2008年 · 第121卷第19期

Oral cancer is designated as carcinomas of the oral mucosa and sometimes as carcinomas of the minor salivary glands in the oral cavity. Carcinoma of the lip should not be included。

Abstract：Background Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors. Methods We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed. Results In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants placed into the fibula bone grafts were 95% and 87%,respectively. The main reasons for failure of the dental implants were infection, tumor recurrence and soft tissue proliferation. The fibula flap presents many advantages for implant placement, but its limited height sometimes makes implant-supported prosthetic rehabilitation difficult. Conclusions Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view。

Abstract：Background β-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 β-catenin has been associated with progression and metastasis of various human cancers. The aim of this study was to elucidate the expression pattem of β-catenin in primary oral squamous cell carcinoma and examine the correlation between β-catenin expression and tumor differentiation, histological grade and lymph node status as well as its clinical significances.Methods Seventy-six patients with oral squamous cell carcinoma and sixteen metastatic lymph nodes were studied.The β-catenin expression was determined by immunohistochemical staining. The correlation with clinical, histological data was analyzed statistically.Results Normal oral epithelium showed strong β-catenin expression at the cell membrane, but no cytoplasmic or nuclear expression. Different degrees of reduced expression of β-catenin at the cell membrane were found in 54 cases with squamous cell carcinoma (71%). Cytoplasmic β-catenin expression was found in 17 tumors (22.4%). Three caseswere found with nuclear β-catenin expression. In sixteen lymph nodes with metastatic squamous cell carcinoma,negative β-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 β-catenin expression and lymph node status and histological grade of tumors.Conclusions Reduced β-catenin expression at the cell membrane is clearly associated with lymph node metastasis. A reduced expression of β-catenin may constitute a hallmark of aggressive biological behavior of squamous cell carcinoma。

Abstract：Background Researchers have recently demonstrated that thrombospondin-1 (TSP-1) has an important function in regulating neovascularization. Whether it inhibits or accelerates neovascularization, however, is still controversial. We found few reports about the correlation between TSP-1 and vascularization in mucoepidermoid carcinoma. In this research, the distribution and expression of TSP-1 in mucoepidermoid carcinoma were investigated. We also analyzed (1) the correlation between the expression of TSP-1 and microvessel density (MVD), as an indicator of neovascularization activity, and (2) the effect of TSP-1 on neovascularization and tumor growth in the subcutaneous xenotransplanted model of mucoepidermoid carcinoma.Method (1) The sites and intensity of expression of TSP-1 and the MVD were analyzed in 45 cases of mucoepidermoid carcinoma after surgery by the method of streptavidin-peroxidase (SP) immunohistochemistry; and (2) recombinant human thrombospondin-1 (rhTSP-1) was injected twice a week for five consecutive weeks around the tumor in the subcutaneous xenotransplanted tumor model of mucoepidermoid carcinoma in nude mice. Each week, the tumor size was measured, in order to draw the growth curve of the xenotransplanted tumor model of mucoepidermoid carcinoma,and MVD was measured.Results (1) The positive expression of TSP-1 protein was 57.78% (26/45). Most positive staining for TSP-1 was found in the cytoplasm of the cancer cells, while some staining occurred in the extracellular matrix. The mean MVD in 45 cases of mucoepidermoid carcinoma was 58.17±19.77 per 100 visual fields. Tumors with a high expression of TSP-1 showed a low MVD value, and the TSP-1 immunocompetence and microvessel density showed a significant negative correlation (r<,s>=-0.947, P<0.001). (2) The xenotransplanted tumors with the injection doses of 1.25, 0.75 and 0.25 μg/ml respectively were 36.97%, 53.36% and 73.61% of the size of the control group ((451±92), (651±113), (898±86) and (1220±157) mm<'3> respectively, F=53.167, P <0.001), and their weights were respectively 35.14%, 51.35% and 70.27% of the control group ((1.3±0.5), (1.9±0.5), (2.6±0.3), and (3.7±0.7) g respectively, F=62.669, P <0.001). Their MVDs were 25.00%, 45.93%,and 72.20% respectively of the control group and concentration dependent (15.43±3.45, 28.35±4.24, 44.57±3.35 and 61.73±5.43 per 100 visual fields respectively, F=-54.582, P <0.001).Conclusions The TSP-1 has a higher expression in mucoepidermoid carcinoma and the expression has a significant negative correlation with neovasculadzation. The TSP-1 inhibits neovascularization and tumor growth, and it might be a new biological therapy for treatment of patients with mucoepidermoid carcinoma。

Abstract：Background 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.Methods The human immortalized oral epithelial cells, which have been established through transfection of E6/E7 genasof human papillomavirus type 16 and proved to be non-tumorigenic in nude mice, were treated with benzo (a) pyrene.Tumorigenesity 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.Results 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.Concluslona 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。

