1.Effect of Schisanlactone E on Neuroinflammation and Synaptic Damage in APP/PS1 Mice and Their Relationship with Th17/Treg Immune Balance
Wenjing YU ; Miao YANG ; Chunxiang HE ; Jiawei HE ; Zhenyan SONG ; Ping LI ; Shaowu CHENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(22):112-123
ObjectiveTo investigate the effect of schisanlactone E in ameliorating neuroinflammation and synaptic injury in APP/PS1 mice and to elucidate whether its mechanism is related to the regulation of helper T cell 17 (Th17)/regulatory T cell (Treg) immune balance. MethodsAPP/PS1 transgenic mice were assigned into model, low- and high-dose (2 mg·kg-1·d-1 and 4 mg·kg-1·d-1, respectively) schisanlactone E, and donepezil (1 mg·kg-1·d-1) groups. C57BL/6J mice were used as the control group. Each group received the corresponding drug by gavage for 30 days. Learning and memory abilities were assessed by the Morris water maze and novel object recognition tests. The percentages of Th17 and Treg cells in the peripheral blood were analyzed by flow cytometry. The mRNA levels of retinoid-related orphan receptor γt (RORγt), interleukin (IL)-17A, forkhead box protein 3 (FoxP3), and IL-4 in the hippocampus were determined by Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR). The synaptic ultrastructure in the hippocampus was observed by transmission electron microscopy. The protein levels of synapsin Ⅰ and postsynaptic density protein 95 (PSD95) in the hippocampus were measured by Western blot. Aβ aggregation and microglial activation in the hippocampus were observed by immunofluorescence staining. The mRNA levels of tumor necrosis factor (TNF)-α, IL-6, and IL-1β in the hippocampus were determined by Real-time PCR. ResultsCompared with the control group, the model group showed prolonged escape latency (P<0.05), decreased time spent in the target quadrant, platform crossings, novel object exploration time, and percentage of novel object contact frequency (P<0.05, P<0.01), increased Aβ aggregation in the hippocampal tissue (P<0.01), an increased proportion of Th17 cells (P<0.05), a decreased proportion of Treg cells (P<0.05), and an increased Th17/Treg ratio (P<0.01) in the peripheral blood. Furthermore, the hippocampal tissue in the model group exhibited upregulated mRNA levels of RORγt and IL-17A (P<0.05, P<0.01), downregulated mRNA levels of FoxP3 and IL-4 (P<0.01), decreased synapses (P<0.05), decreased PSD density, synaptic interface curvature, and active zone length (P<0.05, P<0.01), and increased synaptic cleft width (P<0.05), downregulated protein levels of Synapsin Ⅰ and PSD95 (P<0.01), increased microglial activation (P<0.01), and upregulated mRNA levels of TNF-α, IL-6, and IL-1β (P<0.05). Compared with the model group, the high-dose schisanlactone E group and the donepezil group exhibited shortened escape latency and increased time in the target quadrant and platform crossings (P<0.05, P<0.01). The schisanlactone E groups and the donepezil group showed increased novel object exploration time (P<0.05, P<0.01) and percentage of novel object contact frequency (P<0.05, P<0.01), and reduced hippocampal Aβ aggregation (P<0.05, P<0.01). The schisanlactone E groups showed a decreased proportion of Th17 cells (P<0.05) and an increased proportion of Treg cells (P<0.05) in the peripheral blood, and all treatment groups showed a decreased Th17/Treg ratio (P<0.05, P<0.01). The high-dose schisanlactone E group showed a downregulated mRNA level of RORγt in the hippocampal tissue (P<0.05), and all treatment groups showed a downregulated mRNA level of IL-17A (P<0.05, P<0.01), and upregulated mRNA levels of FoxP3 and IL-4 (P<0.05, P<0.01). The schisanlactone E groups and the donepezil group showed increased synapses, active zone length, synaptic interface curvature, and PSD density, decreased synaptic cleft width (P<0.05, P<0.01), and upregulated protein levels of synapsin Ⅰ and PSD95 (P<0.05, P<0.01). The high-dose schisanlactone E group and the donepezil group showed decreased microglial activation in the hippocampus (P<0.01). The schisanlactone E groups and the donepezil group showed downregulated mRNA levels of TNF-α, IL-6, and IL-1β in the hippocampal tissue (P<0.05, P<0.01). ConclusionSchisanlactone E significantly improves the cognitive function in APP/PS1 mice by regulating the Th17/Treg immune balance, inhibiting neuroinflammation, and ameliorating synaptic injury.
