Neck observation versus elective neck dissection in management of clinical T1/2N0 oral squamous cell carcinoma: a retrospective study of 232 patients

Objective: The management of early-stage (cT1/2N0) oral squamous cell carcinoma (OSCC) remains a controversial issue. The aim of this study was to compare the clinical outcomes of neck observation (OBS) and elective neck dissection (END) in treating patients with cT1/2N0 OSCC. Methods: A total of 232 patients with cT1/2N0 OSCC were included in this retrospective study. Of these patients, 181 were treated with END and 51 with OBS. The survival curves of 5-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates were plotted using the Kaplan-Meier method for each group, and compared using the Log-rank test. Results: There was no significant difference in 5-year OS and DSS rates between END and OBS groups (OS: 89.0% vs. 88.2%, P=0.906; DSS: 92.3% vs. 92.2%, P=0.998). However, the END group had a higher 5-year RFS rate than the OBS group (90.1% vs. 76.5%, P=0.009). Patients with occult metastases in OBS group (7/51) had similar 5-year OS rate (57.1% vs. 64.1%, P=0.839) and DSS rate (71.4% vs. 74.4%, P=0.982) to those in END group (39/181). In the regional recurrence patients, the 5-year OS rate (57.1% vs. 11.1%, P=0.011) and DSS rate (71.4% vs. 22.2%, P=0.022) in OBS group (7/51) were higher than those in END group (9/181). Conclusions: The results indicated that OBS policy could obtain the same 5-year OS and DSS as END. Under close follow-up, OBS policy may be an available treatment option for patients with clinical T1/2N0 OSCC.

Neck dissection for recurrent and persistent lymph nodes of nasopharyngeal carcinoma after radiotherapy： effect and choice

Objective： To investigate the best surgical mode for the patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy. Methods： The clinical data of 88 patients of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy were analyzed retrospectively. The levels of involved lymph nodes and the relationship among the levels were analyzed; the survival rate and recurrent rate of the surgical modes including radical neck dissection （RND）, modified radical neck dissection （MRND）, selective neck dissection （SND）, and lymph node resection （LNR） were analyzed; the role of postoperative radiotherapy was evaluated. Results： （1） The recurrent and persistent lymph nodes mainly located in level Ⅱ（55.6% and 58.6%, respectively）, next was level Ⅲ and rarely in level Ⅳ, Ⅴ, and Ⅰ, but the number of levels Ⅳ Ⅴ, and Ⅰ with cancer-bearing lymph nodes was relatively more than that of clinical measurement. （2） Patients with lymph nodes involved in level Ⅲ and Ⅳ, usually, have other levels involved simultaneously; the percentages were 63.6% and 88.9%, respectively. However, the lymph nodes in level Ⅱ and Ⅴ were mainly isolated. （3） The 5-year survival rate and recurrent rate of the whole group were 42.77% and 22.7%, respectively. （4） The 5-year survival rates of RND, MRND, SND, and LMR groups were 39.75%, 60.00%, 37.87%, and 44.10%, respectively; the differences were insignificant （Log-rank = 1.0, P = 0.8011）; the recurrent rate between the extensive and local surgery groups were insignificant （X^2 = 0.470, P = 0.493）. （5） The 5-year survival rates of the patients with and without postoperative radiotherapy were 39.06% and 45.26%, respectively; the difference was insignificant （Log-rank = 0.06, P = 0.8138）. Conclusion： The extensive surgery was recommended when the recurrent and persistent lymph nodes were more than one level involved or very large or immovable, otherwise, the SND should be performed and postoperative radiotherapy was important compensation if necessary.

THE UNILATERAL BIG HOCKEY STICK INCISION FOR NECK DISSECTION IN THYROID CARCINOMA

Objective: To investigate the feasibility and advantages of the unilateral big hockey stick incision in thyroid carcinoma. Method: Neck dissection using the unilateral big hockey stick incision was performed on 23 patients with thyroid carcinoma. Results: The big hockey stick incision results in a cosmetic scar which is barely visible and easily covered by hair or clothing, while it provides sufficient exposure of the operation field. A small area of marginal necrosis is occasionally seen at the apex of the skin flap due to preoperative radiotherapy. Conclusion: The unilateral big hockey stick incision has adequate surgical access, good healing of skin flaps, and a good cosmetic result.

