Computed tomography-defined sarcopenia as a risk factor for short-term postoperative complications in oral cancer patients with free flap reconstruction: A retrospective population-based cohort study.

BACKGROUND: Postoperative complications after free flap reconstruction for oral cancer can increase cost and prolong hospitalization. This study explored risk factors for complications, focusing on sarcopenia. METHODS: The study explored the associations between computed tomography-defined sarcopenia and the occurrence of postoperative complications, adjusted for age, gender, smoking, alcohol, ASA scoring, clinical stage of tumor, tumor site, type of free flap used, presence of tracheotomy, and blood test parameters. RESULTS: Of 253 patients, 17.39% (44/253) of oral cancer patients had comorbid sarcopenia. Univariate analysis showed an overall postoperative complication rate of 65.90% in the sarcopenia group and 51.67% in the non-sarcopenia group. Multivariate modeling showed sarcopenia and smoking were major risk factors for total and respiratory complications, increasing the risks by over two-fold. No factors significantly impacted surgery-specific complications. CONCLUSIONS: This study identified sarcopenia as a risk factor for postoperative complications in oral cancer patients undergoing flap reconstruction.

Factors associated with follow-up attendance of patients with oral squamous cell carcinoma: A retrospective cohort study.

BACKGROUND: This study examined the postoperative follow-up attendance of oral squamous cell carcinoma (OSCC) patients, evaluated some of the factors associated with it, and assessed its relationship with early detection of postoperative disease progression. METHODS: An exploratory retrospective cohort study of 430 OSCC patients was conducted. We examined associations of follow-up attendance within the first year after surgery with selected demographic and clinical factors, and with early detection of disease progression. RESULTS: The mean number of follow-up visits within the first year after surgery was 3.9 out of the 12 recommended at our center; few patients were fully adherent. Age ≥70 years, unmarried status, high education level, and negative history of surgery for premalignant or malignant lesions from oral cavity or other sites were significantly associated with lower follow-up attendance. Greater follow-up attendance was significantly associated with early detection of disease progression during the first year after surgery (p = 0.025). CONCLUSIONS: Adherence to follow-up visits was poor. Several sociodemographic and clinical factors were related to follow-up attendance, greater follow-up attendance was significantly associated with early detection of disease progression, and these should be further explored in future research.

Factors affecting postoperative sleep quality of patients undergoing flap transfer for head and neck reconstruction.

OBJECTIVES: This study aimed to examine the postoperative sleep quality of patients undergoing flap transfer for head and neck reconstruction and to identify the associated factors. MATERIALS AND METHODS: We carried out a prospective cohort study of patients who underwent flap transfer for head and neck reconstruction at our institute between August 2020 and December 2021. The insomnia severity index (ISI) was used to examine the patients' sleep quality at postoperative week 1. Patients with an ISI score ≥ 15 were recognized as suffering from significant clinical insomnia. Descriptive statistics was used to expound the postoperative sleep quality. Associations between postoperative sleep quality and clinical variables were examined using the Chi-squared test and a Binary logistics regression model to identify the associated risk factors. RESULTS: Among the 101 patients included, their average ISI score was 15.6 (range 2-25), and 62 patients (61.4%) experienced significant clinical insomnia. Anxiety (odds ratio = 8.361; 95% confidence interval: 1.001-69.837; P = 0.049) and postoperative complications (odds ratio = 6.285; 95% confidence interval: 1.941-20.351; P = 0.002) were significantly associated with postoperative insomnia of the included patients. CONCLUSION: Postoperative sleep disturbances are highly prevalent among patients undergoing flap transfer for head and neck reconstruction, for which anxiety and postoperative complications are independent risk factors. Psychotherapy is necessary for patients with anxiety symptoms and measures should be taken to minimize the postoperative complications. Moreover, pain treatment is necessary to improve postoperative sleep quality and quality of life.

Comprehensive co-expression analysis reveals TMC8 as a prognostic immune-associated gene in head and neck squamous cancer.

The occurrence and prognosis of head and neck squamous cell cancer (HNSC) is closely associated with human papillomavirus (HPV) infection. Transmembrane channel-like 8 (TMC8) is a key gene affecting the susceptibility of HPV and that plays an important role in T cell regulation. However, the mechanism by which TMC8 affects T cells and whether it further affects the prognosis of patients with HNSC remains unclear. In the present study, oral cancer cell lines and independent tumor specimens were used to detect TMC8 expression in HNSC. Differential expression of TMC8, methylation status, function and associated signaling pathways were further analyzed. Then, multiple databases were cross-analyzed for the relationship of TMC8 with immune cell infiltration and its impact on the prognosis of numerous types of cancer. The results showed that TMC8 was upregulated in HNSC and high expression was predictive of an improved prognosis. Furthermore, TMC8 was concentrated in multiple immune-associated signaling pathways and the expression of TMC8 was associated with the infiltration of CD4+ T cells and their subsets, including CD8+ T cells, B cells and macrophages, suggesting that TMC8 may play an anti-HPV role by regulating CD4+ T cells. Thus, TMC8 plays an anti-HPV role by regulating the infiltration level of CD4+ T cells, and could therefore be used as a potential prognostic marker for patients with HNSC.

Factors Affecting Volume Change of Anterolateral Thigh Flap in Head and Neck Defect Reconstruction.

PURPOSE: The anterolateral thigh flap (ALTF) volume will decrease over time after surgery. We measured and identified the risk factors for postoperative volume changes in the ALTF. MATERIALS AND METHODS: We designed and performed a retrospective cohort study of patients who had undergone reconstruction of oral and maxillofacial defects using ALTFs at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2012 to December 2018. We measured the volume of the ALTFs at 1, 3, 6, 12, and 24 months postoperatively; the flap volume at 1 month postoperatively was taken as the baseline. The primary outcome variables were the residual ALTF rates at 3, 6, 12, and 24 months postoperatively, defined as the ratio between the present volume at each month and at baseline. The primary predictor variables were the clinical variables that might be associated with ALTF volume loss. Descriptive and bivariate statistics were computed, and the P value for statistical significance was set at ≤ .05. RESULTS: The sample included 70 subjects with a mean age of 53.8 years (46 men and 24 women). The postoperative residual rates at 3, 6, 12, and 24 months were 72.3, 69.0, 67.9, and 68.7%, respectively, of the baseline volume. The use of postoperative radiotherapy (P < .01) and low body mass index (BMI; P = .006) were significantly associated with postoperative ALTF volume loss. CONCLUSIONS: The results of the present study suggest that ALTF volume shrinkage mainly occurs within 6 months postoperatively and that postoperative radiotherapy and a low BMI are risk factors for volume loss. Overcorrection should be performed to account for the shrinkage of ALTFs, and postoperative nutrition management is important to avoid ALTF volume loss.

[Flipping moxibustion of Hui medicine at acupoints in governor vessel combined with acupuncture for vascular dementia].

OBJECTIVE: To observe the difference for vascular dementia among flipping moxibustion of Hui medicine at acupoints in governor vessel combined with acupuncture, simple Hui medicine and simple acupuncture. METHODS: A total of 120 patients with vascular dementia were randomly assigned into a combination group, a flipping moxibustion group and an acupuncture group, 40 cases in each one, with 2 patients dropping respectively. Flipping moxibustion was used at the acupoints of group A on Monday and at the acupoints of group B on Friday in the flipping moxibustion group. The acupoints of group A were Baihui (GV 20), Dazhui (GV 14), Shenzhu (GV 12), Zhiyang (GV 9), Jizhong (GV 6), Mingmen (GV 4), Yaoyangguan (GV 3), and the acupoints of group B were Fengfu (GV 16), Taodao (GV 13), Shendao (GV 11), Jinsuo (GV 8), Xuanshu (GV 5), Changqiang (GV 1). Acupuncture was used in the acupuncture group at the main acupoints of Baihui (GV 20), Sishencong (EX-HN 1), Neiguan (PC 6), Zusanli (ST 36), Taixi (KI 3) and Xuanzhong (GB 39), matched with the acupoints based on syndrome differentiation, 30 min a time, once a day, continuous 5 times a week. The above two methods were applied in the combination group. All the treaments were for 4 weeks. The indexes were observed before and after treatment, including syndrome differentiationof TCM scale for vascular dementia (SDSVD), simple mental state scale (MMSE), self-care ability of daily life scale (ADL). The clinical effects and safety were evaluated. RESULTS: After treatment, the total effective rate in the combination group was 89.5% (34/38); the rate in the flipping moxibustion group was 65.8% (25/38); the rate in the acupuncture group was 63.2% (24/38). The difference among groups was statistically significant (P<0.05). The effect in the combination group was better than those in the flipping moxibustion group and in the acupuncture group (both P<0.05). There was no statistically significant difference between the flipping moxibustion group and the acupuncture group (P>0.05). The SDSVD scores after treatment were lower and the MMSE and ADL scores after treatment were higher than those before treatment in the three groups (all P<0.01), with better results on the above three scores in the combination group than those in the other two groups (P<0.05, P<0.01), and the differences on the three scores between the flipping moxibustion group and the acupuncture group were not statiatically significant (all P>0.05). The treatment in the three groups was safe, without stastical significance (P>0.05). CONCLUSION: The effect of flipping moxibustion combined with acupuncture for vascular dementia is better than those of simple flipping moxibustion and simple acupuncture. The combination treatment achieves better effect on TCM syndrome, cognitive function and daily activity ability than the other two simple treatment.

[Flipping moxibustion of Hui medicine combined with western medication for rheumatoid arthritis with cold dampness bi syndrome].

OBJECTIVE: To compare the effects of flipping moxibustion of Hui medicine combined with western medication and simple western medication for rheumatoid arthritis with cold dampness bi syndrome. METHODS: Eighty patients were randomly assigned into an observation group and a control group, 40 cases in each group. Oral methotrexate (1 time a week) and sulfasalazine (twice a day except the day for methotrexate) were used in the two groups. Patients in the observation group were treated with flipping moxibustion of Hui medicine, twice a week. The main acupoints were Shenshu (BL 23), Guanyuan (CV 4), Zusanli (ST 36), Yinlingquan (SP 9), and the matching acupoints were in the meridians related to the disease location. All the treatment was given for continuous 4 weeks. The TCM symptom score, visual analogue scale (VAS) score, blood sedimentation (ESR), rheumatoid factor (RF) and C-reactive protein (CRP) were observed before and after treatment. The effect was evaluated. RESULTS: The total effect rate in the observation group was 95.0% (38/40), which was better than 77.5% (31/40) in the control group (P<0.05). After treatment, the VAS score, TCM symptom score, RF, ESR, CRP levels decreased in the two groups (all P<0.05), with better effects in the observation group (all P<0.05). The adverse reactions in the observation group were lower than those in the control group. CONCLUSION: Flipping moxibustion of Hui medicine combined with western medication for rheumatoid arthritis with cold dampness bi syndrome are better than simple western medication, which are safer and more effective.