Three-dimensional finite element analysis on splint fixation for treating ulnar styloid process fracture / 中国组织工程研究

BACKGROUND: Distal radius fractures are often accompanied by the ulna styloid process fractures, and the treatment of the ulna styloid process fracture is disputed in clinic. Manipulative reduction and splint fixation is a common method to treat such diseases. The mechanism of intervention on ulnar styloid process is difficult to obtain in the corpse mechanics experiments. In recent years, the finite element analysis method has been widely used in the field of orthopedics, which has opened up a way for the study of orthopedic disease. OBJECTIVE: To explore the biomechanical mechanism of splint intervention on ulnar styloid fracture by finite element analysis, and to provide the basis for clinical treatment choice. METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. The validity of the model was verified by comparing with the experimental data in the literature. On this basis, four wrist joint finite element models with and without splint fixation for ulnar styloid type I and type II fractures were established. Under axial compression, lateral extension, pronation and supination working conditions, the changes of the relative displacement of the distal radioulnar joint and the ulnar styloid fracture broken end were analyzed. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of normal wrist joint was established and validated, and the other four models were established based on this model. (2) In pronation and supination conditions, the relative displacement values of the ulnar and radial joints in the ulnar styloid type I and II fracture models were greater than those in the normal wrist joint model, and the displacement was smaller in the type I fracture model than in the type II fracture model; the displacement was significantly reduced after the intervention on the two fracture models by the splint. (3) In the lateral tension, pronation and supination conditions, the displacement values of the ulnar styloid fracture end in the ulnar styloid type I fracture model were smaller than in the type II fracture model, and the displacement values were significantly reduced after the intervention by the splint. Under the remaining conditions, the change of the above values was not obvious. (4) In conclusion, the stability of distal radioulnar joint became worse after ulnar styloid fracture, and the stability of distal radioulnar joint after type I fracture was less than that after type II fracture. As an elastic fixation method, splint can increase the stability of the wrist ulnar column during the treatment.

Protective effect of reduced glutathione C60 derivative against hydrogen peroxide-induced apoptosis in HEK 293T cells / 华中科技大学学报（医学）（英德文版）

Hydrogen peroxide (H2O2) and free radicals cause oxidative stress, which induces cellular injuries, metabolic dysfunction, and even cell death in various clinical abnormalities. Fullerene (C60) is critical for scavenging oxygen free radicals originated from cell metabolism, and reduced glutathione (GSH) is another important endogenous antioxidant. In this study, a novel water-soluble reduced glutathione fullerene derivative (C60-GSH) was successfully synthesized, and its beneficial roles in protecting against H2O2-induced oxidative stress and apoptosis in cultured HEK 293T cells were investigated. Fourier Transform infrared spectroscopy and (1)H nuclear magnetic resonance were used to confirm the chemical structure of C60-GSH. Our results demonstrated that C60-GSH prevented the reactive oxygen species (ROS)-mediated cell damage. Additionally, C60-GSH pretreatment significantly attenuated H2O2-induced superoxide dismutase (SOD) consumption and malondialdehyde (MDA) elevation. Furthermore, C60-GSH inhibited intracellular calcium mobilization, and subsequent cell apoptosis via bcl-2/bax-caspase-3 signaling pathway induced by H2O2 stimulation in HEK 293T cells. Importantly, these protective effects of C60-GSH were superior to those of GSH. In conclusion, these results suggested that C60-GSH has potential to protect against H2O2-induced cell apoptosis by scavenging free radicals and maintaining intracellular calcium homeostasis without evident toxicity.

