Objective:To evaluate the use and effect of reconstruction with anterolateral thigh flap(ALTF)in orbitomaxillary defect resulting from oral maxillofacial oncology surgery.Methods:Patients with orbitomaxillary defects following enucleation of orbit were reconstructed with ALTF from January 2013 to September 2020 in Department of Oral & Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People’s Hospital and the data of the cases were collected. Based on the types of the defects, they were classified as orbit-nasal-oral defect, oronasal defect without defect of peri-orbit skin, nasal-orbit defect without defect of oral mucosa and peri-orbit skin defect. Based on the types of the defects and the number of the perforators of ALTF, the flaps were designed as tri-lobed, bi-lobed or mono-lobed flaps and oronasal fistula was determined to repair. Performance of maxillary prosthesis depended on the intraoral situation.Results:There were 19 male cases and 10 female cases and the age arranged from 23 to 82 years old. In terms of defect type, there were 8 cases of orbit-nasal-oral defect, 17 cases of oronasal defect without defect of peri-orbit skin, 1 case of nasal-orbit defect without defect of oral mucosa, 3 cases of peri-orbit skin defect. All the 29 cases of ALTF were successfully completed. Loculated flaps were designed in 16 cases, including 3 cases of tri-lobed flap and 13 cases of bi-lobed flaps. The oral-nasal fistula was repaired with ALTF in 11 cases and maxillary prosthesis was used in 7 cases after surgery. The oral-nasal fistula was not repaired in 14 cases and maxillary prosthesis was used in 6 cases in this group. Two cases were reconstructed with implant supported prosthesis with artificial eyes. The follow-up duration was 4 to 88 months. Eleven patients died of recurrence or metastasis and the other patients were alive without recurrence.Conclusions:In the reconstruction of the maxillary defects with intra-orbital loss following oromaxillofacial tumor resection, ALTF could be an ideal donor site because of flexible design, applicable in complicated defect repair and closure of oronasal fistula, improvement of facial appearance and sanitary maintenance of the oral and nasal cavities.

Objective:To study the applicable value of personalized polyetheretherketone (PEEK) in maxillary reconstruction.Methods:6 patients with benign lesions in the maxilla and 7 patients with maxillary defects after tumor resection were repaired with personalized PEEK implant in our department from September 2018 to November 2020. In 6 patients with benign maxillary lesions, the maxillary defect models were obtained after the extent of tumor resection was established by virtual surgical design. Then, the individual PEEK was designed and produced on the base of mirroring technique. Cutting guide plates were also designed and printed according to virtual surgical planning. Then ablative surgery was performed under the guide of cutting guide, and PEEK was implanted. For 7 patients with maxillary defects, 3D models of maxillary defects were directly reconstructed in the computer based on the preoperative maxillofacial CT, then the individual PEEK was designed and produced based on mirroring technique. Afterwards PEEK was implanted associated with anterolateral thigh flap to repair palatal defects if necessary. All patients were followed up at regular intervals after surgical implantation of PEEK to observe postoperative complications. And postoperative appearance and function of the patients were evaluated by clinical and CT examinations one month after surgery.Results:PEEK implant operation was carried out with all of the patients according to the preoperative design. During implantation, PEEK did not match exactly with the defects in 2 patients. Then PEEK could be put into position after trimming and grinding. Three patients were performed anterolateral thigh flaps at the same time to restore the palatal defects to separate the oral and nasal cavity. The wound healed well after operation in all of the patients. All of the flaps survived, and the survival rate was 100%. Facial symmetry and eyeball location were well restored and mouth opening was recovered to normal after surgery. Image fusion showed the location of PEEK implant was accurate with an error of (0.68±0.12) mm. In 6 patients with benign lesions, postoperative orbital volume [(26.37±0.94) ml], eye vertical position [(0.98±0.48) mm] and the ratio of exophthalmos [(1.10±0.28) mm ]were significantly improved compared to pre-operation [(24.06±0.85) ml, (3.83±0.81) mm, (2.53±0.67) mm]. The difference were statistically significant ( P<0.05). In 7 patients with maxillary defects after tumor resection, postoperative eye verticalposition [(0.77±0.42) mm] and the ratio of exophthalmos [(0.61±0.31) mm] were significantly improved compared to pre-operation [(2.03±1.07) mm, (2.01±0.34) mm]. The difference were statistically significant ( P<0.05). The range of postoperative follow-up was 1-27 months [(12.0±7.6 ) months]. During follow-up, a PEEK implant was removed in one case because of implant extrusion and the other due to tumor recurrence. Conclusions:With the aid of virtual surgical planning, the personalized PEEK implant combined or not with hard/soft tissue flap can accurately restore the maxillary appearance and support the orbital floor, thus effectively improving the accuracy and safety of maxillary reconstruction.

