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Energy and water are scarce resources and understanding the complicated energy–water nexus is an important issue for effective resource management. The purpose of this research was to analyze the competitive and cooperative relationships involving energy and water production and use. Specifically, tradeoff and integrated management of hydropower generation and water supplies are analyzed for energy–water systems. A Nash–Cournot model was established to analyze strategic behaviors among participants in energy–water systems. In the model, tradeoff analysis and integrated management of hydropower and water supplies were simulated for a reservoir system. In addition, hydropower and thermal power generation in competitive energy markets was examined. A case study of Dajia River reservoirs in the Tai-Chung and Chang-Hwa energy–water systems is presented. Dajia River is the second longest river in central Taiwan; the reservoirs system of Dajia River generates hydropower with installed capacity of 1150 MW. Strategic competitive and cooperative behaviors regarding energy–water linkage were quantified in the results. The results show that integrated management of hydropower and water supplies can increase renewable energy production, lower electricity equilibrium price, and decrease carbon dioxide emission.

There is a lack of evidence supporting the association between carbon monoxide (CO) poisoning and acute kidney injury (AKI). Hence, the present study aimed to evaluate the association between CO poisoning and AKI.From 2000 to 2011, we identified patients diagnosed with CO poisoning from the inpatient claims data. Patients aged below 20 years, who had a history of chronic kidney disease or end-stage renal disease before the index date and had incomplete medical information were excluded. Control patients without CO poisoning were randomly selected from all National Health Insurance beneficiaries, and the same exclusion criteria were used. The control group was frequency matched to patients with CO poisoning based on age, sex, and year of CO poisoning diagnosis. Cox proportional hazards regression analyses were conducted to assess the effects of CO poisoning on the risk of AKI. The hazard ratios and 95% confidence interval (CI) were calculated in the models.Compared with the control cohort, patients with severe CO poisoning were 3.77 times more likely to develop AKI (95% CI = 2.20-6.46), followed by those with less severe CO poisoning (adjusted hazard ratio = 2.21, 95% CI = 1.61-3.03).The findings of this nationwide study suggest an increased risk of AKI in patients with CO poisoning.

Chun-Chieh Huang,1,2 Fu-Min Fang,1 Hui-Chun Chen,1 Hsuan-Chih Hsu,1 Tai-Lin Huang,3 Yu-Li Su,3 Ya-Chun Chang4 1Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, 3Department of Hematology and Oncology, 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China Purpose: Cranial nerve (CN) palsy is the main symptom in patients with locally advanced nasopharyngeal carcinoma (NPC). This study aimed to evaluate the therapeutic outcome of NPC with CN palsy and to analyze the prognostic factors.Patients and methods: A total of 104 NPC patients with CN palsy curatively treated by conventional (n=44) or conformal (n=60) radiotherapy (RT) were enrolled. Upper CN palsy was present in 81 patients, lower CN palsy in four patients, and both upper and lower CN palsy in 19 patients. Forty-one patients had CN palsy for >2months before diagnosis.Results: Complete recovery of CN palsy was observed in 74 patients. The actuarial 5-year locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 58.2%, 62.2%, and 38.4%, respectively. No significant difference was observed in CN recovery, LRC, DMFS, or OS for patients treated by conventional versus conformal technique. However, significant reduction of grade 3 or greater toxicities was found in those treated by the conformal technique (odds ratio =0.28).Conclusion: Patients with CN palsy presenting >2months before diagnosis were hard to recover from palsy. The LRC, OS, and recovery from CN palsy did not significantly change with the treatment evolution. Patients with complete recovery from CN palsy had longer OS. Keywords: nasopharyngeal carcinoma, cranial nerve palsy, radiotherapy

Urban metabolism analyzes the supply and consumption of nutrition, material, energy, and other resources within cities. Food, water, and energy are critical resources for the human society and have complicated cooperative/competitive influences on each other. The management of interactive resources is essential for supply chain analysis. This research analyzes the food-water-energy system of urban metabolism for sustainable resources management. A system dynamics model is established to investigate the urban metabolism of food, water, and energy resources. This study conducts a case study of Shihmen Reservoir system, hydropower generation, paddy rice irrigation of Taoyuan and Shihmen Irrigation Associations, and water consumption in Taoyuan, New Taipei, and Hsinchu cities. The interactive influence of the food-water-energy nexus is quantified in this study, the uncertainty analysis of food, water, and energy nexus is presented.