Influence of peritoneal transport characteristics on nutritional status and clinical outcome in Chinese diabetic nephropathy patients on peritoneal dialysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>High peritoneal transport status was previously thought to be a poor prognostic factor in peritoneal dialysis (PD) patients. However, its effect on diabetic nephropathy PD patients is unclear in consideration of the adverse impact of diabetes itself. The purpose of this study was to investigate the influence of peritoneal transport characteristics on nutritional status and clinical outcome in diabetic nephropathy patients on PD.</p><p><b>METHODS</b>One hundred and two diabetic nephropathy patients on PD were enrolled in this observational cohort study. According to the initial peritoneal equilibration test result, patients were divided into two groups: Higher transport group (HT, including high and high average transport) and lower transport group (LT, including low and low-average transport). Demographic characteristics, biochemical data, dialysis adequacy, and nutritional status were evaluated. Clinical outcomes were compared. Risk factors for death-censored technique failure and mortality were analyzed.</p><p><b>RESULTS</b>Compared with LT group (n = 37), serum albumin was significantly lower and the incidence of malnutrition by subjective global assessment was significantly higher in HT group (n = 65) (P < 0.05). Kaplan-Meier analyses showed that death-censored technique failure and mortality were significantly increased in HT group compared with that in LT group. On multivariate Cox analyses, higher peritoneal transport status and lower residual renal function (RRF) were independent predictors of death-censored technique failure when adjusted for serum albumin and total weekly urea clearance (Kt/V). Independent predictors of mortality were advanced age, anemia, hypoalbuminemia, and lower RRF, but not higher peritoneal transport status.</p><p><b>CONCLUSIONS</b>Higher peritoneal transport status has an adverse influence on nutrition for diabetic nephropathy patients on PD. Higher peritoneal transport status is a significant independent risk factor for death-censored technique failure, but not for mortality in diabetic nephropathy patients on PD.</p>

Chemical constituents from Perovskia atriplicifolia / 中国中药杂志

An investigation on the chemical constituents of the 90% EtOH extract of Perovskia atriplicifolia led to the isolation of fifteen compounds from the EtOAc fraction. Based on the detailed spectral analysis (MS, 1D and 2D NMR), as well as comparison with the literatures, the structures of compounds 1-15 were determined as cirsimaritin (1), salvigenin (2), syringaldehyde (3), vinyl caffeate (4), 2α, 3α-dihydroxyolean-12-en-28-oicacid (5), 2α, 3α-dihydroxyurs-12-en-28-oicacid (6), niga-ichigoside F1 (2α, 3β, 19α, 23- tetrahydroxyurs - 12-en-28-oicacid- O-β-D- glucopyranoside, 7), sericoside (8), 4-epi-niga-ichigoside F1 (2α, 3β, 19α, 24-tetrahydroxyurs-12-en-28-oicacid O-β-D-glucopyranoside, 9), 2α, 3β, 24-trihydroxyolean-12-en-28-oicacid O-β-D-glucopyranosyl-(1 --> 2) - β-D-glucopyranoside (10), pruvuloside A (11), asteryunnanoside A [2α, 3β, 23-trihydroxyolean-12-en-28-oicacid O-β-D-glucopyranosyl-(1 --> 2)-β- D- glucopyranoside,12], rosmarinic acid methyl ester (13), β-sitosterol (14), and daucosterol (15), respectively. Compounds 1-13 were isolated from the Perovskia genus for the first time. All the compounds were obtained from P. atriplicifolia for the first time.

Regeneration and functional recovery of rabbit knee joint after osteotomy under control of external artificial joint / 医用生物力学

