Logo: to the web site of Uppsala University

uu.sePublications from Uppsala University
Change search
Link to record
Permanent link

Direct link
Alternative names
Publications (10 of 87) Show all publications
Hirsch, J., Sandy, R., Hasséus, B. & Lindblad, J. (2023). A paradigm shift in the prevention and diagnosis of oral squamous cell carcinoma.. Journal of Oral Pathology & Medicine, 52(9), 826-833
Open this publication in new window or tab >>A paradigm shift in the prevention and diagnosis of oral squamous cell carcinoma.
2023 (English)In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 52, no 9, p. 826-833Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Oral squamous cell carcinoma (OSCC) is a widespread disease with only 50%-60% 5-year survival. Individuals with potentially malignant precursor lesions are at high risk.

METHODS: Survival could be increased by effective, affordable, and simple screening methods, along with a shift from incisional tissue biopsies to non-invasive brush biopsies for cytology diagnosis, which are easy to perform in primary care. Along with the explainable, fast, and objective artificial intelligence characterisation of cells through deep learning, an easy-to-use, rapid, and cost-effective methodology for finding high-risk lesions is achievable. The collection of cytology samples offers the further opportunity of explorative genomic analysis.

RESULTS: Our prospective multicentre study of patients with leukoplakia yields a vast number of oral keratinocytes. In addition to cytopathological analysis, whole-slide imaging and the training of deep neural networks, samples are analysed according to a single-cell RNA sequencing protocol, enabling mapping of the entire keratinocyte transcriptome. Mapping the changes in the genetic profile, based on mRNA expression, facilitates the identification of biomarkers that predict cancer transformation.

CONCLUSION: This position paper highlights non-invasive methods for identifying patients with oral mucosal lesions at risk of malignant transformation. Reliable non-invasive methods for screening at-risk individuals bring the early diagnosis of OSCC within reach. The use of biomarkers to decide on a targeted therapy is most likely to improve the outcome. With the large-scale collection of samples following patients over time, combined with genomic analysis and modern machine-learning-based approaches for finding patterns in data, this path holds great promise.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
brush biopsies, explainable AI, oral cancer, oral keratinocytes, precision medicine
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-515133 (URN)10.1111/jop.13484 (DOI)001067002000001 ()37710407 (PubMedID)
Available from: 2023-10-27 Created: 2023-10-27 Last updated: 2024-01-24Bibliographically approved
Huo, J., Hirsch, J. M. & Gamstedt, E. K. (2023). Analytical Study of Stress Distributions around Screws in Flat Mandibular Bone under In-Plane Loading. Bioengineering, 10(7), Article ID 786.
Open this publication in new window or tab >>Analytical Study of Stress Distributions around Screws in Flat Mandibular Bone under In-Plane Loading
2023 (English)In: Bioengineering, E-ISSN 2306-5354, Vol. 10, no 7, article id 786Article in journal (Refereed) Published
Abstract [en]

A known complication for mechanically loaded bone implants is the instability due to screw loosening, resulting in infection and the non-union of fractures. To investigate and eventually prevent such bone degradation, it is useful to know the stress state in the bone around the screw. Considering only in-plane loadings and simplifying the mandibular bone into an orthotropic laminated plate, the analysis was reduced to a two-dimensional pin-loaded plate problem. An analytic model, based on the complex stress analysis, was introduced to the bone biomechanics field to obtain the stress distributions around the screw hole in the bone. The dimensionless normalized stresses were found to be relatively insensitive to the locations of the screw hole over the mandible. Parametric analyses were carried out regarding the friction coefficient and load direction. It was found that the load direction had a negligible influence. On the contrary, the friction coefficient had a significant effect on the stress distributions. Whether the screw was well bonded or not thus played an important role. The proposed analytic model could potentially be used to study bone failure together with stress-based failure criteria.