Background: Nox4 has been reported to promote tumor progression of various types of cancer through many different pathways. The current study was designed to evaluate the prognostic significance of Nox4 in patients with oral tongue squamous cell carcinoma (OTSCC) receiving surgical resection. Methods: We retrospectively analyzed the 161 patients with OTSCC treated with surgical resection, including 81 patients with high expression of Nox4 and 80 patients with low expression of Nox4. Two OTSCC cell lines, SAS and SCC4, were used to investigate the proliferation activity. Results: The univariate and multivariable analyses showed that negative nodal metastasis and low expression of Nox4 were significantly associated with superior disease-free survival (DFS) and overall survival (OS). Western blotting analysis indicated that Nox4 was highly expressed in these two OTSCC cell lines and knockdown of Nox4 was successful by transfecting with Nox4 shRNA. In addition, these cell lines were also treated with a Nox4 inhibitor (GKT-137831) and the results showed GKT-137831 could inhibit the proliferation of OTSCC tumor cells in a dose-dependent manner. Conclusion: Our study suggests that Nox4 plays an important role in disease progression of OTSCC and Nox4 overexpression is a poor prognostic factor for patients with OTSCC who received surgical resection.

This study investigated the therapeutic benefit of radical resection (SRR) for clinical T4b oral cavity squamous cell carcinoma (OSCC) with partial or complete response after radical chemoradiotherapy (CRT).At the authors' institution, 79 patients with newly diagnosed non-metastatic T4b OSCC were treated with CRT from January 2009 to December 2014. All of them were irradiated using intensity-modulated radiotherapy (IMRT), with a radical dose (median 70 Gy; range 66-76 Gy) in the gross tumor area. Of the 65 cases achieving partial or complete response after CRT, 33 were treated further with SRR and 32 with adjuvant chemotherapy or observation. The locoregional control (LRC), overall survival (OS), and cancer-free survival (CFS) rates were compared between the two groups.The 3-year LRC, OS, and CFS rates were respectively 72.3, 75.1, and 72.6 % in the SRR group compared with 32.8, 47.7, and 44.3 % in the non-SRR group (p0.05). Multivariate analysis showed that SRR was the only statistically significant prognostic factor related to LRC, OS, and CFS. For those with SRR, pathologic downstaging was observed in 27 cases (81.8 %). Perioperative flap failure was observed in three cases (9.2 %) and neck wound necrosis in four cases (12.1 %).For T4b OSCC, incorporating SRR in the therapy is technically safe and has survival benefit, with a significant response after CRT applied by IMRT, with a radical dose in the gross tumor area.

Mantispids are small brown bugs about 1.5 cm in length. Mantispid eggs are produced in large quantities, with about 1000 eggs per spawning, and are tiny and densely packed. Traditionally, mantispid eggs are counted manually. However, counting such a large quantity of eggs is difficult. To provide accurate data for researchers, we detail methods to accurately detect and count the number of mantispid eggs using image processing. The following methods were used to count the mantispid eggs: background estimation, morphological image processing, background subtraction, stretching, image thresholding, gray-level transformation, labeling and counting. The results of automated counting were compared with the results of manual counting. The segmentation results were verified, and the accuracy of the mantispid egg counts was determined to be 100%. This provides a useful resource for mantispid egg counting. The automatic counting system cannot only count mantispid eggs, it can also be used to count other similar insect eggs.

In this paper, three-dimensional images were used to analyze the association between dose-volume parameters and radiation-induced brain edema in patients with a brain tumor after receiving stereotactic radiosurgery (SRS). The computed tomography (CT), magnetic resonance images (MRI) and treatment parameters were transferred through the treatment planning system (Multiplan, version 5.1.3). The correlation between the dose of radiation therapy and brain edema was evaluated by image processing methods, such as image normalization, registration, filtering, segmentation, and feature extraction. The association was evaluated by volume index and intersection index. The study results suggest that the volume receiving radiation dose above 30% of the prescribed dose is highly associated with the brain edema in brain tumor patients after SRS. The small number of patients limits the study. Further investigation with larger populations and long-term epidemiological studies are required.

Background To scrutinize the pretreatment prognosticators on survival and late toxicities in a homogenous cohort of nasopharyngeal carcinoma (NPC) patients treated by simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT). Methods A total of 219 non-distant metastatic NPC patients consecutively treated by SIB-IMRT at a single institute were collected. The pretreatment factors including the socio-demographic variables, TNM stages, gross tumor volume (GTV), Epstein-Barr virus (EBV)-DNA, and hematologic inflammatory markers were analyzed. Cox model was used to screen the prognostic factors of late toxicities and four survival outcomes including locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), failure-free survival (FFS), and overall survival (OS). Results Statistically significant inter-correlations were observed between the values of EBV-DNA, some hematologic inflammatory markers, GTV, and N classification. The 5-year LRRFS, DMFS, FFS, and OS rates were 87.9%, 89.4%, 79.4%, and 81.3%, respectively. Multivariate analysis revealed that advanced N classification (N2–3 vs. N0–1) remained the only significant negative prognosticator for all the four survival outcomes. An increased monocyte percentage and a decreased lymphocyte-to-monocyte ratio were significantly associated with poorer FFS and OS, respectively. Larger GTV was observed to be predictive of poorer LRRFS. Patients with T3–4 (HR: 3.5, 95% CI: 1.0–12.1, p = 0.048) or higher GTV (HR: 1.006, 95% CI: 1.001–1.011, p = 0.027) were associated with higher incidence of radiation neuropathy. Conclusion N classification remains the most significant survival predictor for NPC patients treated by SIB-IMRT after adjusting these biomarkers. GTV impacts not only on locoregional control but also radiation neuropathy.

