Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

Objective:To evaluate the role of ERBB2 interacting protein (Erbin)in liver tissues in blood coagulation of septic mice.Methods:Thirty SPF healthy male C57BL/6 mice and 30 Erbin knockout mice, aged 8-10 weeks, weighing 20-30 g, were divided into wild-type+ sham operation group (WT+ Sham group), wild-type+ sepsis group (WT+ SEP group), Erbin gene knockout+ sham operation group (EKO+ Sham group) and Erbin gene knockout+ sepsis group (EKO+ SEP group) by a random number table method, with 15 animals in each group. The mouse sepsis model was prepared by the cecal ligation and perforation method in anesthetized animals. Eye blood samples were collected at 24 h after surgery and liver tissues were obtained for microscopic examination of histopathological changes (by HE staining) which were scored and for determination of plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities (by colorimetry), expression of Erbin and tissue factor (TF) (by Western blot), expression of tissue plasminogen activator (t-PA) and fibrinogen (Fib)mRNA (by quantitative polymerase chain reaction), concentrations of PT, APTT, thrombin time (TT) and Fib (by automatic coagulation analyzer), and plasma TF and interleukin-6 (IL-6) concentrations (by enzyme-linked immunosorbent assay).Results:Compared with WT+ Sham group, the lung injury score was significantly increased, the expression of TF, t-PA mRNA and FGA mRNA was up-regulated, PT, APTT and TT were prolonged, the plasma Fib concentration was increased, and the activities of ALT and AST and concentrations of TF and IL-6 in plasma were increased in WT+ SEP group ( P<0.05). Compared with WT+ SEP group, the lung injury score was significantly increased, the expression of TF, t-PA mRNA and FGA mRNA was up-regulated, PT, APTT and TT were prolonged, the plasma Fib concentration was increased, and the activities of ALT and AST and concentrations of TF and IL-6 in plasma were increased in EKO+ SEP group ( P<0.05). Conclusions:Erbin in liver tissues exerts an endogenous protective effect on blood coagulation by inhibiting the up-regulation of TF expression in septic mice.

Objective     To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods     A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results     A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion     There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.

Objective:To explore prognostic factors of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) patients.Methods:Clinical data on 227 patients with IPMN-B between 2004 and 2015 were retrospectively collected from the surveillance, epidemiology, and end results (SEER) database. There were 126 male and 101 female patients with the age at diagnosis of 69(58, 77) years old. IPMN-B patients were divided into two groups based on whether surgical treatment was performed. There were 129 patients in the surgery group and 98 patients in the non-surgery group. The survival analyses were assessed by Kaplan-Meier analyses and log-rank test was used to compared survival rate. The univariate and multivariate Cox analyses were applied to find independent prognostic factors of the survival in IPMN-B patients.Results:The tumor size of 227 IPMN-B patients from the SEER database was 25(18.5, 45.0) mm. The differences of tumor size, grade of defferentiation, American Joint Committee on Cancer (AJCC) stage, T stage, M stage chemotherapy were statistically significant respectively in surgery group and non-surgery group (all P<0.05). The median overall survival time (OS) of patients with IPMN-B was 14 months and the overall 1-year survival was 53.4%. The median overall survival time of IPMN-B patients in surgery group was 27 months, which was better than 5 months of patients in non-surgery group, and the difference was statistically significant ( P<0.001). Univariate Cox analysis found AJCC stage, T stage, N stage, M stage and surgery were prognostic factors in patients with IPMN-B. Multivariate Cox analysis showed that M1 stage ( HR=2.125, 95% CI: 1.472-3.066, P<0.001) was independent risk factor of prognosis while surgery ( HR=2.983, 95% CI: 2.106-4.224, P<0.001) was independent protective factor of prognosis. Conclusion:The AJCC staging system is an important predictor for evaluating the prognosis of IPMN-B patients. Surgery could significantly improve the prognosis of patients with IPMN-B.