Place, publisher, year, edition, pages
MDPI AG, 2023
Keywords
bone fixation, orthotropic plate theory, analytical analysis, stress distribution
National Category
Applied Mechanics
Identifiers
urn:nbn:se:uu:diva-508879 (URN)10.3390/bioengineering10070786 (DOI)001034884700001 ()37508813 (PubMedID)
Available from: 2023-08-11 Created: 2023-08-11 Last updated: 2023-08-11Bibliographically approved
Edman, K., Runow Stark, C., Basic, V., Lindblad, J. & Hirsch, J.-M. (2023). Dental hygienists and dentists as providers of brush biopsies for oral mucosa screening. International Journal of Dental Hygiene, 21(3), 524-532
Open this publication in new window or tab >>Dental hygienists and dentists as providers of brush biopsies for oral mucosa screening
Show others...
2023 (English)In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 21, no 3, p. 524-532Article in journal (Refereed) Published
Abstract [en]

Background

Oral cancer is a severe and potentially fatal disease usually starting in the squamous epithelium lining the oral cavity. Together with oropharyngeal carcinoma, it is the fifth to sixth most common malignancy worldwide. To limit the increase in the global oral cancer incidence over the past two decades, the World Health Assembly adopted a resolution urging member states to integrate preventive measures such as engagement and training of dental personnel in screening, early diagnosis, and treatment into their national cancer control programs.

Aim

The aim of this study was to investigate if dental hygienists (DHs) and dentists (Ds) in general dental practice care can be entrusted to perform brush sampling of oral potentially malignant disorders (OPMDs), and to evaluate their level of comfort in performing brush biopsies.

Methods

Participants were five DHs and five Ds who received one day of theoretical and clinical training in oral pathology to identify OPMDs (leukoplakia [LP], erythroplakia [EP], and oral lichen planus [OLP]), and perform brush sampling for PAP cytology and high-risk human papillomavirus (hrHPV) analysis.

Results

Out of 222 collected samples, 215 were adequate for morphological assessment and hrHPV analysis. All the participants agreed that sample collection can be incorporated in DHs and Ds routine clinical duties, and most of them reported that sample collection and processing was easy/quite easy.

Conclusion

Dentists and DHs are capable of collecting satisfactory material for cytology and hrHPV analysis. All the participating DHs and Ds were of the opinion that brush sampling could be handled routinely by DHs and Ds in GDP.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
cancer, erythroplakia, leukoplakia, oral lichen planus, potentially malignant oral disorders, oral
National Category
Clinical Medicine Cancer and Oncology Dentistry
Research subject
Computerized Image Processing; Oncology; Medical Science
Identifiers
urn:nbn:se:uu:diva-510270 (URN)10.1111/idh.12713 (DOI)001022848100001 ()37401636 (PubMedID)
Funder
Region Dalarna
Available from: 2023-08-25 Created: 2023-08-25 Last updated: 2023-10-27Bibliographically approved
Runow Stark, C., Gustavsson, I., Horal, P., Kotopouli, M., Gyllensten, U. & Hirsch, J.-M. (2021). Brush Samples of Oral Lesions to FTA Elute Card for High-risk Human Papilloma Virus Diagnosis. Anticancer Research, 41(1), 269-277
Open this publication in new window or tab >>Brush Samples of Oral Lesions to FTA Elute Card for High-risk Human Papilloma Virus Diagnosis
Show others...
2021 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 41, no 1, p. 269-277Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate the level of agreement between three non-invasive methods for hrHPV diagnosis in oral and oropharyngeal squamous cell carcinoma (OSCC, OPSCC) and in oral mucosal lesions.

MATERIALS AND METHODS: For hrHPV DNA FTA Elute card™ and Anyplex II HPV28™ were used and for hrHPV mRNA PreTect SEE™ in tumour patients (n=60), non-tumour lesions (n=51), immunosuppression or previous hrHPV-infection (n=32).

RESULTS: The level of agreement between the DNA-methods was 82.2% (k=0.54, p=0.001). Pair-wise comparison for the FTA Elute card were close to the reference (AUC=0.83, 95% CI=0.73-0.90). hrHPV mRNA was diagnosed in 50% of the tumours, with an agreement level of 58.3%, compared to Anyplex II (k=0.17, p=0.04). The hrHPV positivity in oral lesions was 3.9% for immunosuppression and for previous HPV infection 9.4%.