Background The purpose of this study was to investigate late toxicities and quality of life (QOL) of patients with nasopharyngeal carcinoma (NPC) with long-term survival after treatment by intensity-modulated radiotherapy (IMRT) versus non-IMRT. Methods An observational, cross-sectional study of QOL and late toxicities was conducted in 242 patients with NPC with survival of >5 years after treatment with IMRT (n = 100) or non-IMRT (n = 142) by using physician-assessed toxicities (Common Terminology Criteria for Adverse Events [CTCAE] version 4) and the patient-reported European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC QLQ-C30) and the Head and Neck 35-questions (EORTC QLQ-C30-H&N35) module. Results The IMRT group had both statistically (p

Background This study evaluated the significance of mammalian target of rapamycin (mTOR) activation on the prognosis of patients with locally advanced head and neck squamous cell carcinoma (HNSCC) receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF). Methods Immunohistochemistry (IHC) for phosphorylated-mTOR and phosphorylated-p70 ribosomal S6 protein kinase (p70S6K) examined in 107 patients with locally advanced HNSCC receiving TPF was correlated with treatment outcome. The effect of mTOR inhibition on HNSCC cell lines was investigated in vitro and in vivo. Results Phosphorylated-mTOR expression was independently significantly associated with response to TPF, progression-free survival (PFS), and overall survival (OS). In cell lines and xenograft models, mTOR inhibitor, everolimus, enhanced the effect of docetaxel. Conclusion In patients with locally advanced HNSCC treated with TPF, phosphorylated-mTOR expression was independently associated with prognosis. In vitro and in vivo, concomitant inhibition of mTOR enhanced the effect of docetaxel. Our findings suggest the potential of mTOR as a therapeutic target for locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Objectives/Hypothesis Perineural invasion (PNI), lymphovascular invasion (LVI), and extracapsular spread (ECS) of lymph nodes are adverse histopathologic factors among patients with oral cancer. We analyzed the clinical impact of the combination of PNI, LVI, and ECS among patients with oral cancer. Study Design Retrospective analysis of patients with oral cancer that was treated primarily with surgery with at least 5 years of follow-up data in a tertiary referral center. Methods In total, 554 patients diagnosed with oral cavity squamous cell carcinoma who underwent operations consecutively between 2006 and 2008 in our hospital were enrolled. Clinical characteristics, 5-year survival rates, and local/regional control rates were analyzed. Results There were 41 females and 513 males. Patients with PNI, LVI, or ECS presented pathologically had 5-year overall survival rates of 58.4%, 50.4%, and 31.4%, respectively. Patients with both ECS and PNI or both ECS and LVI presented had 5-year overall survival rates of 31.5% and 22.2%, respectively. Patients presenting with triple-positive status (PNI, LVI, and ECS) had only a 20.0% 5-year overall survival rate. The 5-year local/regional control rate for patients with both ECS and PNI or both ECS and LVI was 26% and 44.4%, respectively; for all three factors, it was 26.7%. Conclusion Patients with triple-positive status (PNI, LVI, ECS), ECS and PNI, or ECS and LVI experienced very low 5-year local/regional control rates, 5-year overall, and disease-specific survival rates. Novel interventions are necessary to improve these clinical outcomes. Level of Evidence 4. Laryngoscope, 125:E300–E305, 2015

Background: The aim of the present study was to evaluate the prognostic value of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF). Materials and Methods: We performed a single-center retrospective analysis of 126 patients with locally advanced HNSCC treated with TPF as induction chemotherapy at Kaohsiung Chang Gung Memorial Hospital. NLR and PLR were calculated from blood tests before induction chemotherapy and correlated with clinical parameters and treatment outcomes. Results: A NLR ≧3 was significantly associated with advanced clinical American Joint Committee on Cancer (AJCC) 7th stage, higher clinical T classification, oral cavity primary tumor site, and alcohol history. A PLR ≧120 was significantly correlated with advanced clinical AJCC 7th stage and oral cavity primary tumor site. The overall response rates of induction chemotherapy were 70% and 50% (P = 0.022) in patients with a NLR

In Taiwan, many industrial facilities are located in coastal regions. A large portion of those facilities are constructed with stainless steel. Over time, sodium chloride from seawater vapor would deposit on the surface of the facilities and the chloride ions in it can lead to corrosion and cracks. This process is the so-called stress corrosion cracking (SCC). Theoretically, the SCC failures increase with the level of residual stress created by the welding and cold working processes. Practically, however, the corrosion risk is governed by various intrinsic and extrinsic factors that interact as a complex process. In this paper, we propose a dynamic approach for controlling the SCC risk. Firstly, we review some recent experimental work and filed investigations on stainless steel facilities in Taiwan. Following that, a dynamic risk management approach is explained and applied to develop a research roadmap for controlling the complex corrosion risk. In sum, we find that the best way to control the corrosion risk of the facilities is to remove the chlorides from the air by an ion exchange process accompanied with continuous monitoring and maintenance efforts during their operation life cycle.

