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This work introduces the concept of thermal yield profile for the hot-spot identification with considering process variations and provides an efficient estimating technique for the thermal yield profile. After executing a mixed-mesh strategy for generating statistical polynomial expression of the on-chip temperature distribution, the thermal yield profile is obtained by a skew-normal based moment matching technique. Comparing with the Monte Carlo method, experimental results demonstrate that our method can efficiently and accurately estimate the thermal yield profile. With the same level of accuracy, our skew-normal based method achieves 215x speedup over the state of the art, APEX [1], for estimating the thermal yield profile. Moreover, results show that our mixed-mesh statistical polynomial expression generator achieves 130x speedup over the statistical collocation based method [2] and still accurately estimates the thermal yield profile.

Background Concurrent chemoradiotherapy (CCRT) has been shown to improve outcomes for stage III–IV nasopharyngeal carcinoma (NPC) patients compared with radiotherapy (RT) alone, but the effectiveness of the combined therapy for stage II NPC patients is unknown. Methods Patients with Chinese 1992 stage II NPC were randomly assigned to receive either RT alone (n = 114) or CCRT (n = 116). The CCRT patients were given concurrent cisplatin (30 mg/m 2 on day 1) weekly during RT. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), distant metastasis-free survival, and locoregional relapse-free survival. All patients were analyzed by the intent-to-treat principle. The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) and in multivariable analyses to test the independent statistical significance of treatment intervention. Toxic effects and the response to treatment were analyzed using the x 2 test. All statistical tests were two-sided. Results With a median follow-up of 60 months, adding chemotherapy statistically significantly improved the 5-year OS rate (94.5% vs 85.8%; HR of death = 0.30, 95% CI = 0.12 to 0.76; P = .007), PFS (87.9% vs 77.8%; HR of progression = 0.45, 95% CI = 0.23 to 0.88; P = .017), and distant metastasis-free survival (94.8% vs 83.9%; HR of distant relapse = 0.27, 95% CI = 0.10 to 0.74; P = .007); however, there was no statistically significant difference in the 5-year locoregional relapse-free survival rate (93.0% vs 91.1%; HR of locoregional relapse = 0.61, 95% CI = 0.25 to 1.51; P = .29). Multivariable analysis showed that the number of chemotherapy cycles was the only independent factor that was associated with OS, PFS, and distant control in stage II NPC. The CCRT arm experienced statistically significantly more acute toxic effects (P = .001), although the rate of late toxic effects did not increase statistically significantly. Conclusion Concurrent chemotherapy and radiotherapy is associated with a considerable survival benefit for patients with

The inadequate infrastructure makes healthcare resources unbalance between rural and city. The telemedicine might be a solution. Patient's information sharing is the prerequisite in telemedicine, and the medical image communication is another critical issue. DICOM is one of the most popular medical image standards. In rural clinics, the ultrasonography is well seen for its non-radical, but usually is early models, which is not DICOM compatible. This situation obstructs the sharing of ultrasonography, and prevents the implement of telemedicine. This research developed a telemedicine counselling structure, which integrated the ultrasonography into modern DICOM system.

To compare the efficacy and side effects of nedaplatin plus 5-fluorouracil (5-Fu) and cisplatin plus 5-Fu for treatment of stage III-IVa nasopharyngeal carcinoma (NPC).A total of 100 patients with NPC proved by histopathology were divided into nedaplatin plus 5-Fu group (NF group) and cisplatin plus 5-Fu group (PF group), 50 cases in each group. NF group: nedaplatin 30 mg/m(2), d1-d3, 5-Fu 500 mg/m(2) d1-d5, repeated every 3 weeks for 2 cycles. PF group: cisplatin 30 mg/m(2) d1-d3, 5-Fu 500 mg/m(2) d1-d5, repeated every 3 weeks for 2 cycles. χ(2) test was used to compare the efficacy and side-effects of the two groups.All the 100 cases were evaluable and their clinical data in the two groups were comparable. Six patients with complete response were observed, 3 cases in NF group and 3 in PF group. The overall response rates were 86.0% in NF group and 84.0% in PF group, with no significant difference (χ(2) = 0.078, P = 0.779). The rates of leukocytopenia, thrombocytopenia, impairment of hepatic and renal function were similar whereas more patients in the PF group than in the NF group suffered from nausea and vomiting (88.0% vs. 56.0%, P = 0.000).Nedaplatin plus 5-Fu is an effective treatment regimen for NPC. When compared with PF regimen, the response rate is similar. However, NF regimen shows a significant superiority in reducing nausea and vomiting.

