Surgical treatment in 184 patients with supraglottic carcinoma at a single institute / 中华耳鼻咽喉头颈外科杂志

Objective@#To summarize clinical experience in surgical treatment of supraglottic carcinoma and reconstructive techniques.@*Methods@#Medical files of 184 patients (173 men, 11 women) were collected and retrospectively analyzed, who underwent surgeries between January 2008 and December 2012 at Qilu Hospital of Shandong University. Among them, T1, T2, T3 and T4 staging tumors accounted respectively for 14.1% (26/184), 41.9%(77/184), 31.5%(58/184) and 12.5%(23/184). Cervical metastasis was histologically identified in 86 cases (98 for N0, 31 for N1 and 55 for N2). Advanced cases (56 cases at stage Ⅲ and 67 at stage Ⅳ), early cases (22 at stage Ⅰ and 39 at stage Ⅱ) accounted respectively for 66.8% and 33.2%. Supraglottic horizontal laryngectomy or total laryngectomy was performed to allow for tumor excision without compromising margins and the tongue flap or sternohyoidmyofascial flap was subsequently used for repairing the defect after removal of tumor. Survival rates were analyzed by the Kaplan-Meier method.@*Results@#Patients receiving conservation laryngeal surgery accounted for 75.5% (139/184). The 3-year and 5-year survival rates for all cases were 84.2% and 70.7%, respectively. Log-rank test demonstrated that cervical lymph node metastasis, primary tumor staging and clinical TNM staging were significantly associated with prognoses of patients (P=0.003, 0.010, 0.035). Dysphagia was not observed in any case and speech function was maintained in petients with partial laryngectomy.@*Conclusion@#Adequate pre-operative evaluation, individualized treatment, and comprehensive application of flaps for repair are critical to precise tumor excision and reconstruction of laryngeal functions.

Comprehensive treatment of 335 patients with pyriform sinus carcinoma by surgery via the paraglottic space approach / 中华耳鼻咽喉头颈外科杂志

Objective@#To report the experience in comprehensive surgical treatment of pyriform sinus carcinoma via the paraglottic space approach.@*Methods@#Three hundred and thirty-five cases with pyriform sinus carcinoma (according to UICC 2012 criteria, stage Ⅰ, 12 cases; Ⅱ, 36; Ⅲ, 79; Ⅳ, 208; T1, 26; T2, 139; T3, 121; T4, 49; cN0, 83; cN1, 61; cN2a-b, 118; cN2c, 71; cN3, 2) treated between 2006 and 2013 were retrospectively reviewed. There were 323 males and 12 females. Age aged from 36 to 80 years old with a median of 60 years old. There was no case with distant metastasis. All patients received modified neck dissection, including unilateral in 240 patients and bilateral in 95 patients. Pharyngoesophageal defects were reconstructed with directly suture in 246 cases, pectoralis major musculocutaneous flaps in 74 cases, and laryngotracheal flaps in 15 cases. Three hundred and nineteen patients received postoperative radiotherapy (55-65 Gy).@*Results@#The overall 3 and 5 year survival rates were 68.6% (230/335) and 52.1%(139/267), respectively. The cervical lymph node metastases were found in 265 (79.1%) patients. Pathologic findings showed that all patients had squamous cell carcinoma. Laryngeal functions (voice, respiration and deglutition) were completely restored in 277 (82.7%) patients.@*Conclusions@#The oncological efficacy of surgery via the paraglottic space approach is sure for pyriform sinus carcinoma, especially suitable for the early and medium-term lesions. The function of the larynx can retain after surgery, with the decreased incidences of cough and pharynx fistula.

Challenges of microfluidic in vitro diagnosis technologies in clinical laboratory medicine / 中华检验医学杂志

From the view-point of a front-line research team in clinical laboratory medicine , the advantages of microfluidic technology and its prospect in the field of in vitro diagnosis ( IVD) were reviewed in this paper. This paper introduces the application of microfluidics in molecular diagnosis , immune detection and microbial pathogen testing , showing the value of this technology in meeting challenges posed by clinical laboratory medicine .Opportunities and challenges of microfluidic IVD technology under the new situation were also discussed.The authors believe this technology will play a great role in promoting the improvement of clinical laboratory technology .