Background Smoking and betel nut chewing are well-known risk factors for head and neck squamous cell carcinoma (HNSCC). Smoking is also a strong prognosticator for patients with locally advanced HNSCC receiving induction chemotherapy. Smoking with or without betel nut chewing is a common practice in Asia. However, little is known regarding whether betel nut chewing can serve as a prognostic factor for smoking patients with locally advanced HNSCC receiving induction chemotherapy. The aim of this study was to evaluate the prognostic impact of betel nut chewing in such patients receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF). Methods From January 2010 to December 2012, we retrospectively analyzed 162 smoking patients with locally advanced HNSCC who received induction chemotherapy with TPF at our institution. Background characteristics, including a history of betel nut chewing, were analyzed as potential prognostic factors. Results Among the 162 smoking patients, 131 patients (81 %) were betel nut chewers, while 31 (19 %) were non-betel nut chewers. One hundred fifty-six (96 %) were men, and 6 (4 %) were women. The median age was 53 years. The overall response rates to induction chemotherapy were 57 and 77 % in patients with and without betel nut chewing history, respectively (P = 0.038). The 2-year progression survival rates were 37 and 67 % in patients with and without betel nut chewing history, respectively (P = 0.004). The 2-year overall survival rates were 47 and 71 % in patients with and without betel nut chewing history, respectively (P = 0.017). Betel nut chewing history was independently associated with a poor response to induction chemotherapy, an inferior progression-free survival rate, and a poor overall survival rate. Conclusions Our results indicate that betel nut chewing history is independently associated with poor prognosis in smoking patients with locally advanced HNSCC receiving induction chemotherapy with TPF. Further investigation is warranted to explain this effect of betel nut chewing history on these patients’ prognosis.

Purpose The purpose of this study was to examine the prognostic value of pretreatment quality of life (QoL) data on locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) in patients with nasopharyngeal carcinoma (NPC). Patients and Methods A total of 347 new patients with NPC, who were curatively treated by conformal radiotherapy from March 2003 to December 2007, were recruited. The Taiwan Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 was completed before treatment. Multivariate Cox's proportional hazards models were used to analyze the impact of clinical and QoL variables on the treatment results. Results The 5-year LRC, DMFS, and OS rates were 72.9%, 79.1%, and 68.4%, respectively. After adjusting the clinical variables, 10 QoL variables were observed to be significantly (P < .05) related to OS, and four QoL variables were related to DMFS. No QoL variable was predictive of LRC. Among the QoL variables that significantly predicted OS and DMFS, physical functioning was the most powerful predictor. A 10-point increase in the physical functioning score was associated with a 23% (95% CI, 12% to 34%) reduction in the likelihood of death and a 22% (95% CI, 9% to 36%) reduction in the likelihood of distant metastasis. Conclusion Our findings indicate that pretreatment QoL variables, especially physical functioning, provide easily available prognostic value for distant metastasis and survival in patients with NPC.

This study evaluated the significance of mammalian target of rapamycin (mTOR) activation on the prognosis of patients with locally advanced head and neck squamous cell carcinoma (HNSCC) receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF).Immunohistochemistry (IHC) for phosphorylated-mTOR and phosphorylated-p70 ribosomal S6 protein kinase (p70S6K) examined in 107 patients with locally advanced HNSCC receiving TPF was correlated with treatment outcome. The effect of mTOR inhibition on HNSCC cell lines was investigated in vitro and in vivo.Phosphorylated-mTOR expression was independently significantly associated with response to TPF, progression-free survival (PFS), and overall survival (OS). In cell lines and xenograft models, mTOR inhibitor, everolimus, enhanced the effect of docetaxel.In patients with locally advanced HNSCC treated with TPF, phosphorylated-mTOR expression was independently associated with prognosis. In vitro and in vivo, concomitant inhibition of mTOR enhanced the effect of docetaxel. Our findings suggest the potential of mTOR as a therapeutic target for locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E844-E852, 2016.