Role of prophylactic central neck lymph node dissection for papillary thyroid carcinoma in the era of de-escalation

Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence worldwide over the last few decades.Patients with papillary thyroid carcinoma(PTC)and clinical evidence of central(cN1)and/or lateral lymph node metastases require total thyroidectomy plus central and/or lateral neck dissection as the initial surgical treatment.Nodal status in PTC patients plays a crucial role in the prognostic evaluation of the recurrence risk.The 2015 guidelines of the American Thyroid Association(ATA)have more accurately determined the indications for therapeutic central and lateral lymph node dissection.However,prophylactic central neck lymph node dissection(pCND)in negative lymph node(cN0)PTC patients is controversial,as the 2009 ATA guidelines recommended that CND“should be considered”routinely in patients who underwent total thyroidectomy for PTC.Although the current guidelines show clear indications for therapeutic CND,the role of pCND in cN0 patients with PTC is still debated.In small solitary papillary carcinoma(T1,T2),pCND is not recommended unless there are high-risk prediction factors for recurrence and diffuse nodal spread(extrathyroid extension,mutation in the BRAF gene).pCND can be considered in cN0 disease with advanced primary tumors(T3 or T4)or clinical lateral neck disease(cN1b)or for staging and treatment planning purposes.The role of the preoperative evaluation is fundamental to minimizing the possible detrimental effect of overtreatment of the types of patients who are associated with low disease-related morbidity and mortality.On the other hand,it determines the choice of appropriate treatment and determines if close monitoring of patients at a higher risk is needed.Thus,pCND is currently recommended for T3 and T4 tumors but not for T1 and T2 tumors without high-risk prediction factors of recurrence.

Correlation between Central and Lateral Neck Dissection in Differentiated Thyroid Carcinoma

Objective: To determine the histopathological correlation between central and lateral neck metastasis in differentiated thyroid carcinoma, and its potential therapeutic impact. Although the central neck dissection (CND) is recommended in differentiated thyroid carcinoma, the indication for lateral neck dissection (LND) remains controversial. Design: Retrospective study. Methods and Main Outcome Measures: Pathological analysis of systematic ipsilateral central neck dissection (CND) and LND performed with total thyroidectomy in differentiated thyroid carcinoma was retrospectively reviewed according to “side” and to “patient”. Results: A total of 56 sides (46 patients) were suitable for analysis. Analysis by “side” revealed that CND and LND dissection samples were both negative in 15 cases, both positive in 32, CND was positive and LND was negative for 8 cases and CND was negative and LND was positive in 1 case. The combined presence of positive LND and positive CND was therefore observed in 32/40 “sides” and 26/46 “patients”. Analysis by “side” of the impact of the treatment decision to perform ipsilateral LND only in patients with positive CND and vice versa demonstrated a sensitivity, specificity, and accuracy of 97%, 65%, and 84%, respectively. Conclusions: In most cases, the presence of positive LND was associated with positive ipsilateral CND. The very low prevalence of positive LND in patients with negative CND may justify LND as a second step procedure only in patients with positive CND, except in the case of documented lateral neck metastasis.

UNILATERAL BIG HOCKEY STICK INCISION FOR NECK DISSECTION IN HEAD AND NECK CARCINOMA

Objective: To investigate for the feasibility and advantages performed by the unilateral big hockey stick incision (BHSI) in head and neck carcinoma. Methods: Neck dissection by using the unilateral big hockey stick incision (BHSI) was performed on 93 patients with head and neck carcinoma. Results: The big hockey stick incision has a cosmetic scar and not scar contraction and is barely visible and easily covered in hair and clothing; sufficient exposure of the operation field; a small area of marginal necrosis was occasionally seen at the apex of the skin flap due to having preoperative radiotherapy. Conclusion: The unilateral big hockey stick incision has adequate surgical access, good healing of skin flaps, and a good cosmetic result.

Validation of the functional rating index for the assessment of athletes with neck pain

AIM: To validate the culturally-adapted Persian Functional Rating Index(PFRI) for assessing neck pain(NP) in athletes. METHODS: In this cross-sectional study, 100 athletes with NP and 50 healthy athletes participated and responded to the PFRI. Fifty athletes with NP completed the PFRI for at least 7 d later to establish test-retest reliability. RESULTS: The athletes with NP responded to all items, indicating excellent clinical utility. No floor and ceiling effects were found, indicating content validity and responsiveness. The PFRI revealed capability to discriminate between the athletes with NP and healthy athletes. The PFRI demonstrated strong correlation with the Numerical Rating Scale(Spearman's rho = 0.94), and the Persian Neck Disability Index(Pearson r = 0.995), supporting criterion and construct validity. Internal consistency reliability was high(Cronbach's α coefficient: 0.97). The test-retest reliability was excellent(ICCagreement = 0.96). The absolute reliability values of standard error of measurement and smallest detectable change were 3.2 and 8.84, respectively. An exploratory factor analysis yielded one factor explaining 78.03% of the total variance. CONCLUSION: The PFRI is a valid and reliable measure of functional status in athletes with NP.