Objective:To evaluate the relationship between Erbin and Bax/Bcl-xL-mediated cell apoptosis during sepsis-induced acute kidney injury in mice.Methods:Thirty-two SPF male wild type C57BL/6 mice, 32 SPF male Erbin (-/-) C57BL/6 mice, aged 6-8 weeks, weighing 20-30 g, were divided into 2 groups ( n=16 each) using the random number table method: wild type sham operation group (WT+ Sham group), wild type sepsis group (WT+ S group), Erbin(-/-) sham operation group (EKO+ Sham group), and Erbin(-/-) sepsis group (EKO+ S group). The sepsis model was established using the moderate cecal ligation and puncture (CLP) in anesthetized animals.The survival rates within 7 days after CLP were recorded.The serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), IL-1β, creatinine (Cr), blood urea nitrogen (BUN) and lactic dehydrogenase (LDH) were determined at 24 h after CLP.Then the renal tissues were taken for assessment of renal injury which was scored and for determination of the apoptosis rate (by TUNEL) and expression of cleaved-caspase-3, Bcl-xL and Bax (by Western blot). Results:Compared with sham operation groups, the survival rates were significantly decreased, the serum concentrations of IL-1β, IL-10, TNF-α, Cr, BUN and LDH, renal injury score and apoptosis rate were increased, the expression of Bax and cleaved-caspase-3 was up-regulated, and the expression of Bcl-xL was down-regulated in sepsis groups ( P<0.05). Compared with WT+ S group, the survival rates were significantly decreased, the serum concentrations of IL-1β, LDH, TNF-α, Cr and BUN and renal injury score were increased, the serum concentration of IL-10 was decreased, the apoptosis rate of renal tissues was increased, the expression of Bax and cleaved-caspase-3 was up-regulated, and the expression of Bcl-xL was down-regulated in EKO+ S group ( P<0.05). Conclusions:Erbin can inhibit Bax/Bcl-xL-mediated cell apoptosis and is involved in endogenous protective mechanism against sepsis-induced acute kidney injury in mice.

Objective:To investiagte the ability of albumin-indocyanine green (ALICE) score, albumin-bilirubin (ALBI) score and Child-Pugh score in predicting postoperative liver failure (PHLF) in patients with hepatocellular carcinoma, and to determine the clinical value of ALICE score.Methods:The clinical data of 397 patients with hepatocellular carcinoma who underwent hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery, Jinhua Hospital Affiliated to Zhejiang University from June 2015 to June 2021 were retrospectively analyzed, including 350 males and 47 females, aged (58.9±11.2) years. Univariate and multivariate logistic regression were used to analyze the risk factors of PHLF. The predictive ability of ALICE score for PHLF was evaluated by receiver operating characteristic (ROC) curve, and compared with ALBI score and Child-Pugh score.Results:There were 74 patients with PHLF and 323 patients without PHLF. Multivariate logistic regression analysis showed that Child-Pugh score ( OR=1.630, 95% CI: 1.251-2.486, P=0.034), ALBI score ( OR=1.863, 95% CI: 1.028-3.119, P=0.049) and ALICE score ( OR=1.759, 95% CI: 1.216-3.078, P=0.038) were independent risk factors for PHLF in patients with hepatocellular carcinoma, and the risk of PHLF increased with the increase of grade. The area under the ROC curve of ALICE score predicting PHLF in patients with hepatocellular carcinoma was 0.613 (95% CI: 0.564-0.662), the area under the ALBI score was 0.612 (95% CI: 0.563-0.661), and the area under the Child-Pugh score was 0.555 (95% CI: 0.505-0.605). The ALICE score was better than the Child-Pugh score, and the difference was statistically significant ( z=2.04, P=0.041). In small liver resection patients, ALICE score was better than Child-Pugh score ( z=2.61, P=0.009). There was no significant difference betwenn ALICE score and ALBI score ( z=0.06, P=0.954). Conclusion:ALICE score can predict the occurrence of PHLF in patients with hepatocellular carcinoma, especially in patients with small liver resection, its value is similar to ALBI score, but better than Child-Pugh score.