2.Aspirin Curcumin Ester Inhibits High Glucose/Aβ1-42-induced Microglial Inflammatory Response by Regulating Glucose Metabolism Reprogramming
Wenjing YU ; Miao YANG ; Chunxiang HE ; Ze LI ; Jiawei HE ; Ping LI ; Zhenyan SONG ; Shaowu CHENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(22):124-137
ObjectiveTo observe the effect of aspirin curcumin ester (CA) on the activation and glucose metabolism reprogramming of the mouse microglia (BV2) model of inflammation induced by high glucose/β-amyloid (Aβ)1-42, and to explore the potential mechanism of CA in reducing neuroinflammatory response in the brain. MethodsThe BV2 activation model was constructed by high glucose combined with Aβ1-42 oligomers. BV2 cells were treated with Aβ1-42 oligomers (10 μmol·L-1) in a high glucose (50 mmol·L-1) environment and allocated into normal, high glucose, Aβ, and high glucose + Aβ groups. The cell morphology of each group was observed under a bright field. Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) was adopted to assess the mRNA levels of inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) as well as glycolysis-related glucose transporter type 1 (GLUT1), hexokinase 2 (HK2), phospofructokinase-2/fructose-2,6-bisphosphatase 3 (PFKFB3), and pyruvate kinase M2 (PKM2). To reveal the effects of CA on inflammatory response and glucose metabolism in BV2 cells exposed to high glucose/Aβ1-42, this study established the BV2 cell model of inflammatory activation by high glucose and Aβ1-42 oligomer intervention. The cells were allocated into normal, model (50 mmol·L-1 glucose + 10 μmol·L-1 Aβ1-42), CA (10 μmol·L-1), 2DG (0.2 mmol·L-1), and DADA (1 mmol·L-1) groups. Cell counting kit-8 (CCK-8) was used to detect cell survival rate. The cell morphology of each group was observed under a bright field. The expression of inflammatory factors TNF-α, IL-6, and IL-1β and glycolysis-related key enzymes GLUT1, HK2, PFKFB3, and PKM2 at the mRNA level in each group was measured by real-time PCR. The protein levels of GLUT1, HK2, PFKFB3, and PKM2 were determined by Western blot. The glycolysis rate in each group was measured by seahorse. LC-MS was employed to identify the glucose metabolism intermediates. The morphology of mitochondria in cells was observed by electron microscopy. ResultsConstruction of the BV2 cell model: Compared with the normal group, the Aβ group and the high glucose + Aβ group showed more amoeboid-shaped cells and cell aggregation. The high glucose + Aβ group exhibited increased the mRNA levels of TNF-α, IL-1β, and IL-6 (P<0.05, P<0.01), as well as those of key glycolytic enzymes GLUT1, HK2, PFKFB3, and PKM2 (P<0.01). The Aβ group also showed significantly increased mRNA levels of PKM2 and PFKFB3 (P<0.01). Effects of CA on the inflammatory response and glucose metabolism in BV2 cells exposed to high glucose/Aβ1-42: Compared with the normal group, the model group exhibited amoeboid-shaped cells and cell aggregation, upregulated mRNA levels of TNF-α, IL-1β, IL-6, iNOS, GLUT1, HK2, PFKFB3, and PKM2 (P<0.01) and protein levels of GLUT1, HK2, and PFKFB3 (P<0.05, P<0.01), an increased basal glycolysis rate (P<0.01), a decreased compensatory glycolysis rate (P<0.01), increased glycolytic intermediates and reduced TCA cycle intermediates. In addition, the mitochondria in the model group exhibited a decreased number (P<0.05), impaired crista integrity (P<0.01), an increased proportion of vacuolization (P<0.01), and abnormal mitochondrial morphology. Compared with those in the model group, the number of amoeboid-shaped BV2 cells reduced in the CA and 2DG groups, while most BV2 cells in the DADA group became elongated spindle-shaped. All the three treatment groups showed downregulated mRNA levels of TNF-α, IL-1β, IL-6, GLUT1, HK2, PFKFB3, and PKM2 (P<0.05, P<0.01), downregulated protein levels of GLUT1, HK2, and PFKFB3 (P<0.05, P<0.01), and slow compensatory glycolysis and basal glycolysis (P<0.05, P<0.01). Glycolytic intermediates were decreased and TCA cycle intermediates were increased in the CA and 2DG groups. Mitochondrial morphology largely returned to the normal level in all the three treatment groups, with an increase in mitochondrial number (P<0.05), improved crista integrity (P<0.05, P<0.01), and a decreased proportion of vacuolization (P<0.05). ConclusionAβ1-42 oligomers can activate BV2 cells and enhance glycolytic activity in the high glucose environment. CA can reduce the expression of inflammatory factors and inhibit the activation of BV2 cells by regulating the glucose metabolism reprogramming in BV2 cells.
