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Background: Although parotid-sparing IMRT decreased the dose distribution of parotid, parotid region recurrence has been reported. Prophylactic irradiation in parotid area would be necessary in patients with high risk of parotid lymph node metastasis (PLNM). This study was to detect the high-risk factors of PLNM in nasopharyngeal carcinoma.Methods: This was a 1:2 case-control study. All patients in this study were newly diagnosed NPC with N2-3 classification from January 2005 to December 2012. Cases were 22 sides with ipsilateral PLNM. Controls were 44 patients who were randomly selected from N2-3 disease in database.Results: 20/1096 (1.82 %) NPC patients were found PLNM. Sum of the longest diameter for multiple lymph nodes (SLD) in level II was larger in case group than that in control group (6.0 cm vs. 3.6 cm, p = 0.003). Level II lymph node necrosis, level Va/b involvement, and rare neck areas involvement were more common in case group (p = 0.016, p = 0.034, and p < 0.001, respectively). RPN, level III, and level IV metastases showed no significant difference between the two groups. Multivariate analysis in logistic regression showed that only SLD ≥5 cm in II area (OR = 4.11, p = 0.030) and rare neck areas involvement (OR = 3.95, p = 0.045) were associated with PLNM in NPC patients.Conclusions: PLNM was an uncommon event in NPC patients. SLD ≥5 cm in level II and involvement in rare-neck areas may be potentially high-risk factors for PLNM. Sparing parotid in IMRT was not recommended for NPC patients with high risks of PLNM. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the potential exposure risks for workers in the workplace exposed to airborne titanium dioxide nanoparticles (TiO-NPs) and carbon black nanoparticles (CB-NPs). The risk management control strategies were also developed for the NP engineering workplace. Methods: The method used in this study was based on the integrated multiple-path particle dosimetry model to estimate the cumulative dose of nanoparticles (NPs) in the human lung. The study then analyzed toxicological effects such as pulmonary cytotoxicity and inflammation and evaluated the health risk associated with exposure to NPs in the workplace. Risk control measures such as the use of ventilating systems and N95 respirator protection are also discussed. Results and discussion: This study found that: (1) the cumulative dose of CB-NPs was greater than that of TiO-NPs in human lungs; (2) there is a potential health risk to workers exposed to TiO-NPs and CB-NPs in the absence of control measures in the workplace, with higher health risks associated with CB-NPs than TiO-NPs; and (3) the use of a ventilating system and an N95 respirator offers greater protection in the workplace and significantly reduces the health risks associated with NP exposure. Conclusion: The present risk management control strategy suggests that the most effective way to reduce airborne NPs is to incorporate the use of a ventilating system combined with N95 respirator protection. This will enable the concentrations of TiO-NPs and CB-NPs to be reduced to acceptable exposure levels. [ABSTRACT FROM AUTHOR]

Huntington disease (HD) is a degenerative disorder caused by expanded CAG repeats in exon 1 of the huntingtin gene (HIT). Patients with late-stage HD are known to have abnormal auditory processing, but the peripheral auditory functions of HD patients have yet to be thoroughly assessed. In this study, 19 HD patients (aged 40-59 years) were assessed for hearing impairment using pure-tone audiometry and assessment of auditory brainstem responses (ABRs). PTA thresholds were markedly elevated in HD patients. Consistent with this, elevated ABR thresholds were also detected in two mouse models of HD. Hearing loss thus appears to be an authentic symptom of HD. Immunohistochemical analyses demonstrated the presence of mutant huntingtin that formed intranuclear inclusions in the organ of Corti of HD mice, which might interfere with normal auditory function. Quantitative RT-PCR and Western blot analyses further revealed reduced expression of brain creatine kinase (CKB), a major enzyme responsible for ATP regeneration via the phosphocreatine-creatine kinase (PCr-CK) system, in the cochlea of HD mice. Treatment with creatine supplements ameliorated the hearing impairment of HD mice, suggesting that the impaired PCr-CK system in the cochlea of HD mice may contribute to their hearing impairment. These data also suggest that creatine may be useful for treating the hearing abnormalities of patients with HD. [ABSTRACT FROM AUTHOR]