Is Routine Bilateral Neck Dissection Absolutely Necessary in the Management of N0 CT Negative Neck in Patients with T4 Laryngeal Head and Neck Carcinoma?

Objectives: Elective neck treatment of clinically N0 patients in patients with head and neck carcinomas is widely accepted as a standard approach. However, the issue whether elective neck treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining whether T4 staged head and neck carcinomas required bilateral neck dissection in the management clinically No necks especially CT negative cervical nodes. Methods: We performed a retrospective analysis of patients with advanced head and neck disease who received bilateral neck dissection. All the patients had curative surgery as their initial treatment for the primary tumor and the neck. Results: All the 28 consecutive patients had T4 staged primary laryngeal cancer. Patients with clinically and radiologically N+ disease had invaded lymph node metastases in all cases. Patients staged clinically and radiologically N0 had no invaded cervical lymph nodes found by pathologic examination. Patients staged clinically N0 and radiologically N+ had invaded cervical lymph nodes in 8/12 cases and in 50% (4/8) of the cases bilaterally. Conclusion: This study showed the importance on adequate clinical and radiological staging. By patients with advanced disease clinically and radiologically N0, bilateral neck dissection should not be necessary. But in patients radiologically N+, routine bilateral neck dissection is beneficial.

Sentinel Lymph Node Biopsy as Guidance for Lateral Neck Dissection in Patients with Papillary Thyroid Carcinoma

Introduction: The surgical management of lateral lymph nodes in differentiated thyroid carcinoma is controversies. Therefore, we analyzed whether sentinel lymph nodes (SLN) biopsy of the first draining nodes in the jugulo-carotid chain is an accurate technique to select patients with true-positive but nonpalpable lymph nodes for selective lateral node dissection. Materials and Methods: From January 2009 to December 2009, 12 patients with solitary papillary carcinoma measuring 2 cm by ultrasonography were included in this study. After the thyroid gland was exposed to avoid injuring the lateral thyroid lymphatic connection, approximately 0.2 ml of 5mg/ml indocyanine green was injected into the parenchyma of upper and lower thyroid gland. Some stained lymph nodes in the jugulo-carotid chain could be identified following the stained lymphatic duct and dissected as the SLN. After that, thyroidectomy with modified neck dissection was performed. Results: The mean tumor size was 22.1 ± 4.6 mm. Identification and biopsy of stained SLN in the ipsilateral jugulo-carotid chain was successful in all 12 cases. In 6 cases, histopathological analysis of SLNs revealed metastases of the papillary thyroid carcinoma. Among them, 2 cases had additional metastatic lymph nodes in the ipsilateral compartment. Of the 6 patients who had negative lymph node metastasis (LNM) in SLNs, all patients had negative LNM in the ipsilateral compartment. Conclusions: The method may be helpful in the detection of true-positive but nonpalpable lymph nodes and may support a decision to perform a selective lateral node dissection in patients with papillary thyroid carcinoma.

Unexpected Airway Obstruction Caused by Bilateral Hypoglossal Nerve Palsy Following Second Radical Neck Dissection

A 67-year-old woman underwent right radical neck dissection for cervical lymph node metastasis from maxillary gingival carcinoma. Two months later, metastasis in the left superior internal jugular lymph nodes were discovered, and left radical neck dissection was performed. Postoperatively, airway obstruction occurred despite performing extubation after confirming that the patient had fully recovered from anesthesia. Bilateral hypoglossal nerve palsy was diagnosed and the patient was reintubated. After extubation on the following day, airway obstruction was relieved, but slurred speech and impaired swallowing were persistent. In view of this, hypoglossal nerve function should be examined before the second radical neck dissection on the contralateral side.

The launch of a special issue on “Neck Dissection in Differentiated Thyroid Carcinoma” in Gland Surgery

Given the high incidence of cervical lymph node metastasis in differentiated thyroid cancer （DTC） and the rapidly increased importance of neck dissection in DTC, the journal of Gland Surgery is launching a special issue on ＂Neck Dissection in Differentiated Thyroid Carcinoma＂ in November Issue of 2013, inviting Dr. Xinying Li from Xiangya Hospital, China, as the guest editor.

