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Objective:To investigate the ethics and existing problems of experimental animals in medical experiments and experimental teaching, and to formulate countermeasures so that animal ethics and animal welfare can be truly reflected in medical experiments.Methods:In this study, a "Basic Function Experiment Center Animal Experiment Questionnaire" with 25 questions was formulated from three aspects: the ethical cognition of experimental animals, whether animal experiments are ethical or not, how to view the problems of animal ethics and experimental teaching and the cognition of virtual simulation experiment teaching. Questionnaire was sent to Hubei University of Medicine to investigate the international students of Batch 2017 (5-year program), undergraduates of Batch 2017 (5-year program) and nursing students of Batch 2018 (4-year program) as well as teachers, researchers and employees of laboratory animal center (all with bachelor degree or above). The survey results were expressed as percentage.Results:The recovery rate of the questionnaire in this study was 98.04%(2 451/2 500), among which the practitioners, teachers and researchers in the laboratory animal center clearly understood the ethics of experimental animals, but there was a widespread phenomenon of lagging ethics among the students. For example, 16.24% (398/2 451) students had not received animal experiment ethics education and training, 29.46% (722/2 451) were not clear about animal protection laws and regulations, 7.14% (175/2 451) thought animal experiments were immoral; 29.54% (724/2 451) had vague cognition of animal welfare and ethical knowledge; 25.91% (635/2 451) were not familiar with the operation steps; 9.38% (230/2 451) were indifferent to the extra treatment of animals due to operation errors, 7.83% (192/2 451) chose to give up the experiment in the treatment of animals after massive bleeding, only 5.43% (133/2 451) chose to continue the experiment after timely hemostasis and infusion, and 9.26% (227/2 451) chose to do operations unrelated to the experiment. After the experiment, 2.28% (56/2 451) chose to kill the animals by bloodletting, only 5.51% (135/2 451) chose excessive anesthesia euthanasia, and 1.96% (48/2 451) chose to kill the animals by cervical dislocation and violence. Only 15.79% (387/2 451) chose to remember the dead animal for 2 minutes. Only 32.56%(798/2 451) of the respondents understood virtual simulation experiment, 34.92% (856/2 451) of the respondents thought that virtual simulation experiment or experimental teaching video could be used to replace the existing live animal experiment, 77.56% (1 901/2 451) believed that the construction of virtual simulation laboratory should be strengthened.Conclusion:It is imperative to strengthen the education of students' ethics of experimental animals, which is conducive to the establishment of correct ethics of experimental animals for medical students, so that the "3R" principle and animal welfare can be truly implemented in experimental teaching and scientific research experiments.
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Objective To investigate the role of transoralsonography guiding fine?needle aspiration biopsy in the diagnosis of retropharyngeal or parapharyngeal masses identified on the CT, MRI or PET?CT images of treated patients with malignant carcinoma. Methods From 2002 to 2013,this study recruited fifty?five patients with a history of cancer, of which 50 were treated with radiation treatment, including 46 nasopharyngeal carcinoma, 3 esophagus squamous cell carcinoma and1 lung apex carcinoma. There were 4 patients with a history of 1 thyroid papillary carcinoma, 1 buccal mucosa squamous cell carcinoma,1 glottis squamous cell carcinoma and 1 sigmoid colon adenocarcinoma treated with surgery. The rest one patient with nasal olfactory neuroblastoma was treated by postoperative radiation. The enlarged retropharyngeal lymph nodes in 44 cases and parapharyngeal masses in 10 cases were identified on CT or MRI imges. The enlarged retropharyngeal lymph node in the rest case was identified on PET?CT. With transoral ultrasound examination, all lesions were with hypo?intensity echo. Cystic areas were noted on occasion. Biopsy was performed in all cases. Results After cytology examination, carcinoma cells were detected in 37 retropharyngeal lymph nodes, with a detection rate of 82% (37/ 45). In the 10 parapharyngeal masses, carcinoma cells were detected in 3 lesions, with a detection rate of 30%. Conclusions Transor alsonography guiding fine?needle aspiration biopsy can be useful in the cytopathology diagnosis of retropharyngeal or parapharyngeal masses identified on the CT, MRI or PET?CT images of treated patients with malignant carcinoma,which facilitates, early diagnosis and treatment for patients.