Importance: The management of cervical esophageal cancer (CEC) is controversial. The advantages of radiotherapy (RT) for CEC are lower rates of acute morbidity and mortality compared with surgery and potential for larynx preservation. The advantage of surgery is that the transposed stomach may function better over the long term than an irradiated esophagus, which tends to become stenotic over time. Which one is the primary treatment of CEC?, Objective: To evaluate treatment outcomes of primary RT and primary surgery in patients with CEC., Design, Setting, and Participants: This retrospective study conducted in a university hospital included 224 patients treated for CEC between 2001 and 2012., Interventions: One hundred and sixty-one patients who received primary RT with or without subsequent surgery were assigned to the RT group, including 133 patients who received RT alone or RT with concurrent chemotherapy and 28 patients who received preoperative RT plus surgery. Sixty-three patients who received primary surgery with or without subsequent RT were assigned to the primary surgery group, including 27 patients who received surgery alone and 36 patients who received surgery plus postoperative RT., Main Outcomes and Measures: The rates of overall 2-year local failure-free survival (FFS), regional FFS, distant FFS, and overall survival for patients undergoing primary RT and primary surgery were compared. A separate analysis using matched cases between the primary RT group and primary surgery group was conducted., Results: The median follow-up time was 15.1 months. The rates of overall 2-year local FFS, regional FFS, distant FFS, and overall survival for patients undergoing primary RT and primary surgery were 69.9% and 68.6%, 79.5% and 69.8%, 74.3% and 62.5%, 49.3% and 50.7%, respectively (P > .05 for all). Matched-case analyses did not show any significant differences in measured survival rates between the treatment groups., Conclusions and Relevance: Given the similarities in rates of local FFS, regional FFS, distant FFS, and overall survival between the primary RT and primary surgery CEC treatment groups, we recommend primary RT for larynx preservation, with surgery offered subsequently for patients who do not respond to RT.

Objective: To investigate the value of narrow band imaging (NBI) endoscopy in the detection of laryngeal cancer and its precursor lesions., Methods: Between December 2008 and July 2009, a total of 122 consecutive patients with suspected precancerous or cancerous lesions of the larynx were enrolled in this study. High performance endoscopic system equipped with the white light mode and NBI mode was introduced in the examination of larynx. Full pharyngeal and laryngeal examination was performed first under white light endoscope and then under NBI. Each lesion was observed by NBI endoscopy and classified according to the detailed morphologic findings of epithelial microvessels. Histological results were then compared to the corresponding white light and NBI images., Results: Among the 122 patients, a total of 149 lesions were detected by white light and NBI modes. The histological diagnoses of these lesions were as follows: 16 laryngeal polyp, 7 laryngitis, 24 simple hyperplasia, 17 mild dysplasia, 6 moderate dysplasia, 6 severe dysplasia, 9 carcinoma in situ, 64 invasive cancer. The diagnostic accuracy by NBI for the laryngeal lesions was 90.6% (135/149), which was significantly higher than that of white light (75.2%, 112/149, chi² = 12.514, P < 0.001). The sensitivity of NBI and white light to detect laryngeal carcinoma was 93.2% (68/73) and 68.5% (50/73), respectively (chi² = 14.317, P < 0.001)., Conclusions: NBI endoscopy was a promising tool for the differentiation of non-malignant from malignant laryngeal lesions in vivo by detection of the morphology of mucosal capillary vessels. NBI endoscopy was easy to application in the routine pharyngolaryngeal examination with high sensitivity, and facilitated to improve the abilities of preoperative diagnosis and postoperative surveillance.

