Black Turmeric and Aloe Vera in the Management of Oral Submucous Fibrosis: A Prospective Clinical Study

Aim: To determine the therapeutic efficacy of Kali haldi in the management of Oral submucous Fibrosis (OSMF) v/s steroid therapy. Materials and Methods: A clinical prospective study was conducted on 42 patients of oral submucous fibrosis were equally divided into 2 groups. Group A patients were treated with a mixture of powdered Kali Haldi and aloe vera gel in equal ratio 3 times a day for 3 months. Group B patients were treated with intralesional injection of hydrocortisone and hyaluronidase for 6 weeks with oral antioxidant supplements for 3 months. Burning sensation, cheek flexibility, mouth opening, and tongue protrusion were evaluated before, during, and after treatment at an interval of 15 days, 1 month, 2, month and 3 months. Results: Statistically significant results were obtained at the end of 3 months duration for both the groups (P < 0.001). The Symptomatic correction was more evident in the case of Group A patients than Group B. Response of the ayurvedic regimen was potentially better as compared to the regular steroid therapy. Conclusion: The study concludes that Combination therapy works wonders in the case of OSMF in stages I, II, III and can be a good option, comparatively safe and with negligible side effects, but potent and equally effective management of oral submucous fibrosis. Henceforth, it will be better to do such kinds of studies on a vast scale including larger samples and longer duration to check the efficacy and durability of this ancient ayurvedic regimen.     

Clinical Assessment of Efficacy of Omega 3 in Oral Submucous Fibrosis Patients - A Randomized Controlled Trial

Background: Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition affecting the oral cavity. Omega 3 has shown innumerable health benefits in yesteryears. So, the aim of the study was to evaluate the efficacy of Omega 3 in the medical management of this disease. Methods: A randomized controlled trial was designed and 48 clinically confirmed patients of OSMF (24 in each group) completed the study. Patients of both the groups were given biweekly intralesional injections of dexamethasone 1.5ml, hyaluronidase 1500 IU mixed with lignocaine for 6 weeks. Additionally, group A received a placebo (lactose capsule) for 3 months while group B received 1gm of omega 3 (flaxseed oil) three times daily continuously for 3 months. Patients were followed every month for 3 months and then, after 6 months and one year. Results: During the first two months, improvement was observed in both the groups independently but intergroup comparison showed no significant difference. However, after 3 months statistically significant (p<0.05) improvement among all three clinical parameters i.e. inter-incisal distance (mean improvement in group A = 3.79±1.07mm and group B = 6.58±1.24mm, p=0.019), tongue protrusion (mean improvement in group A = 1.87±1.54mm and group B = 4.62±1.78mm, p=0.044) and cheek flexibility (mean improvement in group A = 2.08±1.38mm and group B = 3.50±1.84mm, p=0.035) was observed in group B when compared to group A. In contrast, statistically significant improvement in burning sensation was observed after one month itself in group B when compared to group A (mean drop in group A = 2.5±0.78 points and group B = 6.0±1.144 points, p<0.05). Conclusion: Omega 3 in conjunction with intralesional injections is an effective therapy when compared to intralesional injections alone in treatment of patients with OSMF (grade II and III) with no side effects.     