Objective To discuss the possibility for regeneration of knee joint with normal function under bionics biomechanical environment. Methods Seven normal rabbits with two metal frames respectively mounted on their femur and tibia of single (right) side leg by two threading pins of 1.5 mm diameter were used. Then the external artificial joints, containing two four-bar-linkage inside and outside of the knee to simulate motion trajectory of the joint in sagital plane were connected with the two preset fixed frames before osteotomy. The arthro-cartilage of the knee joint, crucial ligaments, semi-lunar fibro-cartilages, and partial under-cartilage-osseous intra articular capsule were cut off during osteotomy, with the patella, sesamoid bones remained intact. Insertion sites of muscle tendons were not invaded as far as possible, and capsules with ligaments outside were kept complete when the incision wound was closed by suture. The rabbits could move freely after osteotomy. The range of motion (ROM) of the knees in sagital plane and bony gap between the femur and tibia were measured by X-Ray films during the fracture healing after osteotomy. Results External artificial knee joints were successfully installed on right legs of 6 rabbits among the seven. The rabbits moved freely after osteotomy under the control of minimal invasive external artificial joint in bionics trajectory. The average angles between femoral shaft and tibial shaft at the 1st week after osteotomy were from (144.7±15.62)° in extremely flexed position to (44.2±25.77)° in extremely extended position, with ROM of (100.5±29.03)°. At the 12th week, the average angles were from (139.4 ± 12.92)° in extremely flexed position to (40.4±22.04)° in extremely extended position, with ROM of (99.0±23.39)°. No significant differences were displayed in flexed/extended position and ROM between the 1st and 12th week, with the bony gaps of the knees still existed but decreased significantly from (4.03±1.84) mm at the 1st week to (2.32±1.05) mm at the 12th week. In contrast, bony gaps of the opposite knees were not changed significantly, which were (1.27±0.22) mm on average. At the end of 16th week after osteotomy, the external artificial joints were removed. Newly born cartilage, with white color and smooth surface, were covered at lower end of the femur and upper end of the tibia. Typical trochlear surface appeared at the front side of regenerated cartilage corresponding to the posterior surface of the patella. And the regenerated fibro-bundle linkage similar with ligament, which started from bony structure of regenerated lower end of the femur and inserted into regenerated upper end of the tibia, was observed in each rabbit. At the 25th week, the average angles between femoral shaft and tibial shaft were from (148.3 ± 4.75)° in extremely flexed position to (48.30±17.57)° in extremely extended position, with ROM of (100.0±20.80)°. In the opposite (left) leg, the average angles between femoral shaft and tibial shaft were from (148.3±7.5)° in extremely flexed position to (21.6±9.09)° in extremely extended position, with ROM of (126.7±6.88)°, and the average bony gap of the knees after osteotomy was (1.4±0.59) mm, while that of the opposite (left) knees was (0.92±0.35) mm. Conclusions The external artificial joint with bionics trajectory could reserve the space for regeneration of rabbit knee joint by providing motion modeling environment, and proved the stress adaption during fracture healing. The present results indicated that regeneration of the knee joint after intra-capsular osteotomy in bionics biomechanical environment was possible.

The study of expression of BRMS1 gene protein and the expression of BRMS1 gene promotor area methylation in supraglottic laryngeal carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) gene protein and the expression of BRMS1 gene promotor area methylation in supraglottic cancer and to evaluate its clinical significance.@*METHOD@#The expression of BRMS1 protein and BRMS1 gene promotor area methylation were examined by using Western blotting method and methylation-specific polymerase chain reaction(MSP) method in 70 cases of supraglottic cancer tissues and 60 cases of their surrounding laryngeal normal mucosa tissues (LNT) and 44 cases of cervical lymph node metastasis of supraglottic cancer.@*RESULT@#Western blot results indicate that BRMS1 protein expression is declined expression level in supraglottic cancer tissue than the expression of BRMS1 protein in LNT of supraglottic cancer. Compared with para carcinoma normal laryngeal mucous tissue, BRMS1 gene protein in supraglottic cancer tissue primary lesion decreased obviously, and it is decreased more obviously in cervical lymph node metastasis lesion, the discrepancy is notable (P < 0.05). MSP results indicate BRMS1 gene promotor methylation is coordinated with its down-expression in supraglottic cancer tissue. BRMS1 promotor area methylation analysis reveal that there were 34 patients with methylation in 70 patients' supraglottic cancer tumor primary lesion, hold 48.6% (34/70); 32 patients have methylation in 44 patients' cervical metastasis lymph node tissue, hold 72.7% (32/44); however, there is no methylation in 60 para carcinoma tissue (r(s) = 0.66, P < 0.05).@*CONCLUSION@#The expression of BRMS1 protein in supraglottic cancer is significantly decreased. It had correlation with clinical stage and pathologic differentiation and cervical lymph node metastasis of supraglottic cancer. BRMS1 gene promotor methylation is related with down-expression of BRMS1 gene protein of supraglottic cancer. Maybe BRMS1 gene promotor methylation is one of the reasons of its down-expression.

