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 observe the effects of low expressed Angiotensin-converting enzyme 2 ( Ace2) gene on senescence related signals of alveolar type Ⅱ epithelial cells in silicotic mice. Methods:In March 2022, 20 8-12W SPF male wild-type C57BL/6 mice and 20 Ace2 gene knockdown mice (Ace2 +/-, C57BL/6 background) were randomly divided into wild-type control group, Ace2 low expression group, wild-type silicosis group, Ace2 low expression silicosis group, with 10 mice in each group. In vitro MLE-12 cells were divided into control group, MLN-4760 (ACE2 inhibitor) group, SiO 2 group and SiO 2+MLN-4760 group. The expression of ACE2, collagen I (Col I), fibronectin 1 (Fn1), α-smooth muscle actin (α-SMA), phosphorylation-ataxia telangiectasia-mutated serine/threonine kinase (p-ATM), phosphorylation-ATM Rad3-related kinase (p-ATR), p-p53, p21 and p16 in mice and MLE-12 cells were detected by Western blotting. The expression and location of β-galactosidase were detected by immunofluorescence, β-galactosidase (SA-β-Gal) staining were used to detect the senescence of MLE-12 cells. Results:HE and VG staining results showed that typical silicon nodules with collagen deposition were formed in the lung of wild-type silicotic mice and Ace2 low expression silicotic mice. Immunofluorescence staining results showed that β-galactosidase was mainly located in alveolar type Ⅱ epithelial cells. Western blot results showed that, compared with wild-type silicosis group, the expression of Col I, α-SMA, p-ATM, p-ATR, p-p53, p21 and p16 in Ace2 low expression silicosis group were significantly up-regulated by 540.71%、26.58%、336.84%、139.58%、152.78%、120.10% and 994.63% ( P<0.05). In MLE-12 cells, results of western blot showed that compared with SiO 2 group, the expression levels of p-ATM, p-ATR, p-p53, p21 and p16 in SiO 2+MLN-4760 group were significantly up-regulated by 168.71%、750.78%、149.51%、554.26% and 254.07% ( P<0.05). Immunofluorescence staining results showed that compared with SiO 2 group, β-galactosidase positive cells were strongly up-regulated in SiO 2+MLN-4760 group, and SA-β-Gal staining results showed that compared with SiO 2 group, the number of senescent cells in SiO 2+MLN-4760 group increased by 63.18% ( P<0.05) . Conclusion:Low expression of Ace2 gene activated senescence related signals of alveolar type Ⅱ epithelial cells and promoted the progression of silicotic fibrosis in mice.

Objective:To observe the effects of low expressed Angiotensin-converting enzyme 2 ( Ace2) gene on senescence related signals of alveolar type Ⅱ epithelial cells in silicotic mice. Methods:In March 2022, 20 8-12W SPF male wild-type C57BL/6 mice and 20 Ace2 gene knockdown mice (Ace2 +/-, C57BL/6 background) were randomly divided into wild-type control group, Ace2 low expression group, wild-type silicosis group, Ace2 low expression silicosis group, with 10 mice in each group. In vitro MLE-12 cells were divided into control group, MLN-4760 (ACE2 inhibitor) group, SiO 2 group and SiO 2+MLN-4760 group. The expression of ACE2, collagen I (Col I), fibronectin 1 (Fn1), α-smooth muscle actin (α-SMA), phosphorylation-ataxia telangiectasia-mutated serine/threonine kinase (p-ATM), phosphorylation-ATM Rad3-related kinase (p-ATR), p-p53, p21 and p16 in mice and MLE-12 cells were detected by Western blotting. The expression and location of β-galactosidase were detected by immunofluorescence, β-galactosidase (SA-β-Gal) staining were used to detect the senescence of MLE-12 cells. Results:HE and VG staining results showed that typical silicon nodules with collagen deposition were formed in the lung of wild-type silicotic mice and Ace2 low expression silicotic mice. Immunofluorescence staining results showed that β-galactosidase was mainly located in alveolar type Ⅱ epithelial cells. Western blot results showed that, compared with wild-type silicosis group, the expression of Col I, α-SMA, p-ATM, p-ATR, p-p53, p21 and p16 in Ace2 low expression silicosis group were significantly up-regulated by 540.71%、26.58%、336.84%、139.58%、152.78%、120.10% and 994.63% ( P<0.05). In MLE-12 cells, results of western blot showed that compared with SiO 2 group, the expression levels of p-ATM, p-ATR, p-p53, p21 and p16 in SiO 2+MLN-4760 group were significantly up-regulated by 168.71%、750.78%、149.51%、554.26% and 254.07% ( P<0.05). Immunofluorescence staining results showed that compared with SiO 2 group, β-galactosidase positive cells were strongly up-regulated in SiO 2+MLN-4760 group, and SA-β-Gal staining results showed that compared with SiO 2 group, the number of senescent cells in SiO 2+MLN-4760 group increased by 63.18% ( P<0.05) . Conclusion:Low expression of Ace2 gene activated senescence related signals of alveolar type Ⅱ epithelial cells and promoted the progression of silicotic fibrosis in mice.