透明质酸酶、地塞米松对长春瑞滨外渗性大鼠皮肤损伤的疗效

 目的　探讨透明质酸酶、地塞米松局部注射对长春瑞滨外渗性大鼠皮肤损伤的防治效果。方法　在40只SD大鼠双后肢制作长春瑞滨血管外渗模型。随机分为5组,分别给予透明质酸酶局部注射、地塞米松局部注射、透明质酸酶联合地塞米松局部注射、0.9 %氯化钠溶液局部注射,模型对照组不进行任何防治措施。观察各组大鼠1、4、8、12、18、24、30 d的损伤面积和损伤愈合时间。结果　透明质酸酶组、地塞米松组、透明质酸酶联合地塞米松组、氯化钠溶液组1、4、8、12、18、24 d损伤面积均显著低于模型对照组（P＜0.05）,其中透明质酸酶组和透明质酸酶联合地塞米松组分别显著低于地塞米松组和氯化钠组（P＜0.05）;透明质酸酶组、地塞米松组、透明质酸酶联合地塞米松组、氯化钠溶液组的损伤愈合时间[（28.8±3.5）d、（28.0±2.9）d、（28.6±4.1）d、（29.8±2.6）d],显著低于模型对照组的（30.6±3.0）d,（P＜0.05）,其中透明质酸酶组和透明质酸酶联合地塞米松组的损伤愈合时间分别显著低于地塞米松组和氯化钠溶液组（P＜0.05）。结论　单用透明质酸酶、地塞米松或0.9 %氯化钠溶液局部注射对长春瑞滨外渗性损伤均有一定的疗效,而透明质酸酶的疗效较好;联合用药可能更有效。     

Trismus in head and neck oncology: a systematic review

The aim of this review was to identify systematically, criteria for trismus in head and neck cancer, the evidence for risk factors for trismus and the interventions to treat trismus. Three databases were searched (time period 1966 to June 2003) for the text "trismus" or "restricted mouth opening". Included in the review were clinical studies (> or = 10 patients). Two observers independently assessed the papers identified. In 12 studies nine different criteria for trismus were found without justifying these criteria. Radiotherapy (follow-up: 6-12 months) involving the structures of the temporomandibular joint and or pterygoid muscles reduces mouth opening with 18% (sd: 17%). Exercises using a therabite device or tongue blades increase mouth opening significantly (no follow-up), effect sizes (ES) 2.6 and 1.5 respectively. Microcurrent electrotherapy (follow-up 3 months) and pentoxifylline (no follow-up) increases mouth opening significantly (ES for both: 0.3).     

Diagnostic accuracy of magnetic resonance imaging (MRI) in the assessment of tumor invasion depth in oral/oropharyngeal cancer

The purpose of the present study was to evaluate the diagnostic value of MRI for measuring invasion depth in oral/oropharyngeal carcinoma. We retrospectively reviewed pathologic specimens and MRI findings of 114 patients who were diagnosed with squamous cell carcinoma of the oral cavity and oropharynx. Invasion depths were evaluated in pathologic specimens and by MRI. The mean histologic and MRI invasion depths were 13.57 ± 8.476 and 15.24 ± 10.700 mm, respectively. The overall Pearson's correlation coefficient for histologic and MRI (T1W-MRI) invasion depths was 0.825, which was statistically significant (P<0.001). Pearson's correlation coefficients for histologic and MRI invasion depths in oral tongue, tongue base, and tonsil cancers were 0.949, 0.941, and 0.578, respectively. The MRI invasion depth was significantly different according to nodal status in cancers of the oral tongue (P=0.001(?)) and tongue base (P=0.003(?)). With MRI, the invasion depth cutoff values for determining positive nodes were 9.5 and 14.5mm in cancers of the oral tongue and tongue base, respectively. Preoperative MRI is an accurate method for measuring tumor invasion depth in oral tongue and tongue base cancers. Furthermore, it has predictive value for nodal metastasis in the oral tongue and tongue base.     

Benefit of Using Muscle Relaxants in the Routine Treatment Protocol of Oral Submucosal Fibrosis: A Pilot Study

