To explore the etiology, clinical manifestations, diagnosis and treatment of IgG4-related Mikulicz disease and to provide a reference for clinical diagnosis and treatment.

Case data from a patient with IgG4-related Mikulicz disease occurring in the submandibular gland and the literature were retrospectively analyzed.

IgG4-related Mikulicz disease is a rare autoimmune disease. Its typical features include lacrimal gland and salivary gland swelling, a significant increase in the serum IgG4 level (> 1.35 g/L), and IgG4-positive plasma cell infiltration into a large number of pathological tissues. The disease can easily recur. Treatment is mainly symptomatic, including surgical resection and administration of glucocorticoid and other drug treatment. Long-term follow-up is required after the operation.

IgG4-related Mikulicz disease has no specific clinical features. The diagnosis relies mainly on pathological examination and serum IgG4 examination. The main treatment methods are surgery and the use of glucocorticoids, which require long-term follow-up.

To investigate the clinical effect of polidocanol sclerotherapy in the treatment of giant venular malformations of the lips and cheeks in adults.

From September 2019 to September 2020, 5 patients with huge venular malformations of the lips and cheeks (4 males, 1 female) admitted to Xuzhou Central Hospital were included in the study. All the patients were treated with local injection of polidocanol foam scleroagent, and all patients were followed up with a 3-week treatment course. If the clinical symptoms were not alleviated and the MRI examination showed that > 25% of the lesion remained, or it relapsed again after symptoms are stable, the patient needed to be treated again. The endpoints of treatment were: ①subsidence of clinical symptoms and MRI showing residual lesions < 25% in size; ②continuous treatment for 4 times without relief or aggravation of symptoms; ③a discontinuation of treatment.

All 5 patients successfully completed the treatment and were injected 2 to 4 times during treatment. The curative effect was evaluated according to the Achauer standard, including grade Ⅰcurative effects in 1 patient, grade Ⅱ in 2 patients, grade Ⅲ in 2 patients. Among them, one patient suffered from erosion and bleeding in the lesion before the operation, and the symptoms were significantly improved postoperatively. No serious side effects were found except skin pigmentation in 1 case.

Local injection of polidocanol foam scleroagent is a safe and effective treatment method for adult giant venular malformations of the lips and cheeks, and it has a hemostatic effect on spontaneous bleeding invenular malformations.

To investigate the effect of tension on donor site recovery of modified forearm flaps (closed forearm donor site skin flaps).

From October 2018 to April 2021, 12 patients with oral cancer underwent forearm flap repair at Xuzhou Central Hospital. Handgrip strength and wrist motion were recorded before surgery. During the surgical incision at the donor site of the forearm, the triangular full-thickness skin of the donor site was used to close part of the surgical incision, and the other part of the surgical incision was directly closed and sutured. Tension was measured with a tension meter during the surgical incision at the donor site. Patients were followed up after surgery to observe whether there were postoperative complications such as necrosis and poor healing of donor site wounds, as well as forearm grip strength, wrist range of motion and appearance satisfaction.

Among the 12 patients, there was only one elderly patient with postoperative necrosis near the wrist in the donor site skin, and the average tension of the patient was 0.65 kg; the lesion healed after dressing changes. All of the other patients recovered well without postoperative complications. The mean tension of 12 patients was (0.51 ± 0.05) kg. The preoperative and postoperative grip strength of 12 patients was (23.7 ± 10.3) kg and (22.3 ± 10.7) kg, respectively, and the difference was not statistically significant (t = 5.872, P<0.001). The mean range of motion of the wrist was (47.6 ± 8.3)°, (45.8 ± 5.8)°; dorsiflexion (54.6 ± 3.2)°, (53.9 ± 2.3)°; radial deviation (37.0 ± 2.3)°, (36.1 ± 2.2)°; ruler deviation (27.1 ± 1.9)°, (26.4 ± 1.3)°, respectively. The t values were 1.64, 1.636, 2.116 and 1.412, and the P values were 0.129, 0.130, 0.058 and 0.186, respectively. All 12 patients were satisfied with the appearance of the donor site of the forearm.

When the average tension during suturing is less than 0.5 kg, there is a lower risk of complications at the donor site of the forearm one month after surgery, a lower risk of impaired donor site function, and a greater possibility of patient satisfaction with the appearance of the donor site.

To establish and validate a risk prediction model for postoperative delirium (POD) in patients with head and neck cancer (HNC) resection with free flap repair and to provide a reference for clinical practice.

This study has been reviewed and approved by the Ethics Committee, and informed consent has been obtained from patients. This study retrospectively collected and evaluated the risk factors and vital signs of patients undergoing head and neck cancer free flap reconstruction in the Department of Oromaxillofacial Head and Neck Oncology, Xuzhou Central Hospital from January 1, 2016, to January 1, 2022. A total of 241 cases were included, of which 171 cases were used to establish the prediction model, and 70 cases were collected for internal verification. Univariate and multivariate logistic analyses and the R Studio software package were used for modeling and statistical analysis.

The research model finally included five risk factors: age, blood transfusion, postoperative sleep disorder and postoperative VAS pain value. The area under the working characteristic curve (AUC) of the subjects in the training set of the model was 0.869 (95% CI: 0.789-0.948), the Youden index was 0.692, the predictive value was 0.215, the sensitivity was 85.3%, the specificity was 83.9%, and the goodness of fit of the Hosmer Lemeshow test was 10.336 (P =0.242). The model fit well. The validation set was verified according to the model. The C index was 0.827 (95% CI:0.681-0.973), and the model prediction effect was very good.

This model may be applied to predict postoperative delirium for patients with head and neck cancer resection and free flap repair, which has a high predictive value for the risk of HNC-POD at admission. The use of this model may help to better implement preventive treatment and nursing measures.