A case control study on the treatment of unstable distal radius fractures with internal and external fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of diaplastic external fixator on the treatment of unstable fractures of distal radius.</p><p><b>METHODS</b>A clinical data of 60 patients with unstable fractures of distal radius admitted to Wangjing Hospital from August 2005 to September 2009 were retrospectively analyzed with the paired design. According to the paired design, 60 patients were equally divided into two groups (internal fixation group and external fixation group), which were respectively treated with open reduction and steel plate internal fixation (internal fixation group) or closed reduction and external fixation (external fixation group), including 8 males and 52 females, with an average age of 60.27 years ranging from 34 to 85 years. Left side was in 33 cases and right side was in 27 cases. All fractures were closed and caused by hand supporting when falling down. According to AO classification, type A3 was in 22 cases, type B2 was in 4 cases, type B3 was in 2 cases, type C1 was in 20 cases, type C2 was in 8 cases, type C3 was in 4 cases. Palmar flexion, dorsiflexion, radial deviation, ulnar deviation, pronation, supination, grip strength, radial angle, radial length, volar tilt were observed before and after operation.</p><p><b>RESULTS</b>All the patients were followed up from 12 to 18 months with an average of 15.4 months. The radial length was (4.85 +/- 2.75) mm,volar tilt (14.66 +/- 10.77) degrees, radial angle (7.90 +/- 4.70) degrees in the external fixation group,while those were (4.29 +/- 1.53) mm, (14.39 +/- 5.01) degrees, (6.19 +/- 3.15) degrees in the internal fixation group, but with no statistical significance (P>0.05). Function comparison of internal and external fixation group, P-value of every function is more than 0.05 or equal to 0.05, with no statistical significance except for supination and radial deviation. The functions of wrist joints were evaluated according to Batra scoring system at 1 year after operation. The average radiological scores of external fixation group was 86.27,in which 15 cases were excellent, 11 good, 1 fair,3 poor,while the average functional scores was 94.93, and all the cases were excellent. The average radiological scores of internal fixation group was 91.27, 16 cases were excellent, 12 good, 2 fair, while the average functional scores was 94.23, in which all the cases were excellent.</p><p><b>CONCLUSION</b>Compared with the open reduction and steel plate fixation, the unstable fractures of distal radius treating by diaplastic external fixator can be achieved a similar result, with no statistical significance.</p>

Gait instability in patients with small acoustic neuroma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Small acoustic neuromas seldom result in typical vestibular symptoms, despite the tumor arising from the vestibular nerve. In this study, we have shown that abnormal gait in eleven patients with small acoustic neuroma could be detected in gait analysis by the use of tactile sensor. Patients displayed no oculomotor abnormality and had tumors less than 10 mm from the porus acoustics.</p><p><b>METHODS</b>Gait related parameters including the coefficients of variations (CV) of stance, swing, double support, area ratio of trajectories of center of force (TCOF), in addition to the foot pressure difference between both feet, were used for assessment of gait.</p><p><b>RESULTS</b>The CV of swing and the area ratio of TCOF were greater in patients than those in the control group (P < 0.05). The values of these two parameters became greater under an eyes closed condition compared to eyes open (P < 0.05) in the patient group.</p><p><b>CONCLUSION</b>These results indicate that gait analysis may be helpful to assess vestibulospinal function of patients with small acoustic neuroma, the slight vestibular deficits of which can not be detected by visual observation.</p>

Detect myelin structure in acoustic tumor / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#By detecting the myelin structure in acoustic tumor tissues, the cell origin and state of acoustic tumor tissues were investigated.@*METHOD@#Immunofluorescence labeling, immunoblot analysis and electron microscopic study were performed to identify myelin structure and myelin protein in acoustic tumor tissues.@*RESULT@#In this work, we found some early stage of myelin forming in acoustic tumor tissues, but there were no axon nor compact myelin formed and the myelin basic protein whose expression indicates the beginning of myelination was negative detected. We also found that the cell of acoustic tumor express p75,a marker for immature Schwann cells and mature non-myelin-forming Schwann cells.@*CONCLUSION@#The date shown in this experiment indicates that the cell of acoustic tumor is in a remyelinating state.

The relationship between different types of lymph node metastasis and contralateral neck metastasis and their impact on prognosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the relationship between different types of lymph node metastasis and contralateral neck metastasis and their impacts on prognosis.@*METHOD@#Two hundred and forty-eight patients with supraglottic carcinomas and complete follow-up were analyzed retrospectively. Transparent lymph node detection and continuous sectioning methods were applied on postoperative neck specimens.@*RESULT@#Cervical lymph node metastases were found in 115 patients and the lymph node metastatic rate was 46.4%. There were three types of lymph node metastases, 39 cases with single type, 34 with multiple type, 42 with fusion type. Contralateral metastatic rates were 5.1%, 44.1% and 61.9% in single, multiple and fusion type respectively. Contralateral metastasis was also related with tumor extension across midline and clinical N stages. The 3- and 5-year survival rates were 79.5% and 74.4% in single type, 61.8% and 41.2% in multiple type, 61.9% and 35.7% in fusion type.@*CONCLUSION@#Bilateral neck dissections should be undertaken in multiple and fusion types of lymph node metastasis. The lymph node metastatic type should be an important criteria to judge prognosis.