Background Head and neck cancer (HNC) is a highly invasive cancer. Aurora-A has been reported for a number of malignancies. However, the identity of downstream effectors responsible for its aggressive phenotype in HNC remains underinvestigated. Methods The mRNA and protein expression levels of Aurora-A and FLJ10540 were assessed in HNC specimens and cell lines using RT-qPCR, western blot, Oncomine, and microarray database analysis. The downstream molecular mechanisms of Aurora-A were confirmed by RT-qPCR, western blot, luciferase reporter, confocal microscopy analyses, immunoprecipitation, colony formation, cell viability, and xenograft model. Cellular functions in response to Aurora-A-modulated downstream targets such as FLJ10540 and MMPs were examined in vitro and in vivo, including cell growth, motility and chemosensitivity. Aurora-A/FLJ10540/MMPs expression was determined in cancer and adjacent normal tissues from HNC patients by immunohistochemistry approach. Results In the current study, Aurora-A exhibited similar gene expression profiles with FLJ10540 by using accessibly public microarray and Oncomine database analysis, raising the possibility that these molecules might coordinately participate in cancer progression and metastasis of HNC. These two molecules connection were also examined in cell lines and tissues of HNC. Aurora-A overexpression could not only bind to the promoter of FLJ10540 to induce FLJ10540 expression, but also increase both mRNA and protein levels of MMP-7 and MMP-10 in HNC cells. Conversely, depletion of Aurora-A expression by using siRNA or Aurora-A kinase inhibitor, MLN8237, suppressed FLJ10540, MMP-7 and MMP-10 mRNA and protein expressions in vitro and in vivo. In addition, the FLJ10540-PI3K complex was destroyed by inhibition the Aurora-A kinase activity. Forced overexpression of FLJ10540 in Aurora-A-depleted or in MLN8237-treated HNC cells attenuated the effect on cytotoxicity to cisplatin. Elevated Aurora-A expression in HNC cells led to the characteristics of more aggressive malignancy, including enhanced chemoresistance and increased the abilities of proliferation, migration and invasion, which was required for FLJ10540/MMP-7 or FLJ10540/MMP-10 expressions. Finally, immunohistochemical analysis of human HNC specimens showed a significant positively correlation among Aurora-A, FLJ10540, MMP-7 and MMP-10 expressions. Conclusion Together, our findings define a novel mechanism by which Aurora-A promotes cell malignancy, with potential implications for understanding the clinical action of Aurora-A. Electronic supplementary material The online version of this article (doi:10.1186/s12943-015-0348-7) contains supplementary material, which is available to authorized users.

A novel benzonorbornane-based dietheramine monomer, 3,6-bis(4-aminophenoxy)benzonorbornane (BAPBN), was prepared in two steps from aromatic nucleophilic chloro-displacement reaction of p-chloronitrobenzene with the potassium phenolate of 3,6-dihydroxybenzonorbornane, followed by hydrazine catalytic reduction of the intermediate dinitro compound. A series of benzonorbornane-based polyimides were prepared from the diamine BAPBN with various aromatic dianhydrides via a conventional two-stage synthesis in which the poly(amic acid)s obtained in the first stage were heated stage-by-stage at 150∼300 °C to give the polyimides. The intermediate poly(amic acid)s had inherent viscosities between 0.58 and 2.03 dL/g. Almost all the solution-cast poly(amic acid) films could be thermally converted into flexible and tough polyimide films with good tensile properties. Some polyimides with more flexible backbones exhibited good solubility in polar organic solvents. Depending on the structures of the dianhydrides, the glass-transition temperatures (T g) of these polyimides were recorded between 209 and 327 °C by differential scanning calorimetry (DSC) or dynamic mechanical analysis (DMA), and the softening temperatures (T s) determined by thermomechanical analysis (TMA) stayed in the 197∼320 °C range. Decomposition temperatures for 10% weight loss all occurred above 480 °C in both air and nitrogen atmospheres. The polyimides also showed low dielectric constants (2.62–3.53 at 1 MHz). For the comparative purpose, a series of corresponding polyimides based on l,4-bis(4-aminophenoxy)benzene (BAPB) was also prepared and characterized.

A novel bis(ether anhydride) monomer, 3,6-bis(3,4-dicarboxyphenoxy)benzonorbornane dianhydride, was synthesized from the nitro displacement of 4-nitrophthalonitrile with 3,6-dihydroxybenzonorbornane in the presence of potassium carbonate, followed by the alkaline hydrolysis of the intermediate bis(ether dinitrile) and the cyclodehydration of the resulting bis(ether diacid). A series of poly(ether imide)s bearing pendant norbornane groups were prepared from the bis(ether anhydride) with various aromatic diamines via a conventional two-stage process that included ring-opening polyaddition to form the poly(amic acid)s followed by thermal imidization to the poly(ether imide)s. The inherent viscosities of the poly(amic acid) precursors were 0.81-1.81 dL/g. The poly(ether imide) with m-phenylenediamine as a diamine showed good organosolubility. Most of the cast poly(ether imide) films have had high tensile strengths and moduli. The glass-transition temperatures of these poly(ether imide)s, except for those from rigid p-phenylenediamine and benzidine, were recorded between 211 and 246°C by differential scanning calorimetry. The softening temperatures of all the poly(ether imide) films stayed within 210-330 °C according to thermomechanical analysis. No polymers showed significant decomposition before 500°C in a nitrogen or air atmosphere. A comparative study of the properties with the corresponding poly(ether imide)s without pendant substituents was also made.

