AbstractBackgroundNo study has evaluated the impact of regimen on recurrence, metastasis and survival in patients with adenoid cystic carcinoma (ACC). The present study aimed to compare the efficacy of radioactive seed implantation and other regimens in treating ACC, so as to investigate the clinical applicability of radioactive seed implantation and determine the indications for this regimen.MethodsA total of 188 patients with ACC in oromaxillofacial region were allocated to four groups according to the treatment regimen: group 1 was treated with a combination of surgery and 125I seed therapy, group 2 with a combination of surgery and external radiotherapy, group 3 with surgery, whereas group 4 was untreated. The Kaplan–Meier method was used to assess the survival rates, and the Cox regression analyses were used to identify the associated prognostic factors.ResultsThe overall survival rates of 188 patients and groups 1, 2, 3 and 4 were 85.7%, 75%, 68.2% and 37.5%, respectively. Cox regression analysis revealed that age, T stage, N stage and regimen were independent prognostic factors of survival. Amongst patients with primary ACC, the efficacy of radioactive seed implantation was higher in those with perineural invasion than in those without.ConclusionPatient age, T stage, N stage and regimen are independent prognostic factors of survival in patients with ACC. Patients treated with surgery combined with postoperative 125I seed radiotherapy have a higher overall survival rate, and those with perineural invasion are more suitable for radioactive seed implantation therapy.

目的:通过探讨头颈部腺样囊性癌(adenoid cystic carcinoma,ACC)的临床特点,分析影响其生存、复发、转移等预后的因素.方法:回顾性收集 2010 年 1 月—2020 年 12 月在山东第一医科大学附属省立医院口腔颌面外科就诊的188 例腺样囊性癌患者的临床资料,进行门诊或电话随访,采用SPSS 26.0 软件包中的Kaplan-Meier法评估生存情况,应用Cox回归分析对其相关预后因素进行分析.结果:188 例患者总体生存率为 76.6%,其中因复发死亡 13.3%,远处转移死亡 10.1%.复发率 23.9%,转移率 10.1%.其中复发患者生存率 42.2%,转移患者生存率为 68.4%.Cox回归分析结果显示,年龄、肿瘤原发灶大小、区域淋巴结转移和治疗方式为影响患者生存率的预后因素.结论:患者年龄、T分期、N分期和治疗方式为影响腺样囊性癌患者生存率的预后因素,患者年龄、神经侵犯为影响腺样囊性癌患者复发的预后因素,患者N分期为影响腺样囊性癌患者转移的预后因素.

目的:对在2019冠状病毒病(corona virus disease 2019,COVID-19)流行期间,山东省立医院口腔颌面外科收治的恶性肿瘤患者的一般情况、收治流程、感染防控措施与治疗方法进行总结和分析,为制订新型冠状病毒流行期间的口腔颌面外科恶性肿瘤的治疗规范提供参考.方法:收集2020-02-01—2020-02-28山东省立医院口腔颌面外科收治的所有恶性肿瘤病例,对患者情况进行统计分析,并探讨疫情期间口腔颌面外科恶性肿瘤患者的处置流程与治疗要点,以及其流行病学特点和意义.结果:21例恶性肿瘤患者中男性12例,女性9例;18～40岁3例,40～65岁11例,>65岁7例;T1期患者9例,T2期患者8例,肿物术后复发等其他情况者4例;黏液表皮样癌1例,腺样囊性癌2例,鳞状细胞癌15例,病理未分型3例;10例患者接受手术治疗,5例患者接受化疗,1例患者拒绝手术并要求出院,5例患者等待手术.诊疗期间无任何患者发生新型冠状病毒感染.结论:COVID-19疫情期间,口腔颌面外科恶性肿瘤患者以鳞状细胞癌为主,中老年患者比例较大.收治口腔颌面部恶性肿瘤患者时,应做好医院感染防控措施.综合分析病情,选取最适宜的治疗方案,尽量减少创伤,缩短手术时间.围手术期间,主管医师必要时要与医院管理部门及感控专家组联系,以控制感染概率.

目的:探讨微血管吻合器在腓骨肌皮瓣重建颌骨缺损中的应用效果.方法:22例腓骨肌皮瓣在修复口腔颌面部术后缺损中应用微血管吻合器用于静脉端-端吻合,共用32个吻合器.结果:微血管吻合器适用于腓骨肌皮瓣的静脉端-端吻合,平均吻合时间为3.5～9 min,明显缩短了手术时间.皮瓣均移植成功,未出现危象或血栓.结论:微血管吻合器在腓骨肌皮瓣重建颌骨缺损中吻合质量可靠,可明显缩短手术时间,具有较高的临床应用价值.

