白藜芦醇对KBv200细胞多药耐药逆转作用的研究

目的 探讨白藜芦醇对人口咽腔上皮癌KBv200耐药细胞株的多药耐药逆转作用及可能的逆转机制.方法 采用四甲基偶氮唑盐比色法检测KBv200耐药细胞中白藜芦醇对长春新碱、多柔比星和紫杉醇的逆转倍数,流式细胞仪检测细胞的凋亡情况,应用反转录聚合酶链反应(RT-PCR)和蛋白质印迹法(Western blot)检测每组KBv200细胞中肿瘤多药耐药相关基因1(multidrug resistance 1,MDR1)和B细胞淋巴瘤基因2(Bcl-2)mRNA和蛋白水平的表达.结果 白藜芦醇对化疗药物具有协同增效作用,显著逆转KBv200耐药性.200 umol/L白藜芦醇对长春新碱、紫杉醇和多柔比星(阿霉素)的逆转倍数达到77.1、61.3和5.9.白藜芦醇能显著降低Bcl-2、MDR1mRNA和蛋白的表达,100 umol/L、200 umol/L白藜芦醇处理组与未加白藜芦醇组的MDR1、Bcl-2mRNA表达差异均有统计学意义(t值分别为2.98、3.51和3.12、4.56,P值均<0.05).结论 白藜芦醇对口咽腔上皮癌耐药细胞具有耐药逆转作用,该逆转作用可能是通过降低耐药基因表达、促进细胞凋亡实现的.     

反义核酸逆转Hep-2v细胞多药耐药的研究

目的探讨克服肿瘤细胞的多药耐药(multidrug resistance,MDR)的有效方法.方法用反义硫代磷酸寡聚脱氧核苷酸(asODN)对Hep-2v细胞进行多药耐药(MDR)逆转实验,(1)将Hep-2细胞经长春新碱(VCR)筛选建立Hep-2v耐药细胞株为靶细胞;(2)针对mdr1 mRNA序列计算机辅助设计人工合成两个15mer反义寡聚脱氧核苷酸序列asODNⅠ、Ⅱ,以硫代法修饰,其中序列Ⅰ和Ⅱ的作用位点相邻接,互补位点为MDR-mRNA的330～359碱基;(3)MDR逆转实验两个反义序列分别或联合作用于Hep-2v细胞,MTT法测定反义核酸作用前后VCR对Hep-2v细胞IC50,比较其细胞毒作用;用流式细胞仪(FCM)检测反义核酸作用后各实验组细胞表面糖蛋白P-170的阳性率;RT-PCR法检测mdr1 mRNA表达水平.结果两个反义核酸均使Hep-2v细胞的P-170阳性率下降,mdr1 mRNA水平低调,VCR对Hep-2v的细胞毒作用IC50从900nmol/L降至＜200nmol/L.结论两个反义核酸用于Hep-2v的MDR均获得明显的逆转效果,序列Ⅰ+Ⅱ联合作用的效果更强,表明两个序列可能有协同作用.     

MDR1基因RNA干扰逆转喉癌细胞多药耐药性的研究

目的采用RNA干扰（RNA interference,RNAi）技术通过敲减MDR1基因编码的P糖蛋白的表达,逆转人喉癌耐药细胞系（LSC-1,WⅨ）对于化疗药物的多药耐药性（multidrugresistance,MDR）。方法采用表达MDR1shRNA（smallhairpinRNA）的慢病毒载体转染LSC-1/TAX细胞,干扰MDR1mRNA。体外MTT实验观察其对各种化疗药物敏感性,裸鼠荷瘤试验在体检测其对TAX的敏感性,通过免疫组化方法在蛋白水平检测体内外细胞中MDR1基因的表达。结果体外逆转LSC-1／TAX喉癌细胞对多种化疗药物的MDR,裸鼠荷瘤试验显示细胞化疗药物的敏感性被成功回复。免疫组化方法证实MDR1shRNA可以在体内外有效地敲减MDRl基因的表达。结论表达MDR1shRNA的慢病毒载体可以在转录后明显降低MDR1基因的表达,从而提高喉癌细胞对常用化疗药物的敏感性。     