Purpose: We aimed to investigate the prognostic role of endothelin-1 (EDN1) and endothelin A receptor (EDNRA) gene polymorphisms in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Experimental Design: Two hundred three consecutive patients with locoregionally advanced NPC were enrolled. Seven potentially functional polymorphisms in the EDN1 and EDNRA genes were determined by ligase detection reaction-PCR method from prospectively collected blood samples. The influence of the genetic polymorphisms on patient overall survival (OS) was analyzed using Cox proportional hazards model, Kaplan–Meier method, and the log-rank test. Results: The 5-year OS in patients with EDNRA/H323H TT, TC, and CC genotypes were 81.3%, 62.1%, and 75.0%, respectively (P = 0.004). Patients carrying the heterozygous (TC) or homozygous variant (CC) genotype in EDNRA/H323H were combined for analysis, which revealed that the 5-year OS in patients with TC/CC genotypes was significantly lower than those with the wild-type TT genotype (63.2% vs. 81.3%; P = 0.002). Multivariate analysis showed that EDNRA/H323H polymorphism (HR: 1.95; 95% CI: 1.18–3.23; P = 0.009) and N classification (HR: 1.35; 95% CI: 1.03–1.79; P = 0.03) were independent significant prognostic factors for OS in patients with locoregionally advanced NPC. In contrast, the EDN1 polymorphisms revealed no prognostic value. Conclusions: The EDNRA/H323H polymorphism was a novel and independent prognostic marker for patients with locoregionally advanced NPC. The analysis of EDNRA/H323H polymorphism may help identify patient subgroups at high risk for poor disease outcome. Clin Cancer Res; 17(8); 2451–8. ©2011 AACR.

Rapidly ascend to high altitude may cause oxygen exchange reducing, and induce acute mountain sickness. For prevention of disaster occurrence, this study proposes a device for SpO2 surveillance for hiking, which would measure the SpO2 and issue a warning when in the risk of AMS. The device is constructed with an embedded system and a PDA phone, which could analyze the SpO2 data, and then issues proper advices.

Adequate reminding would facilitate the management of emotion. That would prevent out control of destructive rage, and facilitate the emotion expression and balance. This study developed a portable system for emotion assessment basing on HRV method, which would feedback to user with proper advices for help the management of emotion. The system is constructed with an embedded system and a PDA phone, which firstly measures the ECG signal, and then analyzes HRV, finally presents the emotion status.

In this work, a statistical electro-thermal analyzer with high compatibility of power model is developed. The developed analyzer takes both the easily implementing advantage of Monte Carlo method and the fast convergent advantage of stochastic analysis method to effectively solve the statistical electro-thermal problem. Experimental results indicate that the developed electro-thermal analyzer can be orders of magnitude faster than the Monte Carlo method under the same accuracy level. The computational time is only 1.16 seconds for a design with over one million gates, and the maximum errors are only 0.34% and 1.84%, compared with the Monte Carlo method, for estimating the mean and the standard deviation profiles of full-chip temperature distribution, respectively.

Background and objective We previously reported that C-KIT overexpression and mutation exist in biopsy samples of nasopharyngeal carcinoma (NPC). Yet whether Imatinib had an inhibitory effect on the proliferation of NPC in vitro was still unknown. So, this study examined whether sensitivities to Imatinib of other cell lines are different and whether C-KIT expression and mutations exist, to analyze the correlations between them. Methods The expression of C-KIT in NPC cell lines, including CNE-1, CNE-2, Hone-1, C-666, SUNE-1, 5-8F, and nasopharyngeal epithelial (NPE) cell line NP-69, were detected by Western blot. Direct sequencing of polymerase chain reaction (PCR) products was performed to analyze the sequences of C-KIT from the above-mentioned cell lines. Inhibitory effects on proliferation by Imatinib on these cell lines were determined by CCK-8 assay. Pearson product moment correlation and t test were used to analyze the correlation betweeen C-KIT overexpression, C-KIT gene mutation, and the inhibitory effect of Imatinib. Results Compared with NPE cell line NP-69, NPC cell lines CNE-1, CNE-2, Hone-1, C-666, SUNE-1, and 5-8F had significantly higher levels of C-KIT expression. Heterozygous IVS17+78T>C were found in CNE-1, CNE-2, Hone-1, and NP-69 cell lines, homozygous IVS17+78T>C was found in C-666, and no mutation was found in SUNE-1 or 5-8F. Imatinib had a dose-dependent inhibitory effect on proliferation for CNE-1, CNE-2, Hone-1, C-666, SUNE-1, and 5-8F. No significant correlation between the inhibitory effects of Imatinib, C-KIT overexpression, or C-KIT mutation was found. Conclusion C-KIT overexpression and intron mutation were found in NPC cell lines and Imatinib had a dose-dependent inhibitory effect on proliferation for NPC cell lines, yet no significant correlation between C-KIT overexpression, C-KIT mutation, or the inhibitory effect of Imatinib was found.