A set of new aromatic polyamides containing ether and benzonorbornane units were synthesized by the direct phosphorylation polycondensation of 3,6-bis(4-carboxyphenoxy)benzonorbornane with various aromatic diamines. The polymers were produced in high yields and moderate to high inherent viscosities (0.64–1.70 dL/g). The polyamides derived from rigid diamines such as p-phenylenediamine and benzidine were semicrystalline and insoluble in organic solvents. The other polyamides were amorphous and organosoluble and afforded flexible and tough films via solution casting. These films exhibited good mechanical properties, with tensile strengths of 95–101 MPa, elongations at break of 13–25%, and initial moduli of 1.97–2.33 GPa. The amorphous polyamides showed glass-transition temperatures between 176 and 212 °C (by differential scanning calorimetry) and softening temperatures between 194 and 213 °C (by thermomechanical analysis). Most of the polymers did not show significant weight loss before 450 °C in nitrogen or in air. Some properties of these polyamides were also compared with those of homologous counterparts without the pendent norbornane groups. © 2002 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 40: 947–957, 2002

A set of new aromatic polyamides containing ether and benzonorbornane units were synthesized by the direct phosphorylation polycondensation of 3,6-bis(4-aminophenoxy)benzonorbornane (BAPBN) with various aromatic dicarboxylic acids. The polymers were produced with high yields and medium inherent viscosities (0.40–0.82 dL g-1). The polyamides based on rigid diacids showed limited solubility in organic solvents and could not afford ductile films. The polyamides derived from less rigid diacids were readily soluble in polar organic solvents and gave flexible and tough films via solvent casting. These polyamides showed glass-transition temperatures in the range of 200–269°C (by DSC), softening temperatures in the range of 220–289°C (by TMA), and 10% weight loss temperatures in excess of 450°C (by TGA). For a comparative study, a series of analogous polyamides based on 1,4-bis(4-aminophenoxy)benzene (BAPB) were also prepared and characterized.

The purpose of this study was to investigate late toxicities and quality of life (QOL) of patients with nasopharyngeal carcinoma (NPC) with long-term survival after treatment by intensity-modulated radiotherapy (IMRT) versus non-IMRT.An observational, cross-sectional study of QOL and late toxicities was conducted in 242 patients with NPC with survival of5 years after treatment with IMRT (n = 100) or non-IMRT (n = 142) by using physician-assessed toxicities (Common Terminology Criteria for Adverse Events [CTCAE] version 4) and the patient-reported European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC QLQ-C30) and the Head and Neck 35-questions (EORTC QLQ-C30-HN35) module.The IMRT group had both statistically (p .05) and clinically (difference of predicted mean scores ≥10 points) better outcome in global QOL, cognitive functioning, social functioning, fatigue, and 11 scales of the head and neck module. Late toxicities, including neuropathy, hearing loss, dysphagia, xerostomia, and neck fibrosis were significantly less severe in the IMRT group. Multivariate analysis revealed that the radiotherapy (RT) technique was statistically significantly associated with late toxicities and QOL outcome after adjusting for other clinical and demographic variables.The use of the IMRT technique was associated with the improvement of physician-assessed late toxicities and patient-reported QOL in NPC survivors. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1026-E1032, 2016.

Baroreflex failure has been reported as a late sequalum of neck radiotherapy. In this study we investigated cardiovascular autonomic function in patients after neck radiotherapy to determine predictive factors associated with outcome.Eighty-nine patients with nasopharyngeal carcinoma were evaluated ≥6 months after radiotherapy for cardiovascular autonomic function and compared with 48 control subjects. Inflammatory markers and carotid intima-media thickness were also assessed.Autonomic parameters of heart rate response to deep breathing and Valsalva ratio were significantly lower in the patient group. Cardiovascular autonomic impairment was generally mild with relative sparing of the efferent cardiovagal pathway. By univariate and multivariate analyses, the time after radiotherapy and C-reactive protein level were significantly associated with the degree of cardiovascular autonomic dysfunction.Radiation-induced cardiovascular autonomic impairment is a dynamic and progressive process that occurs long after radiotherapy. Chronic inflammation plays a major role in this process.

The objective of this study was to evaluate the effect of p16 expression on response to chemoradiation in stage IVa/b head and neck squamous cell carcinoma (HNSCC) patients.We retrospectively identified 64 patients with stage IVa/b HNSCC who received chemoradiation. Eligibility criteria included presence of biopsy-proven stage IVa/b HNSCC without a prior history of chemotherapy or radiotherapy. Immunohistochemistry was used to assess p16 protein expression in pretreatment biopsy specimens.Of the 64 patients, 38 showed high p16 expression, and 50 patients responded to chemoradiotherapy, 32 exhibiting a complete and 18 a partial response. Response was significantly associated with p16 expression (P0.001) and multivariate analysis indicated that that p16 expression (HR: 2.62, 95%C.I.: 1.14-6.06; P=0.024) was an independent prognostic factor for overall survival.High p16 expression predicts a better response to chemoradiation in patients with stage IVa/b HNSCC.