Objective To discuss the effect of electronic bronchoscopy comprehensive therapy in the diagnosis and treatment of glottis and subglottic stenosis after intubation in children.Methods The records of 28 children diagnosed as glottis and subglottic stenosis after intubation by bronchoscopy in Qilu Children's Hospital of Shandong University from January 2012 to January 2015 were reviewed.They all had the neck and chest CT,bronchoscopic diagnostics,and received comprehensive treatment of laser,forceps,balloon angioplasty under electronic bronchoscopy,preoperative and postoperative evaluation was performed according to the improvement of respiratory status and endoscopic findings.All patients were followed up for 6-12 months.Results These 28 children were successfully extubated,and inspiratory dyspnea,hoarseness,and other symptoms were improved,endoscopic narrowest part was widened by 6-12 months of follow-up,including 17 cases reached clinical cure,about 6 times per patient;7 cases were successfully extubated and still in follow-up currently;2 cases of neonatal infants were extubated successfully,but they had vocal congestion,edema,glottis narrow fissure without special intervention,and were under clinical observation currently;2 cases gave up treatment because of the other problems.All patients had no serious bleeding,respiratory insufficiency or other complications.Conclusions Electronic bronchoscopic comprehensive treatment is an effective and safe method to treat glottis and subglottic stenosis after intubation in children.

BACKGROUND: The expression of Bcl-2/adenovirus E1B 19 kDa-interacting protein3 (BNIP3) has been explored in many human malignancies, but not in adenoid cystic carcinoma (ACC). OBJECTIVE: This study investigated the clinical significance of expression of BNIP3 in ACC tissues and cells and elucidate d its correlations to hypoxia-induced autophagy. METHODS: Immunohistochemical and immunofluorescence staining were used to explore BNIP3, HIF-1α and LC3 expression. RESULTS: BNIP3 was positively expressed in 41 cases (63.1%), and was significantly correlated with histological grade (P= 0.001). HIF-1α was positively expressed in 52 cases (80.0%) and was significantly correlated with TNM stage (P= 0.023) and histological grade (P= 0.024). LC3 was positively expressed in 37 cases (56.9%) and was significantly correlated with TNM stage (P= 0.019). The expression of BNIP3 was correlated with HIF-1α expression (P= 0.011). The overall survival in the negative BNIP3 expression group tended to be better than in the positive BNIP3 expression (P= 0.011). In vitro experiment, BNIP3 immunofluorescence staining was detected in cells treated with CoCl2 (for hypoxic condition). CONCLUSIONS: The data indicated that BNIP3 plays a vital role in the tumorigenesis of adenoid cystic carcinoma and could be a new target for gene therapy of adenoid cystic carcinoma.

Objective:To evaluate the clinical value of microvascular anastomotic devices in free antebrachial flap anasto-mosis in the reconstruction of oral and maxillofacial defects. Methods: From April 2013 to May 2014, 22 pieces of mi-crovascular anastomotic advices were applied in 19 patients with oral and maxillofacial defects. The length of anastomosis time, patency rate, flap survival rate, and complications were observed and recorded. Result:In 19 patients, microvascular anastomotic devices were applied in 19 veins and 3 arteries with shorter anastomosis time. The flap survival and vascular anastomosis patency rate was 100%. No intra- and post-operative complications associated with microvascular anastomotic devices were observed. Conclusion:This paper provides an evaluation of the applicable foreground on the effectiveness of microvascular anastomotic devices.

Objective To investigate the efficacy and safety of integrated interventional treatment for children with endobronchial tuberculosis by electronic bronchoscopy.Methods From January of 2011 to August of 2014,45 cases(31 boys and14 girls)were enrolled,their age ranged from 4 months to 12 years old.On the basis of the conventional anti-tuberculosis treatment in all the patients,electrocoagulation under the bronchoscopy was performed,together with laser,refrigerant or balloon expansion.The tracking observation of curative effect and adverse reaction were observed.Based on the main symptoms of patients after treatment,and the conditions of chest imaging,bronchoscopy,the lesion repair,airway mucosa,lumen patency,therapy efficacy were evaluated.All patients underwent 6-12 months follow-ups.Results Among 45 cases of endobronchial tuberculosis in children,there were 9 cases suffering from ulcers and cheese necrotic changes (20.0％),granulation proliferative changes in 8 cases,accounting for 17.8％,stenosis scar changes in 7 cases(15.5％);44 mixed cases (97.8％) were observed under the microscope,of which 20 cases had tuberculosis lesions by bronchial biopsy,and of them acid-fast staining was positive in 12 cases (60.8％) confirmed by bronchoscopy combined with anti-tuberculosis treatment,and they received 8 to 13 times of treatment,32 cases were markedly effective,accounting for 71.1％,10 cases were effective,accounting for 22.2％;3 cases lost follow-up,and the total efficiency was 93.3％;all patients had no pneumothorax,pulmonary secondary infection,hemoptysis and other adverse reactions.Conclusions In addition to conventional anti-tuberculosis treatment,local comprehensive interventional treatment under the bronchoscopy can effectively remove cheese-like necrosis and reduce granulation hyperplasia and relieve the airway obstruction,promote the absorption of lesions and atelectasis recovery.The therapy is safe and reliable and worth of clinical application.