Long-term follow-up study of 559 cases with laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the long-term follow-up result of partial laryngectomy and reservation of laryngeal function.</p><p><b>METHODS</b>Five hundred and fifty-nine patients who underwent partial laryngectomy from 1996 to 2002 were summarized (male 435 cases, female 124 cases). Among them, 200 cases were supraglottic carcinomas (classified accordingly by UICC standard of years 2002 into: 15 cases of I, 81 cases of II, 72 cases of III, and 32 cases of IV), 354 cases were glottic carcinomas (141 cases of I, 124 cases of II, 88 cases of III, and 1 cases of IV), 5 cases were transglottic carcinomas (2 cases of II and 3 cases of III). In common 7 kinds of operations were performed: 66 cases underwent cordectomy, 119 vertical laryngectomy, 62 horizontal supraglottic laryngectomy, 113 horizontovertical (3/4) laryngectomy, 88 subtotal laryngectomy with cricoglossoepiglottic anastomosis, 26 near total laryngectomy with cricoglossal anastomosis (with reservation of unilateral arytenoid cartilage), 85 laser laryngectomy. Two hundred and sixty-one cases underwent concurrent neck dissection (174 unilateral, 87 bilateral). Safety margin of less than or equal to 5 mm was suspected of having residual lymph node metastasis, the postoperative radiation therapy to treatment.</p><p><b>RESULTS</b>All cases restored their phonation and overcame aspiration with removing nasal feeding from 7 to 24 days after operations. Four hundred and sixty-six cases were decannulated from 9 days to 3 months after operations. Decannulation rate was 98.3%. Through periodic review of out-patient clinics or telephone follow-up, family members follow-up a variety of ways, three, five or ten years follow-up rate: 99.6% (557/559), 98.2% (549/559), 95.8% (183/191), dollars lost to death. The three years survival rates were 89.6% (501/559). Among them, the survival rates for supraglottic carcinoma patients of stage I and II was 90.6%, stage III and IV 81.7%, for glottic carcinoma patient of stage I and II was 95.2%, stage III and IV 82.4%. The five years survival rates were 75.0% (419/559). Among them, the survival rates for supraglottic carcinoma patients of stage I and II was 75.0%, stage III and IV 62.5%, for glottic carcinoma patient of stage I and II was 81.8%, stage III and IV 70.6%. The ten year survival rates were 71.2% (136/191). Among them, the survival rates for supraglottic carcinoma patients of stage I and II was 69.7%, stage III and IV 65.2%, for glottic carcinoma patient of stage I and II was 77.6%, stage III and IV 72.1%.</p><p><b>CONCLUSIONS</b>Partial laryngectomy is a kind of radical operation with reservation of laryngeal function. Qualities of life and curative effect, were greatly improved.</p>

Expression of gene BRMS1 and CD44v6 protein in supraglottic laryngeal carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) and CD44v6 protein in supraglottic cancer and to evaluate its clinical significance.@*METHOD@#The expression of BRMS1 protein and CD44v6 protein were examined by using immunohistochemical method in 70 cases of paraffin-embedded supraglottic cancer tissues and their surrounding laryngeal normal mucosa tissues (LNT).@*RESULT@#The expression of BRMS1 protein in LNT of supraglottic cancer was positive, and the positive rate was 85.7% (60/70); in tumor tissue was negative or lower expression, and the positive rate was 35.7% (25/70). The expression of CD44v6 protein in tumor tissue of supraglottic cancer was positive, the positive rate was 82.9% (58/70), in LNT was negative. There was a significant difference in BRMS1 and CD44v6 protein expression between the supraglottic cancer tissue and LNT (P0.05). The expression of BRMS1 protein was related to the expression of CD44v6 protein (r = -0.9042, P0.05), there is a significant survival difference at 3-year between the group with positive CD44v6 protein expression and the group with negative CD44v6 protein expression in tumor tissues (P<0.05).@*CONCLUSION@#The expression of BRMS1 protein in supraglottic cancer is significantly decreased and the expression of CD44v6 protein in supraglottic cancer is significantly increased. The expression of BRMS1 protein and CD44v6 protein has a close relationship with pathologic differentiation and clinical stage and cervical lymph node metastasis of supraglottic cancer. Combined detection of the expression of them in supraglottic cancer may provide a significant parameter to judge the cervical lymph node metastasis of supraglottic cancer.