CONCLUSION: The FTA card is reliable for hrHPV DNA diagnosis while mRNA gives an insight into viral activity and correlates with severity of the lesion.

Keywords
DNA, FTA Elute card, hrHPV, human papillomavirus, mRNA, oral- and oropharyngeal cancer, potentially malignant oral disorders, real-time PCR
National Category
Cancer and Oncology Microbiology in the medical area
Identifiers
urn:nbn:se:uu:diva-430547 (URN)10.21873/anticanres.14773 (DOI)000608664500003 ()33419821 (PubMedID)
Funder
Region UppsalaRegion Stockholm, SOF 4640/2016
Available from: 2021-01-11 Created: 2021-01-11 Last updated: 2021-03-01Bibliographically approved
Sundberg, J., Öhman, J., Korytowska, M., Wallström, M., Kjeller, G., Andersson, M., . . . Hasséus, B. (2021). High-risk human papillomavirus in patients with oral leukoplakia and oral squamous cell carcinoma-A multi-centre study in Sweden, Brazil and Romania.. Oral Diseases, 27(2), 183-192
Open this publication in new window or tab >>High-risk human papillomavirus in patients with oral leukoplakia and oral squamous cell carcinoma-A multi-centre study in Sweden, Brazil and Romania.
Show others...
2021 (English)In: Oral Diseases, ISSN 1354-523X, E-ISSN 1601-0825, Vol. 27, no 2, p. 183-192Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Although causal associations between oral leukoplakia (OL), oral squamous cell carcinoma (OSCC) and high-risk human papillomavirus (HR-HPV) have been speculated upon in several reports, conclusive evidence has not been presented. This study investigates whether the number of cases of HR-HPV in OL has increased over time and whether the prevalence of HR-HPV-positive OL differs in various parts of the world.

PATIENTS AND METHODS: A total of 432 patients with OL from Sweden, Brazil and Romania were analysed. Patients were divided into historical (1992-2002) and contemporary (2011-2017) cohorts from the respective countries. Seventeen patients with OL developed oral squamous cell carcinoma (OSCC). A real-time PCR assay, targeting HPV sub-types 6,11,16,18,31,33,35,39,45,52,56,58 and 59, was performed to detect HR-HPV in patients with OL.

RESULTS: In the Swedish and Romanian cohorts, none of the investigated HPV sub-types were detected. In the Brazilian cohorts, five patients with OL (3%) were positive for HR-HPV, including four patients from the contemporary cohort (HPV 16, 31, 33) and one from the historical cohort (HPV 11). All the cases of OL that transformed into OSCC were HR-HPV-negative, as were the corresponding tumours.

CONCLUSIONS: In summary, the prevalence of HR-HPV in OL is low in all the tested countries, and the incidence has not changed over time. HR-HPV in OL does not seem to be a driver of oncogenesis.

Keywords
HPV, PCR, global variation, oral cancer, potentially malignant oral disorders, virus
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-430495 (URN)10.1111/odi.13510 (DOI)000548629700001 ()32568421 (PubMedID)
Available from: 2021-01-11 Created: 2021-05-06 Last updated: 2021-05-06Bibliographically approved
Hirsch, J.-M., Haj-Hosseini, N., Krüger Weiner, C., Hasséus, B. & Lindblad, J. (2021). Icke-invasiv kontroll av cellförändringar i munslemhinnan. Tandläkartidningen (9), 48-55
Open this publication in new window or tab >>Icke-invasiv kontroll av cellförändringar i munslemhinnan
Show others...
2021 (Swedish)In: Tandläkartidningen, ISSN 0039-6982, no 9, p. 48-55Article, review/survey (Refereed) Published
Keywords
tissue biopsy, oral cancer, cytology, optical diagnostics, fluorescence, optical coherence tomography, Raman, artificial intelligence, vävnadsbiopsi, munhållecancer, cytologi analys, optisk diagnostik, fluorescens, optisk koherenstomografi, Raman, artificiell intelligens
National Category
Medical Image Processing Medical Equipment Engineering Radiology, Nuclear Medicine and Medical Imaging
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-457736 (URN)
Funder
Vinnova, AIDA (2017–02447, 2019–1908 och 2020– 03611)Region Stockholm, Folktandvården Stockholms län ABRegion Dalarna, Forskningsstiftelsen Folktandvården Dalarna
Available from: 2021-11-01 Created: 2021-11-01 Last updated: 2023-05-25Bibliographically approved
Korytowska, M., Schwab, G., Giglio, D., Hirsch, J.-M., Holmberg, E., Kjeller, G., . . . Hasséus, B. (2021). Patient-reported pain after surgical removal of leukoplakia: an observational 1-year follow-up study. Acta Odontologica Scandinavica, 79(5), 383-389
Open this publication in new window or tab >>Patient-reported pain after surgical removal of leukoplakia: an observational 1-year follow-up study
Show others...
2021 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, no 5, p. 383-389Article in journal (Refereed) Published
Abstract [en]

