Background: Little is known about the nature of metaistasis to small cervical lymph nodes(SCLNS) in the patients with nasopharyngeal carcinoma(NPC)examined by using 18-fluoro-2-deoxy-glucose(^(18)F-FDG) positron emiss...Background: Little is known about the nature of metaistasis to small cervical lymph nodes(SCLNS) in the patients with nasopharyngeal carcinoma(NPC)examined by using 18-fluoro-2-deoxy-glucose(^(18)F-FDG) positron emission tomography/computed tomography(PET/CT).The present study aimed to evaluate the diagnostic values of PET/CT in identifying metastasis in SCLNs in NPC patients.Methods: Magnetic resonance images(MRI) and PET/CT scans for 470 patients with newly diagnosed, non-distant metastatic NPC were analyzed. Metastatic rates of SCLNs were defined by the positive number of SCLNs on PET/CT scans and total number of SCLNs on MRI scans. Receiver operating characteristic curve was applied to compare PET/CT-determined stage with MRI-determined stage.Results: In total, 2082 SCLNs were identified, with 808(38.8%) ≥ 5 and < 6 mm in diameter(group A), 526(25.3%)≥ 6 and < 7 mm in diameter(group B),374(18.0%)≥ 7 and < 8 mm in diameter(group C), 237(11.4%) ≥8 and<9 mm in diameter(group D),and 137(6.5%) ≥ 9 and <10 mm in diameter(group E).The overall metastatic rates examined by using PET/CT for groups A, B,C,D, and E were 3.5%, 8.0%, 31.3%, 60.0%, and 83.9%, respectively(P< 0.001). In level IV/Vb, the metastatic rate for nodes ≥ 8 mm was 84.6%. PET/CT examination resulted in modification of N category and overall stage for 135(28.7%) and 46(9.8%) patients, respectively. The areas under curve of MRIdetermined and PET/CT-determined overall stage were 0.659 and 0.704 for predicting overall survival, 0.661 and 0.711 for predicting distant metastasis-free survival, and 0.636 and 0.663 for predicting disease-free survival.Conclusions: PET/CT was more effective than MRI in identifying metastatic SCLNs, and the radiologic diagnostic criteria for metastatic lymph nodes in level IV/Vb should be re-defined.展开更多
Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of ...Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.展开更多
Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV d...Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation. Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed. According to incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%), medium-risk (5%-30%), and low-risk (<5%) groups. The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines, which were further categorized into the upper neck (retropharyngeal region and level Ⅱ), middle neck (levels Ⅲ and Va), and lower neck (levels Ⅳ and Vb and the supraclavicular fossa). The high-risk anatomic sites were adjacent to the nasopharynx, whereas those at medium- or low-risk were separated from the nasopharynx. If the high-risk anatomic sites were involved, the rates of tumor invasion into the adjacent medium-risk sites increased; if not, the rates were significantly lower (P < 0.01). Among the 1920 (81.1%) patients with positive LN, the incidence rates of LN metastasis in the upper, middle, and lower neck were 99.6% , 30.2%, and 7.2%, respectively, and skip metastasis happened in only 1.2% of patients. In the 929 patients who had unilateral upper neck involvement, the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%, respectively. Thus, local disease spreads stepwise from proximal sites to distal sites, and LN metastasis spreads from the upper neck to the lower neck. Individualized CTV delineation for NPC may be feasible.展开更多
The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and ...The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy.Thirty-four patients(aged 8–20 years)with histologically proven,non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study.The disease stage distribution was as follows:stage I,1(2.9%);stage III,14(41.2%);and stage IV,19(55.9%).All patients underwent SIBIMRT and 30 patients also underwent cisplatin-based chemotherapy.The prescribed dose of IMRT was64–68 Gy in 29–31 fractions to the nasopharyngeal gross target volume.Within the median follow-up of 52months(range,9–111 months),1 patient(2.9%)experienced local recurrence and 4(11.8%)developed distant metastasis(to the lung in 3 cases and to multiple organs in 1 case).Four patients(11.8%)died due to recurrence or metastasis.The 5-year locoregional relapse–free survival,distant metastasis–free survival,disease-free survival,and overall survival rates were 97.1%,88.2%,85.3%,and 88.2%,respectively.The most common acute toxicities were grades 3–4 hematologic toxicities and stomatitis.Of the 24 patients who survived for more than 2 years,16(66.7%)and 15(62.5%)developed grades 1–2 xerostomia and ototoxicity,respectively.Two patients(8.3%)developed grade 3 ototoxicity;no grade 4 toxicities were observed.SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC,with mild incidence of late toxicities.Distant metastasis is the predominant mode of failure.展开更多