3.Progress in the pharmacological effects of naringin on cardiovascular diseases
Dan LIU ; Jiawei MIAO ; Zihao TAN ; Chunyao HE ; Mingzhu ZHAO ; Xiuzhen HE
Chinese Journal of Clinical Pharmacology and Therapeutics 2025;30(2):272-281
Naringin is a flavonoid compound with a wide range of biological and pharmacologi-cal activities,which can be used in treating tumor,diabetes,neurodegenerative diseases,cardiovascu-lar diseases,metabolic syndrome,etc.Among them,the application of naringin in cardiovascular diseases has attracted the attention of many re-searchers.This article mainly reviews the role of naringin in cardiovascular disease(regulating blood lipids,anti atherosclerosis,lowering blood pres-sure,inhibiting myocardial hypertrophy,anti myo-cardial infarction,protecting myocardial ischemia/reperfusion injury,reducing myocardial ischemia/reperfusion injury and improving pulmonary arteri-al hypertension),the protective effect on cardiotox-icity,and the signal pathways in cardiovascular dis-ease(PI3K-Akt-mTOR,p-eNOS/p-Akt/p-ERK,miR-126/GSK-3 β/β-Catenin),clinical trials,etc.This pa-per is expected to review the current research sta-tus of naringin in cells and animal models so as to reveal its clinical application prospects and provide reference for further research in related fields.
4.Preliminary application of patient-derived tumor organoids in biliary tract cancers: analysis of 38 cases
Yihang WANG ; Xiaoxiao ZHANG ; Yinghao GUO ; Shuangda MIAO ; Jiawei HU ; Qi LI ; Yanzhi PAN ; Haoran DIAO ; Yun JIN ; Yuanquan YU ; Jiangtao LI
Chinese Journal of Surgery 2025;63(11):1044-1051
Objective:To explore genomic features associated with gemcitabine sensitivity, patient-derived organoid models of biliary tract cancer (BTC) were established and characterized.Methods:This is an experimental study. The tissue specimens of BTC were collected from patients who underwent surgical resection at the Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and December 2023. The tumor organoids were cultured in vitro and histologically characterized. Drug sensitivity testing was performed using gemcitabine,cisplatin,paclitaxel,fluorouracil,and lenvatinib etc. to evaluate cell viability. The correlation between the drug sensitivity of organoids and clinical therapeutic response was analyzed.Results:Thirty-eight patient-derived organoids (PDO) models were successfully established from 43 biliary tract malignancy patients with complete follow-up data,including gallbladder cancer PDO 14 cases,distal bile duct cancer PDO 16 cases,intrahepatic cholangiocarcinoma PDO 8 cases,achieving an overall success rate of 88.4%. Drug sensitivity testing (DST) was performed on the successfully generated PDO,with 35 models successfully completing DST experiments. The overall consistency rate between drug responses in PDOs and clinical survival outcomes in corresponding patients was 8/14. Transcriptomic analysis of gemcitabine-sensitive vs. gemcitabine-resistant PDO identified 71 differentially expressed genes in the resistant group,the significantly up-regulated genes including GLDC, LINC01595, IL-27, ANGPTL3, CYP7A1,and AKR1C1;the significantly down-regulated genes including P2RY2,LIPC,and ECHDC3. Conclusion:A biobank of patient-derived organoids of BTC has been established,which demonstrates its potential as preclinical models and tools for predicting chemotherapy responses for BTC patients.