Objective:To study the applicable value of personalized polyetheretherketone (PEEK) in maxillary reconstruction.Methods:6 patients with benign lesions in the maxilla and 7 patients with maxillary defects after tumor resection were repaired with personalized PEEK implant in our department from September 2018 to November 2020. In 6 patients with benign maxillary lesions, the maxillary defect models were obtained after the extent of tumor resection was established by virtual surgical design. Then, the individual PEEK was designed and produced on the base of mirroring technique. Cutting guide plates were also designed and printed according to virtual surgical planning. Then ablative surgery was performed under the guide of cutting guide, and PEEK was implanted. For 7 patients with maxillary defects, 3D models of maxillary defects were directly reconstructed in the computer based on the preoperative maxillofacial CT, then the individual PEEK was designed and produced based on mirroring technique. Afterwards PEEK was implanted associated with anterolateral thigh flap to repair palatal defects if necessary. All patients were followed up at regular intervals after surgical implantation of PEEK to observe postoperative complications. And postoperative appearance and function of the patients were evaluated by clinical and CT examinations one month after surgery.Results:PEEK implant operation was carried out with all of the patients according to the preoperative design. During implantation, PEEK did not match exactly with the defects in 2 patients. Then PEEK could be put into position after trimming and grinding. Three patients were performed anterolateral thigh flaps at the same time to restore the palatal defects to separate the oral and nasal cavity. The wound healed well after operation in all of the patients. All of the flaps survived, and the survival rate was 100%. Facial symmetry and eyeball location were well restored and mouth opening was recovered to normal after surgery. Image fusion showed the location of PEEK implant was accurate with an error of (0.68±0.12) mm. In 6 patients with benign lesions, postoperative orbital volume [(26.37±0.94) ml], eye vertical position [(0.98±0.48) mm] and the ratio of exophthalmos [(1.10±0.28) mm ]were significantly improved compared to pre-operation [(24.06±0.85) ml, (3.83±0.81) mm, (2.53±0.67) mm]. The difference were statistically significant ( P<0.05). In 7 patients with maxillary defects after tumor resection, postoperative eye verticalposition [(0.77±0.42) mm] and the ratio of exophthalmos [(0.61±0.31) mm] were significantly improved compared to pre-operation [(2.03±1.07) mm, (2.01±0.34) mm]. The difference were statistically significant ( P<0.05). The range of postoperative follow-up was 1-27 months [(12.0±7.6 ) months]. During follow-up, a PEEK implant was removed in one case because of implant extrusion and the other due to tumor recurrence. Conclusions:With the aid of virtual surgical planning, the personalized PEEK implant combined or not with hard/soft tissue flap can accurately restore the maxillary appearance and support the orbital floor, thus effectively improving the accuracy and safety of maxillary reconstruction.