BACKGROUND AND OBJECTIVE PF regimen is the standard chemotherapy for advanced head and neck cancers including nasopharyngeal cancer. Recently PF has been found to enhance the tumor control by addition of Taxotere. The purpose of this study was to evaluate the dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of TPF neoadjuvant regimen (taxotere, cisplatin (DDP) and 5-fluorouracil (5-FU)) followed by radical radiotherapy in advanced nasopharyngeal carcinoma (NPC). METHODS Between December 2006 and May 2008, 41 patients with newly diagnosed UICC stage III or IV advanced nasopharyngeal cancer were enrolled. There were 29 male and 12 female patients, with a median age of 47 years (range, 29-60 years), and ECOG performance status < or = 2. The initial dose was taxotere 40 mg/m(2) d1, DDP 40 mg/m(2) d1, and 5-FU 400 mg/m(2) d1-5. The treatment was repeated every 3 weeks for two cycles. Each dose of taxotere and DDP was increased by 5 mg/m(2) and 5-FU by 50 mg/m(2), respectively. The dose was escalated after six patients completed two cycles at the initial dose and DLT was assessed. Radiotherapy was started from the 5th week, with 68-72 Gy/34-36 fractions delivered to the nasopharynx and 60-66 Gy/30-33 fractions to the node-positive area. RESULTS Forty patients (79 cycles) were evaluated for toxicity and efficacy of the therapy. No DLT occurred at the dose levels 1-4. At dose level 5, three of six patients experienced DLT including grade III/IV neutropenia lasting more than 1 week. Two of them also had grade III mucositis, leading to the interruption of radiotherapy for more than 1 week. Three more new patients were retreated with the same dose (at dose level 6) under the G-CSF support, and no DLT occurred. Dose escalation continued to level 7, and DLT was found in all of the four patients, including three grade IV neutropenia, one of them had fever and pneumonitis; three grade III diarrhea; and one grade III mucositis lasting 10 days. Dose escalation was stopped and three more new patients were treated again at dose level 5 and no DLT was found. Other severe toxicities included grade III anemia (1 patients), grade III vomiting (4 patients), and grade III weight loss (9 patients). No severe hepatic and renal toxicities were found. CONCLUSION TPF neoadjuvant chemotherapy is a safe and effective regimen in the treatment of advanced NPC, with recommended doses of taxotere 60 mg/m(2) d1, DDP 60 mg/m(2) d1, and 5-FU 600 mg/m(2) d1-5.

We establish explicit necessary and sufficient conditions for the existence of nonnegative solutions of the $p$-Laplacian boundary blow-up problem \begin{equation*} \left\{ \begin{array}{l} \left( \varphi _{p}(u^{\prime }(x))\right) ^{\prime }=\lambda f(u(x)), \, 0 \lt x \lt 1, \\ \lim\limits_{x\rightarrow 0^{+}}u(x)=\infty =\lim\limits_{x\rightarrow 1^{-}}u(x), \end{array} \right. \end{equation*} where $p>1$, $\varphi _{p}\left( y\right) =\left\vert y\right\vert ^{p-2}y$ and $\left( \varphi _{p}(u^{\prime })\right) ^{\prime }$ is the one-dimensional $p$-Laplacian, $\lambda $ is a positive bifurcation parameter and $f$ is a locally Lipschitz continuous function on $[0,\infty)$. The gap is extremely small between the explicit necessary condition and the explicit sufficient condition for the existence of nonnegative solutions. Our results improve and extend some main results of Anuradha, Brown and Shivaji [2] and of Wang [30] from $p=2$ to any $p\gt 1$.

Objective: Wnt signaling has been implicated in the control of cell growth and differentiation during the development of the central nervous system. In this work, we assessed the role of Wnt pathway in the regulation of genes related to the neuronal differentiation of stem cells. Methods: C3H10T1/2 mouse mesenchymal stem cells were transfected with the Ad5 recombinant plasmid encoding Wnt3A. The Wnt3A-induced gene expression profile of these cells was determined with the Affymetrix MG430A 2.0 chip. The microarray results were confirmed by real-time polymerase chain reaction. Results: Several differentially expressed genes were identified in the Wnt3A-transfected cells. Many of these genes are targets of the Wnt signaling pathway, such as those encoding β-catenin, Frizzled7, Frizzled1, LRP5, Dishevelled, axin, and GSK-3β. Transfection of Wnt modulated the expression of genes of neuronal differentiation of these stem cells. Conclusion: This work demonstrated that Wnt is an important regulator gene ...