The aim of this present work is to describe the nature and extent of fibrosis within muscle and to correlate this with the mouth opening (MO) in OSE patients and to prove our results in improvement of mouth opening in patients with OSMF with use of “muscle relaxants” along with other modalities of treatment . The study was conducted on 40 patients who visited our outpatient department with grade 3 (<19 mm) mouth opening. 20 of these patients underwent the routine treatment protocol of weekly injection of hyaluronidase with hydrocortisone and antioxidant capsules with added lycopene for 1 month. The remaining test subjects in addition to the routine injections and antioxidants were given skeletal muscle relaxants like thiocolchicoside or chlorzoxazone. The mouth opening (interincisal distance of maxillary and mandibular incisors at maximum possible mouth opening) was measured and graded as follows: grade 1 (>40 mm), grade 2 (20–39 mm) and grade 3 (<19 mm) with the help of vernier callipers after the study period of 1 month. 17 out of the 20 test patients who received muscle relaxants in addition to the routine protocol showed marked improvement with shift from grade 3 (<19 mm) to grade 1 (>40 mm) i.e. a greater than 20 mm improvement in mouth opening. Using muscle relaxants as a adjuvant therapy in the routine protocol of treatment of oral submucosal fibrosis will not only cater and halt the problem of fibrosis but also will take care of the muscle spasm and inflammation which also inadvertently contribute to the restricted mouth opening. We found excellent improvement on adding muscle relaxants to the routine protocol which was not just an objective but also a subjective success.     

透明质酸酶、喜辽妥软膏治疗多西紫杉醇外渗性大鼠皮肤损伤

目的：探讨单用或联合局部注射透明质酸酶、外涂喜辽妥软膏对多西紫杉醇外渗致大鼠损伤的防治效果。方法：将30只SD大鼠双侧侧腹部制作成多西紫杉醇血管外渗模型后随机分为6组：局部注射透明质酸酶，外涂喜辽妥软膏，局部注射透明质酸酶＋外涂喜辽妥软膏，外涂生理盐水，局部注射生理盐水，模型对照组不进行任何防治措施。观察各组大鼠外渗性损伤发生率、损伤程度（损伤面积的AUC）、损伤愈合时间。结果：单用透明质酸酶组的损伤发生率显著低于外涂喜辽妥软膏组、外涂生理盐水组、局部注射生理盐水组、模型对照组（P〈0．05），其损伤面积AUC和损伤愈合时间显著低于其他4组（P〈0．01）；单用喜辽妥软膏外涂的损伤发生率与生理盐水外涂组、模型对照组无显著性差异，其损伤面积AUC和损伤愈合时间显著低于生理盐水外涂组、模型对照组（P〈0．01）；透明质酸酶＋外涂喜辽妥软膏组的损伤面积AUC和损伤愈合时间大于单用透明质酸酶组，但差异均无统计学意义。结论：单用透明质酸酶局部注射、喜辽妥软膏外涂对多西紫杉醇外渗性损伤均具有一定的防治效果，单药透明质酸酶局部注射疗效最佳，联合用药未能提高疗效。     

Expression of Salivary S100A7 Levels in Stage I Oral Submucous Fibrosis: A Clinical and Laboratory Study

Background: Oral submucous fibrosis (OSF) is a chronic debilitating condition characterized by juxta-epithelial fibrosis. The main etiological agent associated with the high-risk precancerous condition is areca nut use. S100A7 is a member of the largest calcium-binding proteins exclusively found in vertebrates and are associated with the regulation of numerous intracellular and extracellular functions. The aim of this study was to investigate the expression of protein S100A7 in salivary samples of individuals with stage I OSF and healthy controls. Methods: This study included 63 participants, 30 of whom had OSF stage I and 33 healthy controls. Nonprobability quota sampling technique was utilized for recruitment of the study participants. A structured baseline questionnaire was used to collect demographic data. Saliva samples were collected by passive droll technique in a sterile container. Salivary levels of S100A7 were quantified by enzyme-linked immunosorbent assay. For the normality of the data Shapiro Wilk test was performed. Student t-test was commuted to evaluate the expression of S100A7 protein expression between both the study groups. Results: The mean salivary S100A7 value for stage I OSF group was 0.334 ng/ml, compared to 0.172 ng/ml for healthy controls. Student t-test reported a statistically significant difference, indicating higher levels of S100A7 in stage I OSF group than in healthy controls (p < 0.001). In the individual group analysis, a significant negative correlation was found between salivary S100A7 and duration of areca nut use (r = –0.45, p = 0.009) and gutka chewing (r = –0.20, p = 0.03), while a significant positive correlation was found between salivary S100A7 and mouth opening (r = 0.03, p = 0.04). Conclusions: Higher levels of S100A7 protein level was seen in stage I OSF group in comparison to the healthy individuals. Results of our study suggest that S100A7 could be used as a surrogate assessment to identify patients at risk of OSF development.     

Combined cryosurgical, chemotherapeutic, and radiotherapeutic management of T1-4N0M0 oral cavity cancers

Eighty-four previously untreated patients (69 males, 15 females) with squamous carcinoma of the tongue (30 patients), floor of the mouth (30), cheek (16), and retromolar region (8) were treated using a protocol comprising cryosurgery + chemotherapy, followed by external 60Co radiotherapy. The follow-up period was at least 6 months (median, 50 months). Cryosurgery (1-2 sessions in 49 T1-2 cases; 2-4 in 35 T3-4 cases) was accompanied by a CMF (cyclophosphamide, methotrexate, 5-fluorouracil) schedule (T1-2, two courses; T3-4, three courses). Radiotherapy was given 15 to 20 days after combined cryochemotherapy (T1, 50 Gy on tumor and lymph nodes; T2-3-4, same with an extra dose of 10 to 15 Gy on the primary lesion). Complete remission was reached 4 months after treatment in 76 of 84 patients (90.5%). Survival with no evidence of disease (NED) in the 57 patients (27 T1-2, 30 T3-4) with a follow-up of more than 3 years was 59.6% for the series as a whole, 70.3% for T1-2, and 50.0% for T3-4; 78.2% for the tongue, 52.6% for the floor, 66.6% for the cheek, and 0% for the retromolar region. The picture was much the same after 5 years. Actuarial survival at 6 years was 66% in the series as a whole, 75.5% in T1-2, and 57.5% in T3-4 (tongue 86.9%, floor 56.1%, cheek 68.4%, and retromolar region 0%). It is believed that the results obtained in tumors of the tongue, floor and cheek, coupled with the conservative aspects of the protocol, make it a suitable subject for a controlled trial.     

地塞米松对姑息性手术术后小鼠残存Lewis肺癌细胞复发的抑制作用

目的 研究地塞米松对姑息性手术术后小鼠残存Lewis肺癌细胞复发的抑制作用.方法 构建C57 BL小鼠Lewis肺癌姑息性手术切除术后模型,并采用随机数字表法将18只小鼠分为生理盐水组、地塞米松组、顺铂组,每组6只,术后第4～10天用游标卡尺(0.1 mm)测量每组小鼠皮下肿瘤结节.用石蜡免疫组织化学法检测3组小鼠术后残存Lewis肺癌细胞复发肿瘤组织中缺氧诱导因子-1α(HIF-1α)、平均微血管密度(MVD)染色情况.用实时荧光定量PCR和Western blotting检测3组小鼠术后复发肿瘤细胞中HIF-1α、血管内皮生长因子(VEGF)、增殖细胞核抗原(PCNA)基因和蛋白的表达.结果 肿瘤生长曲线显示,接受顺铂和地塞米松治疗的小鼠肿瘤体积分别为(200.34±20.94) mm3和(436.58±37.94) mm3,比生理盐水组(1 398.81±192.85) mm3明显减小,差异均有统计学意义(t=-1201.75,P＜0.001;t=-921.52,P＜0.001).石蜡免疫组织化学结果显示,地塞米松组和顺铂组HIF-1α表达(2.67 ±0.43,1.67 ±0.43)和MVD计数(17.01 ±3.24,9.89 ±2.25)都明显低于生理盐水组(4.21 ±0.35,29.75 ±5.64),差异均有统计学意义(t=-1.55,P＜0.001;t=-1.83,P＜0.001;t=-12.68,P＜0.001;t=-18.35,P＜0.001).实时定量PCR检测显示,HIF-1α(0.56±0.11)、VEGF(0.61±0.18)和PCNA(0.38±0.07) mRNA表达在地塞米松组较生理盐水组(1.21±0.13,1.13 ±0.26,1.06±0.08)明显减少,差异具有统计学意义(t=-0.55,P＜0.001;t=-0.62,P＜0.001;t=-0.69,P＜0.001);HIF-1α(0.31 ±0.12)、VEGF(0.30 ±0.13)和PCNA(0.18±0.06) mRNA表达在顺铂组较生理盐水组也明显减少,差异具有统计学意义(t=-0.73,P＜0.001;t=-0.76,P＜0.001;t=-0.81,P＜0.001).Western blotting结果显示,地塞米松组HIF-1α(85.98±20.86)、VEGF(173.28 ± 30.98)和PCNA蛋白(228.96±22.97)的表达较生理盐水组(198.98±29.89,378.98±28.98,357.98±35.98)明显减少,差异具有统计学意义(t=98.78,P＜0.001;t=85.68,P＜0.001;t=120.86,P＜0.001);顺铂组HIF-1α(65.78±18.62)、VEGF(109.43士19.86)和PCNA蛋白(176.86 ±22.76)的表达较生理盐水组明显减少,差异具有统计学意义(t=132.86,P＜0.001;t=108.68,P＜0.001;t=154.74,P＜0.001).结论 地塞米松对姑息性手术切除术后残存的Lewis肺癌细胞复发有明显抑制作用,有望为姑息性手术切除患者术后治疗提供一种新的辅助治疗方法.     

Analysis of the Filipinos’ Interest in Searching Online for Oral Cancer

Objective: This study analyzed the health-seeking behavior of Filipinos using Google Trends tool to quantify relative search volume by term . Oral cancer, mouth cancer, tongue cancer, gum cancer, and lip cancer were used as predetermined search terms. Material and method: Comma-separated values file containing relative search volumes of search trends pertaining to oral cancer from 2009 to 2019 were assessed. Brown-Forsythe one-way ANOVA was used to measure differences with respect to oral cancer across different years and months. Two-way repeated measures ANOVA was applied to detect differences regarding mouth cancer, tongue cancer, gum cancer, and lip cancer across the years. Time series models were fitted and used to forecast search interests. Results: The results revealed that interest in oral cancer was significantly higher in 2019 (43.75±5.5, p <0.05) compared to 2009 (29.0 ± 6.7). In terms of months, searches were higher in February (45.0 ± 6.6) compared to May (24.8 ± 3.4, p=0.015), June (25.3 ± 4.4, p=0.020), and December (26.5 ± 4.0, p=0.038). Search interests for gum cancer and lip cancer remained significantly lower from 2011 to 2019, and tongue cancer from 2016 to 2018 but approximated mouth cancer in 2019. The forecast showed that mouth cancer (31.67%), tongue cancer (23.75%), and lip cancer (3.83%) would fluctuate through time pass, while gum cancer (8%) would remain steady in 2020. Conclusion: Health-seeking behavior through search trends showed an increased interest in oral cancer in 2019 and during February. It was anticipated that search interests would fluctuate in 2020, but at the end of the year would decrease for mouth cancer and tongue cancer, increase for lip cancer, and remain steady for gum cancer.     

Pleomorphic Adenoma of the Tonsil

The lymphangioma is a comparatively rare vascular tumour. Bill and Sumner (1965) reported a series of lymphangioma consisting of 61 patients. The neck was the most common site followed by the axilla, cheek, tongue, floor of the mouth mediastinum, trunk and extremities.     

Ultrathin Silicon Sheet in the Management of Unilateral Post-traumatic Temporo-Mandibuar Joint Ankylosis in Children: A Good Alternative to Conventional Techniques

We have described a new technique of using ultra-thin silicon sheet (0.2 mm) between two transected bony ends for temporo-mandibular joint (TMJ) ankylosis in children with advantages of short operative time, minimal foreign material insertion and faster recovery time post-operatively which makes our technique a good alternative to conventional techniques. Our study is a non-randomized prospective study conducted on 10 children aged between 4 and 15 years who presented to our tertiary care institute with severe trismus after traumatic injury and were willing to undergo this new technique. The main outcome measure taken into consideration was difference between pre-operative, intra-operative (on table) and post-operative mouth opening (minimum 2 years follow-up). The pre-operative mouth opening in our cases varied from 1 to 5 mm. The intra-operative mouth opening achieved ranged from 2.8 to 3.2 cm. The mouth opening was about more than 2.7 cm in all our cases at 2 years of follow-up. Our technique is a good alternative to conventional techniques used for TMJ ankylosis in children but few more randomized controlled trials are required to assess its effectiveness in comparison to conventional techniques and for universal adoption of this technique.     

A case of large carcinoma of the tongue and mouth floor,in which chemotherapy using a combination of nedaplatin and 5-FU was effective

We encountered a case of extensive squamous cell carcinoma ranging from the tongue to the mouth floor, in which chemotherapy using a combination of nedaplatin and 5-FU was effective. The patient was a 46-year-old male, who noticed a small mass in the mouth floor in September 2000, and visited the department of oral and maxillofacial surgery at a hospital on October 12, 2000. A 27 x 15 mm tumor with erosion was noted on the mouth floor, which was diagnosed as squamous cell carcinoma by biopsy, and the patient was referred to our department for treatment on November 16, 2000. Intra-oral findings included a healthy-colored induration with a bulge in the area ranging from the apex of the tongue posteriorly for 30 mm, and from the right lateral edge of the tongue to the left side exceeding the median area of the tongue by approximately 7 mm. MRI detected a tumor of approximately 2 cm in diameter in the area ranging from the median area of the tongue to the right ventral side of the tongue, which protruded on the mouth floor side. Two courses of combination chemotherapy using nedaplatin and 5-FU were performed. Nedaplatin (90 mg/m2, total 143 mg) and 5-FU (700 mg/m2, total 1,113 mg) were administered in a first course during December 15-19, 2000, and in the same amounts in a second course during January 23-27, 2001. Adverse effects of gastralgia and stomatitis occurred, but they gradually disappeared with time. The tumor with erosion in the tongue and mouth floor and induration disappeared 2 weeks after administration. Tongue was recovered, so that tongue movement was almost normal. Postoperative MR showed no abnormal signals in T2-weighed images, suggesting that the tumor in the right mouth floor had almost disappeared. External irradiation (40 Gy/20 times/28 days, 2 Gy/day, opposing bilateral portal irradiation) between March 13 and April 9, 2001, and micro-selection high dose fractionated interstitial irradiation (42 Gy/7 times/6 days, 6 Gy/1 time) April 18-23, 2001 were performed as booster therapy. Outpatient observation has shown a good clinical course without recurrence.     

A novel technique for cheek mucosa defect reconstruction using a pedicled buccal fat pad and buccinator myomucosal island flap

Reconstruction of cheek mucosa defects following tumor resections can be approached with several techniques, depending on size of the defect. Fasciocutaneous and perforators free flaps are widely employed today for such reconstructions. However, small defects or general health of the patient may limit their indications. Furthermore, approaching moderate size defects, some techniques, like temporalis muscle or fascia pedicled flaps, lead to contracture with limitation of mouth opening or trisma, and others, like intraoral local flaps, do not provide enough tissue for the reconstructions. In this work the authors propose, for reconstructing these kind of defects, the use of a buccinator myomucosal island flap and a buccal fat pad pedicled flap association. A case is reported and the surgical technique is explained. This new reconstructive technique can easily be used for reconstructing moderate-sized cheek defects, achieving optimal results: the internal mucosal lining is restored in few weeks without any retraction, contracture, of scars on the face limiting the aesthetic outcome and mouth opening.     