Objective:To evaluate the use and effect of reconstruction with anterolateral thigh flap(ALTF)in orbitomaxillary defect resulting from oral maxillofacial oncology surgery.Methods:Patients with orbitomaxillary defects following enucleation of orbit were reconstructed with ALTF from January 2013 to September 2020 in Department of Oral & Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People’s Hospital and the data of the cases were collected. Based on the types of the defects, they were classified as orbit-nasal-oral defect, oronasal defect without defect of peri-orbit skin, nasal-orbit defect without defect of oral mucosa and peri-orbit skin defect. Based on the types of the defects and the number of the perforators of ALTF, the flaps were designed as tri-lobed, bi-lobed or mono-lobed flaps and oronasal fistula was determined to repair. Performance of maxillary prosthesis depended on the intraoral situation.Results:There were 19 male cases and 10 female cases and the age arranged from 23 to 82 years old. In terms of defect type, there were 8 cases of orbit-nasal-oral defect, 17 cases of oronasal defect without defect of peri-orbit skin, 1 case of nasal-orbit defect without defect of oral mucosa, 3 cases of peri-orbit skin defect. All the 29 cases of ALTF were successfully completed. Loculated flaps were designed in 16 cases, including 3 cases of tri-lobed flap and 13 cases of bi-lobed flaps. The oral-nasal fistula was repaired with ALTF in 11 cases and maxillary prosthesis was used in 7 cases after surgery. The oral-nasal fistula was not repaired in 14 cases and maxillary prosthesis was used in 6 cases in this group. Two cases were reconstructed with implant supported prosthesis with artificial eyes. The follow-up duration was 4 to 88 months. Eleven patients died of recurrence or metastasis and the other patients were alive without recurrence.Conclusions:In the reconstruction of the maxillary defects with intra-orbital loss following oromaxillofacial tumor resection, ALTF could be an ideal donor site because of flexible design, applicable in complicated defect repair and closure of oronasal fistula, improvement of facial appearance and sanitary maintenance of the oral and nasal cavities.

Objective: To evaluate the patients′ survival and effectiveness of the live cancer screening for population at high risk for liver cancer in Qidong. Methods: According to the Expert Scheme proposed the Expert Committee of Early Detection and Early Treatment, China Cancer Foundation, diagnostical screening by using combined methods of alpha-fetoprotein and B ultrasound monitoring were carried out biannually in individuals with positive HBsAg who were screened from Qidong area. The evaluation indices of the effectiveness are task completion rate of screening, detection rate of liver cancer, early diagnosis rate, and treatment rate. The deadline of the follow-up for the surviving outcome was March 31, 2016. The life-table method was used to calculate the observed survival, and to make comparison and significant tests between survival rates in Group A (those found via repeated periodic screening) and Group B (those diagnosed without periodic screening). Results: Since 2007, 38 016 target population have been screened, and 3 703(9.74%) individuals with positive HBsAg were found. Except for 29 patients with liver cancer at the initial screening, 3 674 persons in the cohort were followed up; 268 patients with liver cancer were detected from the 33 199 person-times screening, with an annual detection rate of 1.61%. Of them, 186 patients were found in Group A(1.12%), in which 149 patients were the early cases, with an early detection rate of 80.11%; 167 out of 186(89.78%) patients received treatment after diagnosis. The incidence of liver cancer in this HBsAg (+ ) cohort of 25 452 person-years was 1 052.96 per 100 000 annually, 187 cases in males(1 488.45/100 000)and 81 cases in females(628.46/100 000). The 1-, 3-, 5-, and 8-year survival of all patients with liver cancer were 64.55%, 40.50%, 32.54%, and 19.65%, respectively. The 1-, 3-, 5-, and 8-year survival rates were 77.16%, 49.04%, 38.53%, and 24.25% in Group A, and were 36.25%, 21.21%, 21.21%, and 0% in Group B, respectively, with significant differences between two groups (P<0.05). Conclusion The findings show that screening of individuals at high-risk of development of liver cancer, with semiannual AFP and B ultrasound, according to the Expert Scheme, is effective not only in increasing detection rate but also in detecting liver cancer at early stage, and in improving patients′ survival as well.

