.

METHODSA retrospective study of the incidence and treatment of oral mucositis was performed in 179 patients (155 male and 24 female;124 patients at stage III and 55 patients at stage IV) receiving concurrent chemotherapy and (or) molecular targeted therapy between November 2007 and November 2010. Grade I, II, III and IV oral mucositis occurred respectively in 49, 50, 67 and 13 patients. All the patients received oral mucositis prophylaxis. After the occurrence of oral mucositis, conventional treatment of mucositis combined with quinolone antibiotics were applied.

RESULTSOf the patients, 99 patients with grade I or II and 4 patients with grade III oral mucositis were effectively managed by conventional treatment; 76 patients with grade III or IV oral mucositis were also significantly controled by conventional treatment plus antibiotics. After the treatments, all patients with oral mucositis were under control, with the decrease in the grade of oral mucositis, the reduction of oral pain and the improvement in ability to eat. None of them had radiation treatment breaks.

CONCLUSIONSCombined modality therapy can effectively control chemoradiation-induced oral mucositis in patients with head and neck squamous cell carcinoma, grade I and II oral mucositis were cured by conventional treatment and quinolone antibiotics play a key role in the treatments for grade III and IV oral mucositis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; radiotherapy ; Chemoradiotherapy ; adverse effects ; Combined Modality Therapy ; Female ; Head and Neck Neoplasms ; drug therapy ; radiotherapy ; Humans ; Male ; Middle Aged ; Molecular Targeted Therapy ; adverse effects ; Retrospective Studies ; Stomatitis ; drug therapy ; etiology ; Young Adult

OBJECTIVETo observe the clinical effect of Chinese medicine for nourishing yin and clearing heat therapy (CM therapy) in treating nasopharyngeal carcinoma (NPC) patients with yin deficiency-induced inner heat syndrome, and suffered from acute radiation oral mucositis.

METHODSSixty patients with NPC fitting to the inclusion criteria and undergoing initial dose radiotherapy were assigned to two groups. The 31 patients in the treatment group received CM therapy, and the 29 in the control group were treated with standard Western medical therapy. The condition of oral mucosa and epidermal growth factor (EGF) content in saliva of patients during the therapeutic period were observed, meanwhile the quality of life (QOL) of patients was estimated with the quality of life questionnaire-core 30 (QLQ-C30) issued by European Organization for Research and Treatment of Cancer (EORTC).

RESULTSAcute radiation oral mucositis occurred in all patients, but the severity in the treatment group was milder than that in the control group (P < 0.01). Salivary EGF content decreased along with the increasing radiation dosage, it decreased significantly when 40 Gy radiated and down to the minimum when 70 Gy radiated, but the decrement in the treatment group was less than that in the control group (P < 0.01). Comparison of QOL by QLQ-C30 scale showed that after radiotherapy the global health status in the treatment group was superior to the control group (P < 0.01).

CONCLUSIONChinese medicine for nourishing yin and clearing heat therapy could actually postpone the occurrence of acute radiation oral mucositis, lessen the adverse reaction of radiotherapy and improve patient's QOL, show a favorable effect in prevention and treatment, and has definite application value for clinical spreading.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Phytotherapy ; Quality of Life ; Radiotherapy ; adverse effects ; Stomatitis ; drug therapy ; etiology ; prevention & control ; Yin Deficiency ; drug therapy ; Young Adult

OBJECTIVETo establish a rat model of oral mucositis (OM) induced by busulfan and cyclophosphamide (BUCY) conditioning regimen of hematopoietic stem cell transplantation (HSCT).

METHODSIn the model group, busulfan (6.0 mg.kg(-1).d(-1) x 4 d) and cyclophosphamide (120 mg.kg(-1).d(-1) x 2 d) were administered by intra-stomach perfusion and intraperitoneal injection, respectively. The left cheek mucosa were irritated by superficial scratching on day 6. The oral mucosal score (OMS) was assessed daily. Animals were sacrificed on day 7, 10, 13, 16 and 18. The samples of blood, bone marrow, and the oral mucosa were harvest to evaluate the clinical and histological changes.

