Retropharyngeal lymph node metastases in head and neck malignancies

Retropharyngeal lymph node (RPLN) metastasis of primary head and neck cancer often receives less consideration than lymph node metastasis in the neck. With improvements in imaging techniques and reports of surgical pathology, there is an improved understanding of the risk and subsequently the need for treatment of RPLNs. The rates of RPLN metastasis from carcinomas of the nasopharynx, oropharynx, hypopharynx, postcricoid region, maxillary sinus, and cervical esophagus are sufficiently high to warrant routine treatment, either electively or therapeutically, of this region. Through improved diagnostic techniques and heightened awareness of RPLN metastasis, patients at risk of having these metastases can be treated more effectively. © 2010 Wiley Periodicals, Inc. Head Neck, 2010     

Central compartment dissection in laryngeal cancer

We report here a review of the literature intended to clarify the nomenclature and boundaries of the nodes in the “central compartment” of the neck, the frequency with which tumors from the different laryngeal sites metastasize to these nodes, and the indications for central compartment node dissection in the treatment of cancers of the larynx. From this review, we conclude that, until consensus is reached about grouping of the lymph nodes in this area, it is best to refer to these nodes by their anatomic location, ie, prelaryngeal, pretracheal, or paratracheal lymph nodes. It is also advisable to describe dissection of these nodes as selective neck dissection (SND) with an annotation about the specific lymph node groups removed. Metastases in prelaryngeal and paratracheal lymph nodes in patients with squamous cell carcinoma of the larynx are associated with increased tumor recurrence, more frequent metastases in lymph nodes of the lateral compartment of the neck, and decreased survival. If untreated, they may lead to the development of peristomal recurrence. Therefore, elective treatment of level VI nodes is recommended in patients with squamous cell carcinomas of the subglottic region, advanced glottis carcinomas with subglottic extension, and in certain advanced carcinomas of the supraglottic region. © 2010 Wiley Periodicals, Inc. Head Neck, 2011     

Characterization of the Withdrawal Phase in a Porcine Donation after the Cardiac Death Model

Transplantation of donation after cardiac death (DCD) livers has higher rates of organ failure and complications, specifically ischemic biliary injuries. Reported large animal DCD models all employ active means to halt circulation, contrary to human DCD protocol. We report a DCD porcine model in which the animal passively progresses to cardiac death, thereby more closely mimicking human DCD scenario. Sixteen Yorkshire pigs (10 females, 6 males, 30–45 kg) had a mean time of 26:19 min ± 14:14 from withdrawal of ventilatory support (WVS) to circulatory arrest and 44:38 min ± 16:37 from WVS to electrical standstill. Cessation of hepatic flow (HF) occurred well before electrical standstill (22:15 min ± 10:09), previously not described in human or animal DCD. Histologically comparing livers from our DCD model demonstrated a dramatic increase in hepatocyte vacuolization, disorganization of endoplasmic reticulum, formation of mitochondrial inclusions and apoptosis compared with control specimens. Subtle changes were also evident in biliary epithelial cells (BEC). This results in severe cellular changes before reperfusion. Early histologic evidence suggests that there is severe hepatocyte and biliary cell disruption in our DCD model. Further research using this model may provide a deeper understanding of the pathophysiology of the DCD liver.     

胆囊癌不同手术方式的疗效分析

目的 探讨胆囊癌不同手术方式的疗效.方法 回顾性分析2000年1月至2009年10月四川大学华西医院收治的81例胆囊癌患者的临床资料,分析胆囊癌患者采用不同治疗方式的疗效,肿瘤不同浸润深度与淋巴结转移的关系.采用Kaplan-Meier法进行生存分析,生存率比较采用Log-rank法.结果 Ⅰ、Ⅱ、Ⅲ、Ⅳ期胆囊癌患者中...     

无创呼吸机在抢救急性左心衰中的临床分析

目的探讨无创呼吸机在抢救急性左心衰中的临床疗效。方法分析我科80例急性左心衰患者,分成研究组和对照组各40例。研究组在常规利尿、强心等药物基础上联用无创呼吸机正压加压通气治疗,对照组仅常规治疗。同时测定两组pH、PaO2、SaO2、PaCO2,血气分析结果,观察血压、心率、呼吸频率的变化及临床转归并进行统计学分析。结果研究组总有效率为85．00％;心率、呼吸频率、血压与治疗前比较显著降低（P〈0．05）;PaO2,SaO2与治疗前比较显著增高（P〈0．01）,对照组总有效率为50．00％,两组比较有显著性差异（P〈0．01）。结论呼吸机正压通气对于急性左心衰的抢救治疗及愈后效果显著,值得推广。     

A critical appraisal of the premotor symptoms of Parkinson's disease: Potential usefulness in early diagnosis and design of neuroprotective trials

The neurodegenerative process is well established in Parkinson patients presenting to a physician with early motor signs. There is increasing evidence that a variety of nonmotor features can antedate the typical presentation by many years. As the search for successful disease‐modifying treatment advances, it is logical to consider how this could be applied to patients in the earliest stages of the disease, indeed before motor features develop, with the obvious goal of delaying and even preventing the onset of the motor syndrome. However, many of these nonmotor symptoms are rather nonspecific and are not uncommon in the general population. Being able to identify individuals in whom these features are more likely to represent true premotor Parkinson's disease represents a major challenge. Until widely applicable and reliable biomarkers for the presence of Parkinson's disease‐related pathology are developed (including biomarkers of disease severity and rate of progression), further evaluation of possible premotor features in selected populations will probably serve as the basis for future studies of disease‐modifying therapies. This article will review the current status of premotor symptoms of Parkinson's disease and discuss their potential for early diagnosis and the design of neuroprotective trials. © 2011 Movement Disorder Society     