长链非编码RNA膀胱癌相关转录因子1通过微小RNA-142/自噬相关蛋白7调节自噬对喉癌细胞化疗耐药的影响#br#

目的　探讨长链非编码RNA（long non-coding RNA，lncRNA）膀胱癌相关转录因子1（bladder cancerassociated transcr ipt 1，BLACAT1）在喉鳞状细胞癌（laryngeal squamous cell carcinoma，LSCC）细胞化疗耐药中的作用。方法　通过顺铂诱导喉癌细胞株Hep-2，建立顺铂耐药喉癌细胞模型（Hep-2/R）。实时荧光定量PCR（RT-qPCR）检测细胞中lncRNA BLACAT1、微小RNA-142 （microRNA-142，miR-142）和自噬相关蛋白7（autophagyrelated protein 7，ATG7）mRNA的表达；Western blot检测细胞中ATG7、多药耐药蛋白1（multidrug resistance protein 1，MRP1）和微管相关蛋白1轻链3（microtubule associated protein 1 light chain 3，LC3）-II/LC3-I和Beclin 1的表达；MTT实验检测细胞活力。双荧光素酶报告基因实验分别检测BLACAT1和miR-142及miR-142和ATG7之间的靶向作用。结果　Hep-2/R组细胞中lncRNA BLACAT1表达水平（3.58±0.47）显著高于Hep-2组1.00±0.06），差异有统计学意义（t =9.431，P<0.05）。Hep-2/R组细胞中miR-142表达水平（0.35±0.04）显著低于Hep-2组（1.00±0.05），差异有统计学意义（t =17.583，P<0.05）。与Vector组比较，pcDNABLACAT1组Hep-2细胞活力显著升高；与NC-siRNA组比较，BLACAT1-siRNA组Hep-2/R细胞活力显著降低。与WT-BLACAT1和NC mimic共转染组相比，WT-BLACAT1和miR-142共转染的细胞中萤光素酶活性显著降低（t =10.832，P<0.05）；与Vector组比较，pcDNA-BLACAT1组细胞中miR-142表达显著降低；与WT-ATG7和NC mimic共转染组相比，WT-ATG7和miR-142共转染的细胞中萤光素酶活性显著降低（t =8.203，P <0.05）；与NC mimic组比较，miR-142 mimic组细胞中ATG7蛋白水平均显著降低。使用自噬抑制剂3-MA处理Hep-2细胞后，pcDNA-BLACAT1显著促进自噬蛋白ATG7、LC3-II/LC3-I和Beclin 1的表达，miR-142 mimic处理后自噬蛋白水平降低。使用DDP处理Hep-2/R细胞后，BLACAT1-siRNA显著抑制Hep-2/R细胞活力和MRP1蛋白的表达，而miR-142 inhibitor逆转这一结果。结论　LncRNA BLACAT1通过miR-42/ATG7信号通路促进LSCC细胞的自噬和化疗耐药性。     

Bmi-1基因RNAi对喉癌细胞Hep-2生物学行为的影响

目的:构建Bmi-1基因的RNAi表达载体,观察其对喉癌细胞Hep-2增殖、侵袭能力的影响。方法:利用慢病毒表达体系pHelper1.0/pHelper2.0/pGCL2GFP,构建Bmi-1基因的RNAi重组质粒vshRNA-Bmi-1。实时定量PCR和蛋白质印迹法分别检测稳定转染vshRNA-Bmi-1后喉癌细胞中Bmi-1mRNA及蛋白的表达;克隆形成实验及小室侵袭实验检测喉癌细胞增殖和侵袭能力的变化。结果:稳定转染vshRNA-Bmi-1后Hep-2细胞Bmi-1mRNA表达均明显下降,Hep-2细胞中Bmi-1蛋白表达明显下降。抑制率分别为79%及88%。Bmi-1干扰后Hep-2细胞增殖减慢、侵袭能力减弱。结论:成功构建Bmi-1基因的RNAi表达载体,vshRNA-Bmi-1重组质粒明显下调Bmi-1mRNA和蛋白在喉癌细胞Hep-2中的表达。Bmi-1基因的RNAi能抑制喉癌细胞Hep-2的增殖和侵袭能力。     

