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Background: Noise-induced hearing loss (NIHL) is one of the common diseases in otology. In general, we assume that most people who are exposed to loud noise constantly, e.g., soldiers, will suffer from hearing loss. Hearing loss is related to the gene polymorphisms, with the Wolfram syndrome type 1 gene (T2500C), interleukin-4 receptor α chain (Q576R) and chloride channel-Kb (T481S) polymorphisms being most related to NIHL., Methods: We analyzed the association between the polymorphisms and the risk of NIHL in 119 subjects who were exposed to the same loud gunfire. In the current study, 39 persons with hearing loss and 80 with normal hearing were recruited from military officers and soldiers that were exposed to gunfire., Results: The results showed that the genetic variation of Wolfram syndrome type 1 gene was a more crucial factor than other genes in causing hearing loss. There was a significant difference (p=0.027) in WFS1 (T2500C) polymorphism between NIHL subjects and controls., Conclusion: In this study, we found that although loud noise could usually result in hearing damage, the clinical characteristics of hearing loss were irrelevant to gunfire noise. The gene polymorphisms provide predictors for us to evaluate the risk of NIHL prior to gunshot training., (Copyright © 2011. Published by Elsevier B.V.)

Objective: To investigate the clinical characteristics, pattern of lymph node metastasis, optimal management and relative prognostic factors of subglottic squamous cell carcinoma., Methods: A retrospective review was conducted in 36 cases with subglottic squamous cell carcinoma from 1970 to 2005. TNM staging showed 6 patients with stage I, 9 stage II, 8 stage III and 13 stage IV (AJCC 2010). Eight of these 36 cases were treated with radiotherapy alone, 18 with surgery alone and 10 with surgery plus perioperative radiotherapy. The overall 5-year survival rate was estimated by the Kaplan-Meier method according to different clinical stages and treatments. Log-Rank analysis was used to identify the prognostic factors., Results: The overall 5-year survival rate was 58.2%, and 5-year survival rates were 66.7%, 66.7%, 62.5% and 30.8% for patients with stage I, II, III and IV, respectively, and the rates were 43.8%, 66.7% and 51.9% for radiotherapy alone, surgery alone, surgery plus perioperative radiotherapy, respectively. The 5-year survival rate of patients with stage I-III was significantly higher than that of patients with stage IV (χ(2) = 3.955, P < 0.05). Pathologically confirmed positive rate of cervical lymph node was 25.0% (9/36), and the positive cervical lymph nodes were mainly distributed in level VI, followed by level II. The 5-year survival rate of patients with negative cervical lymph node was significantly higher than that of patients with positive cervical lymph node (χ(2) = 6.466, P < 0.05)., Conclusions: The prognosis of subglottic squamous cell carcinoma was relatively poor. Total laryngectomy was the the main therapeutic management, and only part of the early cases could be treated with radiotherapy alone or partial laryngectomy. For locally advanced cases, the typical neck dissection including level II-IV and VI should be performed.

Intervertebral disc (IVD) cell apoptosis has been suggested to play an important role in promoting the degeneration process. It has been demonstrated that IVD cell apoptosis occurs through either death receptor, mitochondrial or endoplasmic reticulum (ER) pathway. Our study aimed to explore the relationship among these three pathways and grade of IVD degeneration (IVDD). IVDs were collected from patients with lumbar fracture, vertebral tumor, disc herniation or spondylolisthesis. IVDs were distinguished by MRI and histomorphological examination, cell apoptosis was detected by TUNEL staining. Biomarkers of these three apoptosis pathways were detected by RT-PCR and Western blot. Furthermore, the correlation between apoptosis pathways biomarkers and disc pathology were analyzed. Nucleus pulposus cell density decreased with degeneration process, and increased apoptotic ratio. ER pathway was predominant in mild stage of IVDD (GRP78, GADD153 upregulation and caspase-4 activation), death receptor pathway was predominant in mild and moderate stages (Fas, FasL up-regulation and caspase-8 activation) and mitochondrial pathway was predominant in moderate and severe stages (Bcl-2 down-regulation, Bax up-regulation, cytochrome-c accumulation in cytoplasm and caspase-9 activation). There were significant differences in the expressions of Fas, FasL, Bax, GADD153, cytochrome-c and cleaved caspase-8/9/3 between contained and non-contained discs. In conclusion, apoptosis occurs via these three apoptosis pathways together in IVDD. ER pathway plays a more critical role in the mild compared to moderate and severe stages, death receptor pathway in mild and moderate, and mitochondrial pathway in moderate and severe stages of IVDD. Disc cells apoptosis may progress rapidly after herniation, and may depend on the type of herniation.