Association of blood concentration of sodium valproate and anti-epileptic effect and influencing factors / 重庆医学

Objective To investigate the relationship between blood concentration of sodium valproate and the anti‐epileptic effect and the influencing factors of blood concentration of sodium valproate ,and to provide evidence for clinical individual adminis‐tration .Methods The blood concentrations of 133 cases of patients treated with sodium valproate were determined in the affiliated Yongchuan hospital of Chongqing medical university ,the monitoring results of blood concentration were statistically analyzed ,and the anti‐epileptic effect of 133 cases of patients were observed and analyzed .Results The epilepsy of 80 cases of patients were con‐trolled ,accounted for 60 .15% of the total number;in the 69 cases of patients within the effective blood drug concentration (50-100 mg/L) ,the epilepsy of 51 cases of patients were controlled ,accounting for 38 .35% .In the 44 cases of patients whose blood drug concentration were less than 50mg/L ,the epilepsy of 26 cases of patients were not controlled .The distribution of blood concentra‐tion between men and women were similar .The blood concentrations among each age group were different ,the blood concentrations of 52 .87% patients in the adult group were below or above therapeutic range that were 39 .13% in the minor group .The adverse reactions were increase with the increase of blood concentration .Conclusion There are differences between the blood concentrations of sodium valproate and clinical effect ,the reasonable individual administration should be conducted according to the patient′s blood concentrations of sodium valproate ,the epilepsy control situation of patients and the patients′age .

Surgical treatment of differentiated thyroid carcinoma with laryngeal or tracheal invasion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical characters, surgical treatments and prognosis of differentiated thyroid carcinoma (DTC) with laryngeal or tracheal invasion.@*METHOD@#Forty-six cases including 33 papillary and 13 follicular were retrospectively reviewed. Thirty-four cases with tracheal invasion received conservative resection (17), window resection (11) and sleeve resection (6). One case with subglottic invasion was performed subglottic partial laryngectomy. Eleven cases with trachea-laryngeal invasion received total laryngectomy(4), 3 shave technique and 4 preservative laryngectomy.@*RESULT@#Complications included infections and hypocalcaemia, 15 patients got permanent fistula. 5-year survival rate in cases of tracheal shave resection was 88.2%, while 63.6% in those of window resection and 83.3% in those of sleeve resection. Survival rate within 5 years of patients received preservative laryngectomy was 62. 5%. Conclusion: With meticulous preoperative examination and positive surgical treatment, both survival rate and quality of life could be improved in patients of DTC with laryngeal or tracheal invasion.

Rapid Identification of Multiple Bacteria on a Microfluidic Chip / 分析化学

We developed a microfluidic device to integrate sample introduction, bacteria culturing and results reading. The identification of multiple bacteria was achieved by combining the spatial resolution of the arrayed bacteria culture chambers and the color resolution benefited from the bacteria specific chromogenic media. A set of 4 common pathogenic bacteria responsible for urinary tract infection were used as a model to test the microfluidic assay. Our results showed that the bacteria identification assay can be completed in 15 h, with a limit of detection (LOD) of bacteria density down to 10 cfu / mL. Clinical sample testing using the microchip approach showed a coincidence rate of 96. 3% as compared with the conventional method. The developed microfluidic approach is simple and rapid, thus hold the potential to serve as a powerful tool for detection of multiple bacteria.

