Usefulness of human papillomavirus detection in oral rinse as a biomarker of oropharyngeal cancer

Conclusion: The detection of human papillomavirus (HPV)-DNA in oral rinse with auto-nested GP5+/GP6?+?PCR is useful as a biomarker of oropharyngeal cancer.

Background: This study aimed to determine the usefulness of oral rinse to detect HPV-DNA as a biomarker of HPV-positive oropharyngeal cancer (OPC).

Patients and methods: One hundred and ten patients with various head and neck diseases, including 19 patients with OPC, were enrolled. Oral rinse and tonsillar swab were collected, and auto-nested GP5+/GP6?+?PCR for HPV-DNA was performed. For oropharyngeal cancer, p16 immunostaining was also conducted.

Results: The rate of HPV-DNA detection in both oral rinse and tonsillar swab was significantly higher in OPC compared with non-OPC upper respiratory tract cancer and non-cancer diseases. HPV-DNA was detected in oral rinse in nine out of 12 p16-positive OPC cases, while none of the p16-negative OPC cases demonstrated detectable HPV-DNA. All p16-positive cases were also positive for HPV-DNA in tumor tissue. Based on p16 immunostaining, the sensitivity and specificity of HPV-DNA detection in oral rinse were 75% and 100%, respectively. Among eight of nine evaluable OPC cases positive for HPV-DNA in oral rinse at diagnosis, HPV-DNA was undetectable in oral rinse in seven cases after treatment.     

表面增强激光解吸-电离质谱法筛选唾液中口腔鳞状细胞癌蛋白标志物

目的 在唾液中筛选口腔癌前病变、鳞状细胞癌、转移癌并与健康人鉴别的肿瘤蛋白标志物.方法 在CM-10蛋白质芯片上采用表面增强激光解吸-电离(Surface enhanced laser desorption/ionization(SELDI)质谱法技术对口腔白斑(6例)、鳞状细胞癌(17例)、转移癌(7例)和健康者(15人)的非刺激性全唾液中的蛋白标志物进行检测,支持向量机法建立指纹图谱诊断模式.结果 口腔鳞状细胞癌和健康人唾液蛋白鉴别模式:蛋白质荷比峰(简称:质荷比)5797、2902、3883和4951组合,敏感性为88.24%、特异性为93.33%;口腔鳞状细胞癌和白斑鉴别模式:质荷比为5818、4617和3884的组合,敏感性为100.00%、特异性为100.00%;口腔鳞状细胞癌和局部转移癌的鉴别模式:质荷比为55 809和5383的组合,敏感性为94.12%、特异性为85.71%.结论 通过SELDI质谱法技术筛选出的肿瘤标志物可以辅助口腔鳞状细胞癌的早期诊断,预测白斑向鳞状细胞癌转化及癌局部转移的潜能.     

上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响

目的研究牙槽嵴顶入路上颌窦底提升术后,上颌窦内黏膜囊肿的变化和囊肿区种植体周围的成骨情况,探讨上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响。 方法选取12例上颌后牙缺失骨量不足并患有上颌窦黏膜囊肿的患者,在不摘除窦腔内黏膜囊肿的情况下,经牙槽嵴顶入路提升上颌窦底同期植入种植体14枚。术前测量上颌窦底高度,术后当日测量种植体穿入窦底长度,术后1年测量穿入窦腔内的种植体周围成骨高度,观察黏膜囊肿对种植体周围成骨的影响。采用配对样本t检验对比术前-术后当日及术前-术后6个月黏膜囊肿投影面积变化,评估手术创伤与黏膜囊肿的相互的影响。 结果通过牙槽嵴顶入路上颌窦底提升术植入的种植体在含有上颌窦黏膜囊肿的上颌后牙区种植体周围成骨良好,术后6个月时全部14枚种植体形成良好骨结合。术前上颌窦底高度为（5.5 ± 1.4）mm,术中种植体穿入上颌窦长度为（2.9 ± 1.3）mm,上颌窦底厚度平均增加了（1.8 ± 1.0）mm。根据测量结果计算黏膜囊肿投影面积,术前（201.2 ± 184.0）mm²,术后当日（133.6 ± 187.6）mm²,术后6个月（134.5 ± 107.1）mm²。术前-术后6个月的成对差分均值及标准差[（66.6 ± 142.8）mm²]明显增大,说明术后6个月时黏膜囊肿的体积呈现出多样化的表现。术前-术后当日的黏膜囊肿投影面积相比显著减小,差异有统计学意义（t= 2.685,P= 0.021）,术前-术后6个月的黏膜囊肿投影面积差异无统计学意义（t= 1.617,P= 0.134）。手术短期内会对上颌窦内黏膜囊肿造成一定的创伤,但未对上颌窦黏膜囊肿产生激惹、恶化等不良影响。 结论上颌窦内黏膜囊肿的存在不影响牙槽嵴顶入路上颌窦底提升术的实施与种植体周围成骨。     