重组腺病毒介导的p16基因在喉癌细胞系Hep-2的表达

目的 研究外源性P16基因对喉癌细胞系Hep-2的作用，并探讨P16基因用于治疗喉癌的可行性，方法 将重组体泉病毒介导的P16基因转染到人喉癌细胞系Hep-2，用免疫组化、打点杂交方法检测P16基因在细胞转染前后的表达情况，应用流式细胞仪，细胞DNALadder等方法研究P16基因对喉细胞周期、形态、生长等特性的影响。结果 感染P16基因的Hep-2细胞内有源外源性P16基因的表达，细胞周期明显变化，细胞从G1期到S期发生抑制，细胞有退行性改变，重组体腺病毒能介导外源基因P16在喉癌Hep-2细胞系中高效表达。重组体腺病毒介导的P16在Hep-2细胞系中表达，能抑制Hep-2细胞系的生长，流式细胞仪计数和细胞DNALadder证实p16能诱导喉癌细胞系Hep-2发生调亡并导致G1期阻滞。结论 P16基因抑制喉癌细胞系Hep-2的生长可能是通过诱导肿瘤细胞凋亡及G1期阻滞而发挥作用。     

Beclin1对喉鳞癌细胞Hep-2紫杉醇敏感性影响的体外研究

目的:通过检测不同Beclin1表达水平对喉癌细胞紫杉醇敏感性的影响。方法:本研究利用以喉癌细胞株Hep-2、稳定转染pcDNA3.1-Beclin1质粒的喉癌细胞株Hep-2-Beclin1、稳定转染pcDNA3.1质粒载体的喉癌细胞株Hep-2-pcDNA3.1为研究对象,对3组细胞施加不同浓度的化疗药物紫杉醇(1、2、5、10、20μg/L)干预24h,利用MTT法及流式细胞术检测紫杉醇对3组细胞增殖和凋亡的影响。利用Western blot检测3组细胞Akt和p-Akt蛋白表达水平。结果:不同浓度的紫杉醇处理后的3组喉癌细胞与药物终浓度正相关地出现生长抑制率提高。当紫杉醇浓度大于5μg/L时,紫杉醇对Hep-2-Beclin1的生长抑制率高于对另两株细胞的生长抑制率。以终浓度为10、20μg/L的紫杉醇处理3株喉癌细胞24h后,流式细胞术检测结果显示:各组细胞20μg/L紫杉醇处理后细胞的凋亡率均高于10μg/L紫杉醇处理后细胞的凋亡率(P<0.05)。紫杉醇处理后Hep-2-Beclin1组细胞凋亡率均高于Hep-2组和Hep-2-pcDNA3.1组(P<0.05)。Western blot结果显示:Hep-2、Hep-2-pcDNA3.1、Hep-2-Beclin1细胞Akt相对蛋白表达量分别为:1.24±0.03、1.25±0.05、1.27±0.09,3组细胞间Akt相对蛋白表达量差异无统计学意义(P>0.05);Hep-2、Hep-2-pcDNA3.1、Hep-2-Beclin1细胞p-Akt即活化型Akt相对蛋白表达量分别为:0.98±0.09、1.03±0.04、0.54±0.03,Hep-2-Beclin1细胞p-Akt相对蛋白表达量低于Hep-2、Hep-2-pcDNA3.1组细胞(P<0.05)。结论:Beclin1可能通过抑制PI3K/Akt信号通路的活化上调喉癌细胞对紫杉醇的敏感性。     

RNAi沉默PDCD4基因对人喉癌Hep-2细胞增殖及β-catenin表达的影响

目的 应用RNAi技术下调人喉癌Hep-2细胞中PDCD4基因的表达,探讨其对Hep-2细胞增殖及β-catenin表达的影响。 方法 设计并合成针对PDCD4基因的shRNA质粒与阴性对照质粒,分别转染Hep-2细胞。实时定量RT-PCR和Western blotting检测转染前后阴性对照组与干扰组PDCD4、β-catenin基因mRNA和蛋白的表达。克隆形成实验观察Hep-2细胞增殖能力的变化。 结果 与对照组相比,PDCD4干扰组的Hep-2细胞克隆形成率显著升高(P=0.01),PDCD4干扰组PDCD4mRNA和蛋白均显著减低(P<0.01)、β-catenin mRNA和蛋白均较对照组显著增加(P<0.01)。 结论 成功应用RNAi技术下调人喉癌Hep-2细胞中PDCD4基因的表达,Hep-2细胞克隆形成能力增强,β-catenin mRNA和蛋白表达显著升高。     