Background Pneumoconiosis is the most serious occupational disease in China, and silicosis accounts for about half of it. Any intervention effect of physical exercise as the key and core of lung rehabilitation training on silicosis is still unclear. Objective To explore potential intervention effect of physical exercise on silicotic mice. Methods Forty SPF C57BL/6 male mice were randomly divided into four groups, 10 in each group, including a control group, a physical exercise group, a silicosis model group, and a silicosis model + physical exercise intervention group. Silicotic mouse model was established by using 50 μL SiO₂ suspension (200 mg·mL⁻¹). A treadmill was used to prepare mice receiving physical exercise at 0° inclination, 12.3 m·min⁻¹, 60 min·d⁻¹, 5 d·week⁻¹ for 4 weeks. Pathological morphology of lung tissues was evaluated after hematoxylin-eosin (HE) staining; deposition of collagen in lung tissues was evaluated after Van Gieson (VG) staining; expression of p-protein kinase R-like endoplasmic reticulum kinase (PERK) was detected by immunofluorescence staining; expressions of cyclin dependent kinase inhibitors (p21) and p-p38 mitogen activated protein kinase (p38) were detected by immunohistochemistry. The protein expressions of endoplasmic reticulum stress signal factors [p-inositol-requiring enzyme-1α (p-IRE-1α), p-PERK, and p-eukaryotic initiation factor-2α (p-eIF-2α)], senescence signal factors (p-p53, p21, and p16), mitogen-activated protein kinase (MAPK) signal factors [p-p38, p-extracellular regulated protein kinases (p-ERK), and p-stress-activated protein kinase (p-JNK)] were detected by Western blotting. Results After designed acute SiO₂ exposure, the images of micro computed tomography (CT) showed high density shadows in lung tissues of the silicotic mice and less shadows in lung tissues of the physical exercise intervention mice. After HE staining, the proportions of silicotic nodule area in lung tissues was (18.67±3.89) % in the silicosis model group, and significantly decreased to (8.78±1.05) % in the silicosis model + physical exercise intervention group (P<0.05). After VG staining, the proportion of collagen fiber area of lung tissues was (10.37±2.18) % in the silicosis model group, and significantly decreased to (4.35±0.89) % in the silicosis model + physical exercise intervention group (P<0.05). The results of immunofluorescence staining showed that in the silicosis model group, the expression of p-PERK increased at the location of silicotic nodules, while in the silicotic model + physical exercise intervention group, the expression of p-PERK decreased. The immunohistochemical staining results showed that the expression of p21 and p-p38 increased in the lung tissues of the silicosis model group; the expression of p21 and p-p38 decreased in the lung tissues of the silicosis model + physical exercise intervention group. The results of Western blotting showed that compared with the control group, the expression levels of p-IRE-1α (0.11±0.03), p-PERK (0.95±0.40), p-eIF-2α (3.53±0.91), p-p53 (1.78±0.07), p21 (1.98±0.10), p16 (1.26±0.17), p-p38 (0.41±0.09), p-ERK (0.42±0.05), and p-JNK (3.20±1.23) of the silicosis model group were all upregulated (P<0.05). Compared with the silicosis model group, the expression levels of p-IRE-1α (0.03±0.01), p-PERK (0.31±0.12), p-eIF-2α (0.30±0.06), p-p53 (0.76±0.08), p21 (0.18±0.11), p16 (0.70±0.24), p-p38 (0.03±0.00), p-ERK (0.19±0.03), and p-JNK (0.46±0.21) of the silicosis model + physical exercise intervention group were downregulated (P<0.05). Conclusion Physical exercise may alleviate pulmonary fibrosis in silicotic mice, and inhibit abnormal expressions of endoplasmic reticulum stress signal, MAPK signal, and senescent signal.