Imaging results are important for clinical staging and irradiation target planning of nasopharyngeal carcinoma (NPC). This study tried to analyze the correlations of staging based on computed tomography (CT) and magnetic resonance imaging (MRI) before radiotherapy to prognosis of NPC.Clinical data of 445 pathologically confirmed NPC patients with no metastasis were analyzed. CT was performed on 230 patients before treatmentû MRI was performed on 215 patients. All patients received conventional radiotherapy, and some locally advanced patients received additional chemotherapy. Kaplan-Meier and log-rank tests were used to analyze and compare the survival rates of the two groups. Cox model was used to analyze prognostic factors.The 1-, 2-, and 3-year overall survival rates were significantly lower in CT group than in MRI group (96.9% vs. 98.6%, 90.3% vs. 94.3%, 85.3% vs. 92.3%, Chi2 =6.305, P=0.012). The 1-, 2-, and 3-year disease-free and relapse-free survival rates were also significantly lower in CT group than in MRI group (P0.05). Univariate analysis showed that clinical stage, N stage, imaging method and chemotherapy were prognostic factors of NPC. Multivariate analysis showed that clinical stage and imaging method were independent prognostic factors of NPC.Determining target volume by MRI before radiotherapy can improve the survival rate and local control rate of NPC patients when compared with CT. Clinical stage and imaging method are independent prognostic factors of NPC patients.

The incidence of distant metastasis is high in nasopharyngeal carcinoma (NPC). It is the most important cause of death for NPC patients. This study was to investigate prognostic factors of NPC patients with distant metastasis.A total of 128 NPC patients with distant metastasis were treated in Cancer Center of Sun Yat-sen University from Jan. 1997 to Jun. 2003. Of the 128 patients, 112 were men and 16 were women, with a median age of 48 (range, 15-70); 54 received chemoradiotherapy, 48 received chemotherapy alone, 14 received radiotherapy alone, and 12 received no treatment. The survival rate was calculated by Kaplan-Meier method and compared by log-rank test. COX multivariate prognosis analysis was performed.The 1-, 2-, and 3-year survival rates of the 128 patients were 60.9%, 34.4%, and 14.1%, respectively. The median survival time was 15.6 months (range, 0.8-96.6 months). Univariate analysis showed that age (P=0.038), treatment modality (P=0.041), chemotherapy cycles (P=0.034), and short-term treatment response (P=0.007) were prognostic factors of NPC with distant metastasis. Multivariate analysis showed that sex (P=0.013), chemotherapy cycles (P=0.032), N stage (P=0.011), and short-term treatment response (P0.001) were independent prognostic factors.Sex, chemotherapy cycles, and short-term treatment response are independent prognostic factors of NPC with distant metastasis.

The clinical classification of nasopharyngeal carcinoma (NPC) depends mainly on the materials of medical imaging. This study was to investigate the application of magnetic resonance imaging (MRI) to the clinical classification of NPC.One hundred patients with NPC confirmed by pathohistology received MRI and computed tomography (CT) within 15 days before treatment from May 2002 to Jun. 2005. The patients included 74 men and 26 women with a median age of 46 (21-60). The detection rates of involved sites by MRI and CT were calculated and compared using Chi(2) test. The clinical classification was performed according to 92'staging system of China. The constituent ratios of cases at different T, N, and clinical stages classified by MRI and CT were analyzed by Chi(2) test.The detection rates of skull base bone destruction and retropharyngeal lymph node involvement were significantly lower by CT than by MRI (31.0% vs. 56.0%, Chi(2)=12.715, P=0.000; 40.0% vs. 55.0%, Chi(2)=4.511, P=0.034). The constituent ratio of cases at T1-T4 stages classified by MRI was different from that classified by CT (Chi(2)=8.339, P=0.039), but there was no difference in N staging (Chi(2)=0.275, P =0.965) and clinical classification (Chi(2)=5.525, P=0.137).MRI is more sensitive than CT in detecting skull base bone destruction and retropharyngeal lymph node involvement of NPC. MRI may upstage T classification, tends to upstage clinical classification, and has no influence on N classification of NPC.

New ternary metal nanocrystals of Fe1-xPtMx (M = Ru3+, Sn2+, or Ni2+) were synthesized by chemical transformation from FePt nanocrystals using a cation redox reaction in a solution. The structure and composition of resulting nanocrystals were characterized by high-resolution transmission electron microscopy (TEM), X-ray powder diffraction (XRD) and X-ray photoemission spectroscopy (XPS). Moreover, X-ray absorption near-edge spectroscopy (XANES) was employed to confirm the chemical transformation from FePt to Fe1-xPtRux nanocrystals. The analyses of extended X-ray absorption find structure (EXAFS) revealed the detailed binding structures and coordination numbers of both FePt and Fe1-xPtRux nanocrystals. The results suggested that iron atoms of FePt lattices were oxidized to be Fe2+ and Fe3+ ions and were replaced by ruthenium atoms from the reduction of Ru3+ ions in solution to form Fe1-xPtRux lattices. Our method has opened a new route to easily and rapidly prepare a solid-solution type of ternary metal n...