Objective To evaluate the efficacies of upfront simultaneous integrated boost-intensity-modulated radiation therapy (SIB-IMRT) and epidermal growth factor receptor (EGFR) etyrosine kinase inhibitor (TKI) in patients with epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancers who developed brain metastasis (BM).Methods Sixty-eight patients diagnosed as having EGFR-mutant non-small-cell lung cancer developed BM were recruited in our hospital from July 2012 to January 2016.Of these patients,45 received upffont EGFR-TKI gefitinib and 23 accepted SIB-IMRT.The clinical data of these patients were recorded;the viability curve and encephalic progressive cumulative incidence curve were compared between the two groups.Cox multiple-factor analysis was performed to analyze the influencing factors of prognoses.Results The median survival time in the SIB-IMRT group was shorter than that in upfront EGFR-TKI group (18.9 months [95％ CI:16.5-21.4 months] vs.27.5 months [95％CI:21.6-33.5 months]).Log-rank test indicated that the survival rate of patients from SIB-IMRT group was significantly higher than that of patients from EGFR-TKI group (P＜0.05);in the patients from SIB-IMRT group,61％ patients had encephalic progressive changes,with the median survival time of 20.7 months (95％CI:9.6-14.2 months);in the patients from EGFR-TKI group,89％ patients had encephalic progressive changes,with the median survival time of 11.9 months (95％CI:19.7-49.2 months).The encephalic progressive cumulative incidence in patients from EGFR-TKI group was significantly higher than that in patients from SIB-IMRT group (P＜0.05).Multiple-factor analysis indicated that initial therapeutic schedule,prognosis evaluation and extra-cerebral metastasis were the key influencing factors of prognoses.Conclusion The patients accepted upfront EGFR-TKI treatment has longer overall survival and progression free survival than those accepted upfront SIB-IMRT in patients with EGFR-mutant non-small-cell lung cancer who develop BM.

OBJECTIVETo understand the current status of the disease burden of liver cancer in Jinchang cohort.

METHODSAll the liver cancer death data from 2001 to 2013 and medical records of liver cancer cases from 2001 to 2010 in Jinchang cohort were collected for the analyses of the mortality, standardized mortality, potential years of life lost (PYLL) and working PYLL (WPYLL) associated with liver cancer. Spearman correlation and the average growth rate were used to analyze the trends.

RESULTSA total of 207 liver cancer deaths occurred in Jinchang cohort from 2001 to 2013, accounting for 16.68% of total cancer deaths. There were 259 liver cancer inpatients, accounting for 6.79% of the total cancer cases inpatients, in which 83 died (32.05%). Liver cancer death mainly occurred in males, accounting for 88.89%, and the liver cancer deaths in females accounted for 11.11%. The standardized mortality rate was 42.32/100,000 in males and 15.31/100,000 in females. The growth rate of liver cancer mortality was 5.62% from 2001 to 2013. Liver cancer deaths mainly occurred in age groups 60-69 years (26.57%) and 50-59 years (24.15%). The PYLL was 2906.76 person-years, the average PYLL was 14.04 years. The WPYLL was 1477.00 person-years and the average WPYLL was 7.14 years. The direct economic burden of liver cancer was 6270.78 Yuan per person, 301.75 Yuan per day. The average stay of hospitalization was 21.32 days.

CONCLUSIONThe mortality rate of liver cancer is increasing and the disease burden is still heavy.

Aged ; China ; epidemiology ; Cohort Studies ; Cost of Illness ; Female ; Hospitalization ; economics ; statistics & numerical data ; Humans ; Liver Neoplasms ; economics ; mortality ; Male ; Middle Aged

OBJECTIVETo understand the current status of lung cancer disease burden in Jinchang cohort.

