口腔鳞状细胞癌预后相关基因标志物的分析

［摘要］ 目的 通过生物信息分析途径对口腔鳞状细胞癌患者与正常人群的差异基因进行分析,从分子水平探讨关键基因以及参与的信号通路,初步探索口腔鳞状细胞癌发生、发展的基因标志物。方法 从公共数据库基因表达数据库（GEO）中下载口腔鳞状细胞癌的相关芯片数据（GSE3524和GSE6631）,筛选出口腔鳞状细胞癌组织和对照组织表达有显著差异的基因。并对其功能及预后进行分析。结果 共筛选出129个差异表达基因,其中表达上调45个,下调84个,对其进行基因本体、京都基因与基因组百科全书和蛋白互作网络分析,发现分泌型焦磷酸蛋白（secreted phosphoprotein 1, SPP1）、金属基质蛋白酶（matrix metalloproteinase 1,MMP1）、丝氨酸蛋白酶抑制剂（serpin family E member 1,SERPINE1）、纤溶酶原激活剂（plasminogen activator urokinase,PLAU）处于基因核心节点位置。同时,根据这些关键基因表达水平的高低对口腔鳞状细胞癌患者进行分组,高表达组患者生存时间均低于低表达组,差异有统计学意义（PSPP1=0.045、PMMP1=0.046、PSERPINE1=0.0024和PPLAU=0.00049）。结论 基因组学分析方法筛选出的关键基因和信号通路有助于研究口腔鳞状细胞癌发生、发展的机制,也进一步为治疗靶点及预后分子标志物的选择提供了依据。     

老年口腔肿瘤患者围手术期呼吸道护理

目的:探讨老年口腔肿瘤患者围手术期呼吸道护理。方法:选择我院2009年5月-2011年5月收治的老年口腔肿瘤行手术治疗的患者80例,随机分为两组,对照组40例采用常规护理,观察组40例在此基础上行围手术期整体护理干预,就两组临床资料进行回顾性分析。结果:观察组术后肺部感染1例,痊愈率为97.5%。对照组术后肺部感染5例,呼吸衰竭1例,痊愈率为85%,观察组临床治愈率明显优于对照组,差异有统计学意义,(P>0.05)。结论:老年口腔肿瘤患者加强围手术期护理干预,可显著提高临床治愈率,降低并发症发生率,改善患者生存质量。     

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提要：老年人除口腔组织产生各种增龄性的改变外,全身各器官也都相应地产生衰老的改变,生理功能适应性减退,同时心理状态也有不同程度的变化。此外,老年人还常伴有多种慢性疾病,服用多种药物。以上情况均可影响其口腔疾病的诊断、治疗和预后。这就要求医生必须掌握老年人的各种特点,采取不同于青、壮年人的措施,进行安全有效的治疗。本文介绍了对老年口腔病患者治疗的一般原则,老年人常见全身疾病和口腔治疗的关系以及拔牙、牙体牙髓病、牙周病及口腔修复的特点。     

Food intake and oral health status of inpatients with dysphagia in acute care settings

Adequate oral status and functional assessments are important for dysphagia rehabilitation in acute care inpatient settings, especially to establish individualised oral intake. However, the association between food intake levels and oral function has not been elucidated in acute care inpatients. This cross-sectional study clarified the association between oral intake levels and the oral status/function of patients with dysphagia admitted to acute care settings. Admitted patients aged ≥40 years (n = 459; men: 288; mean age: 70.8 ± 12.0) examined at the Department of Dysphagia Rehabilitation at the Iwate Medical University Hospital from April 2007 to March 2014 were included. The oral health status was evaluated by the tongue coating, oral dryness severity, plaque control, posterior occlusal support and a repetitive saliva swallowing test (RSST). Dysphagia severity was determined from the Dysphagia Severity Scale. Oral intake levels were evaluated using the Functional Oral Intake Scale (FOIS) at the time of the initial dental examination (FOIS-I), and they were re-evaluated after the revision of levels according to the participants’ general condition and oral health status (FOIS-R). Divergence between FOIS-I and FOIS-R was noted in >40% patients. Multiple regression analysis showed significant associations between FOIS-R and consciousness level, activities of daily living, tongue coating, RSST and posterior occlusal support. Patients with dysphagia in acute care settings require detailed assessments of their oral status and function, including swallowing, to determine the most suitable feeding methods and dental interventions to improve oral intake levels.     

时辰新辅助化疗治疗老年人口腔鳞癌的临床研究

目的:探讨卡铂(CBP)联合5-氟脲嘧啶(5-Fu)对老年人口腔鳞癌患者行时辰新辅助化疗的疗效和毒副作用.方法:收集我院2002年6月至2004年9月收治的以卡铂联合5-Fu行新辅助化疗的T3、T4老年口腔鳞癌患者43例,随机分为时辰化疗组23例和常规化疗组20例,比较化疗2个疗程后两组的疗效和毒副作用.结果:时辰化疗组的疗效显著高于常规化疗组(P＜0.05);时辰化疗组的毒副作用发生率显著低于常规化疗组(P＜0.05).结论:卡铂联合5-Fu化疗方案对老年人口腔鳞癌患者行时辰化疗能达到减毒增效的目的,适合临床推广应用.     