Abstract：Background Oral squamous cell carcinoma (OSCC) is the most prevalent malignant tumor in the head and neck region,comprising more than 90% of all oral malignancies. A feasible approach for an animal model to study OSCC lymph node metastasis was established and biological behaviors of three oral squamous cell carcinoma cell lines were compared.Methods After implanting three kinds of call lines (GDC185, Tca8113, Tca83) into three different anatomical sites in nude mice, namely the tongue, floor of the mouth, and axillary fossa, we observed the tumorigenicity and the metastatic capacity, which was confirmed by histopathology under a surgical microscope.Results The animal model injected with GDC185 cells into the floor of the mouth had the highest rate of neck lymph node metastasis (55.6%) and the call lines had significantly different biological behaviors.Conclusions Nude mice injected with GDC185 cells into the floor of the mouth could be used as a feasible animal model to study neck metastasis of oral squamous cell carcinoma。

Abstract：Background In dental clinics, dentition defects are commonly restored with conventional porcelain-fused-to-metal fixedbridges. However, Ni-Cr alloy ceramic fixed bridges are known to have several drawbacks such as marginal coloration of the neck, low casting precision and, most seriously, poor biocompatibility. These problems could be circumvented by using noble metal ceramic bridges; however, one negative issue related to the conventional noble metal ceramic bridges is its high price due to the use of a large amount of gold for pontic. Therefore, an auro-galvanoforming ceramic bridge would be ideal to retain the advantages of a conventional material, yet reduce the amount of noble metal used. This study aimed to investigate whether any destructive changes occur to the auro-galvanoforming ceramic bridge under a fatigue cyclic loading test.Methods On standard models which the left maxillary first premolar is lost and with the cuspid teeth and the second premolar as the fixed bridge abutment teeth, six maxillary auro-galvanoforming ceramic bridges and six corresponding nichrome ceramic jointed crowns were made as group A, six nichrome ceramic bridges and six corresponding nichromeceramic jointed crowns were made as group B (control group). And then all specimens were fixed and tested on a fatigue cyclic loading machine; the changes occurring to the surfaces of occlusal contact with large functional area and to the porcelain-metal interfaces of the nichrome primary copings margins were observed through a scanning electron microscope (SEM).Results In 120 hours' continual observation, none of the specimens had porcelain coating fractures or scraping occurrence and all of the porcelain coatings had been kept intact under sinusoidal cyclic loading with the load range of 120-200 N and frequency of 5 Hz.Conclusions Auro-galvanoforming ceramic bridges exhibited excellent fatigue strength in the fatigue cyclic loading test and may satisfy the clinical demand in theory, while the practical application shall be evaluated by observations in long-term clinical usage。

Abstract：Background Gallbladder carcinoma is rare and associated with dismal outcomes. Radical surgery is the only curative treatment, and options for adjuvant therapy remain limited. This study aimed to determine the factors influencing outcome of treatment in patients with gallbladder carcinoma, and to identify the patients who might benefit from radical surgery and adjuvant therapy.Methods Medical records and follow-up histories of 150 patients with gallbladder carcinoma who had undergone surgery between April 1980 and December 2005 were retrospectively reviewed. The factors predictive for the survival of the patients were identified using multivariate analysis.Results Surgery for gallbladder cancer was associated with an overall 5-year survival rate of 26.2%. After curative resection (40% of the patients), the 5-year survival rate was 60.3%. The patients who underwent R0 resection had a significantly longer median survival (97.3 months) than those who had R1/R2 resection (8.3 months) or only laparotomy (3.7 months) (P <0.0001). Univariate analysis showed that resectability, American Joint Committee on Cancer staging,tumor grade, adjuvant therapy, jaundice at presentation, depth of tumor invasion, lymph node involvement, distant metastasis, and carcinoembryonic antigen level were statistically significant predictors for survival. Multivariate analysis revealed American Joint Committee on Cancer staging and resectability were independent prognostic factors for survival.The patients who underwent noncurative resection might benefit from adjuvant therapy (median survival, 12.4 months vs 7.2 months, P=0.006).Conclusions Favorable survival rate can be achieved after curative resection, even for selected patients with advanced disease. Adjuvant therapy may improve the survival of patients with gallbladder carcinoma。

Abstract：Background This study investigated the relationship between the height of osteotomy and the correction of the kyphotic angle during posterior closing wedge osteotmy with instrumentation and the spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach in thoracolumbar kyphosis, and using this relationship as the basis of the preoperative design.Methods From April 1996 to June 2007, 30 thoracolumbar kyphosis patients with complete medical records and clear X-ray photograms have undergone operation. Of these 30 cases, 16 cases underwent posterior closing wedge osteotmywith instrumentation while the height of the osteotomy and the correction of the angle have been measured; 14 casesunderwent spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posteriorapproach while the height of the osteotomy, the height and the place of the cage and the correction of the angle were also measured. A simple geometrical model was simulated to calculate the relationship between the height of the osteotomy and the correction of the angle and these results are finally compared with the data coming from the actual measuring by the Wilcoxon statistic method.Results The distribution of data from the 16 cases by posterior closing wedge osteotomy with instrumentation was as such: 9 male and 7 female, the mean age was 49.2 years (range 38-70), the kyphosis improved from an average of 30° (range 15°-45°) preoperatively to 4° (range -26°-30°) postoperatively, the kyphosis was corrected on average 2.5° per 1 mm in the height of the osteotomy. The results from the simple geometrical model were that the mean of the correction of the angle per 1 mm was 2.2°. As a result, there was no significant difference (P >0.05) when comparing the measurement collected with the result simulated from the geometric model. The distribution of data from the 14 cases by spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach was as such: 5 male and 9 female, the mean age was 35.3 years old (range 15-57), the kyphosis improved from an average of 64° (range 34°- 95°) preoperatively to 8.7° (range -10°- 22°) postoperatively. The kyphosis was corrected on average of 6.2° per 1 mm in the height of the psteotomy. The results from the simple geometrical model is that the mean of the correction of the angle per 1 mm was 6.6°. There was also no significant difference (P >0.05) when comparing the measurement collected with the result simulated from the geometric model.Conclusions The therapeutic effect is significant for both posterior closing wedge osteotomy with instrumentation and spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach.The posterior closing wedge osteotomy with instrumentation is an easier approach with the mean angle of the correction per 1 mm of 2.5° and the maximum angle of correction of 45°. The spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach is more efficient with the mean angle of correction per 1 mm of 6.2°. It should be reserved for the severe cases of thoracolumbar kyphosis. We can also use the formula to help us constructing preoperative design。