Focal epithelial hyperplasia in a human immuno-deficiency virus patient treated with laser surgery

Focal epithelial hyperplasia(FEH), or Heck's disease, is a rare disease of the oral mucosa; it is mostly found in children or young adults who are immunosuppressed and who live in regions with low socioeconomic status. It is characterized by asymptomatic papules on the oral mucosa, gingiva, tongue, and lips. Healing can be spontaneous, and treatment is indicated if there are aesthetic or functional complications. Human papillomavirus, especially genotypes 13 and 32, has been associated with FEH and is detected in the majority of lesions. Histopathologically, FEH is characterized by parakeratosis, epithelial hyperplasia, focal acanthosis, and fusion and horizontal outgrowth of epithelial ridges. A 37-year-old male patient was referred to the Department of Oral and Maxillofacial Sciences at the Sapienza University of Rome, complaining of numerous exophytic lesions in his mouth. He stated that the lesions were not painful but he had experienced occasional bleeding after incidental masticatory trauma. He had received no previous treatment for the oral lesions. His medical history revealed that he was human immuno-deficiencyvirus positive and was a smoker with numerous, asymptomatic oral papules clinically and histologically corresponding to FEH. The labial and buccal mucosa were especially affected by lesions. Surgical treatment was performed using a 532-nm potassium titanyl phosphate laser(SmartLite, Deka, Florence, Italy) in continuous mode with a 300 μm fiber and power of 1.4 W(power density 1980.22 W/cm2). After anesthesia without vasoconstrictors, the lesions were tractioned with sutures or an Allis clamp and then completely excised. The lesions were preserved in 10% formalin for histological examination, which confirmed the clinical diagnosis of FEH. In this case, the laser allowed excellent control of bleeding, without postoperative sutures, and optimal wound healing.     

纯中药口腔含漱液对皮肤黏膜的刺激性及杀菌作用

目的 观察纯中药口腔含漱液对皮肤、黏膜的刺激反应及对口腔常见细菌的杀菌效果。方法 分别用自制纯中药含漱液和生理盐水对14只5个月龄家兔滴左、右眼7 d;并涂抹10只7个月龄豚鼠左、右侧臀部、腹部、背部（涂药前脱毛）,左右对照,分别于涂抹后第3、7天各处死5只,制作病理切片。分别将金黄色葡萄球菌、大肠埃希氏菌、白念菌、铜绿假单胞菌、乙型链球菌制取的菌悬液加入含不同浓度纯中药含漱液或复方硼砂含漱液（朵贝尔 液）的营养液中,观察细菌的生长情况。分别将黏性放线菌、消化链球菌、核梭杆菌制取的菌液加入等2倍稀释的复方硼砂溶液和纯中药含漱液中,观察有无细菌生长。采用 SPSS17.0软件包对数据进行统计学分析。结果 家兔右眼结膜与对照组相比,无明显充血、发红等变化;豚鼠右侧臀部、腹部、背部皮肤与对照组相比,无明显红肿、皮炎等变化。纯中药含漱液对上述需氧菌和厌氧菌的杀菌效果均显著高于对照组。结论 纯中药含漱液对皮肤、黏膜无刺激反应,对口腔常见细菌有杀菌效果。     

鼻内镜下经口鼻联合径路行腺样体切除术152例疗效分析

腺样体又称咽扁桃体、增殖体,位于鼻咽顶壁和后壁交界处,两侧咽隐窝之间.腺样体出生后即存在,6～7岁时最为显著,10岁后逐渐萎缩[1].腺样体因反复炎症刺激而发生病理性增生肥大,并引起相应的症状者称为腺样体肥大,本病常见于儿童,但部分成人亦可发生,常合并慢性扁桃体炎.肥大的腺样体不同程度地阻塞后鼻孔和压迫咽鼓管,以及分泌物对咽、喉和下呼吸道的刺激,可引起耳鼻咽喉和下呼吸道多种症状.     