Objective

Oral leukoplakia (OL) presents as a white lesion of the oral mucosa and is not typically associated with the sensation of pain. OL should be surgically removed when possible because it is considered a potentially malignant oral disorder (PMOD). This study assessed the pain sensations experienced by patients in association with the occurrence and surgical treatment of OL.

Methods

Inclusion criteria were: a clinical diagnosis of OL; biopsy excision; and observation for at least 12 months in the ORA-LEU-CAN study. At the first visit, all the patients were asked about the occurrence of symptoms within the lesion. Ninety-four subjects were assessed over a period of 1 year. All patients underwent complete removal of OL. The patient cohort was divided into three sub-groups: (i) no pain before excision and at the 1-year follow-up; (ii) pain before excision; and (iii) pain at the 1-year follow-up.

Results

Overall, pain was reported by 21.3% of the patients at the study start whereas 13.8% of the patients reported pain 1 year after surgical treatment. Patient-reported pain from the lesion at study inclusion was significantly associated with lesions found on the lateral side of the tongue (p=.002). Pain reported by patients one year after surgery was significantly related to female gender (p=.038) and the presence of epithelial cell dysplasia (p=.022).

Conclusion

We conclude that surgical removal of OL results in a low risk of long-term post-surgical pain. However, OL located on the lateral side of the tongue and in OL with dysplasia are more likely to be associated with pain.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Leukoplakia, surgical excision, pain, potentially malignant oral disorders
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-454504 (URN)10.1080/00016357.2020.1869826 (DOI)000609561600001 ()33476210 (PubMedID)
Funder
Region Västra Götaland, TUAGBG-620871Region Västra Götaland, VGFOUREG-647771
Available from: 2021-09-28 Created: 2021-09-28 Last updated: 2024-01-15Bibliographically approved
Meyer, S., Hirsch, J. M., Leiggener, C. S., Zeilhofer, H.-F. & Thieringer, F. M. (2020). A simple, effective, universal, and reusable osteotomy tool for jaw reconstructions with microvascular fibula transplants. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 73(1), 98-102
Open this publication in new window or tab >>A simple, effective, universal, and reusable osteotomy tool for jaw reconstructions with microvascular fibula transplants
Show others...
2020 (English)In: Journal of plastic, reconstructive & aesthetic surgery : JPRAS, ISSN 1878-0539, Vol. 73, no 1, p. 98-102Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Precise, expensive individual saw guides are used with increasing frequency for the reconstruction of mandibular defects with fibular grafts. In this report, an alternative is presented - the Multiuse Cutting Jig (MUC-Jig, proprietary development). It is reusable, suitable for all patients, requires simple planning based on conventional CT imaging, and is more economical.

METHODS: To investigate its precision, we conducted a nonblinded experimental study, with ten participating craniomaxillofacial surgeons. Osteotomies of four different fibula segments were carried out at the same angulation, with groups defined according to the proximal and distal fixed angulation: 45°, 30°, 15°, or 0°. The sagittal cut was performed proximally, with the coronal cut performed distally. The resulting 40 segments (n = 40) were analyzed with their Tx length (primary endpoint) and osteotomy angles, and compared to the original planning.

