[Minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure: a series of 60 cases]

Objective: To examine the short-term curative effect with minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure. Methods: The clinical data of 60 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure from August 2021 to August 2022 at Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital were retrospectively analyzed. There were 31 males and 29 females, with the age (M (IQR)) of 54.0(22.3) years (range: 15 to 71 years). The echocardiography confirmed the diagnosis of moderate mitral regurgitation in 30 patients, and severe mitral regurgitation in 13 patients. Systolic anterior motion (SAM) was present preoperatively in 54 patients. All 60 patients underwent transaortic modified Morrow procedure through a right infra-axillary thoracotomy using femorofemoral cardiopulmonary bypass. Surgical procedures mainly included transverse aortic incision, exposure of left ventricular outflow tract (LVOT), septal myectomy, and correction of the abnormal mitral valve and subvalvular structures. Results: All 60 patients underwent the programmatic procedures successfully without conversion to full sternotomy. The cardiopulmonary bypass time was (142.0±32.1) minutes (range: 89 to 240 minutes), while the cross-clamp time was (95.0±23.5) minutes (range: 50 to 162 minutes). The patients had a postoperative peak LVOT gradient of 7.0 (5.0) mmHg (range: 0 to 38 mmHg) (1 mmHg=0.133 kPa). A total of 57 patients were extubated on the operating table. The drainage volume in the first 24 h was (175.9±57.0) ml (range: 60 to 327 ml). The length of intensive care unit stay was 21.0 (5.8)h (range: 8 to 120 h) and postoperative hospital stay was 8 (5) days (range: 5 to 19 days). The postoperative septal thickness was 11 (2) mm (range: 8 to 14 mm). All patients had no iatrogenic ventricular septal perforation or postoperative residual SAM. The patients were followed up for 4 (9) months (range: 1 to 15 months), and none of them needed cardiac surgery again due to valve dysfunction or increased peak LVOT gradient during follow-up. Conclusion: Using a video-assisted thoracoscopic transaortic modified Morrow procedure through a right infra-axillary minithoracotomy can provide good visualization of the LVOT and hypertrophic ventricular septum, ensure optimal exposure of the mitral valve in the presence of complex mitral subvalvular structures, so that allows satisfactory short-term surgical results.

[Retropharyngeal lymph node dissection in head and neck cancers treated with transoral robotic surgery]

Objective: To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection. Methods: The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed. Results: All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden. Conclusions: The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.

Randomized clinical trial of continuous transversus abdominis plane block, epidural or patient-controlled analgesia for patients undergoing laparoscopic colorectal cancer surgery

Background

The optimal analgesia regimen after laparoscopic colorectal cancer surgery is unclear. The aim of the study was to characterize the beneficial effects of continuous transversus abdominis plane (TAP) blocks initiated before operation on outcomes following laparoscopic colorectal cancer surgery.

Methods

Patients undergoing surgery for colorectal cancer were divided randomly into three groups: combined general–TAP anaesthesia (TAP group), combined general–thoracic epidural anaesthesia (TEA group) and standard general anaesthesia (GA group). The primary endpoint was duration of hospital stay. Secondary endpoints included gastrointestinal motility, pain scores and plasma levels of cytokines.

Results

In total, 180 patients were randomized and 165 completed the trial. The intention-to-treat analysis showed that duration of hospital stay was significantly longer in the TEA group than in the TAP and GA groups (median 4·1 (95 per cent c.i. 3·8 to 4·3) versus 3·1 (3·0 to 3·3) and versus 3·3 (3·2 to 3·6) days respectively; both P < 0·001). Time to first flatus was earlier in the TAP group (P < 0·001). Visual analogue scale (VAS) scores during coughing were lower in the TAP and TEA groups than the GA group (P < 0·001). Raised plasma levels of vascular endothelial growth factor C, interleukin 6, adrenaline and cortisol were attenuated significantly by continuous TAP block.

Conclusion

Continuous TAP analgesia not only improved gastrointestinal motility but also shortened duration of hospital stay. A decreased opioid requirement and attenuating surgical stress response may be potential mechanisms. Registration number: ChiCTR-TRC-1800015535 (http://www.chictr.org.cn).

Expression of PD-1/PD-L1 in head and neck squamous cell carcinoma and its clinical significance

OBJECTIVE

To investigate the role of programmed death-1 (PD-1), programmed death-ligand 1 (PD-L1), and P16 in patients with head and neck squamous cell carcinoma (HNSCC).

METHODS

A total of 95 paraffin-embedded samples of tumorous tissue of HNSCC were collected. Expression levels of PD-1, PD-L1, and P16 were determined by immunohistochemistry.

RESULTS

A significantly higher proportion of PD-1 among patients infected with the human papillomavirus was found. PD-L1 expression is closely associated with the primary site of the tumor, postoperative recurrence, survival, PD-1 expression and P16 expression. Univariable analysis indicated that T stage, N stage, tumor node metastasis stage, tumor differentiation, and PD-L1 expression were all shown to be prognostic variables for overall survival in patients with HNSCC. In the multivariate analysis, only N stage (P = 0.010) and PD-L1 expression (P = 0.001) were found to be independent prognostic variables for overall survival. In addition, for disease recurrence, multivariate analysis showed that only PD-L1 expression was the associated independent risk factor. For the patients with negative PD-L1 expression, Kaplan-Meier analysis revealed that they had significantly worse outcomes in terms of overall survival (P = 0.001). Similarly, compared with the patients with positive PD-L1 expression, those with negative PD-L1 expression had a higher probability of recurrence (P = 0.026).

CONCLUSIONS

The expression of PD-L1, PD-1, and P16 in HNSCC is significantly correlated. Human papillomavirus infection (P16 positive) is negatively related to postoperative recurrence. HNSCC patients with positive PD-L1/PD-1 expression tend to have better overall survival outcomes and lower probability of recurrence, providing more evidence for the PD-l-targeted immunotherapy of HNSCC.

[Surgical treatment for inflammatory myofibroblastic tumor in genito-urinary system: a study of 15 cases]

Objective: To present 15 cases of inflammatory myofibroblastic tumor (IMT) in genitor-urinary system, and analyze the characteristics, diagnosis and treatment of the disease. Methods: The diagnostic and therapeutic process of 15 confirmed cases admitted to Sun Yat-sen University Cancer Center between March 2009 and September 2017 were retrospectively analyzed. Of the total cases, 11 cases were diagnosed with cystic IMT with a maximum diameter of 1.0-4.5 cm, 8 cases underwent transurethral resection of bladder tumor(TURBT)and 4 of them underwent partial cystectomy after TURBT and 3 underwent partial cystectomy directly. Two cases were renal IMT with a maximum diameter of 4.0-9.0 cm, one underwent partial nephrectomy and the other accepted radical nephrectomy. One case who was diagnosed with prostatic IMT with a maximum diameter of 3.4 cm underwent transurethral resection of the prostate (TURP) and postoperative radiotherapy. One case who was diagnosed with perineal IMT with a maximum diameter of 2.1 cm underwent tumor resection. Results: The patients were followed up for 10-32 months with a median time of 27 months. No cases relapsed during the follow-up. Conclusion: Surgery is the preferred method for treating IMT in genitor-urinary system. Retrospective study shows a good prognosis in IMT patients, but a long-term follow-up is still required.

Trends in clinical features and survival of oral cavity cancer: fifty years of experience with 3,362 consecutive cases from a single institution

Background

Global data demonstrate minimal improvement in the survival rate for oral cavity cancer (OCC) patients. We wished to know whether or not clinical features and survival rate have changed over time for OCC patients receiving initial treatment and follow-up at a large cancer center in China.

Methods

Clinical features and survival data were collected on patients diagnosed during the successive decades of 1960-1969 (n=253), 1970-1979 (n=497), 1980-1989 (n= 659), 1990-1999 (n=793), and 2000-2009 (n=1,160) at the Sun Yat-sen University Cancer Center.

Results

Over time, the overall 5-year survival rate for OCC patients was 52.0%. According to tumor localization, this rate was 71.4% for lip cancer, 56.3% for oral tongue cancer, and 42.7% for other parts of the oral cavity. From the 1960s to the 2000s, the 5-year survival rate steadily improved from 47.8% to 55.6% (P<0.001). Survival steadily decreased with age and was higher for women than for men in the 3 most recent decades. The survival rate for male patients was constant over time, while the rate for female patients improved dramatically. Obvious trends in clinical features over time included the following: increasing age of patients, increasing proportions of localized disease at diagnosis, decreasing proportions of diagnoses of lip cancer, decreasing proportions of diagnoses of squamous cell carcinoma, and decreasing proportions of non-surgical treatment approaches.