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<p><b>OBJECTIVE</b>To investigate the role of multiple diagnostic methods in the head and neck tumor.</p><p><b>METHODS</b>One hundred and ninety-six patients without definite pathological diagnosis referred from other hospitals were included in this retrospective study. All patients had a biopsy or fine needle aspiration (FNA) of the suspected region after detailed medical history enquiry, physical examination and imaging examination.</p><p><b>RESULTS</b>All patients had ultrasound-guided FNA except 4 patients who had direct FNA. One hundred and seventy-one patients (87.2%) were confirmed to have tumor cells by pathological diagnosis, among them, 31 patients by biopsy of primary region alone, 106 by FNA, and 34 by both. The positive rate of FNA was 71.4% (140/196) for the whole group, 71.1% (123/173), 66.7% (10/15) and 87.5% (7/8) for retropharyngeal lymph node subgroup, parapharyngeal space subgroup and oropharynx subgroup.</p><p><b>CONCLUSION</b>The combined use of endoscope, MRI, and ultrasound-guided FNA is useful for the diagnosis of head and neck tumor.</p>
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Biopsy, Fine-Needle , Methods , Endoscopy , Head and Neck Neoplasms , Diagnosis , Pathology , Magnetic Resonance Imaging , Retrospective StudiesABSTRACT
Objective To summarize our experience and treatment results of nasopharyngeal carcinoma treated in a single institution. Methods From Jan. 2000 to Dec.2003,1837 patients with histologically proven nasopharyngeal carcinoma(NPC) were retrospectively analyzed. The disease was staged according to the Fuzhou stage classification. 885 patients received cisplatin (DDP) based chemotherapy. All patients received radiotherapy to the nasopharynx and neck. The dose was 30.6-74.0 Gy, 1.8-2.0 Gy per fraction over 3.5-8.0 weeks to the primary site with 60Co γ rays or 6 MV X-rays. The dose to lymph nodes was 60-68 Gy. The residual disease was boosted by 192Ir afterloading brachytherapy,small external beam fields, conformal radiotherapy,or X-knife. Results The median follow-up time was 54(3-90) months. The 5-year overall survival(OS), disease-free survival (DFS), relapse-free survival (RFS) and distant metastasis free survival(DMSF) rates were 67.42% ,63.25% ,86.47% and 80.31% ,respectively. Clinical stage was the most significant prognostic factor,and OS was 88% ,74.8% ,65.9% ,52.4% and 20% for stage Ⅰ ,stage Ⅱ,stage Ⅲ,stage ⅣA and stage ⅣB,respectively. Gender,T,N and TNM stage were the significant prognostic factors of OS in multivariate analysis. Conclusions For NPC patients,the 5-year OS of 67.4% is achieved by conventional radiotherapy technique in our institution. Both univariate and multivariate analysis shows that gender and clinical stage are the significant prognostic factors of OS.
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Radiation therapy is the mainstay treatment modality of nasopharyngeal carcinoma (NPC). The treatment outcome of NPC using external beam radiotherapy has been substantially improved over the past several decades. MRI has demonstrated remarkable advantage in detecting the extent of the primary tumor, and has replaced CT scan as the primary imaging modality for both diagnosis and staging for NPC. Functional imaging may further allow more precise staging of the disease and prediction of the treatment outcome. The introduction of Cobalt-60 has substantially improved the treatment outcome for NPC as compared to that in the era of Kilo-Voltage X-ray. And intensity-modulated radiation therapy (IMRT) not only improved the prognosis after treatment as compared to conventional radiotherapy, but also improved the quality of life. In addition, concurrent chemoradiation therapy has been extensively studied and become the standard treatment for locally and/or regionally advanced NPC. However,progress in radiation biology and its clinical application was not observed. This article presented a comprehensive review of the historical evolution of the diagnostic and therapeutic technologies and techniques for the management of NPC.