磁共振弥散成像在鼻咽癌颈部淋巴结转移调强放射治疗中的应用

目的 探讨磁共振弥散成像(DWI)及表观弥散系数(ADC)在鼻咽癌颈部淋巴结转移调强放射治疗(intensity modulated radiation therapy,IMRT)前的诊断及其对放化疗反应的监测能力.方法 对18例病理确诊的鼻咽癌患者在治疗前、治疗中每周及治疗后1个月行DWI检查.所有患者均接受头颈部IMRT及铂类同步化疗.在DWI上共分析了52枚颈部异常淋巴结,将其分为最短径≥10 mm(32枚)及<10 mm(20枚)两组,测量比较治疗前两组的ADC值是否存在差异,观察所有淋巴结治疗过程中ADC值的动态变化,同时观察比较治疗后残存的颈部淋巴结与正常舌肌的ADC值.结果 最短径≥10 mm淋巴结的平均ADC值为(0.71±0.12)×10-3mm/s,与最短径<10 mm者的平均ADC值[(0.73±0.16)×10-3mm/s]差异无统计学意义(t=1.11,P=0.27).治疗前52枚淋巴结的平均ADC值明显低于正常舌肌(t=19.35,P＜0.01).治疗过程中ADC值逐渐上升,以第1、2周改变最明显,以后趋于平稳.治疗后残留淋巴结的ADC值明显增大,与治疗前比较差异有统计学意义(t=12.72,P＜0.01),与正常舌肌比较差异无统计学意义(t=0.34,P=0.73).结论 在鼻咽癌IMRT中,DWI对诊断颈部转移性淋巴结以及监测后者对放化疗的反应具有重要参考价值,从而帮助临床医生合理制定并及时更改放疗计划.

Abstract：

Objective To investigate the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficients (ADC) in detecting metastatic lymph nodes from nasopharyngeal carcinoma (NPC),and predicting the response of these nodes to concurrent chemoradiation (CRT).Methods Eighteen patients with pathologically proven NPC received conventional magnetic resonance imaging (MRI) and DWI before treatment,weekly during treatment,and one month after treatment.DWI was performed using a single-shot echo-planar (SSEPI) MR imaging sequence with b values of 0 and 1500 s/mm2.ADC maps were reconstructed for all patients and ADC values were calculated for each lymph node and tongue muscle.Totally fifty-two morphologically abnormal lymph nodes were analyzed.The ADC values of the metastatic lymph nodes before treatment were compared between those with the short axis≥10 mm (n=32) and those with the short axis<10 mm (n=20),and the dynamic changes in ADC values of the lymph nodes before,during,and after therapy were observed and recorded.Results The average ADC of the 32 lymph nodes with the short axis ≥ 10 mm was (0.71±0.12) x 10-3mm/s,not significantly different from that of the 20 lymph nodes with the short axis < 10 mm [(0.73±0.16) x 10-3mm/s,t = 1.11 ,P =0.27].The average ADC values of these lymph nodes before treatment was significantly lower than that of the tongue muscle (t = 19.35,P < 0.0001).During CRT,the ADC values of the lymph nodes increased gradually,with the most evident change in the first two weeks before reaching a relatively flat plateau thereafter.The ADC value of the residual lymph nodes after CRT was significantly higher than that before treatment (t = 12.72,P < 0.0001),however,not statistically significant different from that of the normal tongue muscle (t = 0.34,P = 0.73).Conclusions DWI plays an important role in diagnosing the metastatic lymph nodes from NPC and is feasible for observation of the early response of the lymph nodes to IMRT,thus helping the clinicians make appropriate treatment planning and replanning in the course of radiotherapy.     

A measurement setup for direct 17O MRI at 7 T

An efficient breathing system was designed for direct ¹⁷O MRI to perform oxygen metabolism studies of the human brain. The breathing system consists of a demand oxygen delivery device for ¹⁷O₂ supply and a custom‐built re‐breathing circuit with pneumatic switching valve. To efficiently deliver the ¹⁷O gas to the alveoli of the lungs, the system applies short gas pulses upon an inspiration trigger via a nasal cannula. During and after ¹⁷O₂ administration, the exhaled gas volumes are stored and filtered in the re‐breathing section to make the most efficient use of the rare ¹⁷O gas. In an inhalation experiment, 2.2 ± 0.1 L of 70%‐enriched ¹⁷O₂ were administered to a healthy volunteer and direct ¹⁷O MRI was performed for a total imaging time of 38 min with a temporal resolution of 50 s per 3D data set. Mapping of the maximum signal increase was carried out showing regional variations of oxygen concentration of up to 30% over the natural abundance of ¹⁷O water. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

Dietary supplements and medications in elite sport – polypharmacy or real need?

The aim of this study was to describe qualitatively and quantitatively dietary supplements (DS) and medication use in elite athletes. Athletes (n=912; age 23.9±6 years; 72% male) reported medications and DSs taken within 3 days before doping control. We analyzed data collected from 2006 to 2008, indentified and classified substances. Total of 74.6% athletes reported use of at least one substance, 61.2% took DS (3.17 per user) and 40.6% took medications. Among users, 21.2% reported the use of six and more different products, and one took 17 different products at the same time. Majority of medication users took non‐steroidal anti‐inflammatory drugs (NSAID) (24.7%), and 22.2% used more than one NSAID. We found no gender differences in DS use (P=0.83). Individual sport athletes used more DS (P<0.01). Our study showed widespread use of DS and drugs by elite athletes. Consumption of DS with no evident performance or health benefits, demonstrated the need for specific educational programs focused on DS use. Amount, quantity and combination of the reported products raised concern about the risk of potential side effects.