多药耐药基因ABCB1和ABCG2在下咽癌FaDu细胞多药耐药中的研究

目的 研究多药耐药基因ABCB1和ABCG2在下咽癌FaDu细胞株及其耐紫杉醇细胞株FaDu/T中的多药耐药特征及其机制,为进一步研究下咽癌细胞的多药耐药性及逆转提供理论支持.方法 以人下咽癌细胞株FaDu为亲本细胞,采用浓度梯度递增法成功建立下咽癌细胞株FaDu的耐紫杉醇细胞株FaDu/T.四甲基偶氮唑蓝法分别检测FaDu和FaDu/T对顺铂、氟尿嘧啶、多柔比星和长春新碱的多药耐药性;多药耐药基因及蛋白表达变化情况分别通过RT-PCR,Western blot和激光共聚焦检测;c-Jun氨基末端激酶(c-Jun N-terminal kinase,JNK)信号转导通路相关蛋白的表达变化通过Western blot检测.结果 耐药细胞株FaDu/T比FaDu细胞有更强的多药耐药性.FaDu细胞相比,FaDu/T细胞株中多药耐药蛋白ABCB1的表达增加(t=22.42,P＜0.05),但ABCG2表达下降(t=10.06,P＜0.05).紫杉醇初始作用于FaDu细胞后JNK信号转导通路被激活,但是在FaDu/T细胞中JNK信号转导通路呈失活状态,丝裂原活化蛋白激酶信号转导通路的激活剂茴香霉素(Anisomycin)可以使FaDu/T细胞的JNK信号通路重新激活.耐药细胞株FaDu/T中加入茴香霉素时ABCB1表达下调(F=33.72,P＜0.05),ABCG2的表达升高(F =220.16,P＜0.05),但是在预先加入JNK特异性抑制剂SP600125的FaDu/T细胞株中加入茴香霉素时,ABCB1和ABCG2的表达无明显变化(P＞0.05),提示JNK信号通路在下咽癌的多药耐药过程中具有重要的调控作用.结论 下咽癌FaDu细胞的多药耐药性以多药耐药蛋白ABCB1的高表达和ABCG2的低表达为主要特征,且两种耐药蛋白的表达变化与JNK信号转导通路密切相关.     

A Decrease in Maxillary Sinus Pressure,as Seen in Upper Airway Allergy or Infection,Results in an Increase in Upper Airway Nitric Oxide Levels

The paranasal sinuses are connected to the nasal cavity via small osties. Ostial occlusion, caused by mucosal swelling, will result in a slowly increasing negative pressure inside the sinus cavity. In parallel, the oxygen content in the sinus will decrease, resulting in the development of relative hypoxia. Hypoxia is a powerful inducer of nitric oxide (NO) synthase, and inducible NO synthase has been shown to be present in considerable amounts in the upper airways, including the sinuses. The present study was designed to investigate whether a reduction in sinus pressure would affect upper airway NO production. Thirteen healthy volunteers were investigated. A pressure chamber was used to lower the ambient pressure to-4.9 kPa. NO was sampled from one nostril or via a drainage tube inserted into the maxillary sinus before, during and after the hypobaric exposure. When the pressure was decreased, NO levels increased from 256 &#45 15 to 316 &#45 19 ppb ( n =13, p <0.001). The NO levels remained elevated (282 &#45 21 ppb; p <0.05) when measurements were repeated 20 min after leaving the chamber. The nasal airway resistance (V2 tot ) also increased as a result of the chamber session (from 16 &#45 2° before to 21 &#45 3° after; p <0.05). An increase in NO levels was also found when the experiments were repeated with NO sampled directly from the maxillary sinus (225 &#45 6 before and 265 &#45 9 ppb after; n =6, p <0.001). For control purposes the nasal analyses were repeated again, this time under hyperbaric conditions (+4.9 kPa). This resulted in a slight decrease in the NO levels (from 273 &#45 22 to 241 &#45 17 ppb; n =10, p <0.001), but there was no change in the nasal airway resistance. We conclude that a reduction in sinus pressure, as seen in upper airway allergy or infection, may result in an increase in upper airway NO production.     