The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma(NPC)has decreased with the extensive use of intensity-modulated radiotherapy(IMRT).We aimed to develop a prognostic...The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma(NPC)has decreased with the extensive use of intensity-modulated radiotherapy(IMRT).We aimed to develop a prognostic scoring system(PSS)that incorporated tumor extension and clinical characteristics for locoregional control in NPC patients treated with IMRT.The magnetic resonance imaging scans and medical records of 717 patients with nonmetastatic NPC treated with IMRT at Sun Yat-sen University Cancer Center between January 2003 and January 2008 were reviewed.Age,pathologic classification,primary tumor extension,primary gross tumor volume(GTV-p),T and N categories,and baseline lactate dehydrogenase(LDH)level were analyzed.Hierarchical cluster analysis as well as univariate and multivariate analyses were used to develop the PSS.Independent prognostic factors for locoregional relapse included N2–3 stage,GTV-p≥26.8 mL,and involvement of one or more structures within cluster3.We calculated a risk score derived from the regression coefficient of each factor and classified patients into four groups:low risk(score 0),intermediate risk(score>0 and≤1),high risk(score>1 and≤2),and extremely high risk(score>2).The 5-year locoregional control rates for these groups were 97.4%,93.6%,85.2%,and 78.6%,respectively(P<0.001).We have developed a PSS that can help identify NPC patients who are at high risk for locoregional relapse and can guide individualized treatments for NPC patients.展开更多
AIM: To evaluate the value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas.METHODS: From January 1999 to October 2004, CT-guided core-needle biopsies were performed in 80 patient...AIM: To evaluate the value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas.METHODS: From January 1999 to October 2004, CT-guided core-needle biopsies were performed in 80 patients with suspected malignant lymphoma. Biopsies were performed with an 18-20 G biopsy-cut (CR Bard, Inc., Covington, GA,USA) needle driven by a spring-loaded Bard biopsy gun.RESULTS: A definite diagnosis and accurate histological subtype were obtained in 61 patients with a success rate of 76.25% (61/80). Surgical sampling was performed in 19 patients (23.75%) with non-diagnostic core-needle biopsies. The success rate of CT-guided core-needle biopsy varied with the histopathologic subtypes in our group.The relatively high success rates of core-needle biopsy were noted in diffuse large B-cell non-Hodgkin's lymphoma (NHL, 88.89%) and peripheral T-cell NHL (90%). However,the success rates were relatively low in anaplastic large cell (T/null cell) lymphoma (ALCL, 44.44%) and Hodgkin's disease (HD, 28.57%) in our group.CONCLUSION: CT-guided core-needle biopsy is a reliable means of diagnosing and classifying malignant lymphomas,and can be widely applied in the management of patients with suspected malignant lymphoma.展开更多
Ultrastable Y zeolite（USY）-supported Pt catalyst was prepared by gas-bubbling-assisted membrane reduction. The influence of reaction conditions and the metal and acid sites of catalysts on the catalytic performance ...Ultrastable Y zeolite（USY）-supported Pt catalyst was prepared by gas-bubbling-assisted membrane reduction. The influence of reaction conditions and the metal and acid sites of catalysts on the catalytic performance of catalyst in hydrogenation and selective ring opening of tetralin, 1,2,3,4-tetrahydronaphthalene（THN）, was studied. It was found that the optimal reaction conditions were at a temperature of 280 °C, hydrogen pressure of 4 MPa, liquid hourly space velocity of 2 h^-1 and H2/THN ratio of 750. Under these optimal conditions, a high conversion of almost 100% was achieved on the 0.3 Pt/USY catalyst. XRD patterns and TEM images revealed that Pt particles were highly dispersed on the USY, favorable to the hydrogenation reaction of tetralin. Ammonia temperature-programmed desorption and Py-IR results indicated that the introduction of Pt can reduce the acid sites of USY, particularly the strong acid sites of USY. Thus, the hydrocracking reaction can be suppressed.展开更多