This paper proposes a Markov chain based hierarchical method to efficiently analyze the power delivery network. After the network being partitioned into several subnetworks, each subnetwork is transformed into a local Markov chain. Then, the connective relations between all subnetworks are modeled as a global Markov chain. Finally, those local and the global Markov chains are incorporated to build a hierarchical bipartite Markov chain engine to analyze the power delivery network. The experimental results not only demonstrate the accuracy of proposed method compared with a very accurate time domain solver [1], but also show its significant runtime improvement, over 200 times faster than the InductWise [1] and over 10 times faster than the IEKS method [2], and less memory usage.

According to the concept of cell physiology, when the cells contact the extracellular matrix (ECM), the cell will adhere, spread and migrates. Despite the sophistication of experimental and computational approaches in cell and molecular biology, the mechanisms by which cells sense and respond to mechanical stimuli are poorly understood. In order to evaluate the characteristics of the cellular physiology, we use atomic force microscopy (AFM) and micro-pillars arrays (MPAs) to measure the cell mechanics of the oral epithelia carcinoma cells (OEC-M1). After AFM measurement, the stiffness of the OEC-Ml-wt was 41-95 kPa, meanwhile the OEC-M1-g6 was 21-46 kPa. In deed, 0.88-4.75 nN of the traction force was generated in OEC-M1-g6 cells, which the actin filament assemble around the cytoplasm might caused by the gelsolin, after forward, both the adherent and moving ability of the cells were increased.

Background Hemoglobin (Hb) levels are regarded as an important determinant of outcome in a number of cancers treated with radiotherapy. However, for patients treated with intensity modulated radiotherapy (IMRT), information regarding the prognostic value of hemoglobin level is scarce. Patients and Methods A total of 650 patients with nasopharyngeal carcinoma (NPC), enrolled between May, 2005, and November, 2012, were included in this study. The prognostic significance of hemoglobin level (anemia or no-anemia) at three different time points was investigated, including before treatment, during treatment and at the last week of treatment. Univariate and multivariate analyses were conducted using the log–rank test and the Cox proportional hazards model, respectively. Results The 5-year OS (overall survival) rate of patients who were anemia and no-anemia before treatment were 89.1%, and 80.7% (P = 0.01), respectively. The 5-year DMFS (distant metastasis-free survival) rate of patients who were anemia and no-anemia before treatment were 88.9%, and 78.2% (P = 0.01), respectively. The 5-year OS rate of patients who were anemia and no-anemia during treatment were 91.7% and 83.3% (P = 0.004). According to multivariate analysis, the pre-treatment Hb level predicted a decreased DMFS (P = 0.007, HR = 2.555, 95% CI1.294–5.046). Besides, the mid-treatment Hb level predicted a decreased OS (P = 0.013, HR = 2.333, 95% CI1.199–4.541). Conclusions Hemoglobin level is a useful prognostic factor in NPC patients receiving IMRT. It is important to control the level of hemoglobin both before and during chemoradiotherapy.

This study was designed to evaluate the anti-tumor activity and toxicity profile of gemcitabine in the treatment of patients with advanced nasopharyngeal carcinoma (NPC) who had been pretreated with platinum-based chemotherapy.This is an open label, single arm phase II trial. All patients were treated with single agent of gemcitabine. Gemcitabine was given in the dosage of 1.0 g/m(2) on days 1, 8, 15, each cycle repeated every 4 weeks. Gemcitabine was added to 100 ml normal saline infused over 30 min.About 32 patients were enrolled in this trial. Thirty patients were assessable for response to treatment. Fourteen patients had a partial response (PR), giving an overall response rate of 43.8% (14/32); 9 patients had stable disease (28.1%) and 7 progressed disease (21.9%). The median time to progression was 5.1 months and median survival time was 16 months, 1 year survival rate was 67%, 2 year overall survival rate was 12%. A total of 11 patients (34.4%) experienced grade 3 and 4 toxicity and the main toxicity was myelosuppression. the non-hematology toxicity was minimal.The effectiveness of gemcitabine was higher and side effects were minimal in advanced NPC patients after platinum-based chemotherapy failed.