Given the essential role of prolactin (PRL) and its receptor (PRLR) in breast tumorigenesis, we investigated whether single nucleotide polymorphisms (SNPs) in the PRL and PRLR genes were associated with breast cancer in Taiwanese women. A total of 160 breast cancer patients and 336 unrelated control Taiwanese women were enrolled in this study. Three SNPs (rs1341238, rs2244502 and rs3756824) in the PRL gene and one SNP (rs10941235) in the PRLR gene were genotyped using allele-specific polymerase chain reaction and DNA sequencing. We showed that the PRLR SNP rs10941235 was associated with breast cancer (P < 0.05) and its genotype frequencies in the breast cancer group were significantly associated (P < 0.05) with the levels of cancer antigen 15-3, a serum biomarker of breast cancer. The PRL SNP rs3756824 was significantly associated with breast cancer metastasis (P < 0.05). These findings suggest that the polymorphism rs10941235 in the PRLR gene is associated with breast cancer and cancer antigen 15-3 levels in Taiwanese women.

Objective: To study surgical managements, outcomes and the factors affecting prognosis of the primary recurrence following partial laryngectomy for laryngeal carcinoma., Methods: The clinical data of 77 patients with salvage surgery for primary recurrence following partial laryngectomy for laryngeal carcinoma were analyzed retrospectively. Fifty-one patients underwent salvage total laryngectomy and other 26 patients with salvage partial laryngectomy. Of them, 19 patients without previous radiotherapy received a combined therapy of surgery and radiotherapy. Survival rates were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression., Results: After salvage surgery, the 3-and 5-year cumulative overall survival rates were 59.1% and 52.7% respectively, and both the 3- and 5-year local recurrence rates were 30.7%. Most patients (48.4%) died of the failure at the primary sites. Multivariate analysis revealed the advanced T stage at initial presentation and the extra-laryngeal invasion of recurrent tumor were adverse prognostic factors for survival rate and also the advanced T stage at initial presentation influenced local recurrence rate., Conclusions: Salvage surgery for the primary recurrence following conservation treatment for laryngeal carcinoma can achieve promising results. Salvage total laryngectomy is the main therapeutic management in most recurrent patients. Salvage partial laryngectomy can achieve sound results in the patients selected carefully.

Objective: To study the clinical characters, the outcomes of treatments and the factors affecting long-term treatment results of adenoid cystic carcinoma (ACC) of the maxillary sinus., Methods: The clinical data of 80 patients with ACC of the maxillary sinus treated initially were analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression., Results: The 5-, 10- and 15-year cumulative overall survival rates were 65.2%, 37.1%, 26.3% respectively and 5-, 10-, and 15-year disease-free survival rates 50.7%, 30.7% and 24.5% respectively. The 5-, 10- and 15-year cumulative local control rates were 68.5%, 47.3% and 47.3% respectively and the cumulative distant metastasis rate were 32.8%, 48.8% and 48.8% respectively. Prognostic factors affecting survival included T stage, pathologic grade and the modes of treatment (P < 0.05). Patients with combined therapy composed of surgery and radiation had a better local control, compared with surgery or radiation alone (χ(2) = 18.33, P < 0.01), and surgery combined with postoperative radiation was prior to preoperative radiation combined with surgery (χ(2) = 6.64, P < 0.05). Patients treated with surgery combined with preoperative radiation, either with doses of ≥ 60 Gy or with negative margins, had a better local control, compared with doses < 60 Gy and with positive margins (χ(2) = 5.06, P < 0.05). The most of patients (62.8%) died of local recurrence., Conclusions: The most of failure was due to recurrence. Combined therapy composed of surgery and radiation improves the local control and survival in patients with ACC of the maxillary sinus, compared with surgery or radiation alone. Surgery combined with postoperative radiation provides the best overall survival and local control and should be the first choice of treatments.

To investigate whether alcohol and tea consumption has an etiological association with nasopharyngeal carcinoma (NPC) in a high-incident population, a large scale case-control study was conducted. The study included 2846 individuals in Guangdong Province, China, with 1387 newly diagnosed cases of NPC and 1459 frequency-matched controls. Exposure histories of alcohol and tea consumption were obtained via personal interviews. Information regarding socio-demographic characteristics (age, sex, education, dialect and household type), family history of NPC, Epstein-Barr virus (EBV) infection, dietary habits and other potential confounding factors was also studied. An analysis was performed using unconditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI). The risk of NPC was found to be associated with habitual alcohol consumption and tea consumption. Tea consumption has been associated with a decreased occurrence of NPC (OR = 0.62), while consumption of alcohol was associated with a complex effect. Specifically, moderate consumption of alcohol was associated with decreased risk of NPC, while overuse, especially strong distillate spirits, appeared to be a risk factor.