5.Research on the Medicinal and Compatibility of Authentic Medicinal Pearl Under the Guidance of Zhuang Medicine Theory
Mingchan WEI ; Jiang LIN ; Yonghui LIU ; Zhaobing NI ; Jiawei HAN ; Miao WEI
World Science and Technology-Modernization of Traditional Chinese Medicine 2025;27(9):2513-2522
Objective Under the guidance of Zhuang medicine theory,this study aims to investigate the medicinal and compatibility rules of authentic medicinal pearls.Method This article focuses on the fourth national survey of traditional Chinese medicine resources—general survey of marine traditional Chinese medicine resources in Guangxi,led by Professor Lin Jiang's team from Guangxi University of Traditional Chinese Medicine and Guangxi Famous Traditional Chinese Medicine.The survey collected original prescriptions containing pearls,as well as data recorded in Zhuang medicine monographs containing pearls.The study integrated the efficacy,indications,pharmacology,and clinical research of pearl Zhuang medicine.Under the guidance of Zhuang medicine prescription compatibility theory,Zhuang medicine disease classification,and Zhuang medicine classification theory,this study explores the compatibility rules based on the data and functions of Zhuang medicine pearl formula.Result Zhuang medicine pearls taste sweet and salty,with a cold nature;It has the effects of activating the Qiao wu(brain),regulating Long lu(blood circulatory system)and Huo lu(nervous system),clearing heat and toxins,calming the mind,calming palpitations,relieving cough,promoting muscle growth,nourishing yin fluids,and Clearing eye mistiness;Indications:Nian nao nuo(Insomnia),Hen feng(Infantile Convulsions),Long lei(Epilepsy),Fright Palpitations,A rou tian(Diabetes),Huo yan ma(Sore throat),Bei ding(Deep-Rooted Boil),Bei nong(Sores and Ulcers),Redness and visual obstruction due to corneal opacity,Re Nong(Otitis media),Kou chuang(Oral ulcers),Da ning(Swelling and pain of eye).Based on the analysis of data on the formula of Zhuang medicine pearls,it was found that the topical use of Zhuang medicine pearls is concentrated in diseases of the ENT(Ear,Nose,and Throat),Ophthalmology,and diseases of the skin and subcutaneous tissue.When combined with drugs such as regulating Long lu,clearing heat toxin,and eliminating dampness-toxin,it is used to treat diseases such as Redness and visual obstruction due to corneal opacity,Oral ulcers,and Skin ulcers;For internal use,it is often combined with medicines that regulating Long lu,replenishing qi and blood,eliminating dampness-toxin,and nourishing the heart-mind,used in hypertension and palpitations.When paired with the medicines of clearing heat toxin,replenishing qi and blood,regulating Qiaowu,it is used to treat insomnia and epilepsy.Based on the analysis of pearl function,it is used in combination with airway and detoxifying drugs to treat airway diseases;Combination therapy with regulating Long lu and Qiao wu(brain)medicine for the treatment of Long lu disease;Combination treatment of gynecological diseases with regulating Long lu and Huo lu medicine and Bu xu medicine;Combination therapy with heat-clearing,detoxifying,and swelling-reducing medicines or astringents,for the treatment of persistent non-healing sores and ulcers;Used in combination with antipyretic drugs and yin tonifying drugs to treat ophthalmic diseases.Conclusion Zhuang medicine pearl has a wide range of therapeutic effects,and its efficacy can be enhanced by compatibility with different Zhuang medicines.Future research can combine modern compatibility methods of traditional Chinese medicine to optimize the compatibility scheme of pearls,study the specialized disease and prescription of Zhuang medicine pearls,combine Zhuang medicine with Western medicine to form prescriptions,and combine the pharmacological effects of pearls to form prescriptions.In depth exploration of the pharmacological substance basis and mechanism of action of pearl prescriptions can be conducted to develop new Zhuang medicine preparations for pearls.