Clinical analysis of 91 cases of primary parapharyngeal space tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To summarize and analyze the clinical features, diagnosis methods, surgical approaches and treatment outcomes of patients with primary parapharyngeal space tumors.</p><p><b>METHODS</b>A retrospective review of 91 cases with primary parapharyngeal space tumors treated from January 1999 to December 2011 was performed. All patients underwent preoperative enhanced CT scan and postoperative histopathologic examination. Intraoperative frozen section biopsies were performed in 36 of 91 cases. The surgical approaches included trans-cervical approach in 73 cases, trans-parotid approach in 5 cases, trans-oral approach in 5 cases, and mandibulotomy in 8 cases.</p><p><b>RESULTS</b>The postoperative pathological diagnoses consisted of 29 variants, including 20 for benign tumors and 9 for malignant tumors. Of the 80 cases with benign tumors, 6 cases were lost to follow-up and 74 cases were followed up for 31-84 months with no recurrence. Eleven cases with malignant tumor were followed up for 8-51 months (median 29 months), of them 7 cases died and 1 case was lost to follow-up. The post-operative complications included Horner syndrome in 3 cases, hoarseness in 2 cases, hypoglossal nerve palsy in 1 case, accessory nerve palsy in 1 case, upper airway obstruction in 1 case, and internal carotid artery cavernous sinus fistula in 1 case.</p><p><b>CONCLUSIONS</b>Parapharyngeal space tumors are rare, with atypical clinical manifestation, and have pathological types of diversification. CT or MRI is helpful to evaluate the tumor size, location and possible sources, and to make operation scheme. Surgery is the first choice for parapharyngeal space tumors. Trans-cervical approach can be applied to most tumors. Parapharyngeal benign tumors have good prognosis, but malignant tumors have poor prognosis.</p>

Pharyngogastric or pharyngocolonic anastomosis in esophageal reconstruction for hypopharyngeal cancer or esophageal disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the surgical indications and postoperative morbidity of pharyngogastric anastomosis or pharyngocolonic anastomosis in esophageal reconstruction for advanced hypopharyngeal and cervical esophageal neoplasms or diffuse corrosive hypopharyngoesophageal stricture.@*METHOD@#Retrospectively analysis the experience and results of 52 patients undergoing esophageal reconstruction with pharyngogastric anastomosis and 66 patients with pharyngocolonic anastomosis. In the group of neoplasms, total esophagectomy with pharyngogastric anastomoses in 52 cases and with pharyngo-colonic anastomosis in 35 cases. Thirty-one cases with diffuse corrosive hypopharyngoesophageal stricture were treated by pharyngo-colonic anastomosis without resection of the strictured intrathoracic esophagus.@*RESULT@#In the group of neoplasm E, preservation of laryngeal functions in pharyngogastric anastomoses was performed in 28/52 cases and that of in pharyngo-colonic anastomosis was in 18/35 cases. There was no significant difference in preservation of laryngeal functions between two groups (P > 0.05). Pharyngocutaneous fistula was happened in 23 patients which significant higher in the group of pharyngocolonic anastomosis (17/66 cases) than that of pharynogogastric anasromoses (5/52 cases) (P < 0.05). Gastric reflux was presented in 19 cases and there was significant higher in pharyngogastric anastomoses (16/52 cases) than that of (3/66 cases) (P < 0.05).@*CONCLUSION@#Substitution of esophagus with stomach or colon can completely removed the neoplasms of hypopharynx or cervical esophagus and preserved laryngeal functions in selected patients. But gastric reflux is a challenging reconstructive problem in pharyngogastric anastomosis. Pharyngocolonic anastomosis should take into consideration to patients with extensive neoplasms and diffuse corrosive stricture or probably preserved the laryngeal functions. However, the swallow function is weak and the incidence of pharyngocolonic fistula is higher than that of pharyngogastric anastomosis.

Precise Prediction of Deoxyribonucleic Acid sizes with Transient Isotachophoreis-Capillary Gel Electrophoresis Analysis on a Microchip / 分析化学

The migration-time in transient isotachophoresis (tITP) separation is affected by sample salinity as the dependence of ITP time on sample-zone conductivity.The sample-to-sample variation of migration-time in microchip tITP-CGE analysis is an undesired factor for precise DNA sizing.In this work, a DNA sizing method that based on relative migration-time proportion (RMP) was developed to eliminate the effect of sample salinity on sizing precision.RMP was defined as the ratio of the migration-time difference between the target fragment and the lower marker to that between the upper marker and the lower marker.The RMP values were tested to be reproducible in microchip tITP-CGE separations irrespective of sample salinity.Size of a target DNA was predicted by fitting its RMP value to the equation derived from RMPs of standard DNA ladder vs.DNA sizes.The precision and reproducibility of the sizing method were validated testing multiple standard PCR amplicons.Experimental results showed that the RMP method is simple and reliable, thus well suited to precise DNA sizing with microchip tITP-CGE analysis.