Background: Nasopharyngeal carcinoma (NPC) is rare in most parts of the world but is a common malignancy in southern China, especially in Guangdong. Dietary habit is regarded as an important modifier of NPC risk in several endemic areas and may partially explain the geographic distribution of NPC incidence. In China, rapid economic development during the past few decades has changed the predominant lifestyle and dietary habits of the Chinese considerably, requiring a reassessment of diet and its potential influence on NPC risk in this NPC-endemic area., Methods: To evaluate the association between dietary factors and NPC risk in Guangdong, China, a large-scale, hospital-based case-control study was conducted. 1387 eligible cases and 1459 frequency matched controls were recruited. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated using a logistic regression model, adjusting for age, sex, education, dialect, and habitation household type., Results: Observations made include the following: 1) consumption of canton-style salted fish, preserved vegetables and preserved/cured meat were significantly associated with increased risk of NPC, with enhanced odds ratios (OR) of 2.45 (95% CI: 2.03-2.94), 3.17(95% CI: 2.68-3.77) and 2.09 (95% CI: 1.22-3.60) respectively in the highest intake frequency stratum during childhood; 2) consumption of fresh fruit was associated with reduced risk with a dose-dependent relationship (p = 0.001); and 3) consumption of Canton-style herbal tea and herbal slow-cooked soup was associated with decreased risk, with ORs of 0.84 (95% CI: 0.68-1.03) and 0.58 (95% CI: 0.47-0.72) respectively in the highest intake frequency stratum. In multivariate analyses, these associations remained significant., Conclusions: It can be inferred that previously established dietary risk factors in the Cantonese population are still stable and have contributed to the incidence of NPC.

Background: Family history of nasopharyngeal carcinoma (NPC) is an established risk factor for this cancer, but the contributions of family history of other types of cancer and its interaction with environmental factors have not been well characterized., Methods: A total of 1845 incident cases of NPC and 2275 matched controls from Guangdong, China were included in this study. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from logistic regression models adjusted for smoking, consumption of alcohol, salted fish consumption, and demographic factors., Results: A significant association between the risk of NPC and family history of any cancers in first degree relatives was observed, and higher number of affected family member was related to a higher risk (P(trend)<0.01). Family history of NPC was the strongest predictor for NPC (OR: 3.35, 95% CI: 2.46-4.55 for all first degree relatives). The risk of NPC was also positively associated with history of head and neck cancer among parents and lung and breast cancers among siblings. The combination of family history of cancer, especially NPC, and the consumption of salt-preserved fish significantly increased the risk for NPC., Conclusions: These results confirm that the risk for NPC increases with family history of NPC and suggest that lung and breast cancer contribute to risk for NPC. A possible interaction between family history of cancer, especially NPC, and consumption of salt-preserved fish in the development of NPC was also identified.

Objective: To explore the difference between familial and sporadic nasopharyngeal carcinoma patients on risk factors and family history and provide evidence on genetic counseling and screening strategy for relatives of nasopharyngeal carcinoma patients in Guangdong province., Methods: The Cantonese nasopharyngeal carcinoma patients diagnosed in Cancer Center, Sun Yat-sen University from October, 2005 to October, 2007 were recruited as subjects. 1877 patients were collected, including 181 familial nasopharyngeal carcinoma patients and 1696 sporadic nasopharyngeal carcinoma patients. The demographic characteristics, clinical characteristics, risk factors and family history between two groups were compared. Moreover, the distribution of nasopharyngeal carcinoma patients in first-degree relatives and the time interval between proband and the affected first-degree relatives in familial nasopharyngeal carcinoma patients was analyzed., Results: All 9.64% of 1877 nasopharyngeal carcinoma patients had affected relatives in first-degree relatives, among them, 58.49% (124/212) were siblings and 41.51% (88/212) were parents. The mean time interval between siblings and proband were (7.40 +/- 5.41) years while the mean time interval between parents and proband were (15.55 +/- 10.61) years when nasopharyngeal carcinoma occurred, and the difference was statistically significant (t = -5.78, P < 0.01). More than 80% patients of the two group were at advanced stage when they were diagnosed. There were no difference (P values were all > 0.05) both in adulthood and childhood in salted fish (OR = 1.01; 95% CI: 0.59 - 1.75 vs OR = 1.31; 95% CI: 0.92 - 1.86), preserved vegetables (OR = 0.93; 95% CI: 0.58 - 1.49 vs OR = 1.12; 95% CI: 0.80 - 1.57), fermented pastes (OR = 0.37; 95% CI: 0.14 - 1.01 vs OR = 1.61; 95% CI: 0.99 - 2.48), fresh fruits (OR = 0.87; 95% CI: 0.60 - 1.26 vs OR = 0.65; 95% CI: 0.20 - 2.12) and cured meat (OR = 1.26; 95% CI: 0.87 - 1.83 vs OR = 1.28; 95% CI: 0.71 - 2.30) diet. No significant difference (P > 0.05) was obtained on smoking (OR = 0.99; 95% CI: 0.68 - 1.45) and incidence of other cancers in first-degree relatives (OR = 0.85; 95% CI: 0.56 - 1.28) in the two groups., Conclusion: Familial nasopharyngeal carcinoma was 9.64% in the observed subjects. In the familial nasopharyngeal carcinoma, the time interval at diagnosis was shorter between proband and siblings as compared with parents. Most of the patients were at advanced stage. So, we recommend the first-degree relatives of nasopharyngeal carcinoma patients, especially siblings, should be screened regularly according to the specific conditions.