6.Preliminary application of patient-derived tumor organoids in biliary tract cancers: analysis of 38 cases
Yihang WANG ; Xiaoxiao ZHANG ; Yinghao GUO ; Shuangda MIAO ; Jiawei HU ; Qi LI ; Yanzhi PAN ; Haoran DIAO ; Yun JIN ; Yuanquan YU ; Jiangtao LI
Chinese Journal of Surgery 2025;63(11):1044-1051
Objective:To explore genomic features associated with gemcitabine sensitivity, patient-derived organoid models of biliary tract cancer (BTC) were established and characterized.Methods:This is an experimental study. The tissue specimens of BTC were collected from patients who underwent surgical resection at the Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and December 2023. The tumor organoids were cultured in vitro and histologically characterized. Drug sensitivity testing was performed using gemcitabine,cisplatin,paclitaxel,fluorouracil,and lenvatinib etc. to evaluate cell viability. The correlation between the drug sensitivity of organoids and clinical therapeutic response was analyzed.Results:Thirty-eight patient-derived organoids (PDO) models were successfully established from 43 biliary tract malignancy patients with complete follow-up data,including gallbladder cancer PDO 14 cases,distal bile duct cancer PDO 16 cases,intrahepatic cholangiocarcinoma PDO 8 cases,achieving an overall success rate of 88.4%. Drug sensitivity testing (DST) was performed on the successfully generated PDO,with 35 models successfully completing DST experiments. The overall consistency rate between drug responses in PDOs and clinical survival outcomes in corresponding patients was 8/14. Transcriptomic analysis of gemcitabine-sensitive vs. gemcitabine-resistant PDO identified 71 differentially expressed genes in the resistant group,the significantly up-regulated genes including GLDC, LINC01595, IL-27, ANGPTL3, CYP7A1,and AKR1C1;the significantly down-regulated genes including P2RY2,LIPC,and ECHDC3. Conclusion:A biobank of patient-derived organoids of BTC has been established,which demonstrates its potential as preclinical models and tools for predicting chemotherapy responses for BTC patients.
7.Research on the Medicinal and Compatibility of Authentic Medicinal Pearl Under the Guidance of Zhuang Medicine Theory
Mingchan WEI ; Jiang LIN ; Yonghui LIU ; Zhaobing NI ; Jiawei HAN ; Miao WEI
World Science and Technology-Modernization of Traditional Chinese Medicine 2025;27(9):2513-2522
Objective Under the guidance of Zhuang medicine theory,this study aims to investigate the medicinal and compatibility rules of authentic medicinal pearls.Method This article focuses on the fourth national survey of traditional Chinese medicine resources—general survey of marine traditional Chinese medicine resources in Guangxi,led by Professor Lin Jiang's team from Guangxi University of Traditional Chinese Medicine and Guangxi Famous Traditional Chinese Medicine.The survey collected original prescriptions containing pearls,as well as data recorded in Zhuang medicine monographs containing pearls.The study integrated the efficacy,indications,pharmacology,and clinical research of pearl Zhuang medicine.Under the guidance of Zhuang medicine prescription compatibility theory,Zhuang medicine disease classification,and Zhuang medicine classification theory,this study explores the compatibility rules based on the data and functions of Zhuang medicine pearl formula.Result Zhuang medicine pearls taste sweet and salty,with a cold nature;It has the effects of activating the Qiao wu(brain),regulating Long lu(blood circulatory system)and Huo lu(nervous system),clearing heat and toxins,calming the mind,calming palpitations,relieving cough,promoting muscle growth,nourishing yin fluids,and Clearing eye mistiness;Indications:Nian nao nuo(Insomnia),Hen feng(Infantile Convulsions),Long lei(Epilepsy),Fright Palpitations,A rou tian(Diabetes),Huo yan ma(Sore throat),Bei ding(Deep-Rooted Boil),Bei nong(Sores and Ulcers),Redness and visual obstruction due to corneal opacity,Re Nong(Otitis media),Kou chuang(Oral ulcers),Da ning(Swelling and pain of eye).Based on the analysis of data on the formula of Zhuang medicine pearls,it was found that the topical use of Zhuang medicine pearls is concentrated in diseases of the ENT(Ear,Nose,and Throat),Ophthalmology,and diseases of the skin and subcutaneous tissue.When combined with drugs such as regulating Long lu,clearing heat toxin,and eliminating dampness-toxin,it is used to treat diseases such as Redness and visual obstruction due to corneal opacity,Oral ulcers,and Skin ulcers;For internal use,it is often combined with medicines that regulating Long lu,replenishing qi and blood,eliminating dampness-toxin,and nourishing the heart-mind,used in hypertension and palpitations.When paired with the medicines of clearing heat toxin,replenishing qi and blood,regulating Qiaowu,it is used to treat insomnia and epilepsy.Based on the analysis of pearl function,it is used in combination with airway and detoxifying drugs to treat airway diseases;Combination therapy with regulating Long lu and Qiao wu(brain)medicine for the treatment of Long lu disease;Combination treatment of gynecological diseases with regulating Long lu and Huo lu medicine and Bu xu medicine;Combination therapy with heat-clearing,detoxifying,and swelling-reducing medicines or astringents,for the treatment of persistent non-healing sores and ulcers;Used in combination with antipyretic drugs and yin tonifying drugs to treat ophthalmic diseases.Conclusion Zhuang medicine pearl has a wide range of therapeutic effects,and its efficacy can be enhanced by compatibility with different Zhuang medicines.Future research can combine modern compatibility methods of traditional Chinese medicine to optimize the compatibility scheme of pearls,study the specialized disease and prescription of Zhuang medicine pearls,combine Zhuang medicine with Western medicine to form prescriptions,and combine the pharmacological effects of pearls to form prescriptions.In depth exploration of the pharmacological substance basis and mechanism of action of pearl prescriptions can be conducted to develop new Zhuang medicine preparations for pearls.
