Gasless Endoscopic Submandibular Gland Excision Through Hairline Approach.

BACKGROUND: The aim of this study was to evaluate the therapeutic effect of gasless endoscopic submandibular gland excision through hairline approach and the safety, feasibility and practicability of this technique. METHODS: Twenty-five patients with submandibular gland lesions who underwent gasless endoscopic submandibular gland excision through hairline approach at the Department of Head and Neck Oncology of the West China Hospital of Stomatology from May 1 st 2021 to May 31 st 2022 were included in this prospective study. The variables were analyzed statistically with SPSS software version 23.0 (IBM Corp, Armonk, New York, USA). RESULTS: There was a female predominance (72%), female to male ratio was 2.6. The mean age was 30.6±10.2 years (range: 11 to 52 year). All 25 cases of endoscopic submandibular gland excision through hairline approach were done without conversion to conventional approach. This approach was indicated in 14 cases (56%) for pleomorphic adenoma, 8 cases (32%) for chronic sialadenitis, 2 cases (8%) for adenoid cystic carcinoma, and 1 case (4%) for lymphadenitis. The incision length mean was 4.8±0.4 mm (range: 4 to 5 mm); the operation duration mean was 100.6±39.7 min (range: 51 to 197 min); the intraoperative bleeding mean was 13.2±5.7 ml (range: 5 to 20 ml); the hospital length of stay mean was 4.5±0.8 days (range: 3 to 6 days). The follow-up mean was 10±3.4 months (range: 5 to 16 months). The patients were very satisfied with postoperative cosmetic result (score mean: 9.2±1). No recurrence of disease and complications such as postoperative bleeding, hematoma, nerve damage, skin necrosis, infection, and hair loss occurred. CONCLUSIONS: Gasless endoscopic submandibular gland excision through hairline approach is safe, feasible and practicable, resulting in a very satisfied cosmetic result without significant complications; the intraoperative bleeding is less, the operative field is clear, the operation duration decreases with accumulation of experience.

Epidemiologic relationship between periodontitis and type 2 diabetes mellitus.

BACKGROUND: To systematically review the epidemiologic relationship between periodontitis and type 2 diabetes mellitus (T2DM). METHODS: Four electronic databases were searched up until December 2018. The manual search included the reference lists of the included studies and relevant journals. Observational studies evaluating the relationship between T2DM and periodontitis were included. Meta-analyses were conducted using STATA. RESULTS: A total of 53 observational studies were included. The Adjusted T2DM prevalence was significantly higher in periodontitis patients (OR = 4.04, p = 0.000), and vice versa (OR = 1.58, p = 0.000). T2DM patients had significantly worse periodontal status, as reflected in a 0.61 mm deeper periodontal pocket, a 0.89 mm higher attachment loss and approximately 2 more lost teeth (all p = 0.000), than those without T2DM. The results of the cohort studies found that T2DM could elevate the risk of developing periodontitis by 34% (p = 0.002). The glycemic control of T2DM patients might result in different periodontitis outcomes. Severe periodontitis increased the incidence of T2DM by 53% (p = 0.000), and this result was stable. In contrast, the impact of mild periodontitis on T2DM incidence (RR = 1.28, p = 0.007) was less robust. CONCLUSIONS: There is an evident bidirectional relationship between T2DM and periodontitis. Further well-designed cohort studies are needed to confirm this finding. Our results suggest that both dentists and physicians need to be aware of the strong connection between periodontitis and T2DM. Controlling these two diseases might help prevent each other's incidence.

Selective intra-arterial infusion of rAd-p53 with chemotherapy for advanced oral cancer: a randomized clinical trial.