Background:The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy(IMRT)as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma(NPC),but the radiation-rel...Background:The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy(IMRT)as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma(NPC),but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients.Endoscopic nasopharyngectomy(ENPG)was successfully applied in recurrent NPC with radiation free and relatively low medical costs.In this study,we examined whether ENPG could be an effective treatment for localized stage I NPC.Methods:Ten newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center.Simultaneously,the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort.The survival outcomes,quality of life(QOL),and medical costs between two groups were compared.Results:After a median follow-up of 59.0 months(95%CI 53.4-64.6),no death,locoregional recurrence,or distant metastasis was observed in the 10 patients treated with ENPG.The 5-year overall survival,local relapse-free survival,regional relapse-free survival,and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients(100%vs.99.1%,100%vs.97.7%,100%vs.99.0%,100%vs.97.4%,respectively,P>0.05).In addition,compared with IMRT,ENPG was associated with decreased total medical costs($4090.42±1502.65 vs.$12620.88±4242.65,P<0.001)and improved QOL scores including dry mouth(3.3±10.5 vs.34.4±25.8,P<0.001)and sticky saliva(3.3±10.5 vs.32.6±23.3,P<0.001).Conclusions:ENPG alone was associated with promising long-term survival outcomes,low medical costs,and satisfactory QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refused radiotherapy.However,the application of ENPG should be prudent,and prospective clinical tri-als were needed to further verify the results.展开更多
Background： Among patients with Charcot-Marie-Tooth disease （CMT）, the X-linked variant （CMTX） caused by gap junction protein beta 1 （GJB1） gene mutation is the second most frequent type, accounting for approxi...Background： Among patients with Charcot-Marie-Tooth disease （CMT）, the X-linked variant （CMTX） caused by gap junction protein beta 1 （GJB1） gene mutation is the second most frequent type, accounting for approximately 90% of all CMTX. More than 400 mutations have been identified in the GJB1 gene that encodes connexin 32 （CX32）. CX32 is thought to form gap junctions that promote the diffusion pathway between cells. GJB1 mutations interfere with the formation of the functional channel and impair the maintenance of peripheral myelin, and novel mutations are continually discovered. Methods： We included 79 unrelated patients clinically diagnosed with CMT at the Department of Neurology of the Chinese People＇s Liberation Army General Hospital from December 20, 2012, to December 31, 2015. Clinical examination, nerve conduction studies, and molecular and bioinformatics analyses were performed to identify patients with CMTX 1. Results： Nine GJBI mutations （c.283G〉A, c.77C〉T, c.643C〉T, c.515C〉T, c.191G〉A, c.610C〉T, c.490C〉T, c.491G〉A, and c.44G〉A） were discovered in nine patients. Median motor nerve conduction velocities of all nine patients were 〈 38 m/s, resembling CMT Type 1. Three novel mutations, c.643C〉T, c.191G〉A, and c.610C〉T, were revealed and bioinformatics analyses indicated high pathogenicity. Conclusions： The three novel missense mutations within the GJB1 gene broaden the mutational diversity ofCMT1X. Molecular analysis of family members and bioinformatics analyses of the afflicted patients confirmed the pathogenicity of these mutations.展开更多
Background：In small fiber neuropathy （SFN）,thinly myelinated Aδ and unmyelinated C fibers are primarily affected,resulting in sensory and/or autonomic symptoms.Various etiologies have been shown to be associated w...Background：In small fiber neuropathy （SFN）,thinly myelinated Aδ and unmyelinated C fibers are primarily affected,resulting in sensory and/or autonomic symptoms.Various etiologies have been shown to be associated with SFN.This study was aimed to analyze a variety of features in peripheral neuropathy （PN） with small fiber involvement.and to compare disease severity among patients with idiopathic PN,PN associated with impaired glucose tolerance （IGT）,and metabolic syndrome （MS） PN.Methods：Thirty-eight PN patients with small fiber involvement were enrolled from December 20,2013 to May 31,2016.Patients were divided into idiopathic PN,IGT-related PN,and MS-related PN groups.Detailed medical history and small fiber neuropathy were investigated,and symptom inventory questionnaire was conducted,as well as the visual analog scale.Nerve conduction studies and skin biopsies were also performed.The differences among the groups were analyzed using analysis of variance and Kruskal-Wallis test.Results：Eight patients were diagnosed with pure SFN.lntraepidermal nerve fiber density （I ENFD） weakly correlated with motor conduction velocity （MCV） （r =0.372,P =0.025）,and proximal （r =0.383,P =0.021） and distal （r =0.358,P 0.032） compound muscle action potential （CMAP） of the tibial nerve.IENFD also weakly correlated with MCV of the peroneal nerve （r=0.399,P =0.016）.IENFD was shown to be significantly different among all groups （x2 =9.901,P-0.007）.IENFD was significantly decreased （x2 =23.000,P=0.003） in the MS-related PN group compared to the idiopathic PN group.The MCV of the tibial nerve was significantly different among all groups （x2 =8.172,P 〈 0.017）.The proximal （F =4.336,P =0.021） and distal （F =3.262,P =0.049） CMAP of the tibial nerve was also significantly different among all groups.Conclusions：IENFD of patients included in the present study weakly correlated with various electrophysiological parameters.Small and large fibers are more involved in patients with MS-related PN than in patients with idiopathic PN.展开更多