RESULTSThe incidence of oral mucositis in model group was as high as 80.00% with a survival rate of 73.33%. The initial lesion on the oral mucosa was noted on day 7 with red spot and edema, and then progressive mucositis was characterized by large areas of ulcer formation. The duration of oral mucositis was 8 to 10 days. A continuous weight loss, white blood cell count decrease and bone marrow suppression occurred in the process of oral mucositis.

CONCLUSIONSAn animal model of conditioning regimen-induced oral mucositis was successfully established.

Animals ; Busulfan ; toxicity ; Cyclophosphamide ; toxicity ; Disease Models, Animal ; Feasibility Studies ; Hematopoietic Stem Cell Transplantation ; Male ; Mouth Mucosa ; pathology ; Rats ; Rats, Sprague-Dawley ; Stomatitis ; chemically induced ; etiology ; pathology ; Transplantation Conditioning ; adverse effects

The application of simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in pediatric and adolescent nasopharyngeal carcinoma (NPC) is underevaluated. This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy. Thirty-four patients (aged 8-20 years) with histologically proven, non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study. The disease stage distribution was as follows: stage I, 1 (2.9%); stage III, 14 (41.2%); and stage IV, 19 (55.9%). All patients underwent SIB-IMRT and 30 patients also underwent cisplatin-based chemotherapy. The prescribed dose of IMRT was 64-68 Gy in 29-31 fractions to the nasopharyngeal gross target volume. Within the median follow-up of 52 months (range, 9-111 months), 1 patient (2.9%) experienced local recurrence and 4 (11.8%) developed distant metastasis (to the lung in 3 cases and to multiple organs in 1 case). Four patients (11.8%) died due to recurrence or metastasis. The 5-year locoregional relapse-free survival, distant metastasis-free survival, disease-free survival, and overall survival rates were 97.1%, 88.2%, 85.3%, and 88.2%, respectively. The most common acute toxicities were grades 3-4 hematologic toxicities and stomatitis. Of the 24 patients who survived for more than 2 years, 16 (66.7%) and 15 (62.5%) developed grades 1-2 xerostomia and ototoxicity, respectively. Two patients (8.3%) developed grade 3 ototoxicity; no grade 4 toxicities were observed. SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC, with mild incidence of late toxicities. Distant metastasis is the predominant mode of failure.
Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma ; Child ; Cisplatin ; administration & dosage ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; etiology ; Lung Neoplasms ; secondary ; Male ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neutropenia ; etiology ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; adverse effects ; methods ; Retrospective Studies ; Stomatitis ; etiology ; Survival Rate ; Xerostomia ; etiology ; Young Adult

ErbB receptor tyrosine kinase inhibitors (EGFR-TKI), gefitinib, erlotinib, icotinib and aftinib, which are approved as a frontline treatment for patients with non-small cell lung cancer (NSCLC) who have tumors harboring EGFR mutations in China. And osimertinib was approved in second line setting for patients with EGFRT 790M-positive NSCLC. Rash, paronychia, diarrhea, stomatitis, liver dysfunction and (interstitial lung disease, ILD) are frequently observed in patients treated with EGFR-TKI. Chinese Society of Lung Cancer, Chinese Anti-Cancer Association, organized Chinese experts to develop the Chinese expert consensus on EGFR-TKI adverse event (AE) management based on domestic diagnosis and treatment of ADR and also incorporating international updated theory and recommendations.
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Antineoplastic Agents ; adverse effects ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; enzymology ; genetics ; China ; Diarrhea ; etiology ; ErbB Receptors ; antagonists & inhibitors ; genetics ; metabolism ; Humans ; Liver Diseases ; etiology ; Lung Diseases ; etiology ; Lung Neoplasms ; drug therapy ; enzymology ; genetics ; Protein Kinase Inhibitors ; adverse effects ; therapeutic use ; Stomatitis ; etiology