Over the last decades the United Kingdom has seen a general increase in the incidence of head and neck squamous cell carcinoma (HNSCC). In addition to the classical risk factors of smoking and alcohol consumption ther...Over the last decades the United Kingdom has seen a general increase in the incidence of head and neck squamous cell carcinoma (HNSCC). In addition to the classical risk factors of smoking and alcohol consumption there now appears that a viral aetiology is attributed to a significant proportion of HNSCC. A number of studies have indicated that human papillomavirus (HPV) infection is implicated with the subtype HPV 16 being found in many histopathological specimens. Further evidence suggests that HPV positive status is a prognostic factor related to a favourable outcome in head and neck cancers. This premise may have a significant impact on our approach to treating HNSCC. Patients belonging to stages I/II are traditionally treated with curative intent, single modality treatments that are either radiation or surgery alone. These treatment regimens are relatively aggressive and may lead to severe functional impairment. HPV patients may not require such an approach. This dissertation examines the current evidence which has given rise to these assertions, and explores the unresolved issues preventing HPV positive status becoming part of the management convention. The methodology involved a comprehensive literature review. The literature conclusions and limitations are discussed with reference to what is becoming accepted universally in this field and what remains to be elucidated. The different prognosis and treatment reaction to radiotherapy and chemotherapy by HPV positive tumours could be extrapolated to suggest that HPV status detection is required to plan treatment regimes. Indeed a separate subset of patients could potentially be categorised with an improvement in morbidity.展开更多
文摘Over the last decades the United Kingdom has seen a general increase in the incidence of head and neck squamous cell carcinoma (HNSCC). In addition to the classical risk factors of smoking and alcohol consumption there now appears that a viral aetiology is attributed to a significant proportion of HNSCC. A number of studies have indicated that human papillomavirus (HPV) infection is implicated with the subtype HPV 16 being found in many histopathological specimens. Further evidence suggests that HPV positive status is a prognostic factor related to a favourable outcome in head and neck cancers. This premise may have a significant impact on our approach to treating HNSCC. Patients belonging to stages I/II are traditionally treated with curative intent, single modality treatments that are either radiation or surgery alone. These treatment regimens are relatively aggressive and may lead to severe functional impairment. HPV patients may not require such an approach. This dissertation examines the current evidence which has given rise to these assertions, and explores the unresolved issues preventing HPV positive status becoming part of the management convention. The methodology involved a comprehensive literature review. The literature conclusions and limitations are discussed with reference to what is becoming accepted universally in this field and what remains to be elucidated. The different prognosis and treatment reaction to radiotherapy and chemotherapy by HPV positive tumours could be extrapolated to suggest that HPV status detection is required to plan treatment regimes. Indeed a separate subset of patients could potentially be categorised with an improvement in morbidity.
文摘目的 观察头穴丛刺长留针法治疗偏头痛的临床疗效。方法 将88例偏头痛患者随机分为观察组(44例,脱落2例)和对照组(44例,脱落3例)。观察组采用常规针刺联合头穴丛刺长留针法治疗,对照组采用常规针刺方法治疗。比较两组临床疗效,观察两组治疗前后的视觉模拟量表(visual analog scale, VAS)评分、偏头痛特异性生活质量问卷(migraine-specific quality of life questionnaire, MSQ)、血清5-羟色胺(5-hydroxytryptamine, 5-HT)浓度。结果 观察组总有效率为92.9%,高于对照组的78.0%,差异有统计学意义(P>0.05)。两组治疗后VAS评分较治疗前降低(P<0.05),两组随访时VAS评分较治疗前和治疗后降低(P<0.05);观察组治疗后及随访时,VAS评分均低于对照组(P<0.05)。两组治疗后MSQ评分较治疗前升高(P<0.05),两组随访时MSQ评分较治疗前和治疗后升高(P<0.05);观察组治疗后及随访时,MSQ评分均高于对照组(P<0.05)。两组治疗后血清5-HT浓度均升高,且观察组高于对照组,差异有统计学意义(P<0.05)。结论 在常规针刺基础上,头穴丛刺长留针法治疗偏头痛临床疗效优于常规针刺方法,且在减轻偏头痛患者疼痛程度,改善其生活质量及提高5-HT浓度方面优于常规针刺方法。