A simple objective evaluation and grading for facial paralysis outcomes

Matrix metalloproteinase (MMP)-2 and -9 degrade type IV collagen, which is one of the major components of the basement membrane in normal tissue and expressed in the surroundings of the cancer nest in squamous cell carinoma. The degeneration of type IV collagen is an essential step in the metastasis to lymph nodes and distant organs. In this study, we examined MMP-2 and -9 levels of cancer tissue and serum obtained from patients with head and neck squamous cell carcinoma (HNSCC) in order to evaluate the relationship between the clinicopathologic features and MMPs. We examined the production of MMP-2 and -9 in cancer tissue homogenates of 73 patients who had HNSCC and the serum MMP levels of 16 patients with HNSCC and 8 healthy volunteers. We also studied the localization of MMP-2 in the carcinoma using an immunohistochemical approach. The concentrations of MMP-2 and -9 in the tissue homogenates and serum were measured by means of a sandwich enzyme immunoassay using a monoclonal antibody. Immunohistochemical analyses were performed with monoclonal antibody to MMP-2. The concentration of MMP-2 in the tumor tissue homogenates was unrelated to tumor size, but that in patients with lymph node metastases was significantly higher than in those without lymph node metastases. The concentration of MMP-9 was unrelated to lymph node metastasis and tumor size. The levels of both MMP-2 and -9 in serum were unrelated to lymph node metastasis. Immunohistochemistry indicated that MMP-2 was mainly expressed in cancer cells. Because MMP-2 degrades type IV collagen, the level of MMP-2 in carcinomas may be a useful indicator of the degree of invasion and metastasis.     

A case of cortical deafness and anarthria

The nasal epithelium protects the underlying tissue from damage. Epithelial cell growth is controlled by epidermal growth factor (EGF) and is possibly affected by toxic proteins, e.g. eosinophil cationic protein (ECP). The aims of this study were to examine nasal fluid epithelial cell counts and their relations to EGF, eosinophils and ECP in 23 patients with seasonal allergic rhinitis and 20 healthy controls. Nasal fluid epithelial cell counts were lower in patients than in controls. EGF levels did not differ between patients and controls, and correlated with epithelial cell counts in controls but not in patients. Eosinophils and ECP were higher in patients than in controls, but did not correlate with epithelial cell counts. The role of growth factors, such as EGF, in regulating epithelial cells merits further study.     

Bilateral versus unilateral cochlear implantation in young children

Objectives

To compare the preverbal communication skills of two groups of young implanted children: those with unilateral implantation and those with bilateral implantation.

Material and methods

The study assessed 69 children: 42 unilaterally and 27 bilaterally implanted with age at implantation less than 3 years. The preverbal skills of these children were measured before and 1 year after implantation, using Tait Video Analysis that has been found able to predict later speech outcomes in young implanted children.

Results

Before implantation there was no significant difference between the unilateral group and the bilateral group. There was still no difference at 12 months following implantation where vocal autonomy is concerned, but a strongly significant difference between the groups for vocal turn-taking and non-looking vocal turns, the bilateral group outperforming the unilateral group. Regarding gestural turn-taking and gestural autonomy, there was a strongly significant difference between the two groups at the 12 month interval, and also a difference before implantation for gestural autonomy, the unilateral group having the higher scores. Multiple regression of non-looking vocal turns revealed that 1 year following implantation, bilateral implantation contributed to 51% of the variance (p < 0.0001), after controlling for the influence of age at implantation and length of deafness which did not reach statistical significance.

Conclusions

Profoundly deaf bilaterally implanted children are significantly more likely to use vocalisation to communicate, and to use audition when interacting vocally with an adult, compared with unilaterally implanted children. These results are independent of age at implantation and length of deafness.     

