Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus / 华西口腔医学杂志

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.

CD133 selected stem cells from proliferating infantile hemangioma and establishment of an in vivo mice model of hemangioma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Infantile hemangioma (IH) is the most common benign tumor in children with prevalence in the face and neck. Various treatment options including oral propranolol have been described for IH, but the mechanism of drugs remains enigmatic. The aim of this study was to investigate the pathogenesis and establish a reliable in vivo model of IH which can provide platform for drug exploration.</p><p><b>METHODS</b>Stem cells from the proliferating hemangiomas (HemSCs) were isolated by CD133-tagged immunomagnetic beads. Their phenotype and angiogenic property were investigated by flow cytometry, culturing on Matrigel, real-time polymerase chain reaction (PCR), immunofluorescent staining and injection into BALB/c-nu mice.</p><p><b>RESULTS</b>HemSCs had robust ability of proliferating and cloning. The time of cells doubling in proliferative phase was 16 hours. Flow cytometry showed that HemSCs expressed mesenchymal markers CD29, CD44, but not endothelial/hematopoietic marker of CD34 and hematopoietic marker CD45. The expression of CD105 was much lower than that of the reported hemangioma derived or normal mesenchymal stem cell (MSC). Real-time PCR showed that the mRNA levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and matrix metalloproteinase-1 (MMP-1) of HemSCs were higher than that of neonatal human dermal fibroblasts (NHDFs) and human umbilical vein endothelial cells (HUVECs). After HemSCs were cultured on Matrigel in vitro, they formed tube-like structure in a short time (16 hours) and differentiated into endothelial cells in 7 days. After 1 - 2 weeks of implantation into immunodeficient mice, HemSCs generated glucose transporter 1 positive blood vessels. When co-injected with HUVECs, the vascularization of HemSCs was greatly enhanced. However, the single implantation of HUVECs hardly formed blood vessels in BALB/c-nu mice (P < 0.05).</p><p><b>CONCLUSIONS</b>HemSCs may be some kinds of primitive mesoderm derived stem cells with powerful angiogenic ability, which can recapitulate human hemangioma by co-injecting into immunodeficient mice with HUVECs.</p>

Time trend analysis of incidence rate for nasopharyngeal carcinoma in urban Shanghai YANG / 中华流行病学杂志

Objective To explore the secular trend of incidence for nasopharyngeal carcinoma (NPC) in urban Shanghai during 1973-2005. Methods The incidence data from the population-based cancer registries in Shanghai was used in our analysis. We calculated the crude incidence rates, age-adjusted incidence rates, trucated rates and cumulative rates of NPC. The annual percentage change (APC) was used as an estimate of the secular trend. Results Over 33 years, a total of 7889 incident NPC cases in urban Shanghai were registered for 5555 males and 2334 females, respectively. The incidence of NPC had remained stable in males during the period (APC=-0.250%, P= 0.340), but a decreasing trend was observed in females with an average reduction of -1.577% (P=0.000) per year. During the period of 1973-1976 to 2001-2005, the crude incidence rates changed from 4.56 to 6.18 and from 3.96 to 2.41 per 100 000 in males and females, and the age-adjusted rates from 4.12 to 3.96 and from 2.18 to 3.42 per 100 000 in males and females, respectively. Conclusion From 1973 to 2005, the incidence of NPC was stable in males while having a decline in females, indicating that further epidemioiogical study and prevention for NPC should be addressed.

Experience and thinking on establishing fine course of oral and maxillofacial surgery / 上海第二医科大学学报

Objective To explore the practical ways on establishing fine course of oral and maxillofacial surgery effectively. Methods Relying on the advantages of the discipline,great efforts had been made in step-by-step enhancement of the quality of teachers,teaching contents,teaching methods and administration. Results Through the establishing of fine course,we could improve the curriculum system,enhance the force of education team,and improve the quality of education. Conclusion Establishing fine course of oral and maxillofacial surgery depends on the environment of sharing educational resources,adjusting the curriculum system and establishing an excellent educational team.