A new device for the identification of lymph nodes removed during different types of neck dissection

Meticulous mapping of the lymph node status is a general principle in present-day head and neck surgery. The removal of a certain number of lymphatic levels during neck dissection may well be therapeutic in intent, but it is also mandatory for correct tumour staging. We pre- sent a precise lymph node mapping during dif- ferent types of neck dissection in the course of major head and neck surgery by a sterile plastic tray moulded in the shape of the neck. This de- vice makes lymph node mapping simpler, safer, quicker and methodically more structured than any of the present methods. It facilitates the work of the pathologist and the flow of reliable information along the surgeon-pathologist- oncologist chain. With this device, a more stru- ctured, methodical means of lymph node removal has become possible.

Fibroblast activation protein (FAP) as a prognostic biomarker in multiple tumors and its therapeutic potential in head and neck squamous cell carcinoma

Background:Fibroblast activation protein(FAP),a cell surface serine protease,plays roles in tumor invasion and immune regulation.However,there is currently no pan-cancer analysis of FAP.Objective:We aimed to assess the pan-cancer expression profile of FAP,its molecular function,and its potential role in head and neck squamous cell carcinoma(HNSC).Methods:We analyzed gene expression,survival status,immune infiltration,and molecular functional pathways of FAP in The Cancer Genome Atlas(TCGA)and Genotype Tissue Expression(GTEx)tumors.Furthermore,to elucidate the role of FAP in HNSC,we performed proliferation,migration,and invasion assays post-FAP overexpression or knock-down.Results:FAP expression was elevated in nine tumor types and was associated with poor survival in eight of them.In the context of immune infiltration,FAP expression negatively correlated with CD8+T-cell infiltration infive tumor types and positively with regulatory T-cell infiltration in four tumor types.Our enrichment analysis highlighted FAP’s involvement in the PI3K-Akt signaling pathway.In HNSC cells,FAP overexpression activated the PI3K-Akt pathway,promoting tumor proliferation,migration,and invasion.Conversely,FAP knockdown showed inhibitory effects.Conclusion:Our study unveils the association of FAP with poor tumor prognosis across multiple cancers and highlights its potential as a therapeutic target in HNSC.

股骨颈骨折空心螺钉内固定术后供养血管注射富血小板血浆效果分析

目的分析股骨颈骨折空心螺钉内固定术后供养血管注射富血小板血浆(PRP)的临床效果。方法选取2019年6月至2021年6月郑州人民医院收治的106例股骨颈骨折患者作为研究对象,按照空心螺钉内固定术后供养血管是否注射PRP将其分为试验组(53例)和对照组(53例)。试验组患者空心螺钉内固定术后于供养血管注射PRP,对照组患者空心螺钉内固定术后不做处理,对比观察两组患者围手术期指标、骨折愈合时间、髋关节功能、骨痂生长情况以及不良事件发生情况。结果试验组患者手术时间明显长于对照组(t=16.915,P<0.001),完全负重所需时间、骨折愈合时间均明显短于对照组(t=12.610、8.213,P均<0.001),术中出血量与对照组无明显差异(t=1.685,P=0.095);术后1、3、6个月,试验组患者Harris评分、Fernandez-Esteve骨痂评分均明显高于对照组(术后1个月:t=8.919、6.118,P均<0.001;术后3个月:t=10.951、9.217,P均<0.001;术后6个月:t=7.024、6.937,P均<0.001);试验组患者术后不良事件发生率为9.43%,明显低于对照组患者的不良事件发生率30.19%(χ^(2)=7.185,P=0.007)。结论与单纯采用空心螺钉内固定治疗相比,于空心螺钉内固定术后给予供养血管注射PRP治疗股骨颈骨折,能够有效促进骨痂生长,明显缩短完全负重所需时间及骨折愈合时间,改善髋关节功能,减少股骨头坏死等不良事件的发生,临床应用价值更高。

覆膜支架腔内修复术对Stanford B型主动脉夹层患者肝肾功能及炎症因子的影响

目的探讨Stanford B型主动脉夹层患者接受将覆膜支架腔内修复术治疗的临床效果。方法本研究共纳入2021年10月至2023年10月河南省胸科医院收治的110例Stanford B型主动脉夹层患者,将所有患者根据随机数字表法分为对照组(55例,接受药物保守治疗)和研究组(55例,采用覆膜支架腔内修复术治疗)。比较两组患者治疗前、治疗2周后肝肾功能指标、血清炎症因子相关指标,以及两组患者病死率、并发症发生情况。结果治疗2周后,研究组患者丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、血尿素氮(BUN)、肌酐(Cr)指标水平相较于治疗前均有所降低,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗2周后,研究组患者血清炎症因子指标肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-1β)、干扰素-γ(IFN-γ)、C-反应蛋白(CRP)相较于治疗前均有所降低,且研究组低于对照组,差异有统计学意义(P<0.05)。两组患者病死率、再次手术或介入率比较,差异无统计学意义(P>0.05)。研究组患者并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论Stanford B型主动脉夹层患者接受覆膜支架腔内修复术治疗,可对肝肾功能起到改善作用,减轻炎症反应,安全性较高,值得临床应用。

SuperPATH入路与后外侧入路髋关节置换术治疗股骨颈骨折患者的效果比较

目的:比较SuperPATH入路与后外侧入路下髋关节置换术治疗股骨颈骨折患者的效果。方法:选取2021年10月至2023年10月该院收治的92例股骨颈骨折患者进行前瞻性研究,按随机数字表法将其分为对照组与观察组各46例。对照组行后外侧入路髋关节置换术治疗,观察组行SuperPATH入路髋关节置换术治疗。比较两组围术期指标(术中出血量、手术时间、首次下床活动时间、住院时间)水平,手术前后疼痛程度[视觉模拟评分法(VAS)]、髋关节功能[Harris髋关节功能评分量表(HHS)]评分,以及并发症发生率。结果:观察组术中出血量少于对照组,手术时间、首次下床活动时间、住院时间均短于对照组,差异有统计学意义(P<0.05);术后3个月,两组VAS评分均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);两组HHS评分均高于术前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:SuperPATH入路髋关节置换术治疗股骨颈骨折患者可提高髋关节功能评分,减少术中出血量,缩短康复进程,以及降低疼痛程度评分和并发症发生率的效果优于后外侧入路髋关节置换术治疗。

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma

Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.

徒手抗阻练习联合舒筋整复手法治疗颈型颈椎病的效果观察

目的探讨徒手抗阻练习结合舒筋整复手法治疗颈型颈椎病的效果。方法选取2021年4月至2023年10月收治的颈型颈椎病患者98例,按随机数字表法分为观察组和对照组各49例。观察组给予徒手抗阻练习联合舒筋整复手法治疗,对照组给予徒手抗阻练习治疗,2组均治疗4周。治疗后比较2组临床疗效,治疗前后症状体征评分、颈椎功能障碍指数(NDI)评分、Spitzer生活质量指数(SQOL)评分、颈椎曲度、颈椎病临床评价量表(CASCS)评分、颈椎活动度及椎-基底动脉血流动力学情况。结果治疗4周后,观察组总有效率为95.92%(47/49)高于对照组的81.63%(40/49),差异有统计学意义(P<0.05);治疗2周、治疗4周观察组颈部疼痛、颈部压痛、颈部活动度评分及NDI评分低于对照组,Borden值、CASCS评分高于对照组(P<0.05)。治疗2周、治疗4周观察组颈部右侧屈、前屈、左旋、左侧屈、右旋、后伸活动度高于对照组(P<0.05)。治疗2周、治疗4周观察组左侧椎动脉、基底动脉、右侧椎动脉平均血流速度高于对照组(P<0.05)。治疗4周观察组SQOL评分高于对照组(P<0.01)。结论徒手抗阻练习联合舒筋整复手法治疗颈型颈椎病可提升患者颈椎活动度,恢复颈椎正常曲度及功能,还能调节血流动力学,减轻临床症状,从而改善生活质量。

新时代航空医学保障的挑战与创新

新型战机特性、新的作战要求和特殊飞行环境对飞行人员身心素质提出更高要求,给航空医学保障带来新的挑战。国内相关团队聚焦航空兵部队实战需求,开展了航空医学保障关键技术研究,创建了新型前庭功能和前庭错觉模拟训练技术,研制了高原微压训练舱和水下逃生训练设备,制定了颈腰伤病综合防治方案,推进解决制约飞行人员作业效能的关键问题。本文总结了近年来我国航空医学保障领域取得的技术突破和理论创新以及成果应用对提高飞行人员作业效能发挥的积极作用,这将对推动航空医学学科发展具有一定指导意义。

Partial aortic root remodeling for root reconstruction in patients with acute type A dissection

In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece （4-5 cm） of collagen coated woven polyester vascular prosthesis was trimmed with one or two ＂tongues＂ to reconstruct the non-coronary sinus and/ or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4~3.6 months. In-hospital mortality was only 5.0% （2/40）; furthermore, 3 （8.6%） patients underwent re-operation of the aortic valve and 2 （5.7%） patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.