To evaluate immunoexpression of epidermal growth factor receptor (EGFR), phosphorylated EGFR (pEGFRTyr1068), and cyclooxygenase-2 (COX-2) and analyze their prognostic utility in nasopharyngeal carcinomas (NPC).We used a retrospective review of charts and tissue specimens. The immunoexpression levels of EGFR, pEGFRTyr1068, and COX-2 were semiquantitatively assessed by the H-score method for 170 NPC samples from patients treated with radiotherapy (RT) alone.The ranges of immunohistochemical H-scores were 0-510 (median 225) for EGFR, 0-395 (median 25) for pEGFRTyr1068, and 0-460 (median 170) for COX-2. None of these 3 markers were significantly associated with one another, clinicopathological factors, or the rates of locoregional control (LRC), distant metastasis-free survival (DMFS), or overall survival (OS). In multivariate analysis, the independent adverse prognosticators were T-stage for LRC, N-stage for DMFS, and T-stage, N-stage, and age60 years for OS.Immunoexpression levels of EGFR, pEGFRTyr1068, and COX-2 were not related to clinicopathological variables and not predictive of outcomes of NPC patients treated with RT alone.

The aim of this study was to investigate the impact of comorbidity on survival for patients with locally advanced head and neck squamous cell carcinoma (HNSCC).A total of 214 patients with locally advanced HNSCC, treated with radiotherapy (RT) or RT plus chemotherapy (CT) from January 2000 to December 2003, were included. Comorbidity was scored by the Charlson comorbidity index (CCI). The patient-, tumor-, and treatment-related variables were recorded and overall survival (OS) and disease specific survival (DSS) were calculated.Seventy-one patients (33%) had at least one comorbid condition. The most common comorbid condition was liver disease (13.6%). Higher CCI scores were not significantly correlated with exposure to smoking, alcohol, or betel quid, but were associated with older age, fewer years of education years, and no CT (p0.05). The 3-year OS and DSS rates were, respectively, 21.9% and 24.4% for all patients; 25.9% and 26.9% for those with CCI scores of 0, 21.8% and 28.3% for scores of 1, and 3.5% and 7.5% for scoresor=2. Multivariate analysis revealed that a CCI scoreor=2, stage IV disease, a RT dose70 Gy, and no CT were significant predictors of poorer OS and DSS.Our data reveal the significant survival impact of comorbidity on patients with locally advanced HNSCC treated by RT or RT plus CT.

Purpose To investigate the changes of quality of life (QoL) and survival outcomes for patients with nasopharyngeal carcinoma (NPC) treated by three-dimensional conformal radiotherapy (3D-CRT) vs. intensity-modulated radiotherapy (IMRT). Methods and Materials Two hundred and three newly diagnosed NPC patients, who were curatively treated by 3D-CRT ( n = 93) or IMRT ( n = 110) between March 2002 and July 2004, were analyzed. The distributions of clinical stage according to American Joint Committee on Cancer 1997 were I: 15 (7.4%), II: 78 (38.4%), III: 74 (36.5%), and IV: 36 (17.7%). QoL was longitudinally assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H&N35 questionnaires at the five time points: before RT, during RT (36 Gy), and 3 months, 12 months, and 24 months after RT. Results The 3-year locoregional control, metastasis-free survival, and overall survival rates were 84.8%, 76.7%, and 81.7% for the 3D-CRT group, respectively, compared with 84.2%, 82.6%, and 85.4% for the IMRT group ( p value > 0.05). A general trend of maximal deterioration in most QoL scales was observed during RT, followed by a gradual recovery thereafter. There was no significant difference in most scales between the two groups at each time point. The exception was that patients treated by IMRT had a both statistically and clinically significant improvement in global QoL, fatigue, taste/smell, dry mouth, and feeling ill at the time point of 3 months after RT. Conclusions The potential advantage of IMRT over 3D-CRT in treating NPC patients might occur in QoL outcome during the recovery phase of acute toxicity.

To review the biologic behavior, therapy and natural courses of patients with extrapulmonary small cell carcinoma (EPSCC) in a medical center.We used the computer assisted search for patients diagnosed with EPSCC registered from July 1986 through April 2005. The eligible patients had pathologically proven SCC in sites other than the lung and normal chest radiographs, computed tomography of the chest, sputum cytology, and/or negative bronchoscopic findings.Twenty patients with EPSCC were identified and 12 patients (60%) had limited disease (LD). For the patients with LD receiving systemic chemotherapy, the response rate was 73% (36.5% complete response (CR), 36.5% partial response (PR). However, most of the patients experienced rapid systemic recurrence, with a median disease free survival (DFS) of 8 months. Patients with extensive disease (ED) received mostly etoposide-cisplatin (EP) based chemotherapy, for which the response rate was 50%. The median overall survival (OS) of the patients with LD and ED was 22 months and 3 months. The patients with EPSCC of the head and neck region showed a favorable clinical course, with a median OS of 43 months. Patients with EPSCC of sites other than the head and neck region had aggressive courses with a median OS of 15.5 months.Integrated chemoradiotherapy with surgery for patients with LD generates realistic survival results. EP-based chemotherapy should be the current chemotherapy regimen of choice for patients with ED. Patients with EPSCC of sites other than the head and neck region was usually had poor overall outcomes.