Conclusion

The survival rate has steadily improved for OCC patients at this cancer center.

Sam68 reduces cisplatin-induced apoptosis in tongue carcinoma

Background

Resistance to anticancer agents is a major obstacle for successful chemotherapy in tongue squamous cancer. Sam68 is an oncogenic-related protein in oral tongue squamous cell carcinoma functions as a signaling molecule mediating apoptosis, whose over-expression is associated with the clinicopathologic characteristics and prognosis of patients. The present study was to examine the effect of Sam68 on chemotherapeutics-induced apoptosis in oral tongue squamous cell carcinoma, and its clinical significance in oral tongue squamous cell carcinoma progression.

Methods

The effect of Sam68 on apoptosis induced by cisplatin was examined both in vitro and in vivo, using Annexin V staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assays. Real-time PCR and Western blotting analysis were used to detect mRNA and protein expression levels.

Results

Upregulation of Sam68 significantly inhibited cisplatin-induced apoptosis in oral tongue squamous cell carcinoma cells, associated with induction of anti-apoptotic proteins caspase-9, caspase-3, and PARP. In contrast, Silencing Sam68 expression significantly enhanced the sensitivity of oral tongue squamous cell carcinoma cells to apoptosis induced by cisplatin both in vitro and in vivo.

Conclusions

The current study suggests that Sam68 could enhance the anti-apoptosis activity of oral tongue squamous cell carcinoma cells. Sam68 is a potential pharmacologic target for the treatment of oral tongue squamous cell carcinoma and inhibition of Sam68 expression might represent a novel strategy to sensitize oral tongue squamous cell carcinoma to chemotherapy.

Seroprevalence of hepatitis C virus infection and its association with natural infection of hepatitis B virus among preschool children in Taiwan

Taiwan is a hyperendemic area of hepatitis B virus (HBV) infection where chronic hepatitis B is the most important cause of liver cirrhosis and hepatoma. Since, diagnostic kit for detecting hepatitis C virus (HCV) infection has been developed, HCV was found to be another important etiology of chronic liver disease. In order to study the seroprevalence of HCV infection among preschool children after mass hepatitis B vaccination program in Taiwan, a community-based survey was carried out in 54 kindergartens in 10 urban areas, 10 rural areas, and two aboriginal areas randomly selected through stratified sampling. Serum specimens of 2538 preschool children were screened for the HCV antibodies (anti-HCV) by a commercially available third-generation microparticle enzyme immunoassay and for HBV markers by radioimmunoassay methods. The multivariate-adjusted odd ratios (ORm) with their 95% confidence intervals (CI) were estimated through the multiple logistic regression analysis. A total of 58 children were anti-HCV seropositive, giving a prevalence of 2.3%. The prevalence of anti-HCV was 1.0% (5 of 484) among aboriginal children, a significantly decreased seroprevalence compared with those among other ethnic groups after multivariate adjustment. Boys had a higher anti-HCV seroprevalence, but not statistically significantly different from girls (ORm: 1.6; 95% CI: 0.9-2.8; p = 0.08). The seroprevalence of the age group of 3-4 years was lower than that of the age group of 5-6 years (ORm: 2.2; 95% CI: 1.1-4.2; p = 0.02). After multivariate adjustment, preschool children with natural HBV infection had a higher anti-HCV seroprevalence, but not statistically significantly different from those without natural HBV-infection (ORm: 2.6; 95% CI: 0.9-7.4; p = 0.08 for HBV-infected vs. uninfected). HCV infection varies with gender, residential area, and natural HBV infection. HCV and HBV might share common transmission routes in Taiwan.

Risk factors for early implant-related surgical site infection

PURPOSE

To identify the risk factors and microbes associated with early implant-related surgical site infection (SSI).

METHODS

Records of 193 implant-related SSIs secondary to primary orthopaedic surgery were reviewed. Early and late SSI was defined as infection diagnosed within and after 3 months of surgery, respectively.

RESULTS

Of the 193 implant-related SSIs, 29 were superficial incisional, 127 were deep incisional, and 37 were organ/space-related. 144 (90%) out of 160 SSIs used cefazolin in their prophylactic antibiotic regimen. In univariate analysis, early SSI was associated with diabetes mellitus, American Society of Anesthesiologists (ASA) score of >2, emergency procedures, and lack of antibiotic prophylaxis. In multivariable analysis, early SSI was associated with an ASA score of >2 (p=0.016).

CONCLUSION

It is important to cross-check ASA score with co-morbidities to reduce early SSIs. Peri-operative optimisation and antibiotic prophylaxis should be administered prior to surgery. Appropriate modification of antibiotic prophylaxis should be considered.

Epidemiologic characteristics of oral cancer: single-center analysis of 4097 patients from the Sun Yat-sen University Cancer Center

Background

Oral cancer is a common type of head and neck cancers. Knowing its epidemiologic characteristics is crucial to preventing, diagnosing, and treating this cancer. This study aimed to explore the epidemiologic characteristics of oral cancer in South China.

Methods

We retrospectively analyzed data from 4097 oral cancer patients treated at the Sun Yat-sen University Cancer Center between 1960 and 2013. We compared the age of onset, sex ratio, pathologic type, and primary tumor location among three subcultural areas (Guangfu, Hakka, and Chaoshan) and between an economically developed region and a less-developed one in Guangdong.

Results

Overall, oral cancer had a male-to-female ratio of approximately 2:1, and this ratio decreased over time. Oral cancer occurred mostly in patients of 45–64 years old (54.5%), and the percentage of older patients gradually increased over time. The most common tumor location was the tongue. Squamous cell carcinoma was the predominant pathologic type. The percentage of blood type O in oral cancer patients was lower than that in the healthy population. The male-to-female ratio in the Chaoshan area was higher than that in the Guangfu and Hakka areas, whereas the age of disease onset in Guangfu was higher than that in Hakka and Chaoshan. The male-to-female ratio was lower and the age of disease onset was higher in the economically developed region than in the less-developed region.

Conclusion

The incidence of oral cancer in South China presents typical characteristics to which doctors should pay attention when diagnosing and treating oral cancer patients.

Effects of anaesthesia on proliferation, invasion and apoptosis of LoVo colon cancer cells in vitro

Tumour cell proliferation, invasion and apoptosis are crucial steps in tumour metastasis. We evaluated the effect of serum from patients undergoing colon cancer surgery receiving thoracic epidural and propofol anaesthesia on colon cancer cell biology. Patients were randomly assigned to receive propofol anaesthesia with a concomitant thoracic epidural (PEA, n = 20) or sevoflurane anaesthesia with opioid analgesia (SGA, n = 20). Venous blood was obtained before induction of anaesthesia and 24 hours postoperatively. The LoVo colon cancer cells were cultured with patient serum from both groups and the effects on proliferation, invasion and apoptosis were measured. Twenty-four hours after surgery, the absorbance value of LoVo cells at 10% serum concentration from PEA was decreased when compared with SGA (0.302 (0.026) vs 0.391 (0.066), p = 0.005). The inhibitory rate of LoVo cells at 10% serum concentration from PEA was higher than that from SGA (p = 0.004) 24 h after surgery. The number of invasive LoVo cells at 10% serum concentration from PEA was reduced when compared with SGA (44 (4) vs 62 (4), p < 0.001). Exposure of LoVo cells to postoperative serum from patients receiving PEA led to a higher luminescence ratio (apoptosis) than those receiving SGA (0.36 (0.04) vs 0.27 (0.05), p < 0.001). Serum from patients receiving PEA for colon cancer surgery inhibited proliferation and invasion of LoVo cells and induced apoptosis in vitro more than that from patients receiving SGA. Anaesthetic technique might influence the serum milieu in a way that affects cancer cell biology and, thereby, tumour metastastasis.

Thymosin beta 10 correlates with lymph node metastases of papillary thyroid carcinoma

BACKGROUND

Thymosin beta 10 (TMSB10) has recently been recognized as being an important player in the metastatic cascade including tumor angiogenesis, invasion, and metastasis. However, a role for this protein in papillary thyroid carcinoma (PTC) has not yet been established.