BACKGROUND: In this study, a combination of recombinant adenoviral p53 (rAd-p53) gene therapy and intra-arterial delivery of chemotherapeutic agents for treatment of oral squamous cell carcinoma was evaluated. METHODS: In total, 99 patients with stage III or IV oral carcinoma who had refused or were ineligible for surgery were enrolled in a randomized, placebo-controlled, double-blind, phase III clinical trial. They were randomly assigned to group I (n = 35; intra-arterial infusion of rAd-p53 plus chemotherapy), group II (n = 33; intra-arterial infusion of rAd-p53 plus placebo chemotherapy), or group III (n = 31; intra-arterial infusion of placebo rAd-p53 plus chemotherapy). RESULTS: The median length of follow-up was 36 months (range, 3 to 86 months). During follow-up, 16 patients in group I, 20 in group II, and 22 in group III died. Group I (48.5%) had a higher complete response rate than groups II (16.7%) and III (17.2%) (P = 0.006). The rate of non-responders in group I was significantly lower than that in groups II and III (P < 0.020). A log-rank test for survival rate indicated that group I had a significantly higher survival rate than group III (P = 0.019). The survival rate of patients with stage III but not stage IV oral cancer was significantly higher in group I than in group III (P = 0.015, P = 0.200, respectively). The survival rate of patients with stage IV did not differ significantly among the three groups. Or the 99 patients, 63 patients experienced adverse events of either transient flu-like symptoms or bone marrow suppression, while 13 patients had both these conditions together. No replication-deficient virus was detected in patient serum, urine, or sputum. rAd-p53 treatment increased Bax expression in the primary tumor of 80% of patients, as shown by immunohistochemical staining. CONCLUSIONS: Intra-arterial infusion of combined rAd-p53 and chemotherapy significantly increased the survival rate of patients with stage III but not stage IV oral cancer, compared with intra-arterial chemotherapy. Intra-arterial infusion of combined rAd-p53 and chemotherapy may represent a promising alternative treatment for oral squamous cell carcinoma. TRIAL REGISTRATION: ChiCTR-TRC-09000392 (Date of registration: 2009-05-18).

[Simultaneous determination of adrenaline, noradrenaline, cortisone and cortisol in plasma with HPLC/MS/MS].

OBJECTIVE: To develop a method for simultaneous determination of adrenaline, noradrenaline, cortisone and cortisol in plasma using HPLC/MS/MS. METHODS: Sample proteins were precipitated with acetonitrile and the sample solution was injected into HPLC/MS/MS after centrifugation at 15,000 r/min for 5 min. Electrospray ionization (ESI) and the positive ion detection were applied with a multiple reaction monitoring (MRM) mode for quantitative analyses. RESULTS: Under the optimal conditions, good linearity (r > 0.999) was observed in the range of 0.02-200.00 ng/mL of target compounds. The detection limit reached 4.13 pg/mL, 4.64 pg/mL, 4.29 pg/mL and 4.52 pg/mL for adrenaline, noradrenaline, cortisone and cortisol respectively. The inter-day and intra-day precisions ranged from 1.19%-5.42% and 2.16%-6.04% respectively. Satisfied results were achieved using human plasma samples, with a spiked recovery in the range of 80.0%-109.0% and a relative standard deviation of 3.93%-7.57%. CONCLUSION: The proposed method is quick, sensitive and suitable for batch analyses of plasma samples.

Chinese surgical robot-assisted surgery for parotid tumor: a case report.

Robotic surgery is known as the "third technological revolution" in the field of surgery, and is an important milestone in the development of modern surgery. However, our country's innovative surgical robot industry is still in its early stages, and it is only being utilized in certain surgical fields. To explore the effectiveness of the application of domestic surgical robot in oral and maxillofacial surgery, the author successfully completed a case of benign parotid tumor resection with the assistance of a domestic autonomous robot. The operation was successful, facial nerve function was preserved, and postoperative wound healing was good.

XRCC1 Arg194Trp polymorphism is associated with oral cancer risk: evidence from a meta-analysis.

Previous studies show that X-ray cross-complementing group 1 (XRCC1) Arg194Trp may result in variations in host's repair efficiency of DNA damage, and this repair deficit may eventually cause individual susceptibility to oral cancer. However, published data regarding the association between XRCC1 Arg194Trp polymorphism and oral cancer risk were contradictory. The aim of this study was to derive a more precise estimation of the association of XRCC1 Arg194Trp polymorphism with oral cancer by performing a meta-analysis. Odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were used to assess the strength of the association. Finally, a meta-analysis of nine eligible studies including 1,281 cases and 1,966 controls was performed. Overall, there was a significant association between XRCC1 Arg194Trp polymorphism and oral cancer risk (for Trp versus Arg: OR = 1.41, 95 % CI 1.08-1.83, P = 0.01; for TrpTrp versus ArgArg: OR = 1.50, 95 % CI 1.00-2.30, P = 0.05; for TrpTrp/ArgTrp versus ArgArg: OR = 1.49, 95 % CI 1.14-1.94, P = 0.003). After excluding those studies containing patients with oral leukoplakia, there was still an obvious association between XRCC1 Arg194Trp polymorphism and oral cancer risk (for TrpTrp/ArgTrp versus ArgArg: OR = 1.40, 95 % CI 1.14-1.71, P = 0.001). Subgroup analysis by ethnicity suggested that there was an obvious association between XRCC1 Arg194Trp polymorphism and oral cancer risk in Asians under three genetic models. In conclusion, the results from this meta-analysis suggest that XRCC1 Arg194Trp polymorphism is associated with oral cancer risk, especially in Asians.