Background:Enlarged retropharyngeal lymph nodes(RLNs)are very common in patients with nasopharyngeal carcinoma(NPC)undergoing radiotherapy.The most suitable treatment option for enlarged RLNs depends on the pathologic...Background:Enlarged retropharyngeal lymph nodes(RLNs)are very common in patients with nasopharyngeal carcinoma(NPC)undergoing radiotherapy.The most suitable treatment option for enlarged RLNs depends on the pathological results.However,RLN sampling is difficult and imminent in the clinic setting.We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for sam-pling RLN tissues sufficient for pathological or cytological diagnosis.Methods:We enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via mag-netic resonance imaging(MRI).The EUS probe was introduced into the nasopharynx via the nostrils,and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath.EUS-FNA was subsequently performed.The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed.Results:Strips of tissue were successfully sampled from all patients using EUS-FNA.Of the 30 patients,23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session.The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session,and two more cases were confirmed possessing cancer cells.The other five patients without con-firmed cancer cells were closely followed with MRI every month for 3 months.After follow-up for 3 months,three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters.The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive.In the whole cohort reported here,the EUS-FNA procedure was not associated with any severe complications.Conclusion:EUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC.展开更多
Background： Few studies have focused on peripheral nerve conduction during exposure to microgravity. The -6° head-down tilt （HDT） comprises an experimental model used to simulate the space flight environment. ...Background： Few studies have focused on peripheral nerve conduction during exposure to microgravity. The -6° head-down tilt （HDT） comprises an experimental model used to simulate the space flight environment. This study investigated nerve conduction characteristics of rhesus monkeys before and alter prolonged exposure to H DT. Methods： Six rhesus monkeys （3-4 years old） were tilted backward 6° from the horizontal. Nerve conduction studies （NCSs） were performed on the median, ulnar, tibial, and fibular motor nerves. Analysis of variance with a randomized block design was conducted to compare the differences in the NCS belbre and 7, 2 l, and 42 days alter the 6° HDT. Results： The proximal amplitude of the CMAP of the median nerve was significantly decreased at 21 and 42 days of HDT compared with the amplitude before HDT （4.38 ± 2.83 vs. 8.40 ±2.66 mV, F = 4.85, P = 0.013 and 3.30± 2.70 vs. 8.40± 2.66 mV, F = 5.93, P = 0.004, respectively）. The distal amplitude of the CMAP of the median nerve was significantly decreased at 7, 21, and 42 days of HDT compared with the amplitude before HDT （7.28 ± 1.27 vs. 10.25 ± 3.40 mV, F= 4.03, P = 0.039; 5.05 ± 2.01 vs. 10.25 ± 3.40 mV, F = 6.25, P = 0.04; and 3.95 ± 2.79 vs. 10.25 ± 3.40 mV, F = 7.35, F=- 0.01; respectively）. The proximal amplitude of the CMAP of the tibial nerve was significantly decreased at 42 days of HDT compared with the amplitude betbre HDT （6.14± 1.94 vs. 11.87± 3.19 mV, F = 5.02, P = 0.039）. Conclusions： This study demonstrates that the compound muscle action potential amplitudes of nerves are decreased under simulated microgravity in rhesus monkeys. Moreover, rhesus monkeys exposed to HDT might be served as an experimental model for the study of NCS under microgravity.展开更多
To the Editor：Spinocerebellar ataxia type 5 （SCA5） is a rare autosomal dominant spinocerebellar ataxia.Mutations in the spectrin beta nonerythrocytic 2 gene （SPTBN2） are known to cause SCA5,six of which have been...To the Editor：Spinocerebellar ataxia type 5 （SCA5） is a rare autosomal dominant spinocerebellar ataxia.Mutations in the spectrin beta nonerythrocytic 2 gene （SPTBN2） are known to cause SCA5,six of which have been reported,including three missense mutations and three deletion mutations.展开更多
基金supported by grants from the Science and Technology Project of Guangzhou City,China(No.14570006)the Planned Science and Technology Project of Guangdong Province,China(No.2013B020400004)