Otolaryngologists may not be doing enough to diagnose pediatric eosinophilic esophagitis

Objective

To systematically evaluate the diagnosis of eosinophilic esophagitis (EE).

Methods

A retrospective review of 657 patients seen at the EE center of a tertiary care children's hospital between 1994 and 2007 was performed. Charts were reviewed for the 144 patients who were also seen by the otolaryngology service.

Results

One hundred forty-four patients received 193 otolaryngology-related diagnoses. Eustachian tube dysfunction (27.5%) and sleep disordered breathing (24.9%) were the most common, followed by dysphagia (13.0%), rhinosinusitis/nasal congestion (9.3%) and airway stenosis (5.2%). Seventy-nine patients (54.9%) had a pre-existing diagnosis of EE at the time of their otolaryngology consultation. Twenty-one patients (14.6%) were referred to the gastroenterology service for evaluation for EE. Forty-four patients (30.5%) remained undiagnosed. Twenty-five of these patients presented with dysphagia, 16 of whom were not previously diagnosed with EE; only 4 of these 16 patients were referred for evaluation for EE. In one case, a child with moderate sized tonsils underwent adenotonsillectomy for dysphagia and failure to thrive; this patient was diagnosed with EE 1 month post-operatively.

Conclusions

Twenty percent of patients with EE may require care by an otolaryngologist for a myriad of complaints. Even experienced pediatric otolaryngologists may not recognize this condition. Otolaryngologists should consider EE in patients presenting with dysphagia. A careful gastroenterology review of symptoms may also allow otolaryngologists to identify EE in patients with allergy mediated nasal complaints, or laryngeal/airway disorders.     

Correction of the Glosso-Larynx and Resultant Positional Changes of the Hyoid Bone and Cranium

In ankyloglossia with deviation of the epiglottis and larynx (ADEL) the tongue is located forward and as a result the epiglottis is elevated and leans towards the mouth. The larynx is also raised and curves ventrally. Various symptoms have been observed as a result of this condition. Correction of the glosso-larynx (CGL) is the operation performed to treat ADEL. The CGL procedure and the results obtained with it are reported in this paper. In addition, we studied the following six parameters using head and neck X-rays before and after CGL (the changes in these parameters as a result of CGL are shown in parentheses): ( i ) the shortest vertical length between the hyoid bone and mandible (+10.3 mm); ( ii ) the vertical length between the hyoid bone and the tangent line of C2-4 (+4.6 mm); ( iii ) the shortest length between the hyoid bone and the chin (+2.9 mm); ( iv ) the angle between the hyoid bone and the tangent line of C2-4 (+3.3°); ( v ) the length of H-M, where H is the intersection of a tangent line of C2-4 and a vertical line from the hyoid bone and M is the intersection of a tangent line of C2-4 and the mandible (+7.4 mm); and ( vi ) the width of the narrowest part of the hypopharynx (+3.0 mm). The changes in all the measured parameters after CGL were significantly different ( p <0.05).     

Autoimmunity in Sudden Sensorineural Hearing Loss: Possible Role of Anti-endothelial Cell Autoantibodies

In order to verify whether anti-endothelial cell autoantibodies (AECAs) can be used as serological markers of inner ear vasculitis in sudden sensorineural hearing loss (SSHL), 32 patients affected by idiopathic SSHL were investigated. All patients underwent a routine general physical examination and extensive audiovestibular, microbiological and immunological investigations. Fourteen normal subjects without a history of HL, autoimmune or metabolic disease served as controls. Detection of AECAs was performed using an indirect immunofluorescence technique. AECA-positive patients were treated with methylprednisone, while AECA-negative patients were treated with a combined regimen of steroids, plasma expander and aspirin. The average hearing recovery for 5 frequencies (0.25-4 kHz) was analyzed in each subject 1 month after treatment and every 3 months thereafter; median follow-up was 12 months (range 9-18 months). A total of 15/32 patients (46.8%; 11/19 females, 4/13 males) were AECA-positive and thus differed significantly from the normal population in whom only 2/14 tested cases were positive ( p =0.03). Severe hearing loss was associated with being AECA-positive in 8/11 cases. During follow-up, 25/32 patients improved their hearing and 17 of these patients were AECA-negative. The seven cases without hearing improvement were all AECA-positive. In patients with SSHL, immune-mediated vascular damage may have a pathogenetic role and AECAs may represent a serological marker of vasculitis even if they are not inner ear-specific and even if they represent an epi-phenomenon rather than the only cause of SSHL.     

