Zhonglong Liu

Microvascular Reconstruction in Elderly Oral Cancer Patients: Does Diabetes Status Have a Predictive Role in Free Flap Complications?

PURPOSE Flap complications still present challenges in the field of microsurgical reconstruction. The aim of this study was to explore the role of diabetes mellitus in free flap prognosis in elderly patients (≥60 years) after oral tumor resection. PATIENTS AND METHODS The data of aged oral cancer patients who had undergone reconstructions with free flaps in our institution were gathered in this retrospective cohort study. The samples were classified into diabetic and nondiabetic groups. The predictive roles of diabetes status and other factors in free flap prognosis were analyzed. The primary outcome variable was the presence of flap complications, which was subdivided into major (requiring re-exploration or local surgery) and minor (dressing or drug treatment) groups. Major complications were defined as the second outcome variable. Univariate and multivariable analyses were used for data statistics. RESULTS A total of 309 patients (176 men [57%] and 133 women [43%]) aged 60 years or older were included in this study. There were 105 diabetic patients (34%) and 204 nondiabetic patients (66%). A total of 75 flap complications occurred during the perioperative period, with an overall incidence of 24.3% (44 diabetic patients [41.9%] and 31 nondiabetic patients [15.2%], P ≤ .001). The odds of susceptibility for flap complication development in elderly diabetic patients was 3.413 times that of nondiabetic patients (odds ratio, 3.413; P ≤ .001). Of 75 flap complications, 43 (13.9%) were deemed major complications (24 diabetic patients [22.9%] and 19 nondiabetic patients [9.3%], P ≤ .001). This statistical association was further confirmed by multivariate analysis (odds ratio, 2.885; P = .002). CONCLUSIONS Diabetes mellitus increases the risk of the development of free flap complications in elderly patients when dealing with oral reconstruction after tumor removal.

Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system

Osteoradionecrosis of the jaw is a common radiation-induced complication that may be observed in oral cancer patients. Several classifications and staging systems have been proposed for osteoradionecrosis of the mandible based on clinical symptoms, radiological findings, and/or the response to diverse treatments. However, none has been universally accepted because of their individual deficiencies. The aim of this study was to introduce a new clinical classification that can be applied to the treatment of osteoradionecrosis in an easier and more acceptable way, through a retrospective analysis of patients with osteoradionecrosis of the mandible. A review was conducted of 99 patients diagnosed with osteoradionecrosis of the mandible in the study institution between 2000 and 2013. A novel classification was established on the basis of bone necrosis and soft tissue defects. A new staging system with four different stages (stage 0, stage I, stage II, and stage III) is proposed. We believe that this new classification and staging system is easier and more acceptable for clinical evaluation than previous ones.

XL413, a cell division cycle 7 kinase inhibitor enhanced the anti-fibrotic effect of pirfenidone on TGF-β1-stimulated C3H10T1/2 cells via Smad2/4

Pirfenidone is an orally bioavailable synthetic compound with therapeutic potential for idiopathic pulmonary fibrosis. It is thought to act through antioxidant and anti-fibrotic pathways. Pirfenidone inhibits proliferation and/or myofibroblast differentiation of a wide range of cell types, however, little studies have analyzed the effect of pirfenidone on the mesenchymal stem cells, which play an important role on the origin of myofibroblasts. We recently found that pirfenidone had anti-proliferative activity via G1 phase arrest and cell division cycle 7 (Cdc7) kinase expression decrease in transforming growth factor-β1 (TGF-β1)-stimulated murine mesenchymal stem C3H10T1/2 cells. Pirfenidone also had inhibiting effect on the migration and α-SMA expression. Moreover, in this study we showed for the first time that Cdc7 inhibitor XL413 enhanced the anti-fibrotic activity of pirfenidone via depressed the expression of Smad2/4 proteins, and also prevented the nuclear accumulation and translocation of Smad2 protein. In conclusion, we demonstrated that pirfenidone inhibited proliferation, migration and differentiation of TGF-β1-stimulated C3H10T1/2 cells, which could be enhanced by Cdc7 inhibitor XL413, via Smad2/4. Combination with pirfenidone and XL413 might provide a potential candidate for the treatment of TGF-β1 associated fibrosis. It needs in vivo studies to further validate its therapeutic function and safety in the future.