OBJECTIVE：To prepare GGPFV-modified Daunorubicin/dioscin liposomes ，and to optimize their formulation and to preliminarily evaluate their cytotoxicity to breast cancer cells in vitro . METHODS ：Daunorubicin and diosgenin were wrapped by thin film dispersion method and ammonium sulfate hydration method ；the surface was modified with DSPE-PEG2000-GGPFV to prepare GGPFV-modified Daunorubicin/dioscin liposomes. Taking encapsulation rate as index ，Box-Behnken response surface methodology was used to optimize the film hydration volume ，cholesterol amount and daunorubicin amount in the formulation. The entrapment efficiency of 3 batches of liposomes prepared according to the optimal formulation was determined. The effects of Daunorubicin/dioscin liposomes ，GGPFV-modified Daunorubicin/dioscin liposomes and blank liposomes on the survival rate of human breast cancer MDA-MB- 435S cells were compared. RESULTS ：The optimal formulation was as film hydration volume of 5 mL，cholesterol of 4 mg，yolk lecithin of 22 mg，daunorubicin of 0.55 mg，dioscin of 0.85 mg，DSPE-PEG2000 of 3.5 mg， DSPE-PEG2000-GGPFV of 2 mg. The encapsulation rate of daunorubicin was （96.21±1.54）％ and that of dioscin was （95.39± 2.48）％ in the 3 batches of liposomes prepared. The in vitro cytotoxicity tests showed that the inhibition effect of GGPFV-modified Daunorubicin/dioscin liposome on MDA-MB-435S cells was significantly stronger than that of Daunorubicin/dioscin liposome （P＜ 0.05）. There was no cytotoxicity in the membrane. CONCLUSIONS ：GGPFV-modified Daunorubicin/dioscin liposomes are successfully prepared ，and its inhibitory effect on human breast cancer MDA-MB- 435S cells in vitro was significantly enhanced.

Objective:To evaluate partial splenectomy (LPS) in the treatment of benign solid tumors of the spleen.Methods:The clinical data of patients with benign solid tumors of spleen treated by laparoscopy from Jan 2010 to Jun 2018 in the Third Affiliated Hospital of Soochow University was retrospectively analyzed. Patients were divided into LPS group and laparoscopic total splenectomy (LTS) group.Results:There were 21 cases in LPS group and 25 cases in LTS group. Differences between the two groups, operative time, blood loss, transfusion rate, maintenance of drain, postoperative hospital stay, costs, postoperative WBC and platelet count, and postoperative complications such as hemorrhage, fever, splenic fossa effusion, pancreatic fistula, venous thrombosis were statistically insignificant. However, the postoperative incidence of thrombocythemia in the LPS group were significantly lower compared to the LTS group (χ 2 =4.293, P<0.05). Conclusions:Patients with benign solid tumors of the spleen will benefit more from LPS compared to LTS.