文摘Background: Little is known about the nature of metaistasis to small cervical lymph nodes(SCLNS) in the patients with nasopharyngeal carcinoma(NPC)examined by using 18-fluoro-2-deoxy-glucose(^(18)F-FDG) positron emission tomography/computed tomography(PET/CT).The present study aimed to evaluate the diagnostic values of PET/CT in identifying metastasis in SCLNs in NPC patients.Methods: Magnetic resonance images(MRI) and PET/CT scans for 470 patients with newly diagnosed, non-distant metastatic NPC were analyzed. Metastatic rates of SCLNs were defined by the positive number of SCLNs on PET/CT scans and total number of SCLNs on MRI scans. Receiver operating characteristic curve was applied to compare PET/CT-determined stage with MRI-determined stage.Results: In total, 2082 SCLNs were identified, with 808(38.8%) ≥ 5 and < 6 mm in diameter(group A), 526(25.3%)≥ 6 and < 7 mm in diameter(group B),374(18.0%)≥ 7 and < 8 mm in diameter(group C), 237(11.4%) ≥8 and<9 mm in diameter(group D),and 137(6.5%) ≥ 9 and <10 mm in diameter(group E).The overall metastatic rates examined by using PET/CT for groups A, B,C,D, and E were 3.5%, 8.0%, 31.3%, 60.0%, and 83.9%, respectively(P< 0.001). In level IV/Vb, the metastatic rate for nodes ≥ 8 mm was 84.6%. PET/CT examination resulted in modification of N category and overall stage for 135(28.7%) and 46(9.8%) patients, respectively. The areas under curve of MRIdetermined and PET/CT-determined overall stage were 0.659 and 0.704 for predicting overall survival, 0.661 and 0.711 for predicting distant metastasis-free survival, and 0.636 and 0.663 for predicting disease-free survival.Conclusions: PET/CT was more effective than MRI in identifying metastatic SCLNs, and the radiologic diagnostic criteria for metastatic lymph nodes in level IV/Vb should be re-defined.
基金supported by grants from the Key Laboratory Construction Project of Guangzhou City,China (121800085)the Health & Medical Collaborative Innovation Project of Guangzhou City,China (201400000001)+2 种基金the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (2014BAI09B10)the National Natural Science Foundation of China (81201746)the Planned Science and Technology Project of Guangdong Province,China (2013B020400004)
文摘Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.
文摘Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation. Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed. According to incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%), medium-risk (5%-30%), and low-risk (<5%) groups. The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines, which were further categorized into the upper neck (retropharyngeal region and level Ⅱ), middle neck (levels Ⅲ and Va), and lower neck (levels Ⅳ and Vb and the supraclavicular fossa). The high-risk anatomic sites were adjacent to the nasopharynx, whereas those at medium- or low-risk were separated from the nasopharynx. If the high-risk anatomic sites were involved, the rates of tumor invasion into the adjacent medium-risk sites increased; if not, the rates were significantly lower (P < 0.01). Among the 1920 (81.1%) patients with positive LN, the incidence rates of LN metastasis in the upper, middle, and lower neck were 99.6% , 30.2%, and 7.2%, respectively, and skip metastasis happened in only 1.2% of patients. In the 929 patients who had unilateral upper neck involvement, the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%, respectively. Thus, local disease spreads stepwise from proximal sites to distal sites, and LN metastasis spreads from the upper neck to the lower neck. Individualized CTV delineation for NPC may be feasible.
基金Natural ScienceFoundation of China(No.81071836)Sun Yat-sen University5010 Projects(No.050243)
文摘The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy.Thirty-four patients(aged 8–20 years)with histologically proven,non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study.The disease stage distribution was as follows:stage I,1(2.9%);stage III,14(41.2%);and stage IV,19(55.9%).All patients underwent SIBIMRT and 30 patients also underwent cisplatin-based chemotherapy.The prescribed dose of IMRT was64–68 Gy in 29–31 fractions to the nasopharyngeal gross target volume.Within the median follow-up of 52months(range,9–111 months),1 patient(2.9%)experienced local recurrence and 4(11.8%)developed distant metastasis(to the lung in 3 cases and to multiple organs in 1 case).Four patients(11.8%)died due to recurrence or metastasis.The 5-year locoregional relapse–free survival,distant metastasis–free survival,disease-free survival,and overall survival rates were 97.1%,88.2%,85.3%,and 88.2%,respectively.The most common acute toxicities were grades 3–4 hematologic toxicities and stomatitis.Of the 24 patients who survived for more than 2 years,16(66.7%)and 15(62.5%)developed grades 1–2 xerostomia and ototoxicity,respectively.Two patients(8.3%)developed grade 3 ototoxicity;no grade 4 toxicities were observed.SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC,with mild incidence of late toxicities.Distant metastasis is the predominant mode of failure.