Objective: To study the clinical features, treatment and prognosis of malignant minor salivary gland tumors of the larynx., Methods: Treatment and outcome were retrospectively analyzed in a consecutive series of 15 patients with malignant minor salivary gland tumors of the larynx treated in this hospital from 1959 to 2005. Ten patients (66.7%) had adenoid cystic carcinoma and 2 (13.3%) had adenocarcinoma. The other three patients had mucoepidermoid carcinomas, polymorphic adenocarcinoma and base cell carcinoma respectively. Eleven (73.3%) were located in the supraglottis and 4 (26.7%) in the subglottis. Fourteen had surgery (7 with adjuvant radiotherapy) and one was treated with radiotherapy plus chemotherapy. Five patients were found to have recurrent disease, 4 of whom underwent salvage surgery, 1 of whom had palliation radiotherapy., Results: With a median follow-up of 8 years (ranging from 2 to 16 years), 7 patients are alive. Five patients have no evidence of disease, 1 of whom had surgery alone, 4 of whom were treated with surgery plus radiotherapy. Four patients died of distant metastases in a range of 2 to 10 years. The other 4 patients were lost to follow-up after treatment (ranging from 2 years to 16 years). Seven patients developed recurrent disease, 1 of whom had local recurrence alone, 1 had regional recurrence alone, 2 had distant metastases alone, and 3 had local and distant metastases., Conclusions: Minor salivary gland carcinomas of the larynx are rare and they are prone to the local recurrence and the distant metastasis in advanced stage. Distant metastases remain the principal cause of treatment failure. Surgery is the primary treatment modality used in most cases and the radiotherapy combining surgery has better local and regional control rate.

Objective: To seek a best therapeutic protocol for small cell neuroendocrine carcinoma of head and neck., Methods: The clinical data of 34 patients with small cell neuroendocrine carcinoma of head and neck, 21 males and 13 females, aged 53 (17 - 71), were retrospectively analyzed. The therapeutic protocols that had been used for the patients included surgery alone (in 5 patients), radiotherapy alone (in 7 patients), combined therapy with surgery and radiotherapy (in 7 patients), combined therapy with surgery and chemotherapy (for 3 patients), combined therapy with radiotherapy and chemotherapy (for 10 patients), and combined therapy with surgery, radiotherapy and chemotherapy (for 2 patients). The follow-up ended on August 1 2007., Results: The prognosis of the patient with small cell neuroendocrine carcinoma of skin was the best. Local recurrence occurred in 7 patients, of which 2 underwent surgery alone, 2 combined therapy with surgery and radiotherapy, 1 combined therapy with surgery and chemotherapy, and 2 combined therapy with radiotherapy and chemotherapy. Recurrence in neck occurred in 1 patient that had undergone combined therapy with surgery and radiotherapy. Neck lymph node metastasis was found in 4 patients of whom 2 had undergone surgery alone, 1 had undergone combined therapy with surgery and chemotherapy, and 1 combined therapy with radiotherapy and chemotherapy. Distant metastasis was found in 11 patients of whom 2 had undergone surgery alone, 2 radiotherapy alone, 3 combined therapy with surgery and radiotherapy, and 3 combined therapy with radiotherapy and chemotherapy. The median survival time was 24 months, and the overall 3-year and 5-year cumulative survival rates were 65.37% and 35.95% respectively., Conclusion: The prognosis of the patient with small cell neuroendocrine carcinoma of head and neck was poor. Small cell neuroendocrine carcinoma cases with the lesions at different sites differ in prognosis and needed different therapeutic fashions. Combined therapy with radiotherapy and chemotherapy is recommended for small cell neuroendocrine carcinoma of head and neck, and surgery serves as a salvage therapeutic measure.