Pharyngogastric or pharyngocolonic anastomosis in esophageal reconstruction for hypopharyngeal cancer or esophageal disease / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the surgical indications and postoperative morbidity of pharyngogastric anastomosis or pharyngocolonic anastomosis in esophageal reconstruction for advanced hypopharyngeal and cervical esophageal neoplasms or diffuse corrosive hypopharyngoesophageal stricture.Method:Retrospectively analysis the experience and results of 52 patients undergoing esophageal reconstruction with pharyngogastric anastomosis and 66 patients with pharyngocolonic anastomosis. In the group of neoplasms, total esophagectomy with pharyngo-gastric anastomoses in 52 cases and with pharyngo-colonic anastomosis in 35 cases. Thirty-one cases with diffuse corrosive hypopharyngoesophageal stricture were treated by pharyngo-colonic anastomosis without resection of the strictured intrathoracic esophagus.Result:In the group of neoplasms, preservation of laryngeal functions in pharyngogastric anastomoses was performed in 28/52 cases and that of in pharyngo-colonic anastomosis was in 18/35 cases. There was no significant difference in preservation of laryngeal functions between two groups(P>0.05). Pharyngocutanuous fistula was happened in 23 patients which significant higher in the group of pharyngocolonic anastomosis (17/66 cases) than that of pharyngogastric anastomoses (5/52 cases) (P<0.05). Gastric reflux was presented in 19 cases and there was significant higher in pharyngogastric anastomoses(16/52 cases) than that of(3/66 cases) (P<0.05).Conclusion:Substitution of esophagus with stomach or colon can completely removed the neoplasms of hypopharynx or cervical esophagus and preserved laryngeal functions in selected patients. But gastric reflux is a challenging reconstructive problem in pharyngogastric anastomosis. Pharyngocolonic anastomosis should take into consideration to patients with extensive neoplasms and diffuse corrosive stricture or probably preserved the laryngeal functions. However, the swallow function is weak and the incidence of pharyngocolonic fistula is higher than that of pharyngogastric anastomosis.

Development of a compact disk type microfluidic chip based on DNA hybridization for phenylketonuria screening / 中华检验医学杂志

Objective To develop a phenylketonuria (PKU) screening method based on a compact disk (CD) type microfluidic chip capable of generating reciprocating flow within the microchannels that facilitate rapid DNA hybridization. Methods This microfluidic device consists of a two-layer structure: a polydimethylsiloxane (PDMS) top layer containing 12 DNA hybridization microchannels, and a bottom glass layer with immobilized hydrogel conjugated DNA arrays. The DNA arrays included R243Q, V245V and the blank control probes. When the CD device was spun, the PCR products were driven into the hybridization channel by centrifugal force. When the rotation of the CD device was stopped, capillary force pulled the PCR products solution to flow back to the channel. After the on-chip hybridization, the hybridization signals were captured on a fluorescence microscope. The specificity, detection limitation and reproducibility of this device were evaluated. Thirty DNA samples from pregnant women with suspected PKU were detected by this device.Then the results were compared with DNA sequencing results. Results With the compact disk type microfluidic chip, the hybridization time could be reduced to 15 min, sample consume could be as low as 1. 5 μl and the detection limitation was 0. 7 ng/μl. With the chip based method, samples of PKU patients and healthy controls were detected and the results were consistent with DNA sequencing results. Five different batches of chips and five micro-channels of each chip were selected to test one PKU patients with V245V mutation. All the results were positive, indicating good reproducibility. Four cases of V245V mutation and 1 case of R243Q mutation were found in 30 suspected PKU carried pregnant women. Conclusion The compact disk microfluidic device has advantages of simple, rapid and highly sensitive, thus is well suited to PKU screening.