METHODS

Real-time polymerase chain reaction was used to examine the expression of TMSB10 messenger RNA in 36 cases of thyroid tissue samples: normal thyroid, PTC without lymph node metastases (LNM) and PTC with LNM (n = 12 cases in each subgroup). For immunohistochemistry, 130 patients with PTC were selected during the period of 2004-2005, 91 with and 39 without LNM. Statistical analysis was applied to evaluate the correlation between TMSB10 expression and LNM of PTC.

RESULTS

By real-time polymerase chain reaction analysis, the expression of TMSB10 messenger RNA in normal thyroid tissue, PTC without LNM, and PTC with LNM tissue were significantly different (P < 0.0001). On immunohistochemistry analysis of 130 patients with PTC, in which 91 cases had cervical LNM and 69 cases had central neck LNM, high expression levels for TMSB10 were more common in patients with cervical LNM compared with patients without (81% versus 33%, P < 0.001). Similarly, high expression levels of TMSB10 were more common in patients with central neck LNM compared with those without (87.0% versus 44.3%, P < 0.001).

CONCLUSIONS

High expression levels of TMSB10 correlated with LNM in PTC, especially in the central neck region. Patients with PTC with low levels of TMSB10 expression may be unlikely to have central neck LNM and could therefore avoid prophylactic central neck dissection.

Should level V be included in lateral neck dissection in treating papillary thyroid carcinoma?

BACKGROUND

The study was designed to explore the regular patterns of level V lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC), and to indicate whether level V should be included in the management of lateral neck dissection when treating PTC.

METHODS

This retrospective study consisted of 330 patients diagnosed with PTC from January 1994 to July 2009 who underwent an operation that included therapeutic lateral neck dissection (levels II to V). The patterns of lateral neck LNM were analyzed and the relevant risk factors of level V LNM were analyzed with univariate and multivariate analysis, respectively.

RESULTS

All the patients underwent lateral neck dissection at levels II to V. The predominant site of metastasis was level III (247/330 (74.8%)), followed by level IV (233/330 (70.6%)), and level II (215/330 (65.3%)). Simultaneous multilevel involvement (level II, III, and IV) of lymphatic metastases presented in 46.1% (152/330) of the cases. Level V showed 28.8% (95/330) of nodal metastasis. Multivariate analysis showed that level V LNM was significantly associated with location (whole thyroid), gross extrathyroidal extension and simultaneous multilevel involvement (level II, III and IV). (P <0.05).

CONCLUSIONS

Due to relatively high rate of level V involvement and its correlation with location (whole thyroid), gross extrathyroidal extension and multilevel involvement, we consider that it may be more rational to include level V in the therapeutic lateral neck dissection when treating PTC, especially for those who have any one of these three independent risk factors.

Irradiation of the recipient site does not adversely affect successful free flap transfer in the repair of head and neck defects after salvage surgery for recurrent nasopharyngeal carcinoma originally treated with radiotherapy

Irradiation of the recipient site has been associated with postoperative complications and an increased rate of flap failure in facial reconstruction. The aim of this study was to report the outcomes of our use of four different types of flaps (two free and two pedicled) for the reconstruction of patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy, who subsequently received salvage surgery after the development of recurrence or secondary primary tumours. The records of 12 NPC patients who underwent salvage surgery and reconstruction from 2002-2007 were retrospectively reviewed. There were no intraoperative or significant postoperative complications. All flaps survived. The average cosmetic outcome was 2.7 (1 = poor, 4 = excellent), all patients could tolerate a liquid to normal diet, and nine patients had normal or intelligible speech, while three exhibited slurred speech. These results indicate that the effects of irradiation on the recipient site do not appear to adversely affect successful flap transfer or outcomes.

Treatment results and prognostic factors of patients undergoing postoperative radiotherapy for laryngeal squamous cell carcinoma

Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this study were to evaluate the treatment outcomes of PRT for patients with laryngeal carcinoma and to identify the value of several prognostic factors. We reviewed the records of 256 patients treated for laryngeal squamous cell carcinoma between January 1993 and December 2005. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank test was employed to identify significant prognostic factors for DFS and OS. The Cox proportional hazards model was applied to identify covariates significantly associated with the aforementioned endpoints. Our results showed the 3-, 5-, and 10-year DFS for all patients were 69.9%, 59.5%, and 34.9%, respectively. The 3-, 5-, and 10-year OS rates were 80.8%, 68.6%, and 38.8%, respectively. Significant prognostic factors for both DFS and OS on univariate analysis were grade, primary site, T stage, N stage, overall stage, lymph node metastasis, overall treatment times of radiation, the interval between surgery and radiotherapy, and radiotherapy equipment. Favorable prognostic factors for both DFS and OS on multivariate analysis were lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment. In conclusion, our data suggest that lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment are favorable prognostic factors for DFS and OS and that reducing the overall treatment times of radiation to 6 weeks or less and the interval between surgery and radiotherapy to less than 3 weeks are simple measures to remarkably improve treatment outcome.

Survival study and clinicopathological evaluation of trichilemmal carcinoma

Trichilemmal carcinoma (TC) is a rare malignancy, commonly located on the scalp, forehead and neck, trunk or the upper extremities. The aim of this study was to investigate the clinicopathological characteristics and prognostic factors of TC, and to determine an optimal treatment strategy for these patients. Consecutive patients who were admitted to the Sun Yat-sen University Cancer Center between 1998 and 2012 were included in this retrospective study. The key prognostic factors affecting survival were lymph node metastasis and surgery margin. Multivariate analysis demonstrated that there was no risk factor for patient survival. Surgery margin and lymph node metastasis were the prognostic factors that influenced the treatment outcome. Simple excision with 1 cm margins is safe, cost-effective and effective for the treatment of TC. Additionally, postoperative follow-up of the patient in order to facilitate early diagnosis of recurrence and distant metastasis is necessary. Systemic chemotherapy should be considered in the case of patients with distant metastases.

Expression TGM2 and BNIP3 have prognostic significance in laryngeal cancer patients receiving surgery and postoperative radiotherapy: a retrospective study

Background

This study was designed to determine the pattern and correlation between expression of the HIF-1α transcriptional targets TGM2 and BNIP3 in laryngeal cancer, and investigate the association of BNIP3 and TGM2 with clinical outcome in laryngeal squamous cell carcinoma (SCC) patients receiving postoperative radiotherapy.

Methods

Immunostaining with antibodies specific to BNIP3 and TGM2 was performed in formalin-fixed, paraffin-embedded specimens from 148 laryngeal SCC patients. BNIP3 and TGM2 expression was scored as high or low, based on the number of tumor cells stained and the staining intensity. All patients received postoperative radiotherapy. Patient follow up and clinicopathological data were compared using the Chi-squared test, univariate and multivariate analyses, and survival curves were generated using the Kaplan-Meier method and log-rank test.

Results

The 3, 5 and 10-year overall survival rates (OS) for all patients were 77.7%, 71.6%, 56.4%, respectively. Primary tumor site, T stage, overall stage, lymph-node metastasis, BNIP3 expression and TGM2 expression were significant prognostic factors for OS in univariate analysis. Negative cervical lymph nodes, high BNIP3 expression and low TGM2 expression were independent prognostic factors of improved OS in multivariate analysis. BNIP3 expression correlates with TGM2 expression in laryngeal SCC (P = 0.012).

Conclusions

This study indicates that lymph-node metastasis, BNIP3 expression and TGM2 expression are independent prognostic factors in laryngeal SCC patients receiving postoperative radiotherapy. Further studies are required to investigate how BNIP3 and/or TGM2 influence the prognosis of laryngeal SCC patients treated with postoperative radiotherapy, and to determine how TGM2 and BNIP3 expression are regulated.

Therapy and prognosis of intracranial invasive olfactory neuroblastoma

OBJECTIVE

There is currently no consensus on a standardized treatment strategy for olfactory neuroblastoma (ONB), especially for intracranial invasion. This purpose of this study is to explore the appropriate treatment modality and prognostic factors of intracranial invasive ONB.

STUDY DESIGN

Case series with chart review.

SETTING

The study was conducted at the Sun Yat-sen Memorial Hospital and the Cancer Center of Sun Yat-sen University, China.

SUBJECTS AND METHODS

Twenty-five cases of intracranial invasive ONB were collected and investigated using a retrospective review analysis from patients diagnosed between 1980 and 2005.