基于德尔菲法构建老年口腔癌患者围术期口腔护理方案

目的 构建老年口腔癌患者围术期口腔护理方案。方法 在前期指南内容分析、医护患相关人群深入访谈的基础上,根据老年口腔癌患者的临床特点、治疗阶段,结合PDCA循环,构建老年口腔癌患者围术期口腔护理方案初稿,采用德尔菲法对16位相关领域专家进行2轮函询,以确定方案。采用Excel 2016、SPSS 25.0软件包进行统计描述和统计分析。结果 2轮专家咨询回收率均为100%,整体专家权威系数为0.84。经过2轮专家咨询,各指标的变异系数为0~0.240,整体协调系数为0.171,形成了术前、术后、放化疗时期3个阶段的口腔护理方案。术前阶段包括4个维度,12个一级条目,56个二级条目;术后阶段包括4个维度,18个一级条目,102个二级条目;放化疗阶段包括4个维度,13个一级条目,35个二级条目。结论 老年口腔癌患者围术期口腔护理方案符合老年口腔癌围术期患者特点,能够满足该群体的口腔护理需求,方案构建具有可靠性,能为临床实践提供参考。     

Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients

Clinical Oral Investigations - This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in...     

Straightforward factors for predicting the prognosis of blow-out fractures

In blow-out fractures, some nonoperative cases have a poor outcome, and a method for accurate prognosis is required. To address this need, we retrospectively reviewed blow-out fractures presenting at Teikyo University Hospital between July 2004 and May 2007 and conducted a survey regarding diplopia and enophthalmos for nonoperative cases. Computed tomographic scan findings were divided according to fracture width and the degree of protrusion of the inferior rectus muscle into the maxillary sinus. We had 106 patients presenting with blow-out fractures, and 89 patients had been treated nonoperatively. In medial orbital wall fractures, no patient had diplopia, and 1 patient had enophthalmos after nonoperative treatment. In punched-out orbital floor fractures, all cases had diplopia when the fracture width was less than half the diameter of the globe, and the protrusion of the inferior rectus muscle into the maxillary sinus was half or more of its section. Even if the fracture width was less than half the diameter of the globe, 2 of 3 patients had enophthalmos when the protrusion of the inferior rectus muscle into the maxillary sinus was half or more of its section. Among the linear orbital floor fractures, 1 case required an emergency operation. We suggest a new algorithm for treatment of blow-out fractures based on computed tomographic scan findings that can also contribute to making a prognosis.     

Early oral intake after reconstruction with a free flap for cancer of the oral cavity

To allow healing of the surgical wound patients are traditionally given nothing by mouth for 6–12 days after resection and reconstruction of a cancer of the oral cavity. Our aim was to assess the impact of introducing oral intake within 6 days postoperatively. Consecutive patients who had resection and reconstruction of a cancer of the oral cavity with a free flap within an 8-year period were selected from the head and neck database. Personal and social data; type, stage, and site of the tumour; type of resection and free flap; postoperative complications; and duration of hospital stay were recorded, supplemented by review of casenotes for the time that oral intake was started, duration of nasogastric and tracheostomy intubation, and changes in body weight. Patients in the early oral intake group started oral intake within 5 days postoperatively, and those in the late group began feeding from postoperative day 6. The duration of hospital stay in the early group was significantly shorter than that in the late group. There was, however, no difference in the morbidity, including orocutaneous fistula, between the two groups. The duration of nasogastric and tracheostomy intubation was shorter, and weight loss was less, in the early group than in the late group, but not significantly so. Early oral feeding does not increase the morbidity for patients having resection and reconstruction with free flaps for cancers of the oral cavity. Early oral intake is associated with a shorter hospital stay, and this may have implications for improved postoperative outcome.     

老年人口腔肿瘤全麻术后意识障碍的护理

口腔颌面部施人型复杂手术后，出现的意识障碍多发生于采用静脉复合麻醉的老年人，常于术后12-48h内出现思维紊乱、烦躁不安、兴奋、行为失控。2-3d后可恢复正常。呈现为一过性。加强临护及护理措施，愈后效果良好。现将我们对6例老年口腔肿瘤病人全麻术后出现意识障碍的护理体会报告如下。     

Impact of oral diseases on systemic health in the elderly: diabetes mellitus and aspiration pneumonia

Evidence is increasing that oral health has important impacts on systemic health. This paper presents data from the third National Health and Nutrition Examination Survey (NHANES III) describing the prevalence of dental caries and periodontal diseases in the older adult population. It then evaluates published reports and presents data from clinical and epidemiologic studies on relationships among oral health status, chronic oral infections (of which caries and periodontitis predominate), and certain systemic diseases, specifically focusing on type 2 diabetes and aspiration pneumonia. Both of these diseases increase in occurrence and impact in older age groups. The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. Our review found clinical and epidemiologic evidence to support considering periodontal infection a risk factor for poor glycemic control in type 2 diabetes; however, there is limited representation of older adults in reports of this relationship. For aspiration pneumonia, several lines of evidence support oral health status as an important etiologic factor. Additional clinical studies designed specifically to evaluate the effects of treating periodontal infection on glycemic control and improving oral health status in reducing the risk of aspiration pneumonia are warranted. Although further establishing causal relationships among a set of increasingly more frequently demonstrated associations is indicated, there is evidence to support recommending oral care regimens in protocols for managing type 2 diabetes and preventing aspiration pneumonia.     