Occult cervical lymph node metastases in 100 consecutive patients with cN0 tongue cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Squamous cell carcinoma (SCC) of the tongue is one of the most common cancers in the oral and maxillofacial region. To provide clinical evidence for selective neck dissection in management of cN0 patients by analyzing the characteristics and correlation of factors of occult cervical lymph node metastases (OCLNM) in patients with SCC of the tongue.</p><p><b>METHODS</b>From 2002 to 2006, 100 consecutive patients with SCC of the tongue were reviewed by analyzing the characteristics of OCLNM, diameter of the tumor, T classifications, depth of invasion, forms of growth, pathological grade and degree of differentiation.</p><p><b>RESULTS</b>The rate of OCLNM in 100 patients with SCC of the tongue was 22%. The most common region with OCLNM was level II in the ipsilateral neck, followed by levels I and III. There were 51.61% (16/31) of OCLNM in level II and 87.10% (27/31) of OCLNM in levels I - III. There was no significant correlation between the diameter of tumor and OCLNM (P > 0.05). OCLNM was statistically significantly correlated with the depth of invasion, forms of growth, pathological grade and degree of differentiation (P < 0.05). The rate of occult metastases increased with the increased pathological grade, the decreased degree of differentiation and the increased depth of invasion.</p><p><b>CONCLUSIONS</b>The most common regions with OCLNM in cN0 patients with SCC of the tongue were levels I - III in the ipsilateral neck. Supraomohyoid neck dissection should be the elective treatment to the neck in patients with cN0 SCC of the tongue by consideration of the clinical and pathological factors for the depth of invasion, forms of growth, pathological grade, and degree of differentiation.</p>

Benzo (a) pyrene induced tumorigenesity of human immortalized oral epithelial cells: transcription profiling / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The present study was designed to examine and analyze the global gene expression changes during the tumorigenesis of a human immortalized oral epithelial cell line, and search for the possible genes that may play a role in the carcinogenesis of oral cancer associated with benzo (a) pyrene.</p><p><b>METHODS</b>The human immortalized oral epithelial cells, which have been established through transfection of E6/E7 genes of human papillomavirus type 16 and proved to be non-tumorigenic in nude mice, were treated with benzo (a) pyrene. Tumorigenicity of the treated cells were examined through nude mice subcutaneous injection. The global gene expression profiles of immortalized cells and the tumorigenic cells were acquired through hybridization of a microarray of Affymetrix U133 plus 2.0. The data were analyzed using Spring 7.0 software and treated statistically using one-way analysis of variance (ANOVA). The differentially expressed genes were classified using a Venn diagram and annotated with gene ontology. Several highlighted genes were validated in cells using a real-time polymerase chain reaction.</p><p><b>RESULTS</b>There were 883 differentially expressed genes during the tumorigenesis and most of them changed expression in the early stage of tumorigenesis. These genes mainly involved in macromolecule metabolism and signal transduction, possessed the molecular function of transition metal ion binding, nucleotide binding and kinase activity; their protein products were mainly integral to membranes or localized in the nucleus and cytoskeleton. The expression patterns of IGFBP3, S100A8, MAP2K, KRT6B, GDF15, MET were validated in cells using a real-time polymerase chain reaction; the expression of IGFBP3 was further validated in clinical oral cancer specimens.</p><p><b>CONCLUSIONS</b>This study provides the global transcription profiling associated with the tumorigenesis of oral epithelial cells exposed to benzo (a) pyrene; IGFBP3 may play a potential role in the initiation of oral cancer related to benzo (a) pyrene exposure.</p>

Neoadjuvant chemotherapy of cisplatin and fluorouracil regimen in head and neck squamous cell carcinoma: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas (HNSCC) still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil (PF) regimen in enhancing the overall survival of and decreasing locoregional relapse and distant metastasis in HNSCC patients.</p><p><b>METHODS</b>Medline and manual searches were performed to identify all published randomized controlled trials (RCTs) investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included locoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group (chemotherapy plus locoregional treatment) versus the control group (locoregional treatment alone) and was presented as a point estimate with 95% confidence intervals (CI).</p><p><b>RESULTS</b>Eight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the locoregional relapse was 0.92 (0.70 - 1.22, 95% CI), which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 (0.33 - 0.68, 95% CI) and 1.28 (1.01 - 1.62, 95% CI) respectively, which were both statistically significant.</p><p><b>CONCLUSIONS</b>Neoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on locoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.</p>