Distant metastasis is one of the main causes of treatment failure in nasopharyngeal carcinoma (NPC). Trials of combined modality treatment could not demonstrate obvious decrease of the rate of distant metastasis and survival rate, therefore eligible individualized and best combined modality treatment has not been established. Plasma Epstein-Barr virus (EBV) DNA is a sensitive and specific molecular marker, which may reflect the stage, response to treatments and prognosis of NPC. This prospective study was to investigate whether the plasma EBV DNA concentration could be used to predict distant metastasis in NPC, and thus to provide us a molecular marker for individualized combined modality treatment.Blood samples from 69 patients with primary NPC were collected before and after radiotherapy. The content of EBV DNA in the plasma samples was detected by real-time quantitative PCR. All patients received consequent follow up and long-term efficacy and survival assessment. The correlation of pre/post treatment EBV DNA concentrations to survival was analyzed by Kaplan-Meier method. The prognostic factors were evaluated by Cox proportional hazards model.Both pretreatment EBV DNA median concentration (27,000 copies/ml) and post-treatment EBV DNA detecting rate (55.56%) in patients with distant metastasis were higher than those with continuous remission (4,000 copies/ml, 5.56%) and those with local relapse (3,850 copies/ml, 0%)(P = 0.039 and 0.001, respectively). With a cut-off value of 20,000 copies/ml and 0 copies/ml respectively for pretreatment and post-treatment EBV DNA concentration, patients with lower EBV DNA concentration had statistically preferable progression-free survival (PFS), metastasis-free survival(MFS) and overall survival (OS) than those with higher EBV DNA concentration. Cox regression analysis demonstrated that both pretreatment EBV DNA (P = 0.050; RR = 3.95) and post-treatment EBV DNA (P = 0.001; RR = 11.74) were risk factors for MFS. Further analysis of pretreatment and post-treatment EBV DNA concentration revealed that whether EBV DNA concentration could be decreased to 0 after treatment dominated metastasis-free survival (P = 0.000).Plasma EBV DNA concentration before and after treatment, especially whether post-treatment concentration could be decreased to 0 may predict distant metastasis, which helps to select patients with high risks and determine the combined modality treatment.

Purpose A prospective, randomized, phase III study was performed to evaluate the feasibility and efficacy of concurrent weekly oxaliplatin with radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Patients and Methods From January 2001 to January 2003, 115 patients with locoregionally advanced NPC were randomly assigned to either radiotherapy (RT) alone (56 patients) or concurrent chemoradiotherapy (CCRT; 59 patients). All patient characteristics were well balanced in both arms. CCRT with oxaliplatin 70 mg/m2 weekly was administered for six doses from the first day of RT. Results All patients were eligible for toxicity and response analysis. Compliance with the protocol treatment was excellent, with 97% of patients completing all planned doses of oxaliplatin, and a lack of high-grade toxicity was observed. After a median follow-up time of 24 months, there was a significant difference in overall survival (OS), relapse-free survival (RFS), and metastasis-free survival (MFS) in favor of the CCRT arm. The 2-year OS rates were 100% for the CCRT arm and 77% for the RT arm (P = .01). The 2-year MFS rates were 92% for the CCRT arm and 80% for the RT arm (P = .02). The 2-year RFS rates were 96% for the CCRT arm and 83% for the RT arm (P = .02). Conclusion CCRT with weekly oxaliplatin is feasible and improves OS, MFS, and RFS rates in patients with locoregionally advanced NPC. Therefore, further randomized trials including oxaliplatin are warranted.

The recurrence rate in skull base is high for nasopharyngeal carcinoma (NPC) patients with cavernous sinus or/and sphenoid sinus involvement. This study was conducted to explore the impact of dose boost in skull base on the recurrence in skull base and survival of NPC patients with cavernous sinus or/and sphenoid sinus involvement.A total of 120 stage T4 NPC patients with cavernous sinus or/and sphenoid sinus involvement proved by histopathology and computed tomography (CT) were treated in our hospital from Oct. 1996 to Nov. 1998. The irradiation dose was (71.55+/-3.09) Gy in nasopharynx and (58.95+/-6.16) Gy in neck. Of the 120 patients, 27 received irradiation (6-10 Gy) in skull base after radiotherapy (boost group), 93 did not receive irradiation in skull base (control group). Fifty-three patients, 41 in control group and 12 in boost group, received cisplatin-based chemotherapy for 1-3 cycles. The survival rates and the recurrence of the 2 groups were calculated by Kaplan-Meier method and log-rank test.The clinical characteristics of patients were similar in the 2 groups. The 1-, 3-, 5-year skull base control rates were significantly higher in boost group than in control group (100% vs. 93.4%, 91.8% vs. 76.4%, and 86.8% vs. 65.1%, respectively, P=0.045). The 1-, 3-, 5-year disease-freely survival rates were slightly higher in boost group than in control group (85.2% vs. 75.3%, 59.3% vs. 45.2%, and 51.9% vs. 31.2%, respectively, P=0.084). The median disease-freely survival time was longer in boost group than in control group (60 months vs. 30 months). The prevalences of irradiation-induced brain damage were 7.4% in boost group and 4.3% in control group with no significant difference (P=0.514).Dose boost in skull base can reduce the recurrence of stage T4 NPC in skull base and tends to enhance the disease-freely survival rate for NPC patients with cavernous sinus or/and sphenoid sinus involvementû it is recommended to such patients.