Background and Aims: Large clones of rhizomatous plants are found in many habitats, but little is known about whether such clones also occur on cliff faces where environmental conditions are extremely harsh and heterogeneous., Methods: Using molecular (intersimple sequence repeat, ISSR) markers, the genotypic composition of a cliff-face population of Oxyria sinensis in Sichuan, China, was investigated., Key Results: The 98 O. sinensis ramets sampled belonged to 12 different genotypes (clones). The three most frequent clones were represented with 45, 22 and 12 ramets, respectively; the remaining nine were represented with only one to five ramets. The three largest clones spanned at least 2.7 m in the vertical direction and 4.6-6.9 m in the horizontal direction on the cliff face., Conclusions: On the cliff face, large clones of O. sinensis are formed by rhizomes growing along the crevices. Expansion by rhizomes may help O. sinensis to exploit the patchy resources and support establishment and growth of new ramets. Moreover, rooted ramets connected by rhizomes may effectively reduce the susceptibility of O. sinensis to rock fall and erosion and thus greatly improve the chances for long-term survival. The multi-clone structure indicates that sexual reproduction is also important for the long-term persistence of O. sinensis populations on cliffs.

Objective: To study the distribution of cervical lymph nodes metastases in patients with differentiated thyroid carcinoma, explore the surgical modality of the neck of cN + cervical node metastasis and evaluate the role of preoperative ultrasonography in detecting of cervical metastases of differentiated thyroid carcinoma., Methods: Data were reviewed retrospectively from medical records between July 2003 and July 2005, in which 93 patients (113 sides) of differentiated thyroid carcinoma patients with cN + cervical lymph nodes metastasis. Patients were divided into 2 groups: group 1, 64 cervical sides with preoperative palpable cervical lymph nodes; group 2, 49 cervical sides with impalpable node but preoperative ultrasonic positive nodal metastasis. All the pathologic specimens were reviewed by pathologists counting the numbers of pathologic positive nodes and mapping localization of positive nodes in level II, III, IV, V and VI respectively., Results: In 93 patients 21.5% (20/93) of those metastasize bilaterally. In those 113 sides specimens 92 sides (81.4%) involved multi-sites in the neck. The distribution of metastasized nodes were; level II, 60.2% (68/113); level III, 70.8% (80/113); level IV,61.9% (70/113); level VI, 58.4% (66/113); level V, 22.5% (25/113). The numbers of positive nodes of group 1 were more than the number of group 2 (10.1 vs 6.9) and the involved levels of group 1 was also more than the levels of group 2 (3.18 level vs 2.61 level). Preoperative ultrasonography could detect 43.4% (49/113) of lymph nodes metastasis that were missed by palpation in the physical examination., Conclusions: The distribution of the cervical nodes in patients with differentiated thyroid carcinoma were multi-levels in the neck and mainly localized in level II , level III, level IV and level VI. Preoperative ultrasonography is a mainstay in detecting of cervical lymph nodes metastasis in thyroid cancer. For patients with differentiated thyroid carcinoma of cN + cervical lymph nodes should be undergone modified neck dissection, includes level II, III, IV, V, VI.

Objective: To grasp clinical characteristics, therapeutic methods and prognosis of the patients with nasopharyngeal adenoid cystic carcinoma, and explore the optimal therapeutic modalities., Methods: Twenty one cases with nasopharyngeal adenoid cystic carcinoma were retrospectively reviewed. The treatment results were compared between radiotherapy alone and combined therapy., Results: The cases with nasopharyngeal adenoid cystic carcinoma in T1, T2 phases was 28.6%, the cases in T3, T4 phases was 71.4%. The lymphatic node metastasis rate was 14.3%. The present symptoms were nasal discharge with blood, headache, nasal obstruction, deafness, double vision, facial insensibility, etc. One of 21 cases was lost follow up. Five years free-disease survival rates of the patients with nasopharyngeal adenoid cystic carcinoma was 42.9% (9/21). Five years free-disease survival rate of the patients with radiotherapy alone (RA) and the patients with radiotherapy combining surgery (R + S) were respectively 38.5% (5/12) and 50.0% (4/8), P = 0.472. Ten years free-disease survival rates of the patients was 16.7% (3/18). Ten years free-disease survival rates of the patients with RA and the patients with R + S were respectively 0/12 and 3/6, P = 0.025. The local recurrent rate was 50.0% (10/20). The local recurrent rates of the patients with RA and the patients with R + S were respectively 66.7% (8/12) and 25.0% (2/8), P = 0.085. The distant metastasis rate was 30. 0% (6/20). The distant metastasis rates of the patients with RA and the patients with R + S were respectively 25.0% (3/12) and 37.5% (3/8), P = 0.455., Conclusions: The course of nasopharyngeal adenoid cystic carcinoma is long, and it is prone to the local recurrence and the distant metastasis in advanced stage. Comparing with the radiotherapy alone, the radiotherapy combining surgery has better 10 years free-disease survival rate.