Objective: To investigate the indication, location and dose of postoperative radiotherapy for primary intraosseous carcinoma (PIOC) of the jaws., Methods: From October 1969 to November 2005, 13 patients with PIOC were treated at the Cancer Hospital of Chinese Academy of Medical Sciences. Forty six cases with complete clinical data were collected from 27 published reports. Twenty-seven of the 59 patients were treated with surgery plus postoperative radiotherapy, and 22 with surgery alone., Results: All of the 13 cases in our series had advanced disease, and overall 1-, 2- and 3-year survival rats were 59.2%, 33.8% and 12.7% , respectively. For the reported 59 cases in literature, the overall 1-, 2- and 3-year survival rats were 78.4%, 53.9% and 34.0%, respectively. They were 84.3%, 57.2% and 43.6% for the patients treated by surgery plus postoperative radiotherapy, whereas they were 81.8%, 71.2% and 35.1% for the patients by surgery alone (P = 0.908). It seemed that surgery plus postoperative radiotherapy could not improve the survival of PIOC patients with involvement of adjacent soft-tissues or positive neck nodes or partial excision of primary tumor when compared with surgery alone, if the bias of selection in the patients for postoperative radiotherapy was neglected., Conclusion: Postopreative radiotherapy may improve the survival for the patient with primary intraosseous carcinoma of the jaws. Our suggestion is that postoperative radiotherapy should be applied to the patient with any of the following items: positive operative margin; tumor involvement of adjacent soft-tissues; positive neck nodes; partial excision of primary tumor. However, the location and dose of postoperative radiotherapy may be varying at different situation.

Objective: To evaluate the efficacy and safty of the humanized anti-epidermal factor receptor monoclonal antibody h-R3 in combination with radiotherapy for locoregionally advanced nasopharyngeal carcinoma., Methods: Totally, 137 patients from 7 medical center around China were randomly divided into combined therapy group or control group. There was no difference in Karnofsky performance score between two groups. All patients in both groups received radical conventionally fractionated radiotherapy to the total dose of D(T) 70-76 Gy. For the combined therapy group, h-R3 was added at a dose of 100 mg i.v. weekly for 8 weeks started at the beginning of radiotherapy., Results: Of the 137 eligilbe patients, 70 were in the combined therapy group treated by h-R3 plus radiotherapy and 67 in the control group by radiotherapy alone. The intent-to-treat (ITT) population consisted of 130 patients, while the per-protocol (PP) population was composed of 126 patients. The efficacy was assessed respectively at three point of time: the end of treatment, the 5th- and 17th-week after treatment. The complete response (CR) of the combined therapy group was significantly higher than that of the control group in both ITT and PP (ITT: 65.63%, 87.50%, 90.63% versus 27.27%, 42.42%, 51.52%; PP: 67.21%, 90.16%, 93.44% versus 27.69%, 43.08%, 52.31%; P < 0.05, respectively). The most common h-R3-related adverse reactions were fever (4.3%), hypotension (2.9%), nausea (1.4%), dizziness (2.9%) and rash (1.4%), which could be reversible if treated properly. Radiotherapy combined with 100 mg h-R3 i. v. weekly was tolerable and did not aggravate the side effects of radiation. The quality of life in the combined therapy group was comparable to that in the control group., Conclusion: This phase 1 multicenter clinical trial shows that h-R3 in combination with radiotherapy is effective and well-tolerated for the treatment of locoregionally advanced nasopharyngeal carcinoma.

Objective: To study the relationship between the symptoms and prognosis of nasopharyngeal carcinoma (NPC)., Methods: The clinical data of 905 M0 NPC patients who received radical radiotherapy from January 1990 to May 1999 were retrospectively studied. Nodal distribution, cranial nerve paralysis, as well as the relationship between symptom duration and prognosis were analyzed., Results: The most common symptom in patients with NPC is neck node metastasis, with an incidence of 40.0% at the time of diagnosis, followed by blood-staining sputum (18.7%) and aural symptoms (17.0%). Node metastasis in the lower neck and supraclavicular region alone was seen in 10 patients (1.1%). Cranial nerve paralysis was found in 179 patients (19.8%). The 5-year overall survival and disease-free survival were significant lower in symptom duration more than 6 months group than in less than 6 months group (71.2% vs 79.8%, P = 0.008 and 51.9% vs 63.6%, P = 0.0008); however, the local control rate between these two group was not significantly different (79.4% vs 83.5%, P = 0.138)., Conclusion: The symptom duration is associated with the prognosis of NPC. Early diagnosis and treatment are the most important factors in improving the prognosis of NPC.