Objective. This study investigated the clinical significance of Shp2 protein expression in oral squamous cell carcinoma (OSCC) and elucidated its biologic significance in OSCC cells.Study Design. A total of 88 OSCC cases were used to assess Shp2 expression, out of which 70 were for immunohistochemistry and 18 paired tumors vs normal tissues were for Western blot of Shp2 expression. OSCC cells were used to assess the effects of Shp2 knockdown for cell viability, apoptosis, invasion, and protein expressions.Results. Expression of Shp2 protein was significantly upregulated in OSCC tissues compared with the normal tissues, and Shp2 overexpression was associated with advanced tumor clinical stages and lymph node metastasis ex vivo. Knockdown of Shp2 expression in vitro inhibited OSCC cell viability and invasion but induced apoptosis by regulating expression of the apoptosis-related proteins.Conclusions. The data indicated that Shp2 may play an important role in OSCC progression. Further studies will investigate whether a target of Shp2 expression could be a novel therapeutic strategy for clinical control of OSCC.

Reversion-inducing cysteine-rich protein with Kazal motifs (RECK), a glycosylphosphatidylinositol-anchored glycoprotein, inhibits the enzymatic activities of certain matrix metalloproteinases (MMPs). RECK has been studied in numerous human tumors, but the expression of RECK in salivary adenoid cystic carcinoma (SACC), and its correlation with patient prognosis, has never been investigated thus far. In the present study, the expression of RECK and MMP-2 was evaluated in two ACC cell lines and in 83 patients with SACC. The results of quantitative polymerase chain reaction and western blot analysis revealed that the ACC-2 and ACC-M cell lines expressed RECK and MMP-2 mRNA and protein. The immunohistochemical staining in the patients demonstrated that positive expression of RECK and MMP-2 was observed in 21/83 (25.3%) and 69/83 (83.1%) cases, respectively, and that RECK expression was significantly associated with the tumor-node-metastasis stage, histological grade and perineural invasion of patients with SACC (P<0.05). Furthermore, there was a significant association between the positive expression of RECK and that of MMP-2 (P<0.0001). Univariate and multivariate analyses confirmed that a lack of RECK expression was an independent and significant factor for the prediction of a poor prognosis. In conclusion, RECK is a promising prognostic marker and potential therapeutic agent in SACC.

Although cisplatin (DDP)-based adjuvant chemotherapy is widely used in the treatment of salivary adenoid cystic carcinoma (SACC), SACCs have developed resistance to cisplatin, resulting in chemotherapy failure. Autophagy serves as a critical adaptive response, which was increased in tumor cells in chemotherapy. However, the function of autophagy is not clear in SACC. In this study, apoptosis induced by DDP in SACC high metastatic cell line (ACC-M) was revealed using MTT assay, flow cytometry, and caspase-3 immunoblotting. The autophagy activation induced by DDP treatment was measured by transmission electron microscopy, green fluorescent protein-light chain 3 plasmid transfection LC3 immunoblotting and p62 immunoblotting. 3-methyladenine (3-MA) or small interference RNA targeting beclin 1 (beclin 1 siRNA) inhibited autophagy and significantly enhanced DDP-induced apoptosis. ACC-M xenografts in nude mice further verified the synergistic effect of DDP and 3-MA. In conclusion, autophagy activation was caused to protect cancer cells from DDP-induced apoptosis and autophagy inhibition could be a promising strategy for adjuvant chemotherapy in SACC.