口腔鳞状细胞癌侵犯颌骨与破骨细胞及相关细胞因子的关系

目的:研究在口腔鳞状细胞癌侵犯颌骨的病例中,破骨细胞及与破骨细胞相关的两个重要[细胞因子细胞核因子κB受体活化因子配体(receptor activator of nuclear factor-κB ligand,RANKL)和骨保护素(osteoprotegerin,OPG)]的表达情况.方法:选用12例口腔鳞状细胞癌侵犯颌骨病例的手术标本,将新鲜软组织标本制作成冰冻切片,含骨组织标本经固定脱钙后制成石蜡切片.分别对两种切片进行抗酒石酸酸性磷酸酶(TRAP)染色,以及针对RANKL和OPG两种细胞因子的免疫组织化学染色.结果:TRAP阳性的多核细胞出现在肿瘤与颌骨的交界面附近.其下方的骨组织成锯齿样,TRAP阳性细胞位于骨表面的陷窝内.RANKL免疫组化染色阳性的部位主要有血管内皮和上皮基底膜,在与骨面相近的肿瘤组织中也可见位于血管周围的染色阳性细胞,而在靠近骨面的鳞状细胞癌周围的组织内未见OPG特异性染色阳性.结论:在口腔鳞状细胞癌引起颌骨侵犯的病例中,破骨细胞是受到鳞状细胞癌的影响而分化和活化,并最终引起骨组织的吸收破坏.肿瘤细胞是跟随在破骨细胞后面侵入骨组织,并不直接引起骨的变化.骨侵犯性鳞状细胞癌的细胞及周围的血管可以释放出较多的RANKL类细胞因子,促进破骨细胞的分化和活化,最终导致了破骨活动的发生和发展.     

8例重症手足口病的监护

报告8例重症手足口病惠儿的护理方法.包括入院时的急救处理、做好呼吸支持期间的气道管理、口腔护理、严密观察病情、维持稳定的生命体征、加强脑保护,以及严格进行消毒隔离.本组1例死亡,1例因严重脑干损伤意识未能恢复,其余6例康复出院.     

口腔婴儿黑色素神经外胚瘤的诊断及治疗

目的:探讨口腔婴儿黑色素神经外胚瘤的诊断要点及治疗原则.方法:对北京大学口腔医学院1980年至2007年8月间收治的13例口腔婴儿黑色素神经外胚瘤病例进行回顾性研究,复习临床资料及病理切片.结果:9例口腔婴儿黑色素神经外胚瘤发生于上颌骨,3例位于下颌骨,1例位于颊部.发病年龄从2个月至7个月.临床症状均为肿物,5例术前检查发现肿物为紫红色或蓝黑色.肿物生长迅速,3例术前诊断为恶性肿瘤,仅有1例术前临床诊断为婴儿黑色素神经外胚瘤.9例有随访结果,2例确定复发,复发时间均为术后1个月,1例死亡.1例切除不完全的病例术后19年无复发.结论:口腔婴儿黑色素神经外胚瘤具有典型的发病部位与发病年龄,临床检查时应注意肿物的颜色.肿瘤常生长迅速,具有局部侵袭性.对患者术后半年内要密切随访;病理诊断要与儿童小圆细胞恶性肿瘤相鉴别;相对保守的手术为首选治疗方式.     

中西医结合治疗慢性鼻窦炎临床价值初探

目的:探讨中西医结合在治疗慢性鼻窦炎中的疗效.方法:采用上颌窦穿刺、抗生素冲洗、改善和重建鼻腔和鼻窦通气引流功能,结合中药清鼻丸口服治疗.结果:50例中治愈37例(73.7%),好转10例,占20%,总有效率93.7%.无效3例,占6.3%.对部分病例随访6个月～2年未见复发.结论:中西医结合治疗慢性鼻窦炎,疗效优于单纯西医或中医治疗,疗效确切,具有较好的临床实用价值.