METHODSIn this historical cohort study, the mortality data of the lung cancer from 2001 to 2013 and medical records of the lung cancer cases from 2001 to 2010 in Jinchang cohort were used, analyze mortality, direct economic burden, potential years of life lost (PYLL) and working PYLL (WPYLL) associated with lung cancer.

RESULTSA total of 434 lung cancer deaths occurred in Jinchang cohort from 2001 to 2013. The crude mortality rate of lung cancer was 78.06 per 100,000 from 2001 to 2013, with the increasing rate of 4.77%. The mortality rate of lung cancer in males and females were about 108.90 per 100,000 and 26.08 per 100,000 with the increasing rate of 4.24% and 6.91%, respectively. During the thirteen years, the PYLL and average PYLL (APYLL) of lung cancer were 3 721.71 person-years and 8.58 years. The APYLL of lung cancer in females (15.94 years) was higher than that in males (7.87 years). The WPYLL and the average WPYLL (AWPYLL) of lung cancer were 1161.00 person-years and 2.68 years, respectively. The AWPYLL of lung cancer was also higher in females than in males. The direct economic burden of lung cancer from 2001 to 2010 in Jinchang cohort was 6309.39 Yuan per case with no increased trend.

CONCLUSIONLung cancer is the main health problem in Jinchang cohort, causing heavy disease burden.

China ; epidemiology ; Cohort Studies ; Cost of Illness ; Female ; Humans ; Lung Neoplasms ; economics ; mortality ; Male

Objective To investigate the molecular mechanism of P75NTR gene-induced apoptosis in tongue squamous cell carcinoma Tca8113 cell lineage.Methods P75NTR specific siRNA was transferred into P75NTR positive tongue squamous cell carcinoma Tca8113 cells.P75NTR positive Tca8113 cells were divided into 4 groups:blank group (without transfection),negative control group (transfected with negative control siRNA ), experiment group-776 (transfected with siRNA-P75NTR-776 ) and experiment group-1234 (transfected with siRNA-P75NTR-1234).Transfection efficiency and cell apoptosis were detected by flow cytometry.The interference effect of P75NTR mRNA expression was detected by fluorescence quantitative PCR. 3-(4,5-dimethyl-2-thiazoly)-2,5-diphenyl-2H-tetrazolium bromide assay was applied in measuring cell prolife-ration.The protein changes of P75NTR were detected by Western blotting.The distributions of nuclear factor-κB(NF-κB)of cells were observed by cell immunofluorescence labeling method.Results The transfection efficiency was 30%.The apoptosis rate of experiment group-776,experiment group-1234 and negative control group was (20.35 ±0.18)%,(12.32 ±1.51)% and (2.63 ±0.10)% respectively.Compared with the negative control group,the differences of the former two group had statistical significance (t =177.20,P <0.005;t =37.12,P <0.005).The P75NTR gene interference was successful.The inhibition rate of P75NTR protein reached 31% in experiment group-776.The cell viability of Tca8113 cells after P75NTR-siRNA inter-
ference was 70.02%,78.01% and 95.81% in experiment group-776,experiment group-1234 and negative control group.And there were significant differences between experiment group-776 and negative control group (χ2 =235.3,P <0.010),and between experiment group-1234 and negative control group (χ2 =117.5,P <0.005 ).NF-κB distribution was increased in cell cytoplasm in the interference group than that in control group.Conclusion P75NTR may promote the proliferation or inhibit the apoptosis of tongue squamous cell carcino-ma,and the molecular mechanism may be correlated with hindering the transportion of NF-κB into cell nuclear.

OBJECTIVETo examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects.

METHODSPatients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed.

RESULTSAmong the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05).

CONCLUSIONAnterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.

Free Tissue Flaps ; Humans ; Maxillofacial Abnormalities ; surgery ; Myocutaneous Flap ; Necrosis ; Quality of Life ; Reconstructive Surgical Procedures ; methods ; statistics & numerical data ; Surgery, Oral ; Thigh ; Wound Healing