The expression and significance of urokinase-type plasminogen activator and its receptor in squamous cell carcinoma of hypopharynx / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of urokinase-type plasminogen activator (uPA) and its receptor (uPAR) in squamous cell carcinoma of hypopharynx and reveal the correlation of the major clinicopathological parameters and prognosis.@*METHOD@#Samples of 48 hypopharyngeal carcinoma and 10 normal hypopharyngeal tissue were detected by immunohistochemistry method (SP method) for urokinase-type plasminogen activator (uPA) and its receptor (uPAR). The correlation between the expression of urokinase-type plasminogen activator and its receptor and the major clinicopathological parameters of hypopharyngeal carcinoma were analyzed by rank sum test and Spearman correlation analysis. Overall survival were analyzed according to Kaplan-Meier and log-rank statistics, the prognostic relevance of uPA and uPAR and conventional prognostic factors were analyzed by Cox analysis.@*RESULT@#In 48 hypopharyngeal carcinoma specimens, positive expression rates of uPA and uPAR were 77.1% and 68.75% respectively, which were significantly higher than in normal tissues (P < 0.01). The uPA and uPAR positive expression was correlated with pathological grading, lymph node metastases and growth mode of hypopharyngeal carcinoma. The positive expression rate for uPA and uPAR in patients with lower pathological grading, lymph node metastases and invasion growth mode were significantly higher than in patients with higher pathological grading, non-lymph node metastases and non-invasion growth mode. Patients were followed-up postoperatively. The positive expression of uPA and uPAR were correlated with prognosis (P < 0.05 and P < 0.01). According to Log-rank statistics, patients with positive expression of uPA and uPAR had a significantly shorter survival time than those with negative expression of uPA and uPAR. Multivariate Cox analysis revealed that three independent prognostic factors for overall survival time were clinical stage, invasion growth mode and uPAR expression.@*CONCLUSION@#The positive expression of uPA and uPAR in hypopharyngeal carcinoma were significantly higher than in normal tissues. uPAR is a new independent and strong biologically prognostic factors, which positive expression may be a powerful aid in evaluating metastatic potential and High-Risk patients in early stage of hypopharynx carcinoma ryngeal carcinoma.

Expressions of cyclin D1 and p16 in hypopharyngeal squamous cell carcinoma and their clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expressions of Cyclin D1 and p16 proteins in hypopharyngeal squamous cell carcinoma and their clinical significance.@*METHOD@#Immunohistochemical technology (P-V) was applied to detect the expression of Cyclin D1 and p16 in 36 cases of hypopharyngeal squamous cell carcinoma and 10 cases of normal epithelium.@*RESULT@#(1) The expression of cyclin D1 in the tumorous cell was significantly higher than that in normal epithelium (P 0.05); (3) There was correlation between the expression of Cyclin D1 and the expression of p16 (r(s) = -0.420, P < 0.05).@*CONCLUSION@#The over-expression of Cyclin D1 and the under-expression of p16 may play a significant role in the occurrence incidence and development of hypopharyngeal squamous cell carcinoma, and may be important indicators for cervical lymph node metastases.

Relationship between polymorphism of N-acetyltransferase 2 and genetic susceptibility to laryngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the relationship between polymorphism of N-acetyltransferase (NAT2) gene and genetic susceptibility to laryngeal carcinoma.</p><p><b>METHODS</b>A case-control study on 62 laryngeal carcinoma patients and 56 controls was conducted. NAT2 alleles were differentiated by polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) methods using originally created PCR primers and genomic DNA extracted from peripheral white blood cells. Genetic risk for NAT2 genotype was analyzed by smoking index (SI, cigarettes smoked per day x years of smoking).</p><p><b>RESULTS</b>The frequency of NAT2 slow genotype was 80.6% in patients with laryngeal carcinoma and 60.7% in the controls, the difference of which was statistically significant (chi(2) = 5.70, P = 0.017). The odds ratios were 2.70 (95% CI 1.19 approximately 6.11). Among the individuals with NAT2 slow genotype at high level of cigarette smoking, there was a significantly higher risk of 5.64 (95% CI 1.77 approximately 17.92), while those at low level were considered the reference group (OR 1.38, 95% CI 0.42 approximately 4.52).</p><p><b>CONCLUSION</b>NAT2 slow genotype increases the risk of susceptibility to laryngeal carcinoma. The combined effect of NAT2 slow genotype and exposure to smoking is observed during the development of laryngeal cancer.</p>