8.Progress in the pharmacological effects of naringin on cardiovascular diseases
Dan LIU ; Jiawei MIAO ; Zihao TAN ; Chunyao HE ; Mingzhu ZHAO ; Xiuzhen HE
Chinese Journal of Clinical Pharmacology and Therapeutics 2025;30(2):272-281
Naringin is a flavonoid compound with a wide range of biological and pharmacologi-cal activities,which can be used in treating tumor,diabetes,neurodegenerative diseases,cardiovascu-lar diseases,metabolic syndrome,etc.Among them,the application of naringin in cardiovascular diseases has attracted the attention of many re-searchers.This article mainly reviews the role of naringin in cardiovascular disease(regulating blood lipids,anti atherosclerosis,lowering blood pres-sure,inhibiting myocardial hypertrophy,anti myo-cardial infarction,protecting myocardial ischemia/reperfusion injury,reducing myocardial ischemia/reperfusion injury and improving pulmonary arteri-al hypertension),the protective effect on cardiotox-icity,and the signal pathways in cardiovascular dis-ease(PI3K-Akt-mTOR,p-eNOS/p-Akt/p-ERK,miR-126/GSK-3 β/β-Catenin),clinical trials,etc.This pa-per is expected to review the current research sta-tus of naringin in cells and animal models so as to reveal its clinical application prospects and provide reference for further research in related fields.
9.Basic research in sepsis: advances and challenges
Miao WU ; Jiawei BAI ; Yan YAN ; Xinyu XIE ; Chengtai MA ; Xianjin DU
Chinese Critical Care Medicine 2024;36(6):561-566
Although the understanding of sepsis has evolved from "sepsis 1.0" to "sepsis 3.0", and the consensus on clinical management of sepsis has been continuously updated, the incidence rate and mortality of sepsis remain high. Therefore, in-depth investigation of the pathogenesis and related influencing factors of sepsis is of great significance for revealing the nature of sepsis and improving the clinical outcome of sepsis patients. This review will focus on the key issues in the basic research of sepsis, and summarize the recent advances and challenges in this field, mainly including genetic polymorphism, microorganisms, high-mobility group box 1 (HMGB1), endothelial dysfunction, immunotherapy, and biomarkers, aiming to provide new insights for the diagnosis and treatment of sepsis.
10.Expert consensus on surgical treatment of oropharyngeal cancer
China Anti-Cancer Association Head and Neck Oncology Committee ; China Anti-Cancer Association Holistic Integrative Oral Cancer on Preventing and Screen-ing Committee ; Min RUAN ; Nannan HAN ; Changming AN ; Chao CHEN ; Chuanjun CHEN ; Minjun DONG ; Wei HAN ; Jinsong HOU ; Jun HOU ; Zhiquan HUANG ; Chao LI ; Siyi LI ; Bing LIU ; Fayu LIU ; Xiaozhi LV ; Zheng-Hua LV ; Guoxin REN ; Xiaofeng SHAN ; Zhengjun SHANG ; Shuyang SUN ; Tong JI ; Chuanzheng SUN ; Guowen SUN ; Hao TIAN ; Yuanyin WANG ; Yueping WANG ; Shuxin WEN ; Wei WU ; Jinhai YE ; Di YU ; Chunye ZHANG ; Kai ZHANG ; Ming ZHANG ; Sheng ZHANG ; Jiawei ZHENG ; Xuan ZHOU ; Yu ZHOU ; Guopei ZHU ; Ling ZHU ; Susheng MIAO ; Yue HE ; Jugao FANG ; Chenping ZHANG ; Zhiyuan ZHANG
Journal of Prevention and Treatment for Stomatological Diseases 2024;32(11):821-833
With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth>3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.


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