Objective: To evaluate the functional outcome and the complications of allograft replacement in management of giant cell tumors of bone., Methods: Seventy-seven patients who underwent bone tumor resection and massive allograft reconstruction of bone defects between 1992 and 2002 were evaluated. The length of the resected part ranged from 5 to 11 centimeters. Fresh-frozen allografts were employed as osteoarticular grafts (n = 47), hemi-condylar (n = 12), massive (n = 14) or allograft-prosthesis composite (n = 4). Most of the lesions located in proximal and distal femur, proximal tibia and humerus. The oncological parameters that were evaluated including survival of the patient, local recurrence, and metastasis. The radiographic parameters included time to union, stability of the joint, fracture of the allograft. Mankin evaluation system was used to assess functional outcome., Results: At a median of 35 months (range from 12 to 135 months) after the operation, 76 of the patients in the study group were free of disease, and one had died of disease. Eleven (14.1%) patients had local recurrence and 12 (15.4%) nonunion. Late complications included 5 (6.4%) fractures of the allograft and 5 (6.4%) infections of the graft. Instability of the joint in the form of subluxation was noted in 5 (6.4%) patients. One extremity were amputated due to local recurrence. On the basis of Mankin functional evaluation, the total satisfied rate was 83.2 percent. Osteoarticular graft got the highest score (91.5%) and hemi-condylar got the lowest (66.6%). Massive grafts and composite were at the middle (ranges from 71.4% to 75%)., Conclusion: Allografts offer many types of reconstruction for bony defects after tumor resection. The functional results are comparable to other methods of reconstruction, and once incorporated by the host, offer the advantage of longevity. It is also a method with high complication, and decreasing the complications could improve the functional score. Less resection could get better reconstruction and better function, less margin resulted at the same time. The risk of recurrence increases when less surgical margin achieves. The main end-result-influencing factor is local recurrence.

Objective: To investigate the clinical characteristics, treatment and prognosis for poorly differentiated supraglottic carcinomas., Methods: A retrospective study was conducted in 57 cases of poorly differentiated supraglottic carcinomas treated in our hospital from 1980 to 1998. The distribution of the patients according to UICC in 1997 was as follows: stage I 4, stage II 15, stage III 18, stage IV 30. Of the 57 patients, 25 were treated with surgery alone, 9 with irradiation alone, 14 with surgery following preoperative radiation, 7 with postoperative radiation following surgery and 2 with surgery following preoperative chemotherapy. Total laryngectomy was performed on 23 patients and partial laryngectomy on 25 patients. The concurrent neck dissections were undergone for 31 cases (17 unilateral side, 14 bilateral side) and the upper neck dissections for 12 cases., Results: The overall 5-year survival rate, accumulated cervical metastasis rate, metastasis rate of bilateral side of neck, distant metastasis rate, cervical recurrent rate and locally recurrent rate were 47.4% (27/57), 63.2% (36/57), 24.6% (14/57), 21.1% (12/57), 28.1% (16/57) and 10.5% (6/57), respectively. In addition, the local recurrent rate for partial laryngectomy was 12% (3/25). 5-year survival rate for each TNM staging decreases gradually. The difference in 5-year survival rate between T1 + T2 and T3 + T4 and the difference between N0 + N1 and N2 + N3 were statistically significant (chi2 = 4.942, P = 0.026; chi2 = 4.306, P = 0.038). No evidence in our analysis was found about the difference in 5-year survival rate between surgery alone and surgery combined with radiotherapy. The effect of surgery combined with radiotherapy on patients at N2 and N3 was relatively superior to that of surgery alone., Conclusions: Poorly differentiated carcinomas of the supraglottic larynx had characteristics of the advanced stage in terms of earlier lymph node metastasis and a relatively high rate of cervical and distant metastasis. Surgery was still the primary treatment for this disease and it was feasible to perform partial laryngectomy on certain patients. For patients with T3 who need partial laryngectomy and patients with advanced N stage, the combination of surgery with radiotherapy was supposed to be a priority.