Objective: To compare the clinical application of three-dimensional laparoscopic pancreatoduodenectomy (3D-LPD) with that of two-dimensional laparoscopic pancreatoduodenectomy (2D-LPD), and to explore the safety and feasibility of 3D-LPD. Methods: A retrospective analysis was made from the data of 45 patients with 3D-LPD and 45 patients with 2D-LPD who underwent total laparoscopic pancreatoduodenectomy from March 2017 to August 2018 at Department of Hepato-Pancreato-Biliary Surgery, the First People′s Hospital of Changzhou.The differences of intraoperative conditions, postoperative complications and postoperative pathological findings between the two methods were compared.Measurement data were compared with independent sample t-test, enumeration data were statistically analyzed with Chi-square test or Fisher exact probability. Results: The operation time of 3D-LPD group was shorter than that of 2D-LPD group ((335±95) min vs. (419±113) min, t=-3.817, P=0.000), which mainly showed that the time of digestive tract reconstruction was reduced ((92±26) min vs. (131±46) min, t=-4.951, P=0.000). The intraoperative blood loss in the 3D-LPD group was significantly less than that in the 2D-LPD group ((242±124) ml vs. (350±176) ml, t=-3.365, P=0.001), and the perioperative blood transfusion in the 3D-LPD group was significantly less than that in the 2D-LPD group (χ²=4.444, P=0.035). Postoperative hospitalization days and ICU stay time were not significantly different between the two groups(both P>0.05). Postoperative complications such as pancreatic fistula, biliary fistula, postoperative bleeding, gastric emptying disorders, abdominal infection, were not significantly different between the two groups(all P>0.05). Conclusions The operation time of 3D-LPD is shorter than that of 2D-LPD, and the amount of bleeding is less. Short-term clinical data showed that, 3D-LPD is effective, safe and worth popularizing.

Objective To explore the safety,feasibility,clinical efficacy and prognosis of gallbladder carcinoma treated by laparoscopy.Methods The clinical data of 43 patients with gallbladder carcinoma treated by laparoscopy radical cholecystectomy from Jan 2010 to Oct 2017 in the Third Affiliated Hospital of Soochow University were retrospectively analyzed.Results 15 cases underwent simple laparoscopic cholecystectomy,13 cases underwent laparoscopic cholecystectomy + lymphadenectomy and 15 cases underwent laparoscopic cholecystectomy + liver wedge resection + lymphadenectomy.The average operation time was (64 ± 32) min,(100 ± 45) min,and (217 ± 74) min,respectively.The average intraoperative blood loss was (67 ± 83) ml,(58 ± 63) ml and (182 ± 165) ml.The average postoperative hospital stay was (4.3 ± 2.2) days,(5.2 ± 2.0) days,(7.0 ± 1.7) days.All patients were diagnosed as gallbladder carcinoma by postoperative pathology.The median follow-up time was 14.5 months (range from 3 to 97 months).The cumulative survival rates of Tis,T1b,T2 and T3 stage were 100％,90％,52.7％ and 0,respectively (x2 =25.333,P ＜ 0.05).Conclusions It is safe and feasible to treat early gallbladder carcinoma by laparoscopy.

Objective To investigate the strategies in dealing with intraoperative CO2 embolizm during Laparoscopic hepatectomy (LH).Methods We collected and analyzed data from patients who underwent laparoscopic hepatectomy (LH) in our hospital from Jan.2013 to Aug.2017.There were 321 patients.The criteria for the diagnosis of CO2 embolism were rapid intraoperative decrease in petCO2 and SPO2 accompanied with tachyarrhythmia.Results 12 patients were diagnosed to have CO2 embolism.The rate was 3.7％.For these 12 patients,10 patients were dealt with laparoscopically and 2 patients were converted to open surgery.Conclusion CO2 embolism did not rarely occur in LH patients.Sophisticated operations and careful manipulation in LH are the only ways to prevent CO2 embolism.