基金supported by grants from the Natural Science Foundation of China(No.81071836)Sun Yat-sen University 5010 projects(No.050243)
文摘The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma(NPC)has decreased with the extensive use of intensity-modulated radiotherapy(IMRT).We aimed to develop a prognostic scoring system(PSS)that incorporated tumor extension and clinical characteristics for locoregional control in NPC patients treated with IMRT.The magnetic resonance imaging scans and medical records of 717 patients with nonmetastatic NPC treated with IMRT at Sun Yat-sen University Cancer Center between January 2003 and January 2008 were reviewed.Age,pathologic classification,primary tumor extension,primary gross tumor volume(GTV-p),T and N categories,and baseline lactate dehydrogenase(LDH)level were analyzed.Hierarchical cluster analysis as well as univariate and multivariate analyses were used to develop the PSS.Independent prognostic factors for locoregional relapse included N2–3 stage,GTV-p≥26.8 mL,and involvement of one or more structures within cluster3.We calculated a risk score derived from the regression coefficient of each factor and classified patients into four groups:low risk(score 0),intermediate risk(score>0 and≤1),high risk(score>1 and≤2),and extremely high risk(score>2).The 5-year locoregional control rates for these groups were 97.4%,93.6%,85.2%,and 78.6%,respectively(P<0.001).We have developed a PSS that can help identify NPC patients who are at high risk for locoregional relapse and can guide individualized treatments for NPC patients.
文摘AIM: To evaluate the value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas.METHODS: From January 1999 to October 2004, CT-guided core-needle biopsies were performed in 80 patients with suspected malignant lymphoma. Biopsies were performed with an 18-20 G biopsy-cut (CR Bard, Inc., Covington, GA,USA) needle driven by a spring-loaded Bard biopsy gun.RESULTS: A definite diagnosis and accurate histological subtype were obtained in 61 patients with a success rate of 76.25% (61/80). Surgical sampling was performed in 19 patients (23.75%) with non-diagnostic core-needle biopsies. The success rate of CT-guided core-needle biopsy varied with the histopathologic subtypes in our group.The relatively high success rates of core-needle biopsy were noted in diffuse large B-cell non-Hodgkin's lymphoma (NHL, 88.89%) and peripheral T-cell NHL (90%). However,the success rates were relatively low in anaplastic large cell (T/null cell) lymphoma (ALCL, 44.44%) and Hodgkin's disease (HD, 28.57%) in our group.CONCLUSION: CT-guided core-needle biopsy is a reliable means of diagnosing and classifying malignant lymphomas,and can be widely applied in the management of patients with suspected malignant lymphoma.
基金the National Natural Science Foundation of China (U1662103 and 21673290)the National HiTech Research and Development Program (863) of China (2015AA034603)the China National Offshore Oil Corporation Fund (LHYJYKJSA20160002)
文摘Ultrastable Y zeolite（USY）-supported Pt catalyst was prepared by gas-bubbling-assisted membrane reduction. The influence of reaction conditions and the metal and acid sites of catalysts on the catalytic performance of catalyst in hydrogenation and selective ring opening of tetralin, 1,2,3,4-tetrahydronaphthalene（THN）, was studied. It was found that the optimal reaction conditions were at a temperature of 280 °C, hydrogen pressure of 4 MPa, liquid hourly space velocity of 2 h^-1 and H2/THN ratio of 750. Under these optimal conditions, a high conversion of almost 100% was achieved on the 0.3 Pt/USY catalyst. XRD patterns and TEM images revealed that Pt particles were highly dispersed on the USY, favorable to the hydrogenation reaction of tetralin. Ammonia temperature-programmed desorption and Py-IR results indicated that the introduction of Pt can reduce the acid sites of USY, particularly the strong acid sites of USY. Thus, the hydrocracking reaction can be suppressed.