Abstract：Background With advances in pediatric keratoplasty over the last two decades, the success rate of surgery has increased remarkably. However, few epidemiological studies in this field have been performed in China. The present study investigated the indications and characteristics of pediatric penetrating keratoplasty in Shanghai.Methods All records of pediatric keratoplasty performed on 156 eyes in 149 children (<14 years) at four ophthalmic units in Shanghai during a 5-year period (2003-2007) were used for this retrospective study. Patients were from the Eye,Ear, Nose & Throat Hospital of Fudan University, Shanghai No.10 People's Hospital, Shanghai No.1 People's Hospital,and Shanghai Peace Ophthalmology Hospital; and included mostly school-age children (97 boys and 59 girls).Results The median age at surgery was 9 years with an interval quartile range of 6-12 years. Scarring after keratitis (29.5%, 46/156) and traumatic corneal scar (19.2%, 30/156) were the most common indications. Best Corrected Snellen visual acuity (BCSVA) was reported only in 72% (112/156) of cases. Visual acuity outcomes were significantly better for keratoplasty 1 year postoperatively compared to preoperative visual acuity (P=0.001). Of all patients, 13% (14/112) achieved a BCSVA of 6/18 or better. None of the indications was associated with a higher rate of failure compared to after 1 year follow-up.Conclusion We obtained valuable information on pediatric keratoplasty in Shanghai. There was no significant difference in graft survival rate among the two indications. Vision outcomes after corneal transplantation in Chinese children were significantly better compared with pre-operation status. In conclusion, corneal graft survival can be achieved in childhood。

Abstract：Background Normokalaemic periodic paralysis (normoKPP) is characterized by transient and recurrent myoasthenia,and some patients also show muscle stiffness induced by cold exposure (paramyotonia congenita, PMC). It is caused by a mutation in the muscle voltage gated sodium channel alpha subunit (SCN4A) gene. Due to the diversity of the clinical manifestations of patients, it is difficult for clinicians to differentiate some of patients with atypical normoKPP from those who suffer from other periodic paralysis and nondystrophic myotonia. So far, for normoKPP there are almost no ways to assist definite diagnosis besides genetic screening. This research was designed to evaluate an exercise test (ET) in confirming the diagnosis of normoKPP and in assessing the therapeutic effectiveness of some drugs on this disease.Methods ET, described by McMains, was performed on six subjects from a Chinese family, including four patients with overlapping disease of normoKPP and PMC caused by a mutation of SCN4A Met1592Val that is identified by genetic analysis and two normal control members. The change of compound muscle action potential (CMAP) was recorded.Besides the family, two patients were also tested during treatments with acetazolamide.Results All patients showed a slight increase in CMAP immediately after exercise, followed by an abnormal gradual decline, which reached its nadir 25-30 minutes after exercise. CMAP amplitude dropped by more than 40% in patients but less than 23% in controls. In the patients who received treatment with acetazolamide, the change of CMAP amplitude was less than 28% and, at any fixed times, less than pretreatment values.Conclusions The ET may be used as a predictive, easy and reliable method of diagnosing normoKPP under conditions without genetic screening help, and is an objective way to evaluate the therapeutic effectiveness. According to different response patterns, the ET may also be helpful in reducing the scope of genetic screening。

Abstract：Background 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.Methods 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.Results 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.Conclusions 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。

Abstract：Background 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.Methods 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 Iocoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group (chemotherapy plus Iocoregional treatment) versus the control group (Iocoregional treatment alone) and was presented as a point estimate with 95% confidence intervals (Cl).Results Eight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the Iocoregional relapse was 0.92 (0.70-1.22, 95%Cl), which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 (0.33-0.68, 95% Cl) and 1.28 (1.01-1.62, 95% Cl) respectively, which were both statistically significant.Conclusions Neoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on Iocoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival。

Abstract：Objective 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.Results The results show that oral and maxillofacial malignancies diagnosed at an eady 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.Conclusions 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。