Background & Objective: Poorly differentiated thyroid follicular carcinoma is rare, and there were few reports on it. This study was designed to determine clinical characteristics, treatment, and prognosis of poorly differentiated thyroid follicular carcinoma., Methods: Thirty patients with poorly differentiated thyroid follicular carcinoma were investigated retrospectively for their general clinical manifestation, process of treatment,and prognosis. Duration of survival from operation to various endpoints, including local recurrence, distant metastasis, and death from cancer or any causes, was estimated by Kaplan-Meier method. Factors that might be related to prognosis, including age, gender, tumor size, extrathyroidal extension, treatment, and operation status, were analyzed by log-rank test. The difference of data between 2 groups was estimated by t test., Results: The 3-, 5-, 10-year overall survival rates of 30 patients with poorly differentiated thyroid follicular carcinoma were 32.2%, 25.1%, and 12.5%, respectively. The cumulative recurrence rate, regional lymph node metastasis rate, and distant metastasis rate were 37.6%, 57.6%, and 82.5% at 3 years, and 48.0%, 68.2%, and 86.9% at 5 years, respectively. The local recurrence rate decreased significantly (Chi(2)=6.59,P=0.01), and the survival rate increased significantly (Chi(2)=12.40,P=0.00) for patients who had complete removal of the primary lesion and neck metastasis. The recurrence rate of patients with venous tumorous emboli was remarkably higher than that of other patients,(Chi(2)=4.62,P=0.03). The survival time of patients with distant metastases, who had undergone 131I therapy, was significantly longer than that of other patients, who had not undergone 131I therapy (Chi(2)=12.25,P=0.00)., Conclusion: Patients with poorly differentiated thyroid follicular carcinoma had high distant metastasis rate, and poor prognosis. Distant metastasis is an important factor that affects the survival rate. Radical resection is important for control primary tumor, and improve survival rate. 131I therapy is an effective treatment and could prolong the survival time of patients with distant metastases.

Objective: To explore the clinical characteristics, diagnosis, treatment and prognosis of adenoid cystic carcinoma of the palate., Methods: A retrospective review was conducted in 42 patients with adenoid cystic carcinoma of the palate treated in our hospital from 1967 to 1998. Statistical analysis was performed using the Kaplan-Meier method. Prognostic factors were analyzed by Log Rank test., Results: The overall 5-, 10-, 15-year accumulative survival rates were 85.0%, 61.8% and 28.1%, and the 5-, 10-, 15-year accumulative disease-free survival rates were 52.4%, 32.7% and 22.4%, respectively. The 5-, 10-, 15-year accumulative local recurrence rates were 25.2%, 50.9% and 73.1%, and the 5-, 10-, 15-year accumulative distant metastasis rates were 28.5%, 50.4% and 66.0% respectively. T stage, bone invasion, extent of tumor, local recurrence and distant metastasis were significant prognostic factors. Treatment method, dose and area covered by radiotherapy were related to the prognosis., Conclusion: Surgery alone can be done for early lesions, and combination of surgery with radiotherapy should be adopted for advanced lesions in adenoid cystic carcinoma of the palate. Radiotherapic salvage could prolong the survival of the locally recurrent patients.

Objective: To study the diagnosis, treatment policy and prognosis in patients with esthesioneuroblastoma., Methods: A retrospective review was conducted in 34 patients treated at Cancer Hospital of CAMS from 1958 to 1998. According to the Kadish system, the patients were staged as follows: stage A, 1 case; stage B, 9 cases; and stage C, 24 cases. Three patients were treated with surgery alone, 9 irradiation alone, and 15 combination with surgery and radiation, 4 combination with radiation and chemotherapy and 3 surgery, radiation and chemotherapy., Results: The overall 5-year survival rate was 47.1% (16/34). The survival rates for stag A, B, and C were 100% (1/1), 88.9% (8/9), and 29.2% (7/24) respectively. The survival rates for surgery alone, radiation alone and combined therapy were 33.3% (1/3), 33.3% (3/9), and 54.5% (7/24), respectively. The local control rate and distant metastasis rate were 61.8% (21/34) and 32.4% (11/34), respectively. There were 10 patients died of distant metastasis and 5 patients died of local recurrence. The survival rate in patients with early stage (A + B) esthesioneuroblastoma was significantly better than that in patients with advanced stage (C) (chi2 = 8. 174, P = 0.004). The young patients (< or = 30 years) had a remarkable higher distant metastasis rate (chi2 = 3.865, P = 0.049) and poor prognosis (chi2 = 4.194, P = 0.041) than elder patients., Conclusions: Early detection and combined therapy were important to improve survival rate. The combined therapy with preoperative radiation therapy and surgery could help to achieve excellent local control. Distant metastasis was an important factor which affected the prognosis of the patients.