Screening of periodontitis with salivary enzyme tests

The purpose of this study was to determine the usefulness of salivary biochemical markers for the screening of periodontal disease and examine the agreement between the results of saliva enzyme tests and those of probing depth. The present study included a total of 187 subjects who underwent annual medical check-ups at the Comprehensive Health Care Center, Honjo, Saitama Prefecture, Japan. Periodontal pocket probing was performed with a WHO probe, and various enzymes and biochemical parameters in saliva were measured. For lactate dehydrogenase (LDH), the proportions of the five isoenzymes were calculated. To decide the cut-off point for each enzymatic activity, receiver operating characteristic curves (ROC curves) were constructed and the points of minimum difference between sensitivity and specificity were decided. Among the biochemical markers tested, salivary LDH level had the highest sensitivity and specificity (sensitivity 0.66, specificity 0.67), while salivary levels of aspartate aminotransferase (AST) and blood urea nitrogen (BUN) also had sensitivity and specificity above 0.60. Among the LDH isoenzymes, LDH4 and LDH5 dominated in whole saliva samples. Salivary LDH may be a feasible and useful parameter for the screening of periodontal disease, while salivary AST and BUN also appear to be potentially useful for this purpose.     

Correlation of expression of hypoxia-related proteins with prognosis in oral squamous cell carcinoma patients

INTRODUCTION: Hypoxia plays a major role in tumor progression, therapy resistance and for prognosis of oral squamous cell carcinoma (OSCC). The crucial step as a response to hypoxia is the activation and stabilization of the alpha subunit of hypoxia inducible factor 1 (HIF-1α). HIF-1: HIF-1 regulates the expression of different genes to adapt the tumor cells to reduced oxygenation. The HIF-1 system is intrinsic regulated by von Hippel-Lindau protein (pVHL). Main downstream proteins are the glucose transporter 1 (GLUT-1), carbonic anhydrase IX (CAIX), and vascular endothelial growth factor (VEGF). For therapeutical stratification in OSCC, it is important to understand the mechanism caused by hypoxic stress and to comprehend the resulting adaptive process in cancer cells. Therefore, an overview of HIF-1α-depending protein expression, focussed on the expression of GLUT-1, CAIX, and VEGF and their prognostic significance in OSCC is given. CONCLUSION: Several unique roles of hypoxic pathway in the context of tumor progression are described in this review. As a consequence, a marker panel is proposed to allow a more individualized prognosis in OSCC patients. This marker panel should include beside HIF-1α, pVHL, and GLUT-1.     

口腔恶性肿瘤术后患者放疗前营养状况与膳食营养素摄入的相关性研究

目的 探讨口腔恶性肿瘤术后患者放疗前膳食营养素摄入量与主观整体营养状况评量表（PG-SGA）评分间的相关性。方法 选取上海交通大学医学院附属第九人民医院营养门诊就诊的口腔恶性肿瘤术后患者65例,采用72 h膳食调查法了解患者放疗前食物摄入情况,采用PG-SGA对患者的营养状况进行定量评分。采用SPSS 23.0软件包对数据进行统计学分析。结果 男性患者重度营养不良病例数显著高于女性患者（P<0.05）。营养良好/轻度营养不良组、中度营养不良组、重度营养不良组患者膳食提供能量、脂肪量及其供能比、碳水化合物量及其供能比均在中国居民膳食营养素参考摄入量范围内,蛋白质摄入量及其供能比均超过中国居民膳食营养素参考摄入量,3组患者之间无显著差异。营养良好/轻度营养不良组、中度营养不良组、重度营养不良组硒摄入量分别为67.15、81.04、81.59 μg,维生素E分别为27.81、30.88、26.40 mg α-TE,维生素C分别为150.19、159.81、183.71 mg,视黄醇分别为904.65、1401.51、1373.81 μg RAE,均显著高于参考摄入量。烟酸分别为12.97、18.76、14.27 mg NE,达到或高于参考摄入量,3组间无显著差异。在男性患者中,膳食中的能量和烟酸的摄入与PG-SGA得分呈负相关（P<0.05）。结论 口腔恶性肿瘤术后患者放疗前营养不良发生率高,膳食提供能量和蛋白质、脂肪、碳水化合物以及硒、维生素E、维生素C、视黄醇、烟酸等微量营养素的平均摄入量达到或高于参考摄入量。男性患者能量和烟酸的摄入与PG-SGA得分呈负相关。