Expression and clinical significance of breast cancer metastasis suppressor 1 mRNA in supraglottic laryngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of breast cancer metastasis suppressor 1 (BRMS1) mRNA in supraglottic cancer and to evaluate its clinical significance.@*METHOD@#The expression of BRMS1 mRNA was examined by using RT-PCR method which take beta-actin mRNA as reference template in 66 cases of supraglottic cancer tissues and their adjacent normal mucosa tissues (ANT).@*RESULT@#The expression of BRMS1 mRNA in the tissues of supraglottic cancer is lower significantly than that in the tissues of ANT ( P<0.05). There is correlation between BRMS1 mRNA expression and the clinical stage, differentiation and cervical lymph node metastasis in the laryngeal supraglottic cancers (P<0.05). There is no correlation between BRMS1 mRNA expression and sex and age.@*CONCLUSION@#Expression of BRMS1 mRNA in supraglottic cancer is lower than that in adjacent normal mucosa. The decrease of BRMS1 mRNA expression may be related to clinical stage and low differentiation and lymph node metastasis of supraglottic laryngeal cancer.

Clinico-pathological study of contralateral lymph node metastasis in pyriform sinus carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the related factors of contralateral lymph node metastasis in pyriform sinus carcinoma.@*METHOD@#Fifty-three patients with pyriform sinus carcinoma underwent simultaneous neck dissection from Oct. 1993 to Oct. 1999 were collected. Transparent lymph node selection and continuous slicing method were used on the postoperative specimens to observe the status of cervical lymph node metastasis. The relationship between contralateral lymph node metastasis and clinico-pathological factors, ipsilateral neck metastatic status were analyzed by the follow-up data.@*RESULT@#Cervical lymph node metastatic rate was 79.2% in 53 patients with pyriform sinus carcinoma. Contralateral cervical lymph node metastatic rate was 35.8%. Contralateral neck metastasis was closely related with clinical N stage, cell differentiation, fused metastasis and extracapsular spread of ipsilateral neck.@*CONCLUSION@#Contralateral neck dissection should be undertaken in patients with N2,3, moderate and low cell differentiation, or fused fused metastasis and extracapsular spread of ipsilateral neck.

A20 inhibits human salivary adenoid cystic carcinoma cells invasion via blocking nuclear factor-kappaB activation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A20, also known as tumor necrosis factor alpha induced protein 3 (TNFaip3), is a cytoplasmic zinc finger protein that inhibits nuclear factor kappa-B (NF-kappaB) activity and prevents tumor necrosis factor (TNF)-mediated programmed cell death. NF-kappaB is a transcription factor that regulates expression of genes involved in cell proliferation, cell survival and anti-apoptosis. Several studies have implicated that the NF-kappaB signal pathway is associated with angiogenesis and clinico-pathological process of adenoid cystic carcinoma (ACC) of the salivary glands.</p><p><b>METHODS</b>The ability of overexpression of A20 to influence the biological behavior and invasion of ACC cells was examined. The cells were stably transfected with full-length A20 cDNA. Stable gene transfer was verified by realtime-polymerase chain reaction (PCR) and Western blot analysis. The change of cell biological behavior was examined by methyl thiazolyl tetrazolium (MTT) and NF-kappaB luciferase reporter assay and the invasion of the cells was examined by a Matrigel invasion chamber.</p><p><b>RESULTS</b>pEGPFN3-A20 gene was stably transferred into ACC-2 cells and overexpressed. When cells were treated with TNFalpha, the NF-kappaB activity of ACC-2-A20 cells could be down-regulated about 46.32% in contrast to ACC-2-GFP cells (P < 0.05). A20 potently inhibited growth of A20 transfectant ACC-2-A20 compared with control vector transfected groups and the ACC-2 empty control group (P < 0.05). The ACC-2-A20 cells showed significantly reduced ability to invade through Matrigei-coated filters compared to ACC-2-GFP and ACC-2 cells. The inhibition rate was up to 71.05% (P < 0.05).</p><p><b>CONCLUSIONS</b>A20 gene transfer is associated with decreased tumor invasion, in part via the down-regulation of NF-kappaB expression, providing evidence for a potential application of A20 in designing a treatment modality for salivary gland cancers such as ACC.</p>