Nasopharyngeal carcinoma (NPC) patients with negative cervical lymph node (N0-NPC) account for 20% -30% of all NPC patients. Prophylactic irradiation to the upper neck is a criterion of treatment for these patients. But some authors suggest to prophylactically irradiate the the whole neck. This study was to analyze and compare long-term outcomes of the N0-NPC patients treated by prophylactic irradiation to the upper neck and to the whole neck, and explore radiotherapy on neck for N0-NPC patients.A total of 178 N0-NPC patients, proved by pathology, were treated in our hospital from Jul. 1998 to Dec. 1999. Of the 178 patients, 88 received prophylactic irradiation to the upper neck (upper neck group), 90 received prophylactic irradiation to the whole neck (whole neck group). Kaplan-Meier method and log-rank test were used to analyze and compare survival rate of the 2 groups. Cox model was used to study prognostic factors of N0-NPC.The 1-, 3-, and 5-year overall survival rates were 98.9%, 90.9%, and 80.7% in upper neck group, and 97.8%, 80.0%, and 71.1% in whole neck group (P = 0.224). The 1-, 3-, and 5-year disease-free survival rates were 93.2%, 80.7%, and 77.3% in upper neck group, and 85.6%, 68.9%, and 64.4% in whole neck group (P = 0.163). The incidence of cervical lymph nodes recurrence was 1.14% in upper neck group, and 1.09% in whole neck group (P0.05). Multivariate analysis showed that gender, T stage, and short-term outcome were independent prognostic factors of N0-NPC.Prophylactic irradiation to upper neck is recommended for N0-NPC patients.

Capecitabine is an oral fluoropyrimidine, which is converted to fluorouracil (5-FU) by exploiting the comparatively higher activity of thymidine phosphorylase (TP) in tumor tissue. This study was designed to measure the maximum tolerated dose (MTD) of capecitabine in the patients with nasopharyngeal carcinoma.Medical records of 36 patients with nasopharyngeal carcinoma treated with radiation and capecitabine were reviewed. The median dose of capecitabine was 1 600 mgx(m(2)xd)(-1) [700-2 500 mgx(m(2)xd)(-1)] orally for 2 weeks followed 1 week of rest and then another cycle. All the patients received a total dose ranging from 66 Gy to 74 Gy over 6-7.4 weeks.In the 2 300 mgx(m(2)xd)(-1) group, Grade III toxicities observed were hang-foot syndrome (1 patient) and diarrhea (1 patient).Concurrent administration of capecitabine and radiation were tolerable in the patients with nasopharyngeal carcinoma. The maximum tolerated dose is 2 300 mgx(m(2)xd)(-1), The recommended phase II dose is 1 700 mgx(m(2)xd)(-1) daily administered by this intermittent schedule.

End-tidal carbon dioxide pressure (PetCO(2)) was measured in the neonatal intensive care unit (NICU) to assess its reliability and accuracy in predicting arterial partial pressure of carbon dioxide (PaCO(2)). Arterial blood was drawn for gas analysis and compared with exhaled CO(2) measured by mainstream capnography. In total, 130 PetCO(2)/PaCO(2) comparisons were obtained from 61 patients (20 term and 41 preterm infants). PetCO(2) was significantly different from PaCO(2) (PetCO(2) = 42.3 +/- 10.5 mmHg vs. PaCO(2) = 45.8 +/- 12.3 mmHg, P < 0.001, mean +/- SD). The overall PetCO(2) bias (mean +/- SD) was 3.5 +/- 7.1 mmHg. There was a positive correlation between PetCO(2) and PaCO(2) (n = 130, r = 0.818, P < 0.001) in both term (n = 44, r = 0.779, P < 0.001) and preterm infants (n = 86, r = 0.849, P < 0.001). The PetCO(2) biases (95% CI) were 3.5 +/- 9.0 mmHg (0.8-6.2) in the term group and 3.4 +/- 6.0 mmHg (2.2-4.7) in the preterm group. Therefore, PetCO(2) was a valid and reliable method for monitoring PaCO(2) in neonates, especially preterm infants. This method decreases blood loss and prevents complications associated with arterial catheters. In conclusion, we recommend using mainstream capnography to monitor PetCO(2) instead of measuring PaCO(2) in the NICU.

TPS6100 Background: Nasopharyngeal carcinoma (NPC) is an endemic disease with a high incidence in South-East Asian. Standard chemotherapy for metastatic NPC is platinum-based regimen. Improvement t...