基金Funding was provided by the National Natural Science Foundation of China(Nos.81572912,81772895)Guangdong Public Welfare Research and Capacity Building Projects(2014B020212005)+1 种基金the Program of Sun Yat-Sen University for Clinical Research 5010 Program(No.201310)the Major Project of Sun Yat-Sen University for the New Cross Subject,the Special Support Program for High-level Talents in Sun Yat-Sen University Cancer Center(to M.Y.Chen),Guangdong Province Science and Technology Development Special Funds(Frontier and Key Technology Innovation Direction-Major Science and Technology Project),Guangzhou Science and Technology Planning Project-Production and Research Collaborative Innovation Major Project
文摘Background:The National Comprehensive Cancer Network guidelines recommend intensity-modulated radiotherapy(IMRT)as the primary curative treatment for newly diagnosed nasopharyngeal carcinoma(NPC),but the radiation-related complications and relatively high medical costs remain a consequential burden for the patients.Endoscopic nasopharyngectomy(ENPG)was successfully applied in recurrent NPC with radiation free and relatively low medical costs.In this study,we examined whether ENPG could be an effective treatment for localized stage I NPC.Methods:Ten newly diagnosed localized stage I NPC patients voluntarily received ENPG alone from June 2007 to September 2017 in Sun Yat-sen University Cancer Center.Simultaneously,the data of 329 stage I NPC patients treated with IMRT were collected and used as a reference cohort.The survival outcomes,quality of life(QOL),and medical costs between two groups were compared.Results:After a median follow-up of 59.0 months(95%CI 53.4-64.6),no death,locoregional recurrence,or distant metastasis was observed in the 10 patients treated with ENPG.The 5-year overall survival,local relapse-free survival,regional relapse-free survival,and distant metastasis-free survival among the ENPG-treated patients was similar to that among the IMRT-treated patients(100%vs.99.1%,100%vs.97.7%,100%vs.99.0%,100%vs.97.4%,respectively,P>0.05).In addition,compared with IMRT,ENPG was associated with decreased total medical costs($4090.42±1502.65 vs.$12620.88±4242.65,P<0.001)and improved QOL scores including dry mouth(3.3±10.5 vs.34.4±25.8,P<0.001)and sticky saliva(3.3±10.5 vs.32.6±23.3,P<0.001).Conclusions:ENPG alone was associated with promising long-term survival outcomes,low medical costs,and satisfactory QOL and might therefore be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refused radiotherapy.However,the application of ENPG should be prudent,and prospective clinical tri-als were needed to further verify the results.
文摘Background： Among patients with Charcot-Marie-Tooth disease （CMT）, the X-linked variant （CMTX） caused by gap junction protein beta 1 （GJB1） gene mutation is the second most frequent type, accounting for approximately 90% of all CMTX. More than 400 mutations have been identified in the GJB1 gene that encodes connexin 32 （CX32）. CX32 is thought to form gap junctions that promote the diffusion pathway between cells. GJB1 mutations interfere with the formation of the functional channel and impair the maintenance of peripheral myelin, and novel mutations are continually discovered. Methods： We included 79 unrelated patients clinically diagnosed with CMT at the Department of Neurology of the Chinese People＇s Liberation Army General Hospital from December 20, 2012, to December 31, 2015. Clinical examination, nerve conduction studies, and molecular and bioinformatics analyses were performed to identify patients with CMTX 1. Results： Nine GJBI mutations （c.283G〉A, c.77C〉T, c.643C〉T, c.515C〉T, c.191G〉A, c.610C〉T, c.490C〉T, c.491G〉A, and c.44G〉A） were discovered in nine patients. Median motor nerve conduction velocities of all nine patients were 〈 38 m/s, resembling CMT Type 1. Three novel mutations, c.643C〉T, c.191G〉A, and c.610C〉T, were revealed and bioinformatics analyses indicated high pathogenicity. Conclusions： The three novel missense mutations within the GJB1 gene broaden the mutational diversity ofCMT1X. Molecular analysis of family members and bioinformatics analyses of the afflicted patients confirmed the pathogenicity of these mutations.