RESULTS

The 1-, 3-, and 5-year overall survival rates for the group were 55%, 46%, and 31%, respectively. The subgroups who did not receive surgical treatment had worse survival rates than those who did receive treatment. In particular, patients who did not receive any therapy did not live past 1 year. In contrast, the group of patients treated by intranasal resection in combination with radiotherapy and/or chemotherapy showed a slightly better survival rate. It is important to note that the group of patients treated by craniofacial surgery combined with radiotherapy and/or chemotherapy had a markedly favorable prognosis, with 1-, 3-, and 5-year overall survival rates of up to 100%, 88%, and 66%, respectively.

CONCLUSIONS

Craniofacial surgery in combination with radiotherapy and/or chemotherapy was an effective treatment for intracranial invasive ONB. In addition, it was found that age may not be an important prognostic factor for intracranial invasive ONB; however, the rate of intracalvarial invasion was found to be a potent marker for predicting the prognosis of patients.

External monitoring of buried radial forearm free flaps in hypopharyngeal reconstruction

CONCLUSION

The radial forearm free flap (RFFF) is one of the optimal choices for hypopharyngeal reconstruction. Our series demonstrates that the technique of an indicator flap for the monitoring of the buried flap is simple, reliable, and inexpensive. The condition of the indicator flap can be easily interpreted by the physicians and the nursing staff. Therefore, the success rate of this microsurgical reconstruction may be improved.

OBJECTIVES

The RFFF is increasingly applied in reconstruction of the hypopharynx after radical resection for advanced hypopharyngeal cancer. However, postoperative monitoring of the buried free flap is extremely difficult. We designed a small external component as an indicator flap to monitor the perfusion of the buried vascular pedicle.

METHODS

Eight consecutive patients with hypopharyngeal cancer underwent radical surgery and hypopharyngeal reconstruction using RFFF at the Sun Yat-sen University Cancer Center between January 2005 and January 2007. The indicator flap was sutured to the surface of the neck for postoperative monitoring.

RESULTS

All of the indicator flaps remained viable. One patient experienced vascular compromise and was successfully salvaged. The success rate of the buried flaps was 100%. Pharyngocutaneous fistula occurred in one patient. All patients resumed an oral diet eventually.

The structural and optical properties of InN nanodots grown with various V/III ratios by metal-organic chemical vapor deposition

Self-assembled InN nanodots have been prepared at 650 degrees C with various V/III ratios from 500 to 30 000 by metal-organic chemical vapor deposition (MOCVD). It is found that the dot density and morphological size as well as the optical properties all display drastic changes at V/III = 12 000. Generally, denser and smaller InN nanodots with higher emission energy and narrower linewidth were obtained when growth was conducted at V/III ratios slightly lower than 12 000 as compared to those at higher V/III ratios. The physical properties of our MOCVD-grown InN nanodots are sensitive to the surface structure and the morphology is very similar to molecular beam epitaxially grown GaN and InN films, which may be used as a guide to optimize the InN growth.

[Detection and clinical significance of lymphatic microvessel density in supraglottic laryngeal carcinoma]

BACKGROUND AND OBJECTIVE

Lymphatic microvessels may play an important role in tumor metastasis. This study detected lymphatic microvessel density (LVD) in supraglottic laryngeal carcinoma to find its correlation to clinicopathologic characteristics, and to assess its prognostic significance in supraglottic laryngeal carcinoma.

METHODS

Clinical data of 51 supraglottic laryngeal carcinoma patients who underwent primary lesion resection were reviewed. Immunohistochemical staining was performed with podoplanin monoclonal antibody to recognize lymphatic microvessels. The correlations of LVD to clinicopathologic characteristics and prognosis were analyzed.

RESULTS

The mean LVD was 3.25+/-2.37, with a median of 3, in the 51 specimens of supraglottic laryngeal carcinoma. LVD was significantly higher in the patients with cervical lymph node metastasis than in those without (P=0.009). The overall 5-year survival rate was 54.9%. The 5-year survival rate was significantly lower in the patients with poorly differentiated tumor, stages T3-4 disease, lymph node metastasis, stages III-IV disease and high LVD than in their counterparts. Cox regression analysis revealed that LVD, T classification, and differentiation were independent factors for survival.

CONCLUSION

LVD is related to lymph nodes status, and is an independent factor for prognosis of supraglottic laryngeal carcinoma.

[Clinical analysis of 53 cases of esthesioneuroblastoma]

BACKGROUND AND OBJECTIVE

The prognosis of esthesioneuroblastoma (ENB) patients is poor. This study was to analyze prognostic factors and explore a rational treatment for ENB.

METHODS

Clinical data of 53 ENB patients, treated at Sun Yat-sen University Cancer Center from 1980 to 2003, were analyzed retrospectively. The correlation of prognostic factors to clinical features and treatment approaches were analyzed using the Kaplan-Meier method. Efficacy of different treatment modalities was compared.

RESULTS

The five-year overall survival (OS) was 41% of all ENB patients. The five-year OS of the surgery group, radiotherapy group, chemotherapy group, surgery combined with radiotherapy and (or) chemotherapy group, chemoradiotherapy were 42%, 38%, 0, 56%, 0, respectively, which were statistically significant (p<0.05). The five-year OS of Kadish stage A, B, C patients were 100%, 37%, 31%, respectively, which were statistically significant among these three subgroups which (p<0.05). The recurrence rate over the entire period was 51%. The five-year OS of the recurrence group and recurrence-free group were 42% and 48%, respectively, without significant differences (p>0.05).

CONCLUSIONS

ENB is a malignant tumor with high rates of locoregional recurrence and distant metastasis. Surgery-based multimodality is a relatively reasonable method. The prognosis of ENB is associated with the clinical stage and treatment modalities.

[Survival and prognostic analysis of 221 patients with advanced laryngeal squamous cell carcinoma treated by surgery]

BACKGROUND AND OBJECTIVE

The prognosis of advanced squamous cell carcinoma of the larynx is poor Prognostic factors of this disease vary in different studies. This study was to analyze the most important factors affecting the prognosis of the patients with advanced (stage III and IV) squamous cell carcinoma (SCC) of the larynx.

METHODS

Clinical data of 221 patients with advanced SCC of the larynx were retrospectively analyzed. Survival analysis was performed by the life table method; comparison among/between groups was performed using the log-rank test; and multivariate analysis was carried out using the Cox proportional hazard model.

RESULTS

The two- and five-year overall survival rates of the 221 patients were 76.9% and 51.1%; while the 2-and 5-year disease free survival rates were 60.0% and 43.0%. Patients in stage III had better prognosis than those in stage IV. Post-operative radiotherapy improved the survival rate in patients with positive surgical margins. There was no difference in the survival rate between patients underwent partial laryngectomy and those underwent total laryngectomy. Multivariate analyses indicated that age, anatomic type, post-surgical stage, surgical margin and radiotherapy influenced the disease free survival (p<0.05), whereas, age, post-surgical stage and surgical margin affected the overall survival (p<0.05).

CONCLUSIONS

The prognosis of patients with advanced SCC of the larynx receiving surgery is poor. Age, post-surgical stage and surgical margin are the most important factors affecting the overall survival.

[Detection and clinical significance of cervical lymph node micrometastases in patients with cN0 tongue squamous cell carcinoma]

BACKGROUND & OBJECTIVE

Postoperative relapse in tongue squamous cell carcinoma patients with pathologically negative cervical lymph node might be related to micrometastases. This study was to detect the lymph node micrometastases in cN0 tongue cancer patients, and explore its clinical significance.

METHODS

A total of 523 cervical lymph nodes taken from 49 tongue cancer patients were examined by routine HE staining and immunohistochemistry (IHC) with anti-cytokeratin antibody (CK19) staining. The follow-up period ranged from 9 to 83 (mean 56) months.

RESULTS

Metastases were detected in 7 (1.3%) lymph nodes from 5 patients with HE staining, and in 34 (6.5%) lymph nodes from 19 patients with CK19 staining. Micrometastases were detected in 27 (5.2%) lymph nodes from 14 patients. The difference in detecting lymph node metastases between two methods was significant (P=0.001). HE staining upstaged 3 cases from cN0 to pN1, and 2 cases from cN0 to pN2b; IHC staining upstaged 3 cases from cN0 to pN1, and 16 cases from cN0 to pN2b. Lymph node micrometastases showed no correlation to sex, age, T stage, differentiation, and depth of primary tumor invasion (P>0.05). The 5-year survival rates of the patients with and without micrometastases were 78.5% and 86.7%, respectively (P>0.05).

CONCLUSIONS

CK19 staining could increase the detection rate of cervical lymph node metastases and the accuracy of pathologic stage in tongue cancer. The results of our study showed that the presence of lymph node micrometastasis has no correlation to the prognosis. A further study is needed.

[Treatment of advanced maxillary sinus squamous carcinoma: an analysis of 92 cases]

BACKGROUND & OBJECTIVE

There is no satisfactory treatment for advanced maxillary sinus squamous carcinoma. The treatment strategy is controversial. This study aimed to explore a rational treatment for advanced maxillary sinus squamous carcinoma.

METHODS

Clinical data of 92 patients with stage T3-T4 maxillary sinus squamous cell carcinoma, treated in Cancer Center of Sun Yat-sen University from Jan.1978 to Dec.2001, were reviewed. Of the 92 patients, 21 received radiotherapy alone, 8 received surgery alone, 63 received multimodality therapy (51 received surgery combined with radiotherapy, and 12 received chemoradiotherapy).

RESULTS

The 3-and 5-year survival rates were significantly lower in radiotherapy group and surgery group than in multimodality therapy group (19.0% and 25.0% vs. 46.0%, P<0.05; 9.5% and 12.5% vs. 33.3%, P<0.05). In multimodality therapy group, the 3-and 5-year survival rates were 33.3% and 23.8% for the patients who received radiotherapy followed by surgery, 52.9% and 47.1% for the patients who received surgery follow by radiotherapy, 53.8% and 30.8% for the patients who received pre-and postoperative radiotherapy, and 50.0% and 33.3% for the patients who received chemoradiotherapy. There were no significant differences in survival rate between these four subgroups (P>0.05).

CONCLUSIONS

The efficacy of multimodality therapy is better than that of single therapy strategy for advanced maxillary sinus squamous carcinoma. The best treatment pattern for advanced maxillary sinus squamous carcinoma needs further research.

[Treatment and prognosis of gingival carcinoma: a report of 116 cases]

BACKGROUND & OBJECTIVE

The treatment and prognosis of gingival carcinoma, a common oral carcinoma, have seldom been reported. This study was to explore appropriate therapies and analyze prognostic factors of gingival carcinoma.

METHODS

Clinical data of 116 gingival carcinoma patients, treated at Cancer Center of Sun Yat-sen University from 1992 to 2003, were analyzed. Survival analyses were performed for patients who received surgery, radiotherapy, or surgery combined with chemotherapy or/and radiotherapy. The patients had been followed up for more than 3 years.

RESULTS

One hundred patients received radical therapy. The overall 3-and 5-year survival rates were 52.7% and 41.8%. The 5-year survival rates were 50.3% in surgery alone group and 49.0% in combined treatment group, without significant difference. The 5-year survival rate of radiotherapy alone group was only 20.0%. For advanced gingival carcinoma, the recurrence rate was much lower in combined treatment group than in surgery alone group. Clinical stage and surgical margin status were predictors of survival.

CONCLUSIONS

Surgery alone is appropriate for gingival carcinoma patients at an early stage; surgery combined with chemotherapy or/and radiotherapy is an adequate treatment for patients at advanced stages. Clinical stage and surgical margin status are important prognostic factors.

[Application of helix water jet to parotid surgery]

BACKGROUND & OBJECTIVE

Dissecting the facial nerves safely is an important guarantee for the accomplishment of parotidectomy and reduction of postoperative complications. This study was to explore the application of helix water jet to parotidectomy.

METHODS

Clinical data of 43 patients with parotid tumors, who received operation with helix water jet from Feb. 2004 to Feb. 2005 at Cancer Center of Sun Yat-Sen University, were analyzed. Meanwhile, traditional techniques in parotidectomy was performed in 36 patients (control group). Duration of operation, postoperative drainage volume, postoperative hospitalization, and occurrence of postoperative complications, such as facial nerve dysfunction and salivary fistula, of the 2 groups were compared.

RESULTS

The postoperative drainage volume was significantly lower in water jet group than in control group [(9.89+/-3.74) mL vs. (12.15+/-2.11) mL, P<0.05]. There were no significant differences in duration of operation [(90.28+/-25.30) min vs. (76.32+/-20.74) min, P>0.05], postoperative hospitalization [(6.39+/-1.38) days vs. (6.45+/-1.05) days, P>0.05] between the two groups. Of the 43 patients in water jet group, 6 (14.0%) had grade II facial nerve dysfunction and 1 (2.3%) had grade III facial nerve dysfunction; of the 36 patients in control group, 5 (13.9%) had grade II facial nerve dysfunction, 2 (5.6%) had grade III facial nerve dysfunction, 1 (2.8%) had grade IV facial nerve dysfunction and 1 (2.8%) had salivary fistula. There was no permanent facial nerve dysfunction occurred in both groups. There was no significant difference in the occurrence of complications between the two groups. Nine patients who retained nervus auricularis magnus suffered from slight numbness symptom of auricular lobule.

CONCLUSION

Use of helix water jet in parotid surgery is safe and confers some advantages over conventional methods of parotid dissection.

[Reconstruction with pectoralis major myocutaneous flap for surgical defect in advanced head and neck cancer patients]

BACKGROUND & OBJECTIVE

Total or partial defects after one-stage reconstruction for advanced head and neck cancer is a challenging problem in head and neck surgery. Pectoralis major myocutaneous flap (PMMF) plays an irreplaceable role in head and neck reconstruction surgery. This study was to define operational indications for using PMMF in head and neck defect reconstruction, and summarize how to further increase the success rate.

METHODS

From Jan. 2004 to Jan. 2007, 22 patients who underwent head and neck defect reconstruction using PMMF were investigated. Of the 22 patients, 8 had cervical skin defect, 5 had tongue defect, 4 had oropharynx defect, 3 had base of tongue defect, and 2 had hypopharynx defect; 13 had the flap passed through the subclavicular tunnel to the head and neck area, and 9 had the flap transposed over clavicle to the neck. The reconstruction size ranged from 15 cm x 12 cm to 8 cm x 5 cm.

RESULTS

No patient died during operation, 1 had total flap necrosis, and 1 had partial flap necrosis. The success rate of reconstruction was 95.5%. Postoperative complications occurred in 2 (9.1%) patients: 1 had wound hematocele, and 1 had fistula at the base of the tongue.

CONCLUSIONS

PMMF is a good donor for head and neck reconstruction, especially for resurfacing huge cervical skin defect. The approach of passing the vascular pedicle through a subclavicular tunnel will not only enhance the arc of rotation, but also help to prevent compression of the vascular pedicle.

[Serum diagnosis of head and neck squamous cell carcinoma using surface-enhanced desorption ionization mass spectrometry and artificial neural network analyses]

BACKGROUND & OBJECTIVE

The early diagnosis of head and neck squamous cell carcinoma (HNSCC) is the key factor that affecting the treatment result. We performed surface-enhanced desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS) using a multi-layer artificial neural network (ANN) to develop and evaluate a proteomic diagnosis approach for HNSCC.

METHODS

Serum samples from 74 HNSCC patients and 146 healthy individuals were randomized into training set (148 samples) and test set (72 samples). At first, we detected the training set of samples using SELDI mass spectrometry and WCX2 (weak cation-exchange) chips. Using a multi-layer ANN with a back propagation algorithm, we identified a proteomic pattern that could discriminate cancer from control samples in the training set. The discovered pattern was then used to determine the accuracy of the classification system in the test set.

RESULTS

Four top-scored peaks, at m/z (mass/charge) ratio of 4 469 u, 5 924 u, 8 926 u, and 16 697 u, were finally selected as the potential biomarkers for detection of HNSCC with both sensitivity and specificity of 100.0% in the training set. The classifier predicted the HNSCC with sensitivity of 85.7%(18/21) and specificity of 96.1%(49/51) in the test set.

CONCLUSION

SELDI profiling is a useful tool to accurately identify patients with HNSCC.

[Postoperative recurrence-related factors of 125 patients with cT1-2N0 squamous cell carcinoma of the oral tongue]

BACKGROUND & OBJECTIVE

The treatment pattern for cT1-2N0 squamous cell carcinoma (SCC) of the oral tongue is controversial; the postoperative recurrence rate of the disease is high and the salvage effect is poor. This study was to explore the postoperative recurrence-related factors of cT1-2N0 SCC of the oral tongue, to analyze their effects on the survival, and to seek more reasonable therapeutic modality.

METHODS

Clinical data of 125 patients with cT1-2N0 SCC of the oral tongue, treated in Cancer Center of Sun Yat-sen University from Jan. 1992 to Dec. 2000, were reviewed. Of the 125 patients, 58 were at stage T1, 67 were at stage T2; 17 (13.6%) were treated with local operation alone, 53 (42.4%) were treated with both local operation and selective neck dissection, and 55 (44.0%) were treated with operation and chemotherapy and/or radiotherapy. The correlations of disease duration, tumor growth pattern, clinical TNM stage, pathologic grade, occult cervical lymphatic metastasis, tumor invasion depth, treatment methods and neck management to tumor recurrence and prognosis were analyzed.

RESULTS

Forty-one (32.8%) patients had recurrence; the overall 5-year survival rate was 62.59%. The 5-year survival rate was significantly lower in recurrent group than in non-recurrent group (38.74% vs. 74.69%, log-rank=19.27, P<0.001). Disease duration (Chi(2) test, P=0.002), tumor growth pattern (Chi(2) test, P<0.001), neck management (Chi(2) test, P<0.001) and occult cervical lymphatic metastasis (Cox regression, P=0.001) were significantly related to the recurrence of cT1-2N0 SCC of the oral tongue. Tumor invasion depth (Cox regression, P=0.005) and the site of recurrent tumor (Cox regression, P<0.001) were significantly related to the prognosis of cT1-2N0 SCC of the oral tongue.

CONCLUSION

Disease duration, tumor growth pattern, neck management, and occult cervical lymphatic metastasis are main recurrent factors of cT1-2N0 SCC of the oral tongue; tumor invasion depth and the site of recurrent tumor are important prognostic factors.

[Roles of single photo emission computed tomography-CT in detecting residual tumor from patients with thyroid carcinoma]

OBJECTIVE

As newly, functional, diagnostic measure-18F-deoxyglucose single photo emission computed tomography (18F-FDG SPECT-CT) has well sensitivity and specialty , it was proved availability in differentiating benign and malignant tumor. In this study, it was compared the efficiency of detecting residual tumor of thyroid cancer between 18F-FDG SPECT-CT and CT-TWIN.

METHODS

During May 2004 to August 2004, 56 patients with thyroid disease were divided into two groups, one group was 32 cases suffered thyroid tumor, another was 24 cases suffered improper operation. All cases must take 18F-FDG SPECT-CT and CT-TWIN.

RESULTS

Forty eight cases had been performed operation, and 8 cases waited and watched because they didn't be found residual tumor by 18F-FDG SPECT-CT and CT-TWIN. The results in detecting thyroid tumor showed that the same rate of diagnostic correction of SPECT-CT was 87.5% (28/32), and the Youden index of SPECT-CT was 0.667, higher than that of CT which was 87.5% (28/32) and 0.633 respectively. When the results two methods were accordant, the rate of diagnostic correction was 100% (24/24), and Youden index was 1, and the result had statistic signification. The rate of diagnostic correction of SPECT-CT in detecting residual tumor was 84.6%, and its Youden index was 0.675. The rate of diagnostic correction of CT in detecting residual tumor was 75.0%, and its Youden index was 0.492; and the result had statistics signification by being compared two different measures.

CONCLUSIONS

SPECT-CT and CT all had higher diagnostic efficacy, and they could promote the diagnostic efficacy when they have the same diagnosis in detecting thyroid tumor. The rate of detecting residual tumor of SPECT-CT was 81.3%, compared with that of CT the diagnostic efficacy has greater raise.

[Significance of level VI neck dissection in surgical operation for thyroid cancer]

BACKGROUND & OBJECTIVE

Patients with thyroid cancer often come along with level VI lymph nodal metastasis. Neck dissection, which includes level VI, is routinely performed on cN1 patients, but whether cN0 patients need routine level VI neck dissection is uncertain. This study was to explore the rule of level VI lymph nodal metastasis in thyroid cancer and the significance of level VI neck dissection in surgical operation for thyroid cancer.

METHODS

Clinical data of 130 patients with thyroid cancer, who received level VI neck dissection from Jan. 1988 to Jan. 2000, were analyzed retrospectively.

RESULTS

Of the 130 patients, 97 had level VI lymph node metastasis, 14 (10.8%) had post-operative complications, including 4 cases of recurrent laryngeal nerve injury. Multivariate survival analysis indicated that level VI lymph nodal metastasis was correlated to the survival of thyroid cancer patients.

CONCLUSIONS

Routine level VI neck dissection may be helpful to improve the survival of thyroid cancer patients. Meanwhile, complication could be decreased by improving surgical skills.

[Clinical characteristics and prognosis of primary nasal mucosal melanoma--a report of 44 cases]

BACKGROUND & OBJECTIVE

Primary mucosal malignant melanoma of the nasal cavity, paranasal sinuses, and nasopharynx is rare and current research data of this disease are mainly from western populations. This study was to analyze the clinical characteristics of this disease and prognositic factors.

METHODS

From Jan. 1971 to Jul. 2005, 66 patients with primary nasal mucosal melanoma were treated in Cancer Center of Sun Yat-sen University, China. Demographics and baseline characteristics, treatments, recurrence, metastasis, and survival were documented in hospital records. All records of these patients were analyzed retrospectively. Kaplan-Meier method was used to calculate survival rate; Cox model was used to analyze prognostic factors.

RESULTS

Among 44 evaluable cases, 37 were originated from the nasal cavity, 5 from the paranasal sinuses, and 2 from the nasopharynx. Cervical lymphadenopathy at initial presentation occurred in 12 patients. Of the 31 patients received operation-dominated treatment, 8 received adjuvant radiotherapy, 13 received adjuvant chemotherapy, and 6 received adjuvant non-specific immunotherapy. The median time of follow-up was 29 months. Local recurrence, cervical lymphadenopathy, and distant metastasis occurred in 24, 10, and 11 patients, respectively, during follow-up. The median survival time was 24 months and the 5-year survival time was 25%. Clinical stage affected prognosis, whereas age, gender, site, primary tumor mass, and adjuvant therapy were not correlated to survival status.

CONCLUSION

Nasal mucosal melanoma has high incidence of local recurrence and distant metastasis, especially cervical lymphadenopathy. Clinical stage affects the prognosis.

[Analysis of serum T-lymphocyte subsets and NK cell activity in patients with hypopharyngeal squamous cell carcinoma]

BACKGROUND & OBJECTIVE

T-lymphocyte subsets and NK cell are the major forms of cellular immunity. Study of these 2 types of cells may lead to the better understanding of the function of cellular immunity in the onset and development of carcinoma. To a certain degree, there may be cellular immunodeficiency existing in patients with hypopharyngeal squamous cell carcinoma. This study was to investigate the cellular immunity function in these patients.

METHODS

T-lymphocyte subsets and NK activity were determined by flow cytometry in 78 patients with hypopharyngeal squamous cell carcinoma. Blood samples of 20 non-tumor patients were used as control.

RESULTS

The levels of CD4 lymphocyte subsets, CD4/CD8 ratio, and NK activity were lower in carcinoma group than in control group, but CD8 lymphocyte level was higher in carcinoma group. The levels of CD4 lymphocyte subsets, CD4/CD8 ratio, and NK activity were lower in T3-4 group than in T1-2 group, and lower in N+ group than in N0 group. The levels of CD4 lymphocyte subsets and CD4/CD8 ratio were decreased in the carcinoma with moderate or low differentiation (P<0.05).

CONCLUSIONS

T-lymphocyte subsets and NK activity are inhibited, and the cellular immunology is suppressed in the patients with hypopharyngeal squamous cell carcinoma. Analyzing T-lymphocyte subsets and NK activity would be helpful to evaluate the cellular immunologic condition of these patients.

Optical properties and carrier dynamics of self-assembled GaN/Al(0.11)Ga(0.89)N quantum dots

GaN quantum dots were grown on an Al(0.11)Ga(0.89)N buffer layer by using flow rate modulation epitaxy. The Stranski-Krastanov growth mode was identified by an atomic force microscopy study. The thickness of the wetting layer is about 7.2 monolayers. The temperature dependent photoluminescence studies showed that at low temperature the localization energy, which accounts for de-trapping of excitons, decreases with the reducing dot size. The decrease in emission efficiency at high temperature is attributed to the activation of carriers from the GaN dot to the nitrogen vacancy (V(N)) state of the Al(0.11)Ga(0.89)N barrier layer. The activation energy decreases with reducing dot size.

[Expression of S100-labeled dendritic cells in glottic squamous cell carcinoma and its correlation to prognosis]

BACKGROUND & OBJECTIVE

Dendritic cells (DCs) are the most important antigen-presenting cells, and can synthesize and secrete S100 protein. This study was designed to investigate the expression of S100-labeled DCs in glottic squamous cell carcinoma, and analyze its correlation to the prognosis.

METHODS

The expression of S100-labeled DCs in peritumoral tissues of 111 specimens of gllotic squamous cell carcinoma was detected by immunohistochemistry; 17 specimens of normal tissues were used as control. The correlation of S100-labeled DCs expression to prognosis of the 111 patients was evaluated.

RESULTS

The positive rates of S100-labeled DCs were 51.35% (57/111) in peritumoral tissues of gllotic squamous cell carcinoma, and 0 in normal tissues. The 5-year survival rate was significantly higher in S100-positive group than in S100-negative group (72.31% vs. 53.91%, P=0.030).

CONCLUSIONS

The glottic squamous cell carcinoma patients with obvious infiltration of S100-labeled DCs may achieve good prognosis.

[Expression and clinical significance of CD1a+ dendritic cells in glottic squamous cell carcinoma]

BACKGROUND & OBJECTIVE

Dendritic cells (DCs) are the most important antigen-presenting cells. CD1a, a marker of immature DCs, plays a role in tumorigenesis. This study was designed to explore the correlation of CD1a(+) DCs to pathologic degree, T stage, local recurrence, and prognosis of glottic squamous cell carcinoma.

METHODS

Clinical and follow-up data of 111 patients with glottic squamous cell carcinoma were analyzed retrospectively. The expression of CD1a(+) DCs in the 111 specimens of glottic squamous cell carcinoma and 17 specimens of non-tumor tissue was detected by immunohistochemistry. Correlations of CD1a(+) DCs to pathologic degree, T stage, local recurrence, and prognosis of glottic squamous cell carcinoma were analyzed.

RESULTS

Positive rates of CD1a(+) DCs were 59.46% in glottic squamous cell carcinoma tissues, and 0 in non-tumor tissues; it was significantly higher in well-differentiated group than in moderately-and poorly-differentiated group [71.43% (55/77) vs. 28.57% (11/34), P<0.05], higher in T1-T2 group than in T3-T4 group [67.16% (45/67) vs. 47.73% (21/44), P<0.05], and higher in non-recurrence group than in local recurrence group [65.06% (54/83) vs. 42.86% (12/28), P<0.05].

CONCLUSIONS

The lower pathologic degree and higher T stage of glottic squamous cell carcinoma, the lower expression of CD1a(+) DCs. The positive rate of CD1a(+) DCs is low in recurrent glottic tumor. High expression of CD1a(+) DCs may indicate better prognosis of glottic squamous cell carcinoma.

[Management option for cervical metastases in tongue squamous cell carcinoma with clinically N0 neck]

OBJECTIVE

This study was designed to explore the optimal management option for cervical metastases in tongue squamous cell carcinoma (SCC) with clinically N0 neck in order to avoid excessive or inadequate treatment in clinical practice.

METHODS

Clinical data of 327 cases of tongue SCC with cN0 neck were retrospectively analyzed. Neck control rates affected by different pathoclinical parameters were compared. Prognosis analysis and death analysis were also performed.

RESULTS

Overall 3-year survival was 69.7% (228/327), 3-year survival of neck recurrent group and non-recurrent group was 39.1% (25/64) and 77.2% (203/263), and 51.5% (51/99) of the death related to neck failure. Overall neck control rate was 80.4% (263/327); neck control rate of wait and watch group, level I neck dissection, level I + II neck dissection, supraomohyoid neck dissection, radical neck dissection, functional neck dissection, was 67.5% (27/40), 72.7% (24/33), 60.0% (15/25), 84.9% (45/55), 86.8% (131/151), 84.0% (21/25), respectively. Treatment modality and cervical lymph node involvement were independent factors for neck control.

CONCLUSIONS

Neck control is a key for prognosis of tongue SCC with cN0 neck. Supraomohyoid neck dissection is the first choice in management of cervical metastases in tongue SCC with cN0 neck, during which the suspected involved lymph nodes should be sent for frozen section to determine whether comprehensive neck dissection required. Multimodal metastasis and/or capsular spread are the indications for postoperative irradiation.

A CRH1Antagonist into the Amygdala of Mice Prevents Defeat-Induced Defensive Behavior

Corticotropin-releasing hormone (CRH) is believed to play an important role in the regulation of behavioral responses to stress. CRH(1) receptor antagonists may reduce stress responsivity. Stress increases CRH in the amygdala, important in memory consolidation. We hypothesized that infusion of a CRH(1) antagonist into the amygdala following social defeat would prevent the development of generalized fear responses. Acute social defeat in mice increases defense towards intruders, even nonaggressive intruders, placed within their home cage. We infused the CRH(1) antagonist antalarmin (0.25 microg/125 nl) bilaterally into the amygdala of mice immediately after defeat and measured their response to a nonaggressive intruder stimulus mouse placed within their home cage 24 h after defeat. Defeated mice that received vehicle displayed high levels of crouch defensive posture and numerous flights from intruders, relative to nondefeated mice that received vehicle. Defeated mice that received antalarmin into the amygdala exhibited significantly less defensive posture than did vehicle-treated defeated mice. Display of defensive posture in antalarmin-treated mice approached that of vehicle-treated nondefeated mice. These findings support a role for CRH in the amygdala to promote consolidation of emotional memory and indicate that antagonism of CRH(1) receptors in the amygdala may prevent the development of exaggerated fear responses in stressed mice.

[Surgical treatment of well-differentiated thyroid carcinoma invading trachea: a report of 15 cases]

BACKGROUND & OBJECTIVES

At present head and neck surgeons from many countries have different opinions on management of well-differentiated thyroid cancer (WDTC). We will discuss WDTC invading trachea surgical treatment and its clinical significance.

METHODS

Retrospectively reviewed clinical data of 15 cases WDTC invading trachea, According to WDTC invading extent and grade, there were 3 kinds of surgical approaches: 1) end to end anastomosis; 2) tissue flap reconstruction; 3)larynx-tracheal dissociation.

RESULTS

15 cases underwent radical resection and reconstruct the defect of tracheal or larynx-tracheal dissociation. 2 cases received directly suture, 5 cases received sternocleidomastoid muscle flap reconstruction, 2 cases received pectorlis major muscle flap reconstruction, 2 cases received platysma flap reconstruction, 2 cases received free forearm flap with muticore titanium-board reconstruction, 2 cases received larynx-tracheal dissociation with larynx block out and tracheal fistula. 10 cases (10/15, 66.7%) received decannulation postoperation. Patients who were success fully decannulated could recover phonation and maintain airway breath. In the 5 patients who couldn't decannulate, underwent sternocleidomastoid muscle flap reconstruction, 1 underwent free forearm flap with muticore titanium-board reconstruction, 1 underwent pectorlis major muscle flap reconstruction, 2 underwent larynx-tracheal dissociation, but all of them could hardly utter voice by compress tracheostoma and needed permanent tracheostoma due to collapse of trachea. The recurrence rate of our group is 33.33%, 5 years survival rate is 88.89%.

CONCLUSIONS

WDTC with trachea invading easily cause dyspnea or emptysis influencing on 5 years survival rate. We should take more actively surgical approach to resect all the tumor and involved organ, thus improve survival rate and reduce recurrence postoperation.

[Clinical study of 39 cases of inferior postcricoid carcinoma]

BACKGROUND & OBJECTIVE

There were many treatment strategies for inferior postcricoid carcinoma; however, the total survival rates were not so good till now. This study was designed to investigate the effective method for treatment of inferior postcricoid carcinoma.

METHODS

Thirty-nine cases of inferior postcricoid carcinoma from 1970 to 1997 in Department of Head and Neck, Cancer Center, Sun Yat-sen University were surveyed. The treatment modalities were classified into two groups: simple radiotherapy and multimodality (surgery operation plus postoperational radiotherapy). The 3-year and 5-year survival rates of the two groups were analyzed. The different local lymph nodes metastasis was explored at the same time.

RESULTS

Both the 3-year and 5-year survival rates of the simple radiotherapy group (35.2% and 17.6%) were lower than another group (59.1% and 45.5%) with significant difference (P< 0.05). Of 39 follow-up patients, 18 were found with neck lymph node metastasis. Contralateral or (and) bilateral lymph node metastasis were found in 72.7%(13/18) of the patients with neck lymph node metastasis.

CONCLUSION

Multimodality is an effective method for inferior postcricoid carcinoma. It will increase the survival rate of the inferior postcricoid carcinoma by paying more attention to contralateral or (and) bilateral lymph node metastasis and dealing with it actively.

[Regularity and therapeutic strategy of cervical lymph node metastasis in squamous cell carcinoma of the tongue]

BACKGROUND & OBJECTIVE

At present, whether neck dissection should be employed in squamous cell carcinoma (SCC) of the tongue with clinically node negative neck(cN0) is still controversial. This study was designed to explore the regularity of cervical lymph node metastasis in SCC of the mobile part of the tongue, and to discuss the theories and principles of employment of selective neck dissection in cN0 cases.

METHODS

A retrospective research was performed on clinical data of 214 cases of SCC of the tongue treated with surgery from 1991 to 1997. Distribution of cervical lymph node metastasis of cN0 pN(+)= (pathologically node positive) and cN(+) (clinically node positive) pN(+)= cases were analyzed; the survival rates of different groups were compared; the factors that impact the survival of SCC of the tongue were screened out by Cox regression analysis.

RESULTS

Cervical lymph node metastases were found in 69 cases. The metastatic rate was 32.2%. Metastases occurred in level I, II, III, IV, V of the ipsilateral neck were 22.3%, 33.5%, 22.3%, 4.6%, 1.0%, in level I,II,III, IV,V of the contralateral neck were 6.6%, 3.6%, 3.0%, 2.0%, 0.5%, respectively. The 5-year survival rates of the pN(+)= group and the pN0 group were 47% and 83%, respectively(P< 0.001). T stage and N stage were independent factors that impact the long-term outcome of SCC of the tongue.

CONCLUSION

Level I,II,III of the ipsilateral neck tend to be involved when cervical lymph node metastases occur. Selective neck dissection can be used to treat the cervical metastasis in cN0 cases, as well as to evaluate the cervical lymph node status in order to determine whether comprehensive neck dissection should be employed.

Objective evidence of decreased salivary function in patients with autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis)

Impaired salivary flow is found in Sjögren's syndrome, which is a common, chronic, autoimmune, inflammatory connective tissue disease, mainly affecting the exocrine glands. Histopathologically, lymphocytic infiltrations of the salivary glands are found in Sjögren's syndrome that are similar to those of the thyroid gland in autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis). To test this hypothesis by Daniels et al ., salivary function was measured by quantitative salivary scintigraphy in autoimmune thyroiditis patients, as well as in age- and sex-matched controls. Forty patients, each with a history of autoimmune thyroiditis of over 10 years, and 61 healthy controls were enrolled in the study. All of the 40 autoimmune thyroiditis patients had good blood sugar control. None presented autonomic neuropathy. They were separated into two subgroups: patient group 1, 20 patients with xerostomia; patient group 2, 20 patients without xerostomia. Two control groups of healthy subjects were included for comparison: control group 1, 36 subjects without xerostomia; control group 2, 25 subjects with xerostomia. After intravenous injection of 5 mCi (99m)Tc-pertechnetate, sequential images at 1 min per frame were acquired for 30 min. The first and 15th minute uptake ratios (URs) were calculated from the tracer uptakes in the four major salivary glands relative to the background regions of interest (ROIs). Saliva excretion was stimulated by one tablet of 200 mg ascorbic acid given orally 15 min after injection of the tracer. The maximal excretion ratios (ERs) of the four major salivary glands after sialagogue stimulation were calculated. Impaired salivary function, represented by significantly decreased UR and ER values, in autoimmune thyroiditis patients with xerostomia was demonstrated in this study. Significantly poorer salivary function was found in autoimmune thyroiditis patients with xerostomia, when compared with autoimmune thyroiditis patients without xerostomia and healthy controls with or without xerostomia, via objective and quantitative salivary scintigraphy. However, a larger series of autoimmune thyroiditis patients is necessary to confirm our findings.

Were there enough physicians in an emergency department in the affected area after a major earthquake? An analysis of the Taiwan Chi-Chi earthquake in 1999

STUDY OBJECTIVE

The purpose of this study was to evaluate physician manpower and mobilization in an urban emergency department receiving patients after a major earthquake.

METHODS

Patient charts were reviewed. The workload of physicians was assessed semiquantitatively before and after a major earthquake. The physicians' mobilization in the postearthquake emergency response was assessed by using a confidential questionnaire.

RESULTS

In the 3 days after the earthquake, 566 patients with earthquake-related illnesses or injuries were sent to the urban ED. Three hundred one (53.2%) patients arrived within the initial 10 hours. In the initial hours, there was no significant difference between the number of patients per physician per hour before and after the earthquake. Workloads of wound treatment and advanced life support procedures were significantly higher after the earthquake compared with before the earthquake, during the first to sixth hour and second to fifth hour, respectively. Sixty-five percent of the hospital's physicians did not assist in either the ED or in any other parts of the hospital in the initial 6 hours after the earthquake.

CONCLUSION

The number of physicians in the ED was insufficient in the initial hours after the earthquake because of the sudden influx of a large number of patients. Future disaster planning must address the issue of physicians' behavior with regard to their priorities immediately after a major earthquake and include greater provision for efficient mobilization of physicians.

Synergistic effect of cadmium chloride and acetaldehyde on cytotoxicity and its prevention by quercetin and glycyrrhizin

Cadmium chloride at concentrations of 10-50mM and acetaldehyde (AA) at 1-5mM showed synergistic toxic effects on V79 cells in vitro. Furthermore, synergistic effects of these chemicals were also observed in mutagenicities of the Hprt gene within certain dose ranges (cadmium chloride 5-10mM, and AA 1-2.5mM). Moreover, lipid peroxide formation, malondialdehyde (MDA) formation, detected by 2-thiobarbituric acid (TBA) reaction and the mitochondrial membrane potentials detected by rhodamine 123 uptake were significantly increased with the combined effect of cadmium and AA in V79. Thus, the cytotoxicity and genotoxicity displayed by combination of these chemicals can be considered to be associated with oxidative stress. Further, these effects were efficiently reduced by quercetin and less efficiently with glycyrrhizin.

Experimental investigation on moving chemical reaction boundary theory for weak-acid-strong-base system with background electrolyte KCl in large concentration

In this report, the moving chemical reaction boundary (MCRB) was formed with the weak acid of acetic acid (HAc) and the strong alkali of NaOH, coupled with the excess of background electrolyte KCl. The experiments were compared with the predictions by the moving chemical reaction boundary equation (MCRBE). It is very interesting that (1) the experimental results are in good agreement with the predictions with the original MCRBE if the MCRB is an anodic moving boundary, (2) however, the experiments are extremely far away from the predictions with the original MCRBE if a cathodic moving boundary. Hence, the original MCRBE must be corrected under the later situation of cathodic moving MCRB. The corrected MCRBE was well quantitatively proved to be valid for the cathodic moving MNRB formed with the same electrolytes of HAc, NaOH and KCl.

Vasopressin into the preoptic area increases grooming behavior in mice

In mice, the neuropeptide arginine-8-vasopressin (AVP) induces excessive grooming, scratching, and hyperactivity when administered intracerebroventricularly. In hamsters, AVP infusion into the medial preoptic area/anterior hypothalamus (MPOA/AH) increases flank marking and flank mark grooming. We measured the behavioral effects of administration of AVP (0, 1, and 10 ng/250 nl) into the preoptic area (POA) of male C57BL/6 mice. Administration of AVP into the POA induced robust effects on grooming, including increased hindleg scratching and face washing. Rearing and olfactory investigation were inhibited by AVP into the POA. These findings indicate that the POA is one site in which AVP induces grooming behavior in mice.

Corrections to moving chemical reaction boundary equation for weak reactive electrolytes under the existence of background electrolyte KCl in large concentrations

In this report, the moving chemical reaction boundary (MCRB) was formed by the weak reaction electrolytes of NH3.H2O and CH3COOH under the existence of background electrolyte KCl in large concentrations, the experiments were compared with the predictions by the moving chemical reaction boundary equation (MCRBE) for weak reactive electrolytes. It was found that the experimental results are far from the predictions with the MCRBE. So the MCRBEs must be corrected under the given experimental conditions. The corrected MCRBEs are given for the MCRB formed with weak reactive electrolytes coupled with KCl at high concentrations.