BACKGROUND:Nasopharyngeal carcinoma (NPC) is known for its high metastatic potential and locoregional recurrence, although the molecular alterations that are driving NPC metastasis remain unclear at this time. This study aimed to examine the expression of fibulin-5 in NPC, correlate the results with clinicopathological variables and survival, and to investigate the role of fibulin-5 in human NPC cell lines. MATERIAL AND METHODS:Standard semi-quantitative-RT-PCR, quantitative-RT-PCR, immunoblotting, and immunohistochemistry were used to investigate the mRNA and protein expression profiles of fibulin-5 in normal and NPC tissues. Immunohistochemistry of fibulin-5 was correlated with clinicopathological characteristics by univariate analyses. NPC cells overexpressing fibulin-5 or fibulin-5-siRNA cells were generated by stable transfection to characterize the molecular mechanisms of fibulin-5-elicited cell growth and metastasis. RESULTS:Our results demonstrated that fibulin-5 overexpression in NPC specimens and significantly correlated with advanced tumor metastasis indicating a poor 5-year overall survival. Fibulin-5 was mainly expressed in the nucleus in human NPC specimens and cell lines. Functionally, fibulin-5 overexpression yielded fast growth in NPC cells. In addition, fibulin-5 promotes cell metastasis in NPC cells through increased FLJ10540 and phosphor-AKT activity. In contrast, siRNA depletion of fibulin-5 suppressed FLJ10540 expression and phosphor-AKT activity. Suppression of either fibulin-5 or FLJ10540 can cause significant inhibition with regards to cell motility in NPC cells. Finally, immunohistochemical analysis of human aggressive NPC specimens showed a significant and positive correlation between fibulin-5 and FLJ10540 expression. CONCLUSION:Higher fibulin-5 expression is not only an important indicator of poor survival, but also contributes to the development of new therapeutic strategies in the FLJ10540/AKT pathway for NPC treatment.

Background Vascular abnormalities are the predominant histologic changes associated with radiation in nasopharyngeal carcinoma (NPC). This study examined if the duration after radiotherapy correlates with the progression of carotid intima-media thickness (IMT) and investigated its relationship with inflammatory markers. Methods One hundred and five NPC patients post-radiotherapy for more than one year and 25 healthy control subjects were examined by B-mode ultrasound for IMT measurement at the far wall of the common carotid artery (CCA). Surrogate markers including lipid profile, HbA1c, and high sensitive C-reactive protein (hs-CRP) were assessed. Results The IMT of CCA was significantly increased in NPC patients and carotid plaque was detected in 38 NPC patients (38/105, 36.2%). Significant risk factors for carotid plaques included age, duration after radiotherapy, and HbA1c levels. Age, duration after radiotherapy, hs-CRP, HbA1c, and platelet count positively correlated with IMT. The cut-off value of age and duration after radiotherapy for the presence of plaque was 52.5 years and 42.5 months, respectively. In NPC subjects, multiple linear regression analysis revealed that age, gender, duration after radiotherapy and platelet counts were independently associated with CCA IMT. After adjustments for age, gender and platelet counts, IMT increased in a linear manner with duration after radiotherapy. Conclusions Radiation-induced vasculopathy is a dynamic and progressive process due to late radiation effects. Extra-cranial color-coded duplex sonography can be part of routine follow-up in NPC patients aged ≥50 years at 40 months post-radiotherapy.

Background This study aimed to analyze the clinical features, causative pathogens, neuro-imaging findings, and therapeutic outcomes of bacterial brain abscess in patients with nasopharyngeal carcinoma (NPC) following radiotherapy. Methods NPC patients with bacterial brain abscess were evaluated. Their clinical data were collected over a 22-year period. For comparison, the clinical features, causative pathogens, neuro-imaging findings, and therapeutic outcomes between NPC and non-NPC patients were analyzed. Results NPC accounted for 5.7% (12/210) of the predisposing factors, with Viridans streptococci and Staphylococcus aureus as the two most common causative pathogens. Significant statistical analysis between the two groups (NPC and non-NPC patients) included chronic otitis media (COM) as the underlying disease, post-radiation necrosis by neuro-imaging, and the temporal lobe as the most common site of brain abscesses. The fatality rate in patients with and without NPC was 16.7% and 20.7%, respectively. Conclusions NPC patients with bacterial brain abscess frequently have COM as the underlying disease. Neuro-imaging often reveals both post-radiation necrosis and the temporal lobe as the most common site of brain abscesses, the diagnosis of which is not always a straightforward process. Radiation necrosis can mimic brain abscess on neuro-imaging and pose significant diagnostic challenges. Early diagnosis and treatment is essential for survival.