文摘Background：In small fiber neuropathy （SFN）,thinly myelinated Aδ and unmyelinated C fibers are primarily affected,resulting in sensory and/or autonomic symptoms.Various etiologies have been shown to be associated with SFN.This study was aimed to analyze a variety of features in peripheral neuropathy （PN） with small fiber involvement.and to compare disease severity among patients with idiopathic PN,PN associated with impaired glucose tolerance （IGT）,and metabolic syndrome （MS） PN.Methods：Thirty-eight PN patients with small fiber involvement were enrolled from December 20,2013 to May 31,2016.Patients were divided into idiopathic PN,IGT-related PN,and MS-related PN groups.Detailed medical history and small fiber neuropathy were investigated,and symptom inventory questionnaire was conducted,as well as the visual analog scale.Nerve conduction studies and skin biopsies were also performed.The differences among the groups were analyzed using analysis of variance and Kruskal-Wallis test.Results：Eight patients were diagnosed with pure SFN.lntraepidermal nerve fiber density （I ENFD） weakly correlated with motor conduction velocity （MCV） （r =0.372,P =0.025）,and proximal （r =0.383,P =0.021） and distal （r =0.358,P 0.032） compound muscle action potential （CMAP） of the tibial nerve.IENFD also weakly correlated with MCV of the peroneal nerve （r=0.399,P =0.016）.IENFD was shown to be significantly different among all groups （x2 =9.901,P-0.007）.IENFD was significantly decreased （x2 =23.000,P=0.003） in the MS-related PN group compared to the idiopathic PN group.The MCV of the tibial nerve was significantly different among all groups （x2 =8.172,P 〈 0.017）.The proximal （F =4.336,P =0.021） and distal （F =3.262,P =0.049） CMAP of the tibial nerve was also significantly different among all groups.Conclusions：IENFD of patients included in the present study weakly correlated with various electrophysiological parameters.Small and large fibers are more involved in patients with MS-related PN than in patients with idiopathic PN.
文摘Background:Enlarged retropharyngeal lymph nodes(RLNs)are very common in patients with nasopharyngeal carcinoma(NPC)undergoing radiotherapy.The most suitable treatment option for enlarged RLNs depends on the pathological results.However,RLN sampling is difficult and imminent in the clinic setting.We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for sam-pling RLN tissues sufficient for pathological or cytological diagnosis.Methods:We enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via mag-netic resonance imaging(MRI).The EUS probe was introduced into the nasopharynx via the nostrils,and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath.EUS-FNA was subsequently performed.The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed.Results:Strips of tissue were successfully sampled from all patients using EUS-FNA.Of the 30 patients,23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session.The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session,and two more cases were confirmed possessing cancer cells.The other five patients without con-firmed cancer cells were closely followed with MRI every month for 3 months.After follow-up for 3 months,three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters.The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive.In the whole cohort reported here,the EUS-FNA procedure was not associated with any severe complications.Conclusion:EUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC.
文摘Background： Few studies have focused on peripheral nerve conduction during exposure to microgravity. The -6° head-down tilt （HDT） comprises an experimental model used to simulate the space flight environment. This study investigated nerve conduction characteristics of rhesus monkeys before and alter prolonged exposure to H DT. Methods： Six rhesus monkeys （3-4 years old） were tilted backward 6° from the horizontal. Nerve conduction studies （NCSs） were performed on the median, ulnar, tibial, and fibular motor nerves. Analysis of variance with a randomized block design was conducted to compare the differences in the NCS belbre and 7, 2 l, and 42 days alter the 6° HDT. Results： The proximal amplitude of the CMAP of the median nerve was significantly decreased at 21 and 42 days of HDT compared with the amplitude before HDT （4.38 ± 2.83 vs. 8.40 ±2.66 mV, F = 4.85, P = 0.013 and 3.30± 2.70 vs. 8.40± 2.66 mV, F = 5.93, P = 0.004, respectively）. The distal amplitude of the CMAP of the median nerve was significantly decreased at 7, 21, and 42 days of HDT compared with the amplitude before HDT （7.28 ± 1.27 vs. 10.25 ± 3.40 mV, F= 4.03, P = 0.039; 5.05 ± 2.01 vs. 10.25 ± 3.40 mV, F = 6.25, P = 0.04; and 3.95 ± 2.79 vs. 10.25 ± 3.40 mV, F = 7.35, F=- 0.01; respectively）. The proximal amplitude of the CMAP of the tibial nerve was significantly decreased at 42 days of HDT compared with the amplitude betbre HDT （6.14± 1.94 vs. 11.87± 3.19 mV, F = 5.02, P = 0.039）. Conclusions： This study demonstrates that the compound muscle action potential amplitudes of nerves are decreased under simulated microgravity in rhesus monkeys. Moreover, rhesus monkeys exposed to HDT might be served as an experimental model for the study of NCS under microgravity.
文摘To the Editor：Spinocerebellar ataxia type 5 （SCA5） is a rare autosomal dominant spinocerebellar ataxia.Mutations in the spectrin beta nonerythrocytic 2 gene （SPTBN2） are known to cause SCA5,six of which have been reported,including three missense mutations and three deletion mutations.