Single incision-plus approach for gasless endoscopic parotidectomy: a seven-step procedure.

Endoscopic parotidectomy has the potential to become a reliable procedure for benign and low-grade malignant parotid gland tumors. Based on the previous literature review and our own clinical experience, we introduced in detail the surgical procedure of single incision-plus approach for gasless endoscopic parotidectomy. This method contributes a logical approach to achieving endoscopic resection of parotid gland tumor and preservation of facial nerve, which can be summarized into the following seven-step method: preoperative preparation; design of retroauricular-hairline incision and plus-incision; surgical cavities creation and coalescence; separation of surgical boundaries; separation and protection of the facial nerve trunk; processing of the branches of facial nerve; en bloc resection of the superficial parotid gland and tumor. Endoscopic parotidectomy is a more difficult procedure than conventional parotid surgery, requiring more precision as well as more experience and equipment. The learning curve of time and frequency is influenced by many factors, like anatomy, instruments, procedures and patience. We contribute our clinical exploration of anatomical precautions, feasible instruments, and surgical procedures and summarize precautions under single incision-plus in gasless endoscopic parotidectomy. Given the growing interest in the aesthetic process of the parotid region, the seven-step method may have the potential to be a method for teaching gasless endoscopic parotidectomy.

[Advances in molecular mechanisms of bone invasion by oral cancer].

Bone invasion by oral cancer is a common clinical problem, which affects the choice of treatment and predicts a poor prognosis. Unfortunately, the molecular mechanism of this phenomenon has not been fully elucidated. Current studies have revealed that oral cancer cells modulate the formation and function of osteoclasts through the expression of a series of signal molecules. Many signal pathways are involved in this process, of which receptor activator of nuclear factor-κB ligand/receptor activator of nuclear factor-κB/osteoprotegerin signaling pathway attracted much attention. In this review, we introduce recent progress in molecular mechanisms of bone invasion by oral cancer.

[Progress on photodynamic therapy in oral diseases].

Photodynamic therapy (PDT) has developed rapidly in basic and clinical research, and its therapeutic prospects have received increasing attention. PDT has the advantages of minimally invasive, low toxicity, high selectivity, good reproducibility, protection of appearance and vital organ function, and has become a treatment. With the development of medicine, the field of application of PDT becomes more wildly, and brings a new direction for the treatment of oral diseases. This article reviews the basic principles, treatment elements and research results of PDT in the treatment of oral diseases.

Advances on mechanism and treatment of salivary gland in radiation injury.

Oral squamous cell carcinoma (OSCC) is the most frequent tumour in head and neck malignant. The current treatment is mainly based on surgery therapy, radiation therapy and chemical therapy. Meanwhile, there are many a defect in the treatment. For example, there are many defects in radiotherapy. Radioactive salivatitis is the most common. In addition, there are a series of changes such as dry mouth, oral mucositis, rampant dental caries, and radioactive osteomyelitis of jaw, which cause swallowing, chewing problems, and taste dysfunction. Currently, the research on radioactive salivatitis is progressing rapidly, but its mechanism is more complication. This paper review aims to summarize the research progress in this field.

Baseline HbA1c Level Influences the Effect of Periodontal Therapy on Glycemic Control in People with Type 2 Diabetes and Periodontitis: A Systematic Review on Randomized Controlled Trails.

INTRODUCTION: The question of whether periodontal therapy is an effective strategy for achieving glycemic control in people with type 2 diabetes mellitus (T2DM) and periodontitis continues to be open to debate. To clarify this issue, we conducted a systematic review and meta-analysis. METHODS: A systematic literature search of randomized controlled trials (RCTs) was carried out by searching four electronic databases and four journals up to April 2020. RCTs that evaluated the effect of periodontal therapy on glycemic control in people with T2DM were included. RESULTS: A total of 23 RCTs were included in this systematic review and meta-analysis. We found that after 3 and 6 months, periodontal therapy could significantly reduce glycosylated hemoglobin (HbA1c) level (3-month: weighted mean difference [WMD] - 0.514, 95% confidence interval [CI] - 0.730, - 0.298, p = 0.000; 6-month: WMD - 0.548, 95% CI - 0.859, - 0.238, p = 0.000). However, huge heterogeneity existed. Further analyses on 11 potential sources of heterogeneity found that baseline HbA1c of the included studies was the most significant factor causing heterogeneity. The benefit of periodontal therapy on glycemic control was much more obvious in studies with a higher baseline HbA1c level than in those with a lower baseline HbA1c level. CONCLUSIONS: Periodontal therapy significantly contributed to glycemic control in T2DM patients, especially in patients with higher baseline HbA1c level.