Objective:To evaluate the prediction value of preoperative Fibrinogen(FIB) in combination with neutrophil-lymphocyte ratio(NLR)for the prognosis of operable pancreatic cancer patients.Methods:The clinical data of 124 patients who underwent radical resection for pancreatic cancer in our hospital from Jan 2010 to Dec 2018 were retrospectively analyzed.The patients were divided into three groups according the high and low NLR, FIB value which defined by the receiver operating characteristic curve (ROC). The clinicopathological data and overall median survival time were compared between the three groups.Results:Univarate analysis showed that age, tumor stage, NLR, FIB and F-NLR score were associated with the prognosis( P<0.05), while multivariate analysis showed that high F-NLR score was the independent prognostic factor. The median survival time of patients with F-NLR scores 0, 1 and 2 group was 30.6, 20.3 and 13.9 months( P<0.05). The prognosis of high F-NLR score was significantly worse than that of low F-NLR score( P<0.05). Conclusions:A high preoperative F-NLR score was a promising predictor for the prognosis of pancreatic cancer patients after radical resection.

Objective:To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients.Methods:The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using t test, χ 2 test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. Results:A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes vs. 249(92)minutes)( t=-5.949, P=0.000), higher hospitalization cost ((64.8±7.2) thousand yuan vs. (56.0±9.2)thousand yuan, t=-3.464, P=0.001), but less in estimated blood loss ((249.38±91.40)ml vs.(329.69±120.26)ml) ( t=3.008, P=0.004), shorter in the time to first flatus ((3.39± 1.1)days vs. (5.03±1.65)days, t=5.316, P=0.000) and preoperative hospital stay((18.6±5.59)days vs. (21.9±5.5)days) ( t=2.242, P=0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all P>0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% vs. 62.0%, P=0.729). Conclusions:Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.

Objective:To compare the short-term results of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy in periampullary carcinoma patients.Methods:The clinical data of patients with periampullary carcinoma who underwent laparoscopic pancreaticoduodenectomy or open pancreaticoduodenectomy at Department of Hepatopancreatobiliary Surgery, Jinhua Hospital, Affiliated to Zhejiang University School of Medicine from January 2013 to February 2018 were collected. Totally 127 patients were included in the study. There were 73 males and 54 females, aged (61.2±9.4) years (range: 37-80 years). Propensity score matching method was used to perform 1∶1 matching between laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Perioperative outcomes and overall survival were compared between the two groups using t test, χ 2 test, Fisher exact probability, Kaplan-Meier curve and Log-rank test, respectively. Results:A total of 32 pairs of patients were successfully matched by propensity score matching. There were 21 males and 11 females in open pancreaticoduodenectomy group, aged (62.1±9.3)years, 21 males and 11 females in laparoscopic group, aged (63.7±9.4)years. Comparion with open pancreaticoduodenectomy, the laparoscopic group had longer operative time (381(47)minutes vs. 249(92)minutes)( t=-5.949, P=0.000), higher hospitalization cost ((64.8±7.2) thousand yuan vs. (56.0±9.2)thousand yuan, t=-3.464, P=0.001), but less in estimated blood loss ((249.38±91.40)ml vs.(329.69±120.26)ml) ( t=3.008, P=0.004), shorter in the time to first flatus ((3.39± 1.1)days vs. (5.03±1.65)days, t=5.316, P=0.000) and preoperative hospital stay((18.6±5.59)days vs. (21.9±5.5)days) ( t=2.242, P=0.018). There was no significant difference in vascular invasion, nerve invasion, number of lymph nodes dissected, perioperative complications and pathology (all P>0.05). After PSM, there was no significant difference found in 1-year overall survival rate (60.0% vs. 62.0%, P=0.729). Conclusions:Laparoscopic pancreaticoduodenectomy is safe and feasible for the treatment of periampullary carcinoma. It not only has advantages of less trauma and faster recovery, but also achieves similar of lymph node dissection and equivalent short-term prognosis when compared with open approach.

Due to the complex and diverse cell types, growth sites and metastasis of cancer, the pathogenesis of cancer-related ischemic stroke may be diverse. Existing research shows that, the incidence of ischemic stroke in breast cancer patients is higher than that in normal people. In other words, there is breast cancer-related ischemic stroke in theory. But the exact pathogenesis is not clear, which may include breast cancer direct invasion to heart or blood vessels, high blood coagulation state, and the influence of relevant treatment measures, etc.