Higher positive lymph node ratio indicates poorer distant metastasis–free survival in adenoid cystic carcinoma patients with nodal involvement

OBJECTIVE Extensive studies have been conducted to analyze adenoid cystic carcinoma (ACC) in the head and neck region. No research has been published focusing on ACC patients with cervical lymph node (LN) metastasis. The aims of current investigation were to summarize the clinical characteristics of ACC patients with LN metastasis (ACC-LNM) and to identify prognostic factors for tumor-related outcomes. MATERIAL AND METHODS A retrospective review was conducted with respect to ACC patients with nodal involvement between 2000 and 2013. The clinical variables and outcomes of these special cases were recorded and further analyzed. Metastasis-free survival and overall survival rate were calculated using the Kaplan-Meier method, and the log-rank test and Cox regression analysis were applied to identify the prognostic factors. RESULTS A total of 47 patients (34 male and 13 female) 32-77 years of age (mean: 54.6 years; median: 54 years) were analyzed in the current protocol. The recurrence-free survival (RFS), distant metastasis-free survival (MFS), and overall survival (OS) rate in all patients were 90.1%, 55.6%, and 60.1%, respectively. In univariate analysis, T stage, positive LN ratio, LN-involved section, and extracapsular spread were strongly associated with poorer MFS rate. The predictive roles of LN-involved section and surgical margin on the OS rate were also identified. In multivariate analysis, positive LN ratio and surgical margin were predictors for MFS and OS rate, respectively. CONCLUSIONS Positive LN ratio was strongly associated with distant metastasis. Comprehensive treatment should be performed in ACC patients with higher positive LN ratios. In addition, ideal surgical margin should be achieved to acquire better overall survival rate.

Radiation Induces Apoptosis and Osteogenic Impairment through miR-22-Mediated Intracellular Oxidative Stress in Bone Marrow Mesenchymal Stem Cells

Bone marrow mesenchymal stem cells (BMSCs) were characterized by their multilineage potential and were involved in both bony and soft tissue repair. Exposure of cells to ionizing radiation (IR) triggers numerous biological reactions, including reactive oxygen species (ROS), cellular apoptosis, and impaired differentiation capacity, while the mechanisms of IR-induced BMSC apoptosis and osteogenic impairment are still unclear. Through a recent study, we found that 6 Gy IR significantly increased the apoptotic ratio and ROS generation, characterized by ROS staining and mean fluorescent intensity. Intervention with antioxidant (NAC) indicated that IR-induced cellular apoptosis was partly due to the accumulation of intracellular ROS. Furthermore, we found that the upregulation of miR-22 in rBMSCs following 6 Gy IR played an important role on the ROS generation and subsequent apoptosis. In addition, we firstly demonstrated that miR-22-mediated ROS accumulation and cell injury had an important regulated role on the osteogenic capacity of BMSCs both in vitro and in vivo. In conclusion, IR-induced overexpression of miR-22 regulated the cell viability and differentiation potential through targeting the intracellular ROS.

Nomogram model to predict postoperative infection after mandibular osteoradionecrosis surgery

Osteoradionecrosis of the mandible (ORNM) is one of the most dreaded complications of radiotherapy. The poor healing capacity of soft tissue after radiation may lead to surgical failure. The current study was designed to identify prognostic factors for postoperative infection (PPI) and propose corresponding prophylaxis and intervention protocols. A retrospective study was conducted concerning ORNM patients from 2000 to 2015. A risk-stratification score and nomogram model were established to predict the risk of PPI. A total of 257 patients were analyzed, and the total incidence of PPI was 23.3% (60/257). In multiple logistic regression analysis, radiation dose

Ectopic congenital bronchogenic cyst accompanied by infection appearing in the cervical region of an elderly female patient: A case report

\geqslant

Neutrophil–lymphocyte ratio and intraoperative blood transfusion: independent prognostic factors of elderly patients with oral account

⩾80 Gy (versus <80 Gy, OR = 2.044, P = 0.035, 95% CI: 1.05–3.979), bilateral ORNM (versus unilateral, OR = 4.120, P = 0.006, 95% CI: 1.501–11.307), skin fistula (versus none, OR = 3.078, P = 0.040, 95% CI: 1.05–9.023), and implant utilization (versus none, OR = 2.115, P = 0.020, 95% CI: 1.125–3.976) were significantly associated with PPI. The susceptibility to PPI in patients with risk-stratification scores of 14–22 was 2.833 times that of patients with scores of 7–13, and 7.585 times that of cases defined as scores of 0–6. The discrimination capability of the nomogram model was estimated using a ROC curve with an AUC of 0.708, revealing potentially useful predictive abilities. In conclusion, current risk-stratification scores and nomogram models effectively predicted the risk of PPI in ORNM patients.