RESULTS: The mean (SD) relative deviation of all grafts from the original planning was -0.08 mm (1.12) in length and -0.71° (3.15) for the angle. Only 45° (-2.04 ± 3.71°) and 30° (-1.07 ± 2.52°) cuts differed significantly (p < 0.05) from smaller angle grafts. The mean (SD) absolute deviation was 0.81 mm (0.27) in length and 2.13° (0.93) in graft angles. For individual transplants, 45° cuts (1.28 ± 1.03 mm) differed significantly (p < 0.005) from others. We observed no differences in relative length or absolute angle deviation.

CONCLUSIONS: The MUC-Jig is precise and cost-effective for osteotomies with medium angles and smooth reconstructions of template-guided procedures.

Keywords
Fibula, Inventions, Mandibular reconstruction, Oral surgery, Osteotomy, Tissue transplantation
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-398677 (URN)10.1016/j.bjps.2019.06.026 (DOI)000504882200012 ()31711860 (PubMedID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2020-01-28Bibliographically approved
Messo, E., Grottoli, C. F., Perale, G. & Hirsch, J.-M. (2020). Custom-Made Horizontal and Vertical Maxillary Augmentation with Smartbone® On Demand™: A Seven-Year Follow-Up Case. Applied Sciences, 10(22), Article ID 8039.
Open this publication in new window or tab >>Custom-Made Horizontal and Vertical Maxillary Augmentation with Smartbone® On Demand™: A Seven-Year Follow-Up Case
2020 (English)In: Applied Sciences, E-ISSN 2076-3417, Vol. 10, no 22, article id 8039Article in journal (Refereed) Published
Abstract [en]

The presence of non-sufficient bone height and width requires an increase in the amount of bone available to insert an implant. Different materials are described in the literature, and the “custom-made bone graft approach” is a modern option which currently requires a preoperative stage of studying the bone defect and designing the implant. SmartBone® (SB®) mimics the characteristics of healthy human bone. Thanks to the strong performance, high workability, resistance and shape retention of SB®, it is possible to obtain SmartBone® on DemandTM, a bone graft uniquely shaped exactly to patient specifications, produced by following the data precisely and contoured to the bone defect site. The aim of this study was to determine the success over 7 years following a customized SmartBone® on DemandTM, a xeno-hybrid bone graft and installation of implants in a maxillary horizontal and vertical atrophy. This case study presents the diagnosis for a 60-year-old male patient requesting the rehabilitation of his edentulous maxilla with dental implants. Preoperative evaluation included the study of photographs, a radiological examination and 3D reconstruction to assess the missing bone, implant size, positioning of implants and anatomical landmarks. Rehabilitation included the insertion of a custom-made xeno-hybrid bone block into the maxilla in order to restore the anatomy prior to the implants’ placement. The newly developed bone substitute SB® is a safe and effective material, and its custom-made variant SmartBone® on DemandTM has been shown to be a valid alternative to traditional autologous bone grafting techniques in terms of accuracy, absence of infection/rejection and overall clinical outcome.

Keywords
bone substitute, SmartBone On Demand, custom implants, bone regeneration, xeno-hybrid bone graft
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-429001 (URN)10.3390/app10228039 (DOI)000594952200001 ()
Available from: 2020-12-18 Created: 2020-12-18 Last updated: 2020-12-18Bibliographically approved
Kumar, V. V., Hirsch, J. M. & Thor, A. (2020). Denture Guided Epithelial Regeneration: metod för att skapa keratiniserad gingiva i anslutning till implantat. Tandläkartidningen (10), 60-65
Open this publication in new window or tab >>Denture Guided Epithelial Regeneration: metod för att skapa keratiniserad gingiva i anslutning till implantat
2020 (Swedish)In: Tandläkartidningen, ISSN 0039-6982, no 10, p. 60-65Article in journal (Refereed) Published
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-430544 (URN)
Available from: 2021-01-11 Created: 2021-01-11 Last updated: 2022-02-10Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1060-7757

Search in DiVA

Show all publications