Objective: To assess the feasibility of sentinel lymph node (SLN) radiolocalization in stage in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel lymph node could be prognostic of regional micrometastatic disease., Methods: A prospective trial was made on the application sentinel lymph node radiolocalization in 10 patients with NO squamous cell carcinoma of the head and neck region. For each patient a peritumoral submucosal injection of filtered technetium 99m prepared with dextran colloid (99mTc-DX) was performed immediately. After 30 minutes, focal areas of accumulation corresponding to sentinel lymph nodes (SLN) were marked on the skin surface. The SLN was localized by lymphoscintigraphy and intraoperatively through the intact skin by a hand-held gamma-probe. SLN was defined as the count of lymph node could be detected 4 times more than that of background. Complete neck dissections were performed, and SLNs were identified for later histological evaluation and comparison to the remaining lymphadenectomy specimen., Results: SLN radiolocalization accurately identified one or more SLNs in the ten cases. 3 of 10 cases revealed occult metastatic disease. Therefore the negative metastasis rate was 30% (3/10). The positive rate of SLN and nonsentinel lymph node (NSLN) were 22.7% (5/22) and 0.4% (1/247) respectively. Serial sectioning (SS) and immunohistochemical (IHC) on SLNs would reduce the false-negative rate of sentinel lymph node biopsy (SLNB). There was no instance in which SLN was negative for micrometastatic disease while being positive in a nonsentinel lymph node., Conclusions: SLN evaluation in NO neck in squamous cell carcinoma of the head and neck is accurately feasible and seems to adequately predict the presence of occult metastasis. Although SLN radiolocalization in head and neck squamous cell carcinoma may potentially reduce the time, cost, and morbidity of regional lymph node management, more experience with technique is required before its role can be determined.

Objective: Mitoxantrone-insulin conjugate was prepared through covalent bond, where mitoxantrone was an anticancer model drug and insulin acted as a vector. Its stability in vitro was discussed., Methods: Spacer was used to join insulin and mitoxantrone. The intermediate and the final conjugate were characterized by infra-red spectroscopy (IR), 1H NMR, mass spectrometray (MS) and ultra-violet spectrophotometry (UV). Stability trials of the conjugate were carried out in different pH buffer solutions and mouse plasma at 37 degrees C., Results: Drug loading of the conjugate was 11.68%. The conjugate was stable in phosphate buffer solution of pH 2-8 and mouse plasma at 37 degrees C., Conclusion: Stable mitoxantrone-insulin conjugate was obtained to ensure further tumor targeted study in vivo.

Anticancer drugs have serious side effects arising from their poor malignant cells selectivity. Since insulin receptors highly express on the cytomembrane of some kind of tumor cells, using insulin as the vector was expected to reduce serious side effects of the drugs. The objective of this study was to evaluate the tumor targeting effect of the newly synthesized mitoxantrone-insulin conjugate (MIT-INS) with the drug loading of 11.68%. In vitro stability trials showed MIT-INS were stable in buffers with different pH (2-8) at 37 degrees C within 120 h (less than 3% of free MIT released), and were also stable in mouse plasma within 48 h (less than 1% of free MIT released). In vivo study on tumor-bearing mice showed that, compared with MIT [75.92 microg x h/g of the area under the concentration-time curve (AUC) and 86.85 h of mean residence time (MRT)], the conjugates had better tumor-targeting efficiency with enhanced tumor AUC of 126.53 microg x h/g and MTR of 151.95 h. The conjugate had much lower toxicity to most other tissues with targeting indexes (TIC) no larger than 0.3 besides good tumor targeting efficiency with TIC of 1.67. The results suggest the feasibility to promote the curative effect in cancer chemotherapy by using insulin as the vector of anti-cancer drugs.

Reelin is synthesized and secreted into extracellular matrix by cortical gamma-aminobutyric acid (GABA)ergic interneurons and binds with high affinity to the extracellular domain of integrin receptors expressed in dendritic shaft and spine postsynaptic densities (DSPSD) of pyramidal neurons. In heterozygous reeler mice, reelin bound to DSPSD, and the expression of Arc (activity-regulated cytoskeletal protein) is lower than in wild-type mice. We studied the effect of reelin on Arc and total protein synthesis in synaptoneurosomes (SNSs) prepared from mouse neocortex. Recombinant full-length mouse reelin displaces the high affinity (K(D) = 60 fM) binding of [(125)I]echistatin (a competitive integrin receptor antagonist) to integrin receptors with a K(i) of 22 pM and with a Hill slope close to 1. Echistatin (50-100 nM) competitively antagonizes and abates reelin binding. The addition of reelin (2-40 pM) to SNSs enhances the incorporation of [(35)S]methionine into Arc and other rapidly translated proteins in a concentration-dependent manner. This incorporation is virtually abolished by 50-100 nM echistatin or by 5-10 nM rapamycin, a blocker of the mammalian target of rapamycin kinase. We conclude that reelin binds with high affinity to integrin receptors expressed in SNSs and thereby activates Arc protein synthesis.