Combined and sequential treatment of oral and maxillofacial malignancies: an evolving concept and clinical protocol / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To introduce the concept and rational regimens and present the latest development of combined treatment of oral and maxillofacial malignancies. Data sources The related published literature was searched through the CNKI database and MEDLINE using the terms of oral cancer, oral and maxillofacial malignancies, combined and sequential therapy, multidisciplinary approach. Study selection The available related literature was read and evaluated. Studies that met the inclusion criteria were selected.</p><p><b>RESULTS</b>The results show that oral and maxillofacial malignancies diagnosed at an early stages (stages I and II) can be well treated with surgery alone and/or radiotherapy with optimal outcome, but advanced or recurrent diseases should be treated with rational combined and sequential treatment modalities. The use of concomitant chemoradiotherapy, taxane-containing, three-drug induction regimens and Cetuximab in combination with chemotherapy or radiotherapy demonstrated favorable results in previously untreated patients with head and neck squamous cell carcinoma.</p><p><b>CONCLUSIONS</b>The concept of combined and sequential treatment of advanced oral and maxillofacial malignancies should be widely accepted, and the rational regimen for individual and each type of entity should be determined based on the anatomical site and the patient's performance status.</p>

Dynamics of hippocampal sensory gating during the chronic morphine administration, withdrawal and re-exposure to morphine in rats / 生理学报

Drug addiction is considered as a chronic, recurrent brain disease characterized by relapse. Repeated exposure to certain drugs, such as morphine, can produce deleterious sequelae, such as drug dependence, tolerance and compulsive drug seeking. In the present study, we investigated the dependence and psychological craving for morphine in rats using the conditioned place preference (CPP) paradigm. On the other hand, to study the effect of morphine on hippocampal sensory gating (N40), double click auditory-evoked potential was recorded during the chronic morphine administration, withdrawal and re-exposure to morphine in rats. The rats in morphine group received a course of morphine (10 mg/kg, i.p.) injection for 12 d, followed by 12 d of withdrawal, 1 d of re-exposure to morphine (2.5 mg/kg, i.p.) and 2 d of the second withdrawal. The rats in the control group were treated in the same way except that saline was applied instead of morphine. CPP test demonstrated that the method of drug administration in the present study induced dependence and psychological craving for morphine in rats. The results in the double click auditory-evoked potential experiment showed that during the chronic morphine administration, hippocampal N40 gating was damaged. In the initial 2 d of the first withdrawal hippocampal N40 gating in morphine group was reduced compared with that in the control group and it was significantly greater on the 3rd day, and then recovered gradually to the normal level from day 4 to day 12. After re-exposure to morphine, hippocampal N40 gating in morphine group was significantly reduced compared with that in the control group, and it remained at a lower level during the following 2 d, suggesting that hippocampal N40 gating in rats was more sensitive to morphine during re-exposure. Our results suggest that long-term repeated morphine administration and re-exposure to morphine disrupt hippocampal N40 gating, and that the effect of morphine addiction on the brain is possibly long-term.

The establishment of conditional MT transgenic mice model / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To construct the doxycycline-inducible MT transgenic mice model, and provide a basis for the study of hemangioma as well as MT molecular function in vivo.</p><p><b>METHODS</b>Tetracycline-controlled expression systems were employed to this study. A conditional transgenic vector combining the two transcriptional units on a single plasmid was constructed, and the MT gene was subcloned into this vector. To minimize any potential interference, the two elements were spaced with a 1.2 kb cHS4 insulator. To shield the transgene from the affection of chromosomal position effect and improve its expression efficiency, another cHS4 insulator was inserted into the upstream of transgene cassette. After transient transfection of cells in vitro, and analyzing the relative quantification of MT transcripts (target) in mRNA samples by semi-quantitative RT-PCR method, the pronuclear microinjection technique was used to introduce the purified transgene into the chromosomes of fertilized mice eggs, in order to obtain transgenic positive animals. The MT expression in positive mouse was induced through adding deoxycycline in drinking water. Phenotype analysis was done by pathology, and MT expression was confirmed by RT-PCR.</p><p><b>RESULTS</b>The conditional transgenic vector was constructed successfully, and the expression of MT in vitro was regulated by doxycycline. Five transgenic positive mice were obtained through pronuclear microinjection. After MT induction, one transgenic mice developed hemangiomas, and the expression of MT was confirmed by RT-PCR method. The others were active and in breeding.</p><p><b>CONCLUSION</b>Conditional MT transgenic animal model was constructed successfully, and may provide platform for the experimental research of hemangioma as well as the MT molecular function in vivo.</p>

Auditory evoked potentials recorded in monkeys with hallucinatory-like behaviors induced by bromocriptine / 神经科学通报·英文版

Objective Bromocriptine and other dopamine D2 receptor agonists can affect a range of behaviors in nonhuman primates, particularly those behaviors associated with motor and mental function, such as suppressant behaviors and hallucinatory-like behaviors in monkeys. Besides bromocriptine, the dysfunction of the rapid eye movement sleep (REM) mechanism may also contribute to hallucinations. Dissociation of wakefulness, REM, and non-REM (NREM) can cause a series of psychotic symptoms. Methods We simultaneously recorded auditory evoked potentials (AEP) from five cerebral regions in monkeys during normal and psychotomimetic states to investigate and compare state-dependent changes in AEP. Results Phase reversal of peak-to-baseline amplitude of 250 ms component (PBA250) in dorsolateral prefrontal cortex was common characteristic of hallucinatory-like and REM, and that hallucinatory-like and REM shared the equivalent modulatory orderliness of the PBA250 in dorsolateral prefrontal cortex. This result suggests that hallucinatory-like and REM share an equivalent electrophysiological modulatory in dorsolateral prefrontal cortex. Conclusion These results reveal that emergence of the N250 in dorsolateral prefrontal cortex is an exclusive marker that may help to discern whether hallucinatory-like behaviors is exhibited, which suggests that dorsolateral prefrontal cortex may be the most pivotal region for exhibition of hallucinatory-like behaviors.

Surgery of the carotid artery: a retrospective study of 35 consecutive cases / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To retrospectively analyze a single institution's experience with surgery of the carotid artery performed as part of an oncological procedure and emergency hemostasis, with the aim to determine the preoperative methods for evaluation of cerebral circulation, selection of surgical procedures and perioperative complications.</p><p><b>METHODS</b>From January 1999 to December 2004, a total of 35 patients underwent carotid artery surgery including repair of carotid artery in 7 cases, ligation or resection of carotid artery in 17 cases, and reconstruction of carotid artery in 11 cases. All the patients were evaluated for blood flow in the circle of Willis with DSA, DSA plus TBO plus SPECT, and TCD and followed up from 4 months to 4 years. The perioperative complications and surgical outcomes were recorded and analyzed.</p><p><b>RESULTS</b>There were 16 carotid body tumors, 1 malignant carotid body tumor, 17 malignant tumors involving the carotid artery and 1 traumatic arterio-venous fistula. Twenty-seven patients underwent carotid occlusion test, 10 were positive and 17 were negative (tolerable). Of 7 cases with repair of the carotid artery, 1 patient died of uncontrolled bleeding due to rupture of the anastomosis, and the remaining was uneventful. Of 17 cases with ligation or resection of the carotid artery, 4 developed neurologic deficit 2 weeks postoperatively. Three patients with malignant tumors died 1 month, 4 months, and 4 months postoperatively, respectively. One patient with carotid artery body tumor complained of inarticulate speech 4 months after operation; another patient complained of incapability and limited movement of the ipsilateral upper limbs; 5 patients complained of dizziness 4, 6, 12, 24 and 48 months postoperatively. Of 11 patients who underwent carotid reconstruction, no major cerebral complications were noted after operation. One patient died of recurrence, 1 patient with carotid body tumor complained inarticulate speech and incapability of the contralateral limbs, the remaining was uneventful. Color Doppler showed patent vascular graft 1 year postoperatively.</p><p><b>CONCLUSIONS</b>TBO plus SPECT is a reliable method for evaluation of the circle of Willis currently. The short term and long term complications of ligation of carotid artery are high, therefore, resection and revascularization of the carotid artery is advocated for carotid artery tumors when possible.</p>

Carotid body tumor: a retrospective study of 26 consecutive cases / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To study the clinical features, diagnoses and operative intervention of carotid body tumors.</p><p><b>METHODS</b>The medical records of 26 patients with carotid body paragangliomas between 1993 and 2004 were retrospectively reviewed.</p><p><b>RESULTS</b>Two of twenty-six patients had bilateral tumors. One patient had malignant tumors with cervical lymph nodes metastases. Twenty-one patients were evaluated with a preoperative angiography. No preoperative embolization was performed. Eleven patients underwent ultrasonography, nine had CT scan of the neck, five had magnetic resonance imaging. Twenty-six patients were all operated. Vascular reconstruction was performed in five cases. The ligation of carotid artery was carried out in four cases and another patient had vagus nerve resection. No death and recurrence occurred in all cases.</p><p><b>CONCLUSION</b>Angiography and ultrasonography are valuable in the diagnosis of carotid body tumor. Surgical removal should be made early to avoid the possibility of eventual metastasis and progressive local invasion. The pattern of operation should be chosed according to the relation of tumor and carotid.</p>