Background The aim of this study was to analyze the expression of protein tyrosine kinase 6 (PTK6) in nasopharyngeal carcinoma (NPC) samples, and to identify whether PTK6 can serve as a biomarker for the diagnosis and prognosis of NPC. Methods We used quantitative RT-PCR and Western blotting analysis to detect mRNA and protein expression of PTK6 in NPC cell lines and immortalized nasopharyngeal epithelial cell lines. 31 NPC and 16 non-tumorous nasopharyngeal mucosa biopsies were collected to detect the difference in the expression of mRNA level of PTK6 by quantitative RT-PCR. We also collected 178 NPC and 10 normal nasopharyngeal epithelial cases with clinical follow-up data to investigate the expression of PTK6 by immunohistochemistry staining (IHC). PTK6 overexpression on cell growth and colony formation ability were measured by the method of cell proliferation assay and colony formation assay. Results The expression of PTK6 was higher in most of NPC cell lines at both mRNA and protein levels than in immortalized nasopharyngeal epithelial cell lines (NPECs) induced by Bmi-1 (Bmi-1/NPEC1, and Bmi-1/NPEC2). The mRNA level of PTK6 was high in NPC biopsies compared to non-tumorous nasopharyngeal mucosa biopsies. IHC results showed the expression of PTK6 was significantly correlated to tumor size (P Conclusions Our results suggest that high-expression of PTK6 is an independent factor for NPC patients and it might serve as a potential prognostic biomarker for patients with NPC.

Background To clarify the feasibility and efficacy of chemoradiotherapy (CRT) in elderly (age≥65 years) patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Methods From January 2000 to December 2006, 101 newly diagnosed elderly non-metastatic NPC patients (age≥65 years) who received cisplatin 3-weekly or weekly concurrent CRT with/without sequential chemotherapy were recruited. Each patient from the CRT group was matched to another patient treated with radiotherapy (RT) alone based on age, gender, pathological type, performance status, overall stage, stage method, Adult Comorbidity Evaluation-27 (ACE-27) score and RT technique, from the same institute and time period. We also recruited 101 young patients (age Results CRT was feasible in elderly NPC patients, while a concurrent regimen of weekly cisplatin was more tolerable. Grade≥3 acute toxicity in CRT group was similar with referent group, although it was significantly higher than the RT alone group (65.3% vs. 43.6%, P=0.002). Furthermore, patients with ACE-27 score≥2 in the CRT group had significantly higher severe acute toxicity and dose reduction. Survival was poorer in elderly patients than the referent group. Compared to RT alone, CRT significantly improved the 5-year overall survival (OS: 54.6% vs. 39.3%, P=0.009), cancer-specific survival (CSS: 56.6% vs. 42.7%, P=0.022), disease-free survival (DFS: 51.6% vs. 30.2%, P=0.028) and locoregional relapse-free survival (LRRFS: 78.4% vs. 52.2%, P=0.003), but not distant metastasis-free survival (DMFS: 69.6% vs. 63.6%, P=0.669). However, CRT did not significantly improve 5-year OS (43.6% vs. 27.3%, P=0.893) or CSS (43.6% vs. 34.1%, P=0.971) in elderly NPC patients with ACE-27 score≥2. Conclusions CRT is feasible and effective in elderly patients with locoregionally advanced NPC without severe comorbidities. CRT should be used under serious consideration and be further tested in elderly patients with severe comorbidities. As such, it is essential to perform a comprehensive evaluation of pretreatment comorbidity status for all elderly NPC patients.

10558 Background: Plasma Epstein-Barr virus DNA (EBV DNA) load has been shown to be clinically useful in the detection, monitoring, and prognostication of nasopharyngeal carcinoma (NPC). However, the clinical significance of EBV DNA load detected at different time points has not been addressed to our knowledge. In this study, we investigated whether pre- and post-treatment plasma EBV DNA load have different prognostic implications in NPC patients who were treated with radiotherapy. Methods: Plasma samples from 69 patients with primary NPC were collected before and after radiation treatment, and subjected to a real-time quantitative polymerase-chain- reaction assay of EBV DNA load. The pre-treatment primary tumor volume (GTVnx) calculated through CT images and/or MRI were documented. All patients were scheduled to follow up. Results: The pre-treatment plasma EBV DNA concentration was significantly associated with primary tumor volume (Spearman correlation coefficient=0.614; P=0.000). With a cutoff value of 20,000 copies/ml and 0 copies/ml respectively for pre-treatment and post-treatment plasma EBV DNA copy number, patients with lower EBV DNA concentrations had statistically preferable progression-free survival,metastasis-free survival and overall survival compared with those with higher EBV DNA concentrations. Cox regression analysis demonstrated that both pre-treatment EBV DNA load (P=0.050;RR=3.95) and post-treatment EBV DNA load (P=0.001;RR=11.74) were risk factors for metastasis-free survival. When further integrating pre-treatment with post-treatment concentration of EBV DNA, it was demonstrated that whether EBV DNA concentration could be dropped to 0 after treatment dominate the prognostic effect for metastasis-free survival (P=0.000). Conclusions: Pre- and post-treatment plasma EBV DNA have different clinical significance. Pre-treatment plasma EBV DNA is a reliable molecular marker reflecting primary tumor volume. While the clearance of circulating plasma EBV DNA after treatment is a good predictive marker of freedom from distant metastasis. No significant financial relationships to disclose.