Carcinoma of the Nasopharynx: Analysis of Treatment Results in 91 Patients

The outcome of 91 patients (69 males, 22 females; age range 16-82 years) with nasopharyngeal carcinoma treated in our hospital between 1971 and 1999 was evaluated. Factors that appeared to influence prognosis were assessed using the Kaplan -Meier method. The cause-specific cumulative 5-year survival rate for the entire study population was 61.2%. The 1997 International Union Against Cancer classification was used for disease staging. The 5-year survival rates were as follows: 66.7% ( n ¾ 3) for Stage I; 100% ( n ¾ 2) for Stage IIA; 90.9% ( n ¾ 11) for Stage IIB; 78.8% ( n ¾ 25) for Stage III; 53.0% ( n ¾ 29) for Stage IVA; 37.5% ( n ¾ 16) for Stage IVB; and 20.0% ( n ¾ 5) for Stage IVC. The disease-free cumulative 3-year survival rates of the patients classified based on initial therapy were as follows: radiation alone, 50.0% ( n ¾ 28); combined radiotherapy and chemotherapy that included an undefined anti-cancer drug, 67.2% ( n ¾ 39); combined radiotherapy and chemotherapy that included carboplatin (CBDCA), 92.3% ( n ¾ 19). These results showed a statistically significant difference ( p ¾ 0.043; log-rank test). Stage IVC patients were excluded from the analysis. We conclude that combined therapy, including chemotherapy with CBDCA, is necessary for the treatment of nasopharyngeal carcinoma. In terms of radiation therapy, a field covering the bilateral cervical regions seemed to produce favorable results, even if cervical node metastasis was not confirmed by palpation at the first hospital visit.     

Treatment Effects in Patients with Squamous Cell Carcinoma of the Oral Cavity

A total of 221 patients (155 males, 66 females; stage I, n ¾ 55; stage II, n ¾ 58; stage III, n ¾ 57; stage IV, n ¾ 51) with squamous cell carcinoma of the oral cavity were studied. Tumor localization was as follows: cancer of the tongue, n ¾ 161; cancer of the oral floor, n =28; cancer of the hard palate, n ¾ 12; cancer of the buccal mucosa, n ¾ 11; and cancer of the gingiva, n ¾ 9. In order to compare the effect of different treatments, three major treatment groups were defined, namely a surgery group, a radiotherapy group and a combination treatment group. Five-year cumulative survival rates showed significant differences between stage classifications (stage I=91%, stage II=73%, stage III=63%, stage IV=47%; p <0.01) but not between tumor sites. The 5-year cumulative survival rate was highest for oral floor cancer (80%). In the early-cancer group, the 5-year cumulative survival rate for the surgery group (92%) was significantly higher ( p <0.05) than those for both the radiation (69%) and combination (71%) groups. In the advanced-cancer group, the 5-year cumulative survival rate for the surgery group (74%) was significantly higher ( p <0.05) than those for both the radiation (37%) and combination (51%) groups. No significant difference in regional control rates was observed between the treatment groups. Five-year regional control rates were 86% for cervical untreated patients with T1N0 tumors and 60% for cervical untreated patients with T2N0 tumors. Fourteen N0 cases were treated with neck dissection. Cervical metastasis was found pathologically in 2/14 (14%) of these cases. The 5-year survival rate for patients with cervical recurrences after primary tumor resection was 70% ( n ¾ 15). In contrast, the 5-year survival rate for patients with both primary tumor resection and neck dissection was 74% ( n ¾ 14) but no significant difference was observed between these 2 groups.rate .     

One‐stop neck lump clinic: phase 2 of audit. How are we doing?

One‐stop neck lump clinic: phase 2 of audit. How are we doing? Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one‐stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral.