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.

Postoperative position change of fibular bone after reconstruction of maxillary defect using free fibular flap / 北京大学学报(医学版)

OBJECTIVE@#To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change.@*METHODS@#Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress.@*RESULTS@#A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.

Measurement of the weight and volume of submandibular gland in vitro / 北京大学学报(医学版)

OBJECTIVE@#To measure the weight and volume of normal submandibular gland by in vitro detection of glandular body, to compare with the measurement values of CT volume rendering to evaluate the consistency of the two methods, and to explore the related factors affecting the weight and volume of the submandibular gland.@*METHODS@#The patients who underwent neck dissection due to oral cancer and were confirmed with normal submandibular gland by postoperative histopathology in Peking University School and Hospital of Stomatology from May 2019 to January 2020 were collected in this study and divi-ded into 4 groups according to the age standards raised by the Society of Geriatrics Chinese Medical Association and WHO (2000) age standards. The submandibular gland was carefully dissected along with the capsule immediately after neck dissection. The weight and volume of submandibular gland were accurately measured by an integrated aseptic measuring device. The volume of submandibular gland was measured by CT volume rendering before operation and the consistency of the two methods was evaluated. The 95% confidence interval of the weight and volume of submandibular gland in the different groups of Chinese people, which were divided by gender and age, were calculated, and the correlation with age, gender, height, weight, body mass index (BMI) and other factors was analyzed.@*RESULTS@#The weight and vo-lume of submandibular gland were measured in 220 subjects. The average weight and volume of submandibular gland were (11.69±2.45) g and (11.55±2.41) cm3 respectively. The volume of submandibular gland measured by CT volume rendering ranged from 70% to 82% of that measured by in vitro detection of glandular body, and the correlation coefficient between the two methods was 0.976 (P < 0.05). The gender difference of weight and volume of submandibular gland existed in the groups of youth, middle-aged, young elderly and elderly groups, the values of males were obviously higher than those of females (P < 0.05). There was no gender difference of weight and volume of submandibular gland in the adolescent group (P > 0.05). The weight and volume of submandibular gland had a strong positive correlation with body height (P < 0.05), a weak positive correlation with body weight (P < 0.05), and no correlation with BMI (P > 0.05). The female's weight and volume of submandibular gland in the young elderly and elderly groups were significantly lower than those in the other three groups (P < 0.05).@*CONCLUSION@#The normal reference range of the weight and volume of submandibular gland in vitro were established in different age and gender groups of Chinese people. The volume of submandibular gland mea-sured by CT volume rendering was 70%-82% of that measured by in vitro detection of glandular body. The results of the two methods had a high degree of consistency. The weight and volume of submandibular gland were related to age, gender, body height and body weight.

Role and mechanism of muscarinic acetylcholine receptor in the regulation of submandibular gland secretion / 北京大学学报(医学版)

Muscarinic acetylcholine receptors (mAChRs), including M1-M5 subtypes, are classic receptors in regulating water, ion, and solute transport in salivary gland. Our work focuses on the studies on the expression pattern and function of mAChR in the submandibular gland (SMG), and the underlying mechanism involved in the mAChR-regulated secretion, together with the effect of parasympathectomy on the salivary secretion. Microvascular autotransplantation of SMG into the temporal fossa provides a continuous and endogenous source of fluids, and is currently an effective method for treating severe keratoconjunctivitis sicca. By using RT-PCR, Western blotting, and immunofluorescence, our data demonstrated that the expression of M1 and M3 subtypes were decreased in latent period in rabbit SMG autotransplantation model, whereas carbachol stimulation promoted the salivary secretion, as well as M1 and M3 expressions. By contrast, mAChRs were hypersensitive in epiphora SMGs, whereas atropine gel and botulinum toxin A application significantly inhibited the hypersecretion in both animal models and patients. Furthermore, the possible intracellular signal molecules involved in the mAChR-modulated salivary secretion were explored. Activation of mAChR upregulated the expression of aquaporin 5 (AQP5), the main transporter that mediated water secretion through transcellular pathway, and led to AQP5 trafficking from lipid rafts to non-lipid microdomain. Extracellular signal-regulated kinase 1/2 (ERK1/2) was involved in the mAChR-regulated AQP5 content. mAChR activation also modulated the expression, distribution, and function of tight junction proteins, and increased paracellular permeability. ERK1/2/β-arrestin2/clathrin/ubiquitin signaling pathway was responsible for the mAChR-regulated downregulation of tight junction molecule claudin-4. Cytoskeleton filamentous actin (F-actin) was also involved in the distribution and barrier function of epithelial tight junctions. Besides, endothelial tight junctions were opened by mAChR agonist-evoked salivation in the mice. Furthermore, parasympathetic denervation increased resting salivary secretion in the long terminrats and minipigs. Taken together, our work demonstrated that mAChR regulated saliva secretion via transcellular and paracellular pathways in SMG epithelium as well as tight junction opening in SMG endothelium. Modulation of mAChR might be a promising strategy to ameliorate SMG dysfunction.

Delayed diagnosis of oral squamous cell neoplasms at different sites / 北京大学学报(医学版)

OBJECTIVE@#To investigate the diagnostic delay of patients with oral squamous cell carcinoma by self-designed questionnaire to find out the significant influencing factors, so as to identify the influencing factors of the patient's delay and the risk of oral cancer.@*METHODS@#A total of 514 patients with primary oral squamous cell carcinoma were enrolled at Peking University School and Hospital of Stomatology from January 2014 to April 2016, including 334 men and 180 women, with a male to female ratio of 1.85:1. The youngest participant was 21 years old, with a maximum of 89 years and a median age of 57.6 years. The position of the disease according to International Classification of Diseases-10 (ICD-10) was divided into lip, buccal, gingival, retromolar, palate, floor of the mouth, tongue, and oropharynx. The age group is divided into 10 years. The level of education was divided into illiteracy, primary education level and advanced education level. Body mass index (BMI) was divided into three levels by 18 kg/m2 and 25 kg/m2. Visual analog scale (VAS) method was to evaluate the patient's preoperative pain. At the same time, the patients were examined by detailed questionnaire to understand the delay factors and delay characteristics, and use SPSS 18.0 software, analysis of variance and chi-square test to explore correlation.@*RESULTS@#Among all patients, the proportion of patients developed in the tongue was the highest (43.3%). Delay was defined by a span of three months or longer from the onset of symptoms until treatment. The delays to diagnosis according to location were as follows (in months and in descending order): lip (6.1 months), buccal (4.1 months), floor of the mouth (3.9 months), tongue (3.6 months), oropharyngeal (2.9 months), retromolar (2.7 months), palatine (2.4 months), and gingival (2.4 months). Different sites and delayed diagnosis were statistically significant (P=0.048). There were no statistically significant differences in gender, education, pain, smoking, drinking and VAS score.@*CONCLUSION@#The study has found that tumor positions and delay have a significant correlation. The position of the tumor is an obvious factor associated with the findings. The lip is the most likely to delay the diagnosis of oral positions. For the lip of the lesion, more than three months' obvious mass is recommended for timely treatment, while at admission, physicians should take the appropriate diagnostic method as soon as possible.

A 20-year study on microvascular autologous transplantation of submandibular gland for treatment of severe dry eye / 北京大学学报(医学版)

Severe dry eye is a refractory ophthalmologic disease. Our multidisciplinary research group treated severe dry eye by microvascular autologous transplantation of submandibular gland (SMG) during the past 20 years. The SMG, with its blood vessels and Wharton's duct, was harvested from the submandibular triangle and transferred to the temporal area. The blood vessels in the SMG were anastomosed with the temporal blood vessels using a microsurgical technique. Then, the distal end of Wharton's duct was sutured to form an opening in the upper lateral conjunctival fold. The tear was replaced by the secretion of the transplanted SMG to lubricate the ocular surface. In our study, the surgical techniques of blood vessel management were continuously modified to increase the survival rate of the transplanted SMG. A novel surgical modality of partial transplantation of SMG was established to prevent postoperative epiphora. A clinical study with the largest case number in the world was conducted and the effectiveness of transplantation of SMG for severe dry eye was fully confirmed. In order to resolve two main clinical problems including ductal obstruction resulted from low secretion rate during the latent period, and epiphora due to over secretion of the transplanted SMG in the later term of transplantation, the regulation of the secretion mechanism of the normal and transplanted SMG were investigated. New opinions on mechanisms of saliva secretion were provided. Based on the priniciple of translational medicine, the results of related basic research were applied in the clinic. The clinical guidelines for secretion regulation of transplanted SMG were established. A concept of chronic obstructive sialadenitis of transplanted SMG was provided and its diagnostic criteria, diagnostic technique of sialography, and therapeutic regimen were established. As a result, the surgical success rate was obviously elevated, the surgical complications were decreased, and life quality of the patients was greatly improved.

Microvascular autologous submandibular gland transplantation in severe cases of keratoconjunctivitis sicca / 대한악안면성형재건외과학회지

Dry eye syndrome is a relatively common disease of the tears and ocular surfaces that results in discomfort, visual disturbance, and tear film instability with possible damage to the ocular surfaces. Microvascular submandibular gland (SMG) transfer offers a surgical alternative for a permanent autologous substitution of tears using the basal secretion of a transplanted SMG. Long-term follow-up reveals that this technique is a lasting and effective solution for patients with severe dry eye syndrome. The uncomfortable symptoms were relieved, and the frequency of use of pharmaceutical tear substitutes was reduced. Objective examination showed significant improvement in tear film and some features of ocular surface such as breakup time of tear film and corneal staining. Patients may suffer from obstruction of Wharton's duct or epiphora after surgery. Activation of secretion-related receptors could improve the early hypofunction of the denervated SMG and prevent the duct obstruction. Reduction surgery, partial SMG transplantation, uses of atropine gel or Botulinum toxin A could be the choices of treatment for epiphora.

Preliminary clinic study on computer assisted mandibular reconstruction: the positive role of surgical navigation technique / 대한악안면성형재건외과학회지

BACKGROUND: The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. METHODS: Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. RESULTS: All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. CONCLUSIONS: The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.

Plate related complication after mandibular reconstruction / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the complications and factors associated with titanium plates in mandibular reconstruction with different methods.</p><p><b>METHODS</b>A retrospective analysis of 660 patients who received primary reconstruction of the mandible was conducted. The characters of the mandibular defect and methods of reconstruction were recorded. The complications and factors associated with the reconstruction were analyzed.</p><p><b>RESULTS</b>The majority of mandibular defect was in a shape of L (n = 324 ). The total complication rate was 14.7% (97/660), which included screw loosening 5.8% (38/660), plate fracture 3.3% (22/660), plate exposure 3.8% (25/660), infection 7.4% (49/660) and malunion or ununion 2.9% (19/660). The mandibular defects reconstructed by reconstructive plates had a higher complication rate than that by bone grafts. The complication rate was 10.8% (63/586) in cases reconstructed by bone grafts with miniplates. The complications were associated with radiation therapy and diabetes. Radiation therapy had a significant effect on plate exposure.</p><p><b>CONCLUSIONS</b>Reconstruction with bone grafts can minimize the rate of plate related complication. The complications were associated with radiation therapy and diabetes.</p>

Botulinum toxin A inhibits salivary secretion of rabbit submandibular gland / 国际口腔科学杂志·英文版

Botulinum toxin A (BTXA) has been used in several clinical trials to treat excessive glandular secretion; however, the precise mechanism of its action on the secretory function of salivary gland has not been fully elucidated. In this study, we aimed to investigate the effect of BTXA on secretion of submandibular gland in rabbits and to identify its mechanism of action on the secretory function of salivary gland. At 12 weeks after injection with 5 units of BTXA, we found a significant decrease in the saliva flow from submandibular glands, while the salivary amylase concentration increased. Morphological analysis revealed reduction in the size of acinar cells with intracellular accumulation of secretory granules that coalesced to form a large ovoid structure. Expression of M3-muscarinic acetylcholine receptor (M3 receptor) and aquaporin-5 (AQP5) mRNA decreased after BTXA treatment, and distribution of AQP5 in the apical membrane was reduced at 1, 2 and 4 weeks after BTXA injection. Furthermore, BTXA injection was found to induce apoptosis of acini. These results indicate that BTXA decreases the fluid secretion of submandibular glands and increases the concentration of amylase in saliva. Decreased expression of M3 receptor and AQP5, inhibition of AQP5 translocation, and cell apoptosis might involve in BTXA-reduced fluid secretion of submandibular glands.

Retrospective study of 93 patients with jaw osteoradionecrosis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical feature, treatment, and prognosis of hospitalized patients with jaw osteoradionecrosis.</p><p><b>METHODS</b>A total of 93 cases with jaw osteoradionecrosis treated between 2000 and 2010 was reviewed. Of the 93 cases, 79 cases were with mandible lesions, 13 cases with maxillary lesions, and 1 case with both mandible and maxillary lesions. Sixty-six cases received one course of radiotherapy, with the radiation doses of 34 - 90 Gy (mean 64.6 Gy). Twenty-two cases experienced tooth extraction or other operative procedures before exhibition of the clinical symptoms for osteoradionecrosis. The interval time between radiotherapy and the onset of osteoradionecrosis varied from 2 weeks to 32 years (mean 54 months).</p><p><b>RESULTS</b>Of 93 cases, 56 patients underwent radical resection of the pathologic bone and reconstruction with free tissue flaps, in whom 7 cases received the second surgery due to microvascular thrombosis in flap vessels, and flaps were survival by new vascular anastomosis in 3 cases, the failed flaps were removed and replaced successfully by non vascularized bone grafts in 2 cases, and the failed flaps removed and the defects were repaired with adjacent skin in other 2 cases. In the 56 cases, only one case was with disease recurrence and 53 cases with significant improvement in chewing and swallowing functions. Only 2 of 93 cases underwent resection of the pathologic bone and reconstruction with titanium plates, and thereafter they encountered titanium exposure. Scaling of osteoradionecrosis lesions was applied to 20 of 93 patients and 9 cases of them were with disease recurrence. Fifteen cases had resection of the effected mandible without reconstruction. Disease relapse was encountered in 2 of them, others had poor chewing and swallowing.</p><p><b>CONCLUSIONS</b>The mandible is more susceptible to osteoradionecrosis than maxilla. Radical resection with reconstruction by free tissue flap is recommended for the treatment of jaw osteoradionecrosis, and scaling and reconstruction only with titanium plate should be avoided because of high risks of titanium exposure and disease relapse.</p>

Ultrastructural study on the facial nerve of rabbit after (125)I seed implantation / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the ultrastructural variation of the facial nerve of rabbit with different dosage of (125)I seed brachytherapy.</p><p><b>METHODS</b>Fifty-four big ear rabbits were divided into 3 groups randomly and given 40 Gy, 80 Gy, 120 Gy respectively. Radioactive seeds were implanted in one side of parotid gland, the other side was implanted with vacant shell as a control group. The facial nerves were obtained 2, 4, 6 months respectively after operation and the histological ultrastructural changes observed by electromicroscope.</p><p><b>RESULTS</b>In the control group, epineurium was continuous, there was slight pitting edema under the epineurium, and axonal myelin was loose. In the test groups, there was slight pitting edema under the epineurium, and axonal myelin sheath was loose at 4th month. Macrophage and regenerated fibers were found in the 80 Gy group and myelin sheath lamellar separation, regeneration of nerve in the 120 Gy dosage. The myelin sheath lamellar was separated and axonal myelin loose in the test group at 6th month. Myelin sheath amellar separation and edema under the epineurium were found in the group of 80 Gy and 120 Gy.</p><p><b>CONCLUSIONS</b>The ultrastructure of the facial nerve is damaged by the dosage of 40 Gy, 80 Gy brachytherapy with (125)I seeds. The higher dosage the nerve receives, the more serious the damage will be. Both of the epineurium and axonal myelin sheath are integral and continuous 6 months after operation with dosage of 120 Gy.</p>

Effect of botulinum toxin-A on secretion of parasympathetic denervated rabbit submandibular gland / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of botulinum toxin-A (BTX-A) on secretion of parasympathetic denervated rabbit submandibular gland.</p><p><b>METHODS</b>Twenty-four rabbits were divided into 3 groups: control (n = 4), parasympathetic denervated submandibular gland (n = 4), and parasympathetic denervated submandibular gland with 5 U BTX-A injection (n = 16). Secretion flow was measured by Schirmer test. Composition of saliva was detected by biochemical method.</p><p><b>RESULTS</b>Secretion of parasympathetic denervated submandibular gland increased by 139.0% in rest time (P < 0.01), but decreased by 64.2% in feeding time (P < 0.01) compared with controls. Secretion of submandibular gland decreased in rest time 1, 2, 4, and 12 weeks after BTX-A injection compared with that of parasympathetic denervated submandibular gland without injection (P < 0.05), which was also the same in feeding time 1 and 2 week after injection (P < 0.05). The concentrations of amylase, sodium, potassium, chloride and protein of saliva were not changed after BTX-A injection.</p><p><b>CONCLUSIONS</b>BTX-A could decrease the secretion of parasympathetic denervated submandibular gland.</p>

Reliability of venae comitant of facial artery as the donor vein in microvascular autologous submandibular gland transfer / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To analyse the reliability of concomitant venae of facial artery as the donor vein in microvascular autologous submandibular gland transfer.</p><p><b>METHODS</b>One hundred and seventeen cases with severe keratoconjunctivitis sicca treated by microvascular transfer of autogenous submandibular gland transfer from August of 1999 to November of 2007 were reviewed. The cases were divided into three groups according to their different donor veins, with group A using facial veins, group B using concomitant venae of facial artery, and group C using a vein near the duct. Group A and B were compared in terms of venous thrombosis rate and failure rate related to venous thrombosis.</p><p><b>RESULTS</b>Among 117 cases, there were 122 sides of submandibular gland transfers, with 93 in group A, 27 in group B, and 2 in group C. Postoperative venous thromboses rate was 15% in group A and 7% in group B, with significant difference (P < 0.01). The failure rate of transferred gland related to venous thrombosis was 8% in group A, and 7% in group B, with no significant difference (P > 0.05).</p><p><b>CONCLUSIONS</b>Concomitant venae of facial artery can be used as reliable donor vein in microvascular autologous submandibular gland transfer.</p>

125I seed implant brachytherapy of recurrent parotid gland malignant tumor / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of radioactive seeds for the treatment of recurrence malignant parotid gland tumors.</p><p><b>METHODS</b>Thirty-three patients with recurrence malignant parotid gland tumor treated by radioactive seeds were retrospectively reviewed. Three patients received implanted radioactive seeds alone. Thirty patients underwent both tumor resection and radioactive seeds implanting. The patients were followed up for 1041 months.</p><p><b>RESULTS</b>All three patients receiving implanted radioactive seeds alone achieved CR Twenty-four patients treated by operation and radioactive seeds implanting had no local recurrence. The overall local control rate was 88%. The facial nerves were preserved in thirteen of fifteen patients without facial nerve palsy before treatment, and the facial nerve functioned well after operation. Four patients showed slight radiotherapeutic side effect.</p><p><b>CONCLUSIONS</b>Radioactive seeds implanting combined with operation or implanting radioactive seeds alone for the treatment of recurrent malignant parotid gland tumors could get good local control and treatment effects.</p>

Clinical analysis of 182 cases with facial nerve injury / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the recovery patterns and the influencing factors of facial nerve injury in maxillofacial surgery by retrospective analysis of a serial clinical data.</p><p><b>METHODS</b>A total of 182 patients with facial nerve injury were reviewed. The cause of injury, the initial facial nerve function after trauma, the treatment, the initial recovery time of facial nerve function and the total recovery time were recorded. The factors that influenced the outcome of facial nerve function were analyzed.</p><p><b>RESULTS</b>The facial nerve branch injury was common in maxillofacial injury. The injury pattern, location, age and reconstruction time all had effects on the function recovery of the facial nerve. Within 6 months, 45 of 49 (92%) anatomic injured patients completely recovered in 6 months; 53 of 59 patients (90%) began to recover when nerve had been ruptured. In 12 months, 33 of 35 patients (94%) after nerve anastomosed and 5 of 8 patients (62%) with nerve transplantation got complete recovery.</p><p><b>CONCLUSIONS</b>Preserving the facial nerve during surgery is very important. If the facial nerve is injured, reconstructive surgery should be applied as soon as possible.</p>

Application of near infrared spectroscopy in monitoring blood oxygen saturation of fibula flaps / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the change of tissue oxygen index (TOI) by non-invasive near infrared spectroscopy (NIRS) and to investigate the blood flow variety of fibula flaps after operation.</p><p><b>METHODS</b>Thirty-six patients who accepted fibula flap reconstruction were chosen as subjects. Authors measured the TOI of the fibula flaps and the control side every four hours in the first twenty-four hours, and measured these positions with the intermittence of twelve hours from second to eighth day after operation.</p><p><b>RESULTS</b>Thirty-five flaps were successful and one failed. The TOI of fibula flaps shortly after operation was significantly lower than that before the operation( P<0.05). In the successful cases the TOI of fibula flaps and the control sides was fluctuated from 50.0% to 72.0%. The TOI of fibula flaps was significantly lower than that of the control sides within 144 hours after operation(P<0.05). After 144 hours the TOI was equal to that of the control side. TOI of the failed case decreased dramatically.</p><p><b>CONCLUSIONS</b>NIRS can reliably indicate the change of TOI in buried flaps and detect ischemia at the early stage. The TOI of the fibula flaps depress at the early stage and returns to normal at 144 hours after operation.</p>

Preliminary study of treating parotid gland malignant tumor with saving facial nerve (surgery associated with 125I seed implant brachytherapy) / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the clinical effect of treating parotid gland malignant tumor with facial never-preserving surgery combined with 125I seed implant brachytherapy.</p><p><b>METHODS</b>Thirty-two patients with parotid gland malignancy underwent tumor and parotid gland excision while preserving facial never. According to treating plan system (TPS), 125I seeds were implanted into the target area during or after operation. The patients were followed up after operation and the local tumor control and facial nerve function were observed.</p><p><b>RESULTS</b>Tumor recurrence was not found in any patient treated after 12 to 44 months of follow up. All patients did not show obvious radiation-related complications. The facial never function of all patients was basically normal 6 months after operation.</p><p><b>CONCLUSIONS</b>For parotid gland malignant tumor, surgery combined with 125I seeds implant brachytherapy can save facial nerve function, and the short-term effects were satisfactory.</p>

beta-catenin expression pattern in primary oral squamous cell carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Beta-catenin, a 92 kDa protein that binds to the cytoplasmic tail of E-cadherin, has an essential role in intercellular adhesion and signal transduction. Aberrant expression of beta-catenin has been associated with progression and metastasis of various human cancers. The aim of this study was to elucidate the expression pattern of beta-catenin in primary oral squamous cell carcinoma and examine the correlation between beta-catenin expression and tumor differentiation, histological grade and lymph node status as well as its clinical significances.</p><p><b>METHODS</b>Seventy-six patients with oral squamous cell carcinoma and sixteen metastatic lymph nodes were studied. The beta-catenin expression was determined by immunohistochemical staining. The correlation with clinical, histological data was analyzed statistically.</p><p><b>RESULTS</b>Normal oral epithelium showed strong beta-catenin expression at the cell membrane, but no cytoplasmic or nuclear expression. Different degrees of reduced expression of beta-catenin at the cell membrane were found in 54 cases with squamous cell carcinoma (71%). Cytoplasmic beta-catenin expression was found in 17 tumors (22.4%). Three cases were found with nuclear beta-catenin expression. In sixteen lymph nodes with metastatic squamous cell carcinoma, negative beta-catenin expression at the cell membrane was seen in 13 tumors (81.2%) and weak expression in 3 tumors (18.8%). Statistical analysis showed that there was an inverse correlation between beta-catenin expression and lymph node status and histological grade of tumors.</p><p><b>CONCLUSIONS</b>Reduced beta-catenin expression at the cell membrane is clearly associated with lymph node metastasis. A reduced expression of beta-catenin may constitute a hallmark of aggressive biological behavior of squamous cell carcinoma.</p>

Establishment of submandibular gland allotransplantation model in miniature swine / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Autologous transplantation of the submandibular gland (SMG) into the temporal fossa with microvascular anastomosis has been successfully applied in severe xerophthalmia patients as a permanent tear substitute. However, severe xerophthalmia can be accompanied by salivary gland dysfunction, making such autotransplantation unsuitable. Therefore, SMG allotransplantation might be a solution. The aim of this study was to assess the technical feasibility of submandibular gland allotransplantation.</p><p><b>METHODS</b>Twelve miniature swine were randomized to serve as donors or recipients. One SMG was transplanted between a donor and a recipient. The donor SMG was revascularized by microvascular anastomosis of its vascular pedicle to the recipient lingual artery and external jugular vein. The secretory duct was implanted into the vestibule of the mouth through a subcutaneous tunnel. No immunosuppressive agent was administered. The results were assessed by visual inspection of the secretion, and histopathological examination of the transplanted SMG.</p><p><b>RESULTS</b>Technically, all surgical procedures were successful. Clear secretion flowed out of the duct as soon as blood supply of the transplanted submandibular gland was reestablished. The secretion of the gland lasted for 5 days. As expected, an acute rejection reaction occurred after surgery because no immunosuppressive agents were used. Secretion from the transplanted SMG ceased within 5 days.</p><p><b>CONCLUSIONS</b>A model of SMG allotransplantation can be established in miniature swine. The technique of submandibular gland allotransplantation is feasible.</p>