沉默EC9706核干细胞因子基因对裸鼠移植瘤生长的作用

观察由RNAi诱导的EC9706核干细胞因子（NS）基因沉默对裸鼠移植瘤生长的抑制作用。方法:BALB/c裸鼠15只,分为3组,siRNA干预组皮下注入pRNAT-U6.1-siNS2转染的EC9706细胞,无关siRNA对照组皮下注入pRNAT-U6.1-siC转染的EC9706细胞,空白对照组皮下注入正常EC9706细胞,接种5周分别测定各组裸鼠移植瘤体积,并应用RT-PCR技术检测裸鼠移植瘤组织中NS mRNA的表达。结果:无关siRNA对照组及空白对照组于第4天在接种部位出现肉眼可见的肿块,siRNA干预组于第6天在接种部位发现肉眼可见肿块。第5周各组裸鼠成瘤率均为100%。空白对照组、无关siRNA对照组和siRNA干预组瘤体大小分别为（1 806.40±77.75） mm3、（1 702.20±88.60） mm3和（847.00±82.25） mm3,3组相比差异有统计学意义（P<0.05）。空白对照组、无关siRNA对照组和siRNA干预组移植瘤组织中NS mRNA的表达量分别为0.681±0.033、0.685±0.034和0.497±0.056,3组相比差异有统计学意义（P<0.05）。结论:沉默EC9706细胞的NS基因可抑制裸鼠移植瘤生长,降低裸鼠体内NS mRNA的表达。沉默NS基因有可能成为治疗食管癌的新策略。      

Factors associated with restricted mouth opening and its relationship to health-related quality of life in patients attending a Maxillofacial Oncology clinic

Trismus can be a problematic consequence of treatment for oral and oropharyngeal cancer. The aim of this study was to investigate the relationship between trismus, subjective function and health-related quality of life, in order to postulate a clinically relevant cut-off that might be useful as an indicator of patients who might benefit from intervention. One hundred consecutive patients attending the Maxillofacial Oncology clinic at the University Hospital Aintree were assessed during a period of four months. Mouth opening was recorded in millimetres. Subjective outcomes were evaluated using UW-QOL questionnaire for chewing, saliva, mood, anxiety and overall quality of life. The median age of patients was 63 (IQR 56–69) years. The median time since treatment was 16 (IQR 6–34) months. The median mouth opening (32 mm; range 6–53, IQR 24–40) was associated strongly with clinical T stage (Tis/T1–2 35 mm, T3–4 24 mm), radiotherapy (no 38 mm, yes 27 mm) and type of primary surgery (primary closure 38 mm, soft-tissue flaps 30 mm, composite flaps 24 mm). The amount of mouth opening and of the single question (about how much less mouth opening since treatment) was significantly associated with patients perception of chewing deficit, less than full diet and less than good overall quality of life. This study supports a 35 mm cut-off for trismus. There is merit including the two elements together (opening in mm and the single item question on mouth opening since treatment) as outcome parameters     

等中心位置的选择对肺癌 SBRT 验证计划 Gamma通过率的影响

目的∶研究肺癌立体定向放射治疗（stereoactic body raliotherapy,SBRT）计划设计过程中,等中心位置的选择对验证计划Gamma通过率的影响。方法∶选取2018年1月至2019年3月间的13例肺部SBRT病例,分别通过 Pinnacle9.10计划系统设计两个对应不同等中心的SBRT计划,其中A组的13例计划等中心选在计划靶区（plan- ingtugt wum,PTV）的中心,B组的13 例计划等中心选在CT模拟定位的中心,并分别制作对应的验证计划共26例,通过MapClheck分析软件分别采用3%/2 mm和2%/2 mm的Gamma通过率标准对这26 例验证计划进行评估,记录A组中SBRT计划的验证通过率γ,和B组中 SBRT计划的验证通过率γ,并对以上 Gamma通过率做统计分析。结果∶当采用3%/2mm的Gamm通过率标准时,y,为9.32%±0.68%,Y为95.07%±2.0男%,y与Y差异具有统计学意义（1=7.128,P<0.001）;当采用2%/2 mm的Gamma通过率标准时,y,为97.88%±2.04%,Y为 87.71%±5.47%,γ,与γ差异具有统计学意义（1=5.733,P<0.001）。结论∶等中心位置的选择不同影响了肺部 SBRT 验证计划 Gamma 通过率,且当采用更严格的通过率标准时,影响更显著。     

研究体板结合真空垫及热塑膜技术与传统臂部支撑固定技术在胸部肿瘤放疗摆位中的误差

背景与目的:放射治疗已进入了精确放疗的时代,摆位误差成为影响放疗效果的重要因素.通过采用两种不同体位固定方式,即自行改装后的体板结合真空垫及热塑膜的固定装置和臂部支撑装置,讨论分析胸部肿瘤放疗中的摆位误差.方法:选择肺及食管胸部肿瘤患者19例,随机分成两组,分别采用体板+真空垫+体部热塑膜固定(A组)、臂部支撑装置固定(B组)进行摆位和治疗.A组利用二次摆位技术,即先使患者头脚方向的激光线与真空垫上的定位标记一致,再根据患者体表定位标记进行摆位(第一次摆位),最后覆上热塑膜固定,再根据热塑膜上的定位标记移床至治疗位置(第二次摆位);B组利用一次摆位技术,即直接根据体表标记进行摆位.A、B组均利用千伏级锥形束CT(kilo-voltage cone beam computed tomography,KV-CBCT)采集治疗前﹑后的图像,并与计划CT图像配准,得到治疗前及治疗后的体位误差并进行统计分析.结果:对于两种不同固定方式,A组和B组治疗前误差分别为:X轴(左右方向)(1.06±0.58)和(1.82±0.82)mm,Y轴(头脚方向)(1.31±0.40)和(2.18±1.20)mm,Z轴(腹背方向)(1.28±0.66)和(2.94±1.81)mm.治疗后误差分别为:X轴(0.86±0.54)和(1.29±0.58)mm,Y轴(1.07±0.58)和(1.08±0.45)mm,Z轴(0.98±0.53)和(1.56±0.63)mm.结论:A组误差均小于B组,采用体板结合真空垫及热塑膜固定装置并应用二次摆位技术的患者,在放疗过程中不仅摆位的精确度得以提高,同时也保证了体位的重复性及稳定性.     

Comparison of Cystoscopy with Diffusion-Weighted Magnetic Resonance Images Used in the Diagnosis and Follow-Up of Patients with Bladder Tumors

Purpose: To compare diffusion-weighted magnetic resonance imaging (DW-MRI) with cystoscopy in the diagnosis and follow-up of patients with bladder tumor and to investigate any histopathological correlation. Materials and Methods: Totally 59 patients, between 31-85 years (mean age 60±13) referred to our clinic due to a hematuria complaint were enrolled and evaluated by upper urinary system pathology and then DW-MRI (average 7 days) and cystoscopy. Apparent diffusion coefficients (ADCs) of images were calculated. Results: While a mass in bladder was determined with cystoscopy in 43 out of 59 patients,the mass was not deternined in 16 of the patients(n=34 malign,n=9 benign).While a mass was determined in 40 out of 59 patients with DW-MRI,the mass was not determined in 19 of the patients(n=40 malign,n=19 benign). Regarding ADC values, mean ADC values of 34 patients who were diagnosed with a bladder tumor (1.05±0.22 x 10-³mm²/s), were significantly lower than the mean ADC values obtained from the normal bladder wall (1.830 ±0.18 x 10-³mm²/s) whereas a statistically significant difference was found (p<0.001). ADC values in 9 patients with a benign lesion (1,73±0.12 x 10-³mm²/s), were not found statistically different from the mean ADC values obtained from the normal bladder wall (1.78±0.2x10-³mm²/s) (p>0.05).A significant difference was determined between ADC values of benign lesions and the ADC values of malign lesions (p<0.001). Conclusions: According to cystoscopy, values of DW-MRI’s related with sensitivity, specificity and accuracy were found, respectively 90%, 93% and 91%. As the DW-MRI is a non-invasive and a rapid technique, and does not contain ionized radiation and because it is accepted as an important marker of tumor cellularity, it may be used as an alternative in future diagnosis and follow-up of bladder tumors.