PURPOSE: To study the expression of autophagy related beclin1 in salivary adenoid cystic carcinoma and discuss its relationship with clinicopathological features and prognosis of salivary adenoid cystic carcinoma(SACC).METHODS: The expression of beclin1 in 79 SACC cases and 20 samples of adjacent salivary gland tissues was detected by immunohistochemical staining method,correlation between beclin1 expression and the clinicopathological features in SACC was analyzed.SPSS 16.0 software package was used for statistical analysis.RESULTS: The expression of beclin1 in SACC was significantly higher than that in adjacent salivary gland tissues(P<0.05).In SACC,the degree of beclin1 expression was significantly related to histological grade(P<0.05).The beclin1 expression was greatly reduced in grade 1 and grade 2 SACC compared with that in grade 3.CONCLUSION: Beclin1 expression significantly correlates with the clinicopathological characteristics of SACC.It may serve as a valuable marker for diagnosis and an indicator for prognosis of ACC.

Autophagy is the endogenous cellular pathway that facilitates cellular survival by maintaining energy homeostasis and macromolecular synthesis during cellular stress and nutrient deprivation. Endoplasmic reticulum (ER) stress is the process in which disruption of these physiological functions leads to an accumulation of unfolded proteins and induces the unfolded protein response (UPR). ER stress and autophagy are involved in human cancer. We investigated the expression of autophagic proteins (LC3 and beclin 1) and ER stress-related protein (GRP78) in head and neck adenoid cystic carcinoma tissue. Tissue samples from 79 cases of head and neck adenoid cystic carcinoma tissue were utilized for immunohistochemistry. LC3 expression was significantly correlated with lymph node involvement (P=.016) and TNM (P=.021). Beclin 1 expression was significantly correlated with the histological growth pattern (P=.002), the histological grade (P=.000), and longer survival (P=.000). GRP78 expression was significantly correlated with the histological growth pattern (P=.019), the histological grade (P=.019), and longer survival (P=.001). LC3 expression was positively correlated with beclin 1 expression (P=.000); LC3 and beclin 1 expressions were positively correlated with GRP78 expression respectively (P=.035) (P=.008). Our study describes the expression of LC3, beclin 1, and GRP78 in adenoid cystic carcinoma and its relationship with clinicopathologic factors and overall survival. These results suggest that LC3, beclin 1, and GRP78 may play an important role in the tumorigenesis of adenoid cystic carcinoma, and that beclin 1 and GRP78 may serve as new prognostic indicators for the outcome of patients with adenoid cystic carcinoma.

对63例单侧唇裂术后鼻唇畸形患者进行二期手术整复。认为单侧唇裂术后鼻唇畸形复杂,应根据其病理解剖特点,灵活选用鼻翼软骨复位悬吊、软骨移植等,调整鼻孔过大或过小,应用牙槽裂植骨、调整唇高、重建口轮匝肌功能及修复唇部畸形。恢复鼻唇部关系协调、双侧对称是治疗的重要原则。

2001年8月～2005年8月,我们采取不用手术方式对58例颌骨缺损患者进行了修复重建,效果良好.现报告如下.临床资料:本组58例患者中,男38例,女20例;年龄11～66岁.恶性肿瘤42例(牙龈癌21例,颌骨肉瘤10例,中央性颌骨癌11例),良性肿瘤16例(成釉细胞瘤13例,颌骨黏液瘤2例,角化囊肿1例).肿瘤切除术后上颌骨缺损6例,下颌骨缺损52例.

Objective: To investigate the feasibility of custom-made forearm flap in the restoration of oral defects. Methods: 40 cases of oral defects were restorated by custom-made forearm flaps. In the custom-made flap, subcutaneous fasial tissue containing radius artery and cephalous vein might be larger than superficial cutaneous area. Flaps were checked 1 week, 3 months, and 6 months postoperatively. Results: 3 flaps terminated necrosis; 6 flaps appeared obese and interfere with oral function. Conclusion: Custom-made forearm flap with larger area of subcutaneous fasial tissue including radius artery and cephalous vein is a safe one in the restoration of oral defects.

目的:分析口腔颌面部游离组织瓣移植的临床效果及可能发生的问题。方法:2001年1月-2005年6月应用前臂皮瓣、背阔肌皮瓣及腓骨肌皮瓣3种游离组织瓣修复口腔颌面部组织缺损91例,总结其成活情况、患者外形、功能恢复情况及术后的各种并发症,并分析影响成功的各种因素。结果:91例病例中有7例组织瓣坏死,组织瓣总体成活率为92.3%。绝大多数组织瓣成活的病例均达到了术前所预测的功能与外形,患者满意率达92.8%。影响其成功的主要因素为术后血管危象及术后感染,前者与血管吻合技术、血管情况、组织瓣及血管蒂的放置处理密切相关;其他疾病如高血压、冠心病、糖尿病与组织瓣的成活情况无明显关系。结论:3种组织瓣的移植整体上是安全可靠,且效果良好的,对口腔颌面部游离缺损的修复有很大应用价值。