Nerve growth factor protects salivary glands from irradiation-induced damage.

AIMS: Radiotherapy has become a basic treatment modality for head and neck cancer. However, radiotherapy results in inevitable side effects, particularly radiation sialadenitis, that significantly impairs quality of life. A previous study indicated that nerve growth factor (NGF) has a radio-protective effect, but the mechanism was not determined in salivary glands. In this study, we explored the functional role and mechanism regarding how NGF protects salivary glands against IR-induced damage. MAIN METHODS: Human salivary gland (HSG) cells and C57BL/6 mice were selected to establish an IR-induced salivary gland damage model in vitro and in vivo. Recombinant NGF protein and NGF siRNA and over-expression plasmids were applied to manipulate NGF expression in vitro. AAV-NGF was retrogradely perfused into the submandibular gland (SMG) through the SMG duct to manipulate NGF expression in vitro. Small-molecule inhibitors and siRNAs were applied to inhibit AKT and JNK. Western blotting, quantitative PCR, flow cytometry and histology assays were performed to analyse the functional role and mechanism of NGF. KEY FINDINGS: Our study demonstrated that NGF expression was upregulated following radiotherapy both in human HSG cells and mouse SMG tissues. NGF could reduce IR-induced HSG cell apoptosis, and AAV-mediated gene therapy could restore the salivary flow rate and protect the salivary gland against IR-induced apoptosis in vivo. Mechanistically, NGF protects salivary glands from IR-induced apoptosis by de-phosphorylating JNK kinase rather than promoting AKT phosphorylation. SIGNIFICANCE: The current study findings indicated that the modulation of the NGF pathway might prevent IR-induced salivary hypo-function.

Reconstruction of penetrated nasal defects with nasolabial skin flap pedicled on the infraorbital vessels.

Penetrated nasal defects involve complicated problems of reconstruction because they require a relatively larger volume of flaps and grafts as well as aesthetic needs. The nasolabial skin flap pedicled on infraorbital vessels was evaluated in this research. Sixteen patients underwent nasal defect reconstruction with nasolabial skin flap pedicled on the infraorbital vessels through the subcutaneous tunnel. All of the 16 flaps were viable, with a maximum area of 5.0 x 2.5 cm. The color and texture of the flaps were similar to those of surrounding skin of the recipient site. Thermal and tactile sensation of the flap proved satisfactory in all the patients. The scar of donor site was occulted, and the contour of the nose did not change after the operation. The nasolabial skin flap pedicled on the infraorbital vessels had many distinct advantages and was recommended for defect reconstruction as an adjacent axial flap.

[Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus].

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.

In Vitro and Clinical Studies of Gene Therapy with Recombinant Human Adenovirus-p53 Injection for Malignant Melanoma.

Malignant melanoma is an aggressive tumor with high fatality rates and poor prognosis, mainly due to the lack of efficient treatment methods. The present study investigated the potential antitumor effects of recombinant adenovirus p53 (rAd-p53) on human malignant melanoma. The optimal viral titer on a human malignant melanoma (A-375) cell line was determined for the rAd-p53 treatment. The invasive abilities, apoptosis, variations in the cell cycle, and molecular expression levels of A-375 cells were detected after infection by rAd-p53. A tumor growth curve and hematoxylin and eosin staining were carried out for experiments in nude mice. Twenty-one patients with malignant melanoma were evaluated, including 12 cases without gene therapy and nine cases with rAd-p53 gene therapy. The overall survival rate and the median survival time were analyzed between the two groups of patients. When the multiplicity of infection was 100, the cells showed the best transfection efficiency. The invasive ability, apoptosis, cycle changes of the cells, and the expression of the p53, p21, and Bax genes and proteins were significantly changed in the experimental group. In nude mice, the tumor growth curve and the tumor size in the experimental group were significantly smaller than those of the control group. Hematoxylin and eosin staining revealed tumor metastasis in the blank group and the control group but not in the experimental group. Between the two groups of patients, the median survival of the gene therapy group (38 months) was greater than that of the group without gene therapy (27 months). In this study, high expression of the p53 gene could regulate the gene expression and reduce the invasive and metastatic abilities of the tumor cells. Furthermore, rAd-p53 effectively improved the survival of patients with malignant melanoma. Therefore, rAd-p53 may be a potential treatment method for human malignant melanoma.