Preservation of laryngeal function in surgery for medial wall pyriform sinus cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the feasibility, surgical technique and results of laryngeal function preservation in surgical treatment for medial wall pyriform sinus cancer.</p><p><b>METHODS</b>From 1992 to 1999, 31 patients with medial wall pyriform sinus cancer including stage I 1, II 4, III 14 and IV 12 lesions were treated. Partial resection of pyriform sinus and partial laryngectomy were performed, then, the remains of epiglottis and uni-pedicled sternohyoid myofascial flap were used to restore the defects of larynx. At last, the remaining hypopharyngeal mucosa was sutured to cover the wound of hypopharynx and for artificial rebuild-up. All patients received postoperative radiotherapy.</p><p><b>RESULTS</b>The 3- and 5-year survival rates were 62.1% and 43.6% respectively, with 77.4% patients having laryngeal functions (voice, respiration and deglutition) completely restored and 32.6% partially restored (voice and deglutition).</p><p><b>CONCLUSION</b>Conservative surgery so introduced is feasible for selected medial wall pyriform sinus cancer patients with the lesion completely resected.</p>

Clinical studies on sternocleidomastoid myoperiosteal flap for cervical tracheal reconstruction / 临床耳鼻咽喉头颈外科杂志

Objective:To introduce the experience of repairing the defect of cervical trachea wall by using the sternocleidomastoid myoperiosteal flap after the anterior or posterior wall of cervical trachea was invaded by cervical neoplasm. Method:Between 1989 to 1998 the sternocleidomastoid myoperiosteal flap was applied in 12 patients with different diseases, among which 3 cases were thyroid carcinoma, 5 cases were laryngeal carcinoma, 4 cases were cervical esophageal carcinoma. Result:The operation was successful. 12 patients were decannuated and had normal exercise tolerance. The time from reconstruction to decannulation was ranging from 20 days to 6 months. Conclusion: The sternocleidomastoid myoperiosteal flap is an ideal transplant for cervical tracheal reconstruction.

Measurement of microvessel density in laryngeal carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

Objective:To determine the microvessel density (MVD) in laryngeal carcinoma and its clinical significance.Method:Thirty-eight tumor specimens were selected from laryngeal cancer patients from January,1994 to March,1996.Histological sections of the tumors were stained immunohistochemically for factor Ⅷ.Using light microscopy,we counted microvessels per 400×field in the most active areas of tumor angiogenesis.Result:①The tumor blood vessels,composed of only one layer of endothelium were mainly distrbuted heterogenously in the interstitial tissue of laryngeal carcinoma with irregular lumen,poorly developed structure.②The MVD in the cancer tissues were statistically higher than that in peritumoral tissues (P＜0.01).③The MVD in the cancer tissues in group of patients with metastasis to cervical lymphonodes were statistically higher than in group without metastasis (P＜0.01),the MVD in the cancer tissues in group of advanced cases (Ⅲ,Ⅳ stages) were statistically higher than that in group of early cases (Ⅰ,Ⅱ stages,P＜0.01).④There was no statistically difference in MVD in the cancer tissue between supraglottic and glottic laryngeal carcinoma patients (P＞0.05).⑤There was no statistically difference in MVD in the cancer tissue among the G1,G2 and G3 group (P＞0.05).Conclusion:The laryngeal cancer blood vessels have some characteristics that don′t appear in normal vessels.It is suggested that tumor angiogenesis can promote tumor growth and metastasis and MVD may be a new prognostic indicator of laryngeal carcinoma.