Extracapsular spread in ipsilateral neck metastasis: an important prognostic factor in laryngeal cancer / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the impact of extracapsular spread (ECS) in ipsilateral neck metastasis on prognosis and its related factors in laryngeal cancer.</p><p><b>METHODS</b>The study included 184 patients who underwent laryngectomy and simultaneous radical or modified radical neck dissection between January 1994 and December 1997 for laryngeal cancer. All of them had a complete 5-year follow-up. We used transparent lymph node detection and continuous slicing method on all neck dissection specimens. Kaplan-Meier model was used for survival analysis and the log-rank test was used to assess significance.</p><p><b>RESULTS</b>We found pathological neck metastases in 80 patients. Among them, 26 cases (32.5%) had ECS in ipsilateral neck. ECS incidence increased with advanced pathological N (pN) stages (pN1 3.7%, pN2a 25.0%, pN2b 50.0%, and pN2c 55.6%; P = 0.001). ECS incidence also increased with number of positive nodes (1 positive node 8.6%, 2 positive nodes 33.3%, 3 and more positive nodes 66.7%; P < 0.001). Incidences of contralateral neck metastases and ipsilateral neck recurrence in patients with ECS were higher than those in patients without ECS (46.2% vs. 24.1%, P = 0.046; 34.6% vs. 7.4%, P = 0.002). The 5-year survival rate of patients with ECS was significantly lower than that of patients without ECS (23.1% vs. 57.4%, P = 0.013).</p><p><b>CONCLUSION</b>ECS is an important prognostic factor in laryngeal cancer. Patients with ECS have a higher incidence of contralateral neck metastasis, so bilateral neck dissection should be selected.</p>

Prognostic factors identified by Cox multivariate analysis of surgically treated 1018 laryngeal cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the prognostic factors of 1018 patients with laryngeal cancer treated surgically.</p><p><b>METHODS</b>All patients were treated surgically for laryngeal cancer from 1984 to 1996. A total of 16 clinical factors was studied by univariate analysis and Cox multivariate model.</p><p><b>RESULTS</b>The follow-up rate was 93.5% over 5 years. The overall cumulative survival rate was 79.1% at 3 years, 70.2% at 5 years. The 5-year survival rate of T1N0 is the highest, followed by T1N+, T2N0, T3N0, T4N0, T2N+, T4N+, and T3N+. In univariate analysis, the survival was related to patient age, mobility of vocal cords, preoperative T status, preoperative N status, preoperative UICC stage, postoperative T status, postoperative N status, postoperative UICC stage, topographic location of the tumor and tumor size. In Cox multivariate modal, only postoperative N status, mobility of vocal cords and tumor size were independent prognostic factors.</p><p><b>CONCLUSION</b>Independent prognostic factors for patients with laryngeal cancer after curative resection are postoperative N stage, mobility of vocal cords as well as tumor size. Postoperative follow-up and salvage surgery in time should be attached with importance to improve the survival of patients with laryngeal cancer.</p>

Impact of extracapsular lymph node spread in the ipsilateral neck on contralateral neck metastasis and prognosis of laryngeal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the impact of extracapsular lymph node spread (ECS) in the ipsilateral neck on the contralateral neck metastasis and prognosis of laryngeal cancer.</p><p><b>METHODS</b>The data of 184 laryngeal cancer patients who underwent laryngectomy and simultaneous radical or modified radical neck lymph node dissection between Jan. 1994 and Dec. 1997 were retrospectively analyzed. Of these 184 patients, 144 underwent unilateral neck lymph node dissection and 40 bilateral; 159 had supraglottic lesion and 25 transglottic. All had squamous cell carcinoma. The clinical T stage was T1 in 3, T2 63, T3 77, T4 41; N stage: NO in 123, N1 38, N2a 5, N2b 11, N2c 7. Transparent lymph node detection and continuous sectioning method were applied to all dissected neck lymph nodes. Statistical analysis was carried out using SPSS software package ( version 11.5). Survival curves were calculated through the Kaplan-Meier model. Impact of extracapsular lymph node spread in the ipsilateral neck on prognosis was assessed using the Log rank test.</p><p><b>RESULTS</b>Of these 184 patients, neck lymph node metastasis was pathologically proven in 80, 26 had ECS in the ipsilateral neck with a ECS rate of 32.5% (26/80). The ECS incidence was positively correlated with advanced pathological N stage and metastatic lymph nodes (P < 0.01). The incidence of the contralateral neck metastasis and ipsilateral neck recurrence with ECS were higher than those without ECS, which was 46.2% versus 24.1%, and 34.6% versus 7.4%, respectively (P < 0.05). The 3- and 5-year survival rates of patients with ECS were significantly lower than those of patients without ECS, which was 53.9% versus 70.4%, and 23.1% versus 57.4%, respectively (P = 0.0125).</p><p><b>CONCLUSION</b>Extracapsular lymph node spread is found to be an important prognostic factor in the laryngeal cancer. Bilateral neck dissection may be mandatory due to patients with ECS have a higher incidence of contralateral neck metastasis. The capsule of metastatic lymph nodes should be pathologically checked and reported in order to determine the extra-capsular spread status.</p>

Frequency and prognosis of extracapsular spread in neck metastasis in supraglottic carcinomas / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the frequencyof extracapsular spread (ECS) in neck metastasis and its impact on prognosis in supraglottic carcinoma. METHODS A total of 177 patients with radical or modified neck dissection between Jan. 1994 and Dec. 1997 for supraglottic carcinoma were summarized. Transparent lymph node detection and a series of sectioning method were applied on all neck dissection specimens. The SPSS software package (version 11.5) was used to make statistical analysis. Survival curves were calculated with the Kaplan-Meier model. Impact of extracapsular spread on prognosis was assessed for significance with the Log-Rank test. RESULTS Eighty one patients were pathologically positive in neck specimens and the neck metastatic rate was 45.8 %. ECS was found in 32 cases and the ECS frequency was 39.5 % (32/81). The ECS was related with pathological N stage and the number of positive nodes. Patients with ECS had a higher possibility of regional recurrence and contralateral metastasis. The 5-year survival rates of patients with neck metastasis ECS- and patients with ECS+ were 61.9 % and 22.2 % respectively. The differences had statistically significance. CONCLUSION ECS in neck metastasis affects the prognosis in patients with supraglottic carcinoma. If bilateral neck dissection was not selected simultaneously, close follow-up on contralateral neck should be selected in patients with ECS because of a higher incidence of contralateral neck metastasis.

Missing diagnosis of neck metastases by routine detecting method in laryngeal carcinomas / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the missing diagnosis of neck metastases by routine detecting method (palpation combined with one pathological slide) in laryngeal carcinomas.</p><p><b>METHODS</b>Sixty-six specimens of neck dissections were collected and observed by routine method, transparent method, and continuous sliding method.</p><p><b>RESULTS</b>Totally, 1153 lymph nodes were detected by palpation method and another 1204 lymph nodes were detected by transparent method. The lymph nodes detected by transparent method account for 51.1% of the total, and among them 10 metastases were found, which account for 15.6% (10/64) of metastatic lymph nodes. For those with no metastasis detected by routine method, 50 microm interval continuous sliding method was performed, and 14 tiny metastases were found, which account for 21.9% (14/64) of metastatic lymph nodes. Detecting by routine method, most lymph nodes (95%) were in tumor growth and tumor suffusion stage. The missing diagnosis rate of routine method was 37.5% (24/64).</p><p><b>CONCLUSIONS</b>When routine method was used to detect lymph nodes in neck specimens, missing diagnosis should be considered to select best therapy. Through transparent method small lymph nodes could be found and it is a valuable method to observe pathological changes of small nodes. Continuous sliding method could find micrometastasis precisely, but the work burden is heavy and it is difficult to be widely used.</p>