Clinical analysis of salivary gland tumor cases in West China in past 50 years.

In our study, 3461 cases of salivary gland tumor treated between 1955 and 2002 at West China Stomatology Hospital of Sichuan University were retrospectively analyzed, and compared with the previous reports. Measures such as age, tumor location, tumor histological type, and the nature of the growth (benign or malignant) were recorded at the same time. The findings are as follows: the average ages of salivary gland tumor patients were 41.38 years for the benign cases and 45.20 for the malignant ones; the male:female ratio was 0. 99:1 in the benign cases and 1.34:1 in the malignant ones; primary tumors were mostly in the parotid gland, palate and submandibular gland in sequence. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin's tumor and basal cell adenoma, whereas mucoepidermoid carcinoma, adenoid cystic carcinoma and adenocarcinoma not otherwise specified were the most frequent malignant tumors. The incidence of salivary gland tumors increased with age. The male:female ratio of malignant tumors was higher than that of benign ones. The parotid gland and palate were the most common locations of salivary gland tumors. Pleomorphic adenoma and mucoepidermoid carcinoma were the most frequent benign and malignant tumors, respectively.

Central malignant salivary gland tumors of the jaw: retrospective clinical analysis of 22 cases.

PURPOSE: As a review of central malignant salivary gland tumor cases in Southwest China in the past 20 years, this study provided the clinical, radiologic, and pathologic information of these rare lesions. PATIENTS AND METHODS: In our study, 22 cases of central malignant salivary gland tumor treated between 1986 to 2006 at West China Stomatology Hospital of Sichuan University were retrospectively analyzed. A thorough review of clinical records was carried out and the histologic diagnosis was revised using the 2005 WHO criteria. RESULTS: The average age of patients was 46.5 years old, and the peak incidence age of the tumors was in the fourth, fifth, and sixth decades. The male:female ratio was 0.47:1. The clinical manifestation included swelling of the jaw, pain, paraesthesia, tooth mobility, and pain. All the lesions were radiolucent regions with an ill-defined margin. The most frequent histologic type was the mucoepidermoid carcinoma. Local extensive resection of the primary focus was the primary treatment. CONCLUSION: Central malignant salivary gland tumors often occurred in the middle-aged patients, and there were more cases in the mandible than in the maxilla. The diagnosis should be based on the case history, clinical, pathologic, and radiologic examinations. The major treatment was extensive resection of primary focus.

Malignant sublingual gland tumors: a retrospective clinicopathologic study of 28 cases.

OBJECTIVES: To evaluate the clinicopathologic features and therapeutic efficacy of malignant sublingual gland tumors. PATIENTS AND METHODS: From 1955 to 2005, the clinicopathologic data of 28 patients treated in our hospital were obtained from their medical records and histopathologic slides. RESULTS: There were 16 males and 12 females, with a mean age of 50.3 years. Eighteen cases (64.3%) were adenoid cystic carcinoma; 16 (57.1%) cases were clinically staged as III-IV. Adenoid cystic carcinoma was mainly of the histologic type, and the other histologic classifications included mucoepidermoid carcinoma, myoepithelial carcinoma, polymorphous low-grade adenocarcinoma, adenocarcinoma and malignant pleomorphic adenoma. Pulmonary metastasis and tumor recurrence were the main death reasons. Eleven patients remain alive and well 34-312 months (median 108) after treatment. CONCLUSIONS: Malignant sublingual gland tumors are extremely rare and most are adenoid cystic carcinoma. Surgery is the main treatment option. For adenoid cystic carcinoma, hematogenous spread is common, and pulmonary metastasis is a common pathway of the distant metastasis. For some patients having lung metastasis, regional control is also important as there are some examples of patients surviving many years with asymptomatic pulmonary metastases. Postoperative radiation therapy may be adjuvant for selected patients with high-stage and high-grade tumors, or when there is concern about the inadequacy of the resection. The effect of chemotherapy remains elusive.

Historical and Clinical Experiences of Gene Therapy for Solid Cancers in China.

Based on the theoretical and clinical development of modern medicines, gene therapy has been a promising treatment strategy for cancer and other diseases. The practice of gene therapy is nearly 27 years old, since the first authorized gene transfer study took place at the National Institute of Health in 1989. However, gene therapy was not readily adopted worldwide, until recently. Several gene therapy clinical trials have been carried out in China since 1998, and medical research in China has flourished. In this report, we review the history of gene therapy in China, focusing on treatment protocol, the administration cycle, dosage calculation, and the evaluation of therapeutic effects, in order to provide more information for the additional development of this promising treatment strategy.