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Objective To investigate the feasibility of ?-knife as the only treatment or a second course radiotherapy after ?-knife radiotherapy for nasopharyngeal carcinoma(NPC).Methods From Jan.1998 to Feb.2004,2 recurrent NPC patients and 8 newly diagnosed patients with lesions in nasopharynx and skull base received ?-knife radiotherapy.Among the latter 8 newly untreatment patients,2 had poorly differentiated squamous cell carcinoma in the nasopharynx,while the other 6 patients had been misdiagnosed as nasopharyngeal tumors other than NPC,including 3 clivus chordoma and 2 caverous sinus meningioma diagnosed by MR imaging,and 1 nasopharyneal fibroangioma by direct nasopharyngoscopic examination.After ?-knife radiotherapy,all the 6 non-nasopharyngeal carcinoma patients were pathologically proved to have nasopharyngeal carcinoma.The treatment of this cohort were: 8 untreated patients with ?-knife radiotherapy first as the only treatment,2 recurrent nasopharyngeal carcinoma patients with ?-knife radiotherapy as salvage treatment.Treatment after the initial ?-knife radiotherapy for these patients were: 2 no further treatment,3 with induction chemotherapy followed by conventional radiotherapy,2 with conventional radiotherapy followed by chemotherapy,2 with conventional radiotherapy alone and 1 with chemotherapy alone.The chemotherapy regimen consisted of DDP 30?mg/m~2+5-Fu 500?mg/m~2,d1-3,3 week per cycle,totally 2-3 cycles.The radiotherapy regimen consisted of two opposing faciocervical portals or preauricular plus anterior nasal portals to a total dose of 60-70?Gy within 6-7 weeks for the primary lesion and 5060?Gy for the neck nodes with the residual primary lesion boosted with 500-750 ?cGy. Results No primary lesion of the 8 newly diagnosed patients for whom the ?-knife has been given first as the only treatment was controlled.In the 2 recurrent NPC patients,shrinkage of tumor and relief of symptoms were observed after ?-knife radiotherapy.Among 8 newly diagnosed patients,6 misdiagnosed ones received chemotherapy and radiotherapy before ?-knife radiotheryapy gave survival intervals of 6.0,2.5,2.0 and 1.0 years,while one patient who was refused of radiotherapy died of distant metastasis,and the other patient who received chemotherapy alone died of uncontrolled primary lesion.Conclusions ?-knife radiotherapy alone must not be chosen as the initial only treatment for nasopharyngeal carcinoma.For recurrent NPC,?-knife radiotherapy is indicated,preferably followed by a second course conventional radiotherapy with or without chemotherapy.Giving the green light for the radiation-induced complications of the second course conventional radiotherapy after ?-knife radiotherapy awaits further observation.
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Purpose:To compare chemoradiotherapy against radiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma.Methods:From September 1995 to July 1997,eighty-six patients with histologically proven NPC who were staged according to the Fuzhou stage classification to be N 2-3 were entered. Eighty-four patients were evaluable for tumor response and survival. The patients were randomized to receive two cycles of cisplatin (DDP) 20 mg/m 2 on Days 1-3,fluorouracil (5-Fu) 500 mg/m 2 on Days 1-3,before radical radiotherapy (RT),and three cycles of postradiotherapy chemotherapy (39 patients) or radiotherapy alone (45 patients). For chemoradiotherapy (CT-RT) group,the second cycle was given on Day 14 and the radiotherapy was given on Day 27. All patients received radical radiotherapy to the nasopharynx and neck. Radiation therapy consisted of delivering 65.1-70.3 Gy in 35-37 fractions of 1.85-1.9 Gy each over 7-7.5 weeks to the primary site with external beam 60 Co in both groups. The lymph nodes of the neck were given 56.6-65.5 Gy in 7-7.5 weeks. Boost radiotherapy was given to any residual disease. The rates of radiotherapy for boosting primary site or residual lymph nodes were not significantly different in the two arms. Results:The median follow up was 5.04 years. The 5-year actuarial survival rate (ASR) was 72.3% in CT-RT arm and 58.4% in RT arm ( P =0.154). The 5-year disease free survival rate (DFS) was 59.9% in CT-RT arm and 47.7% in RT arm ( P =0.207). The 5-year free from local failure rate (FLF) in nasopharynx was 89.5% in CT-RT arm and 81.4% in RT arm respectively ( P =0.151). The 5-year FLF in neck was 88.3% in CT-RT arm and 75.2% in RT arm respectively ( P =0.134). The 5-year free from distant metastasis rate (FDM) was 76.3% in CT-RT arm and 60.3% in RT arm ( P =0.181). The median time to first distant metastasis was 1.08 years in CT-RT arm and 0.88 year in RT arm. Although the differences did not reach statistical significance,there was some benefit from adjunctive chemotherapy to radiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma. Toxicities in CT-RT arm were mainly myelosuppression and nausea and vomiting. There was no significant difference in the incidence and severity of acute mucositis between the two arms during radiotherapy. There was no treatment-related death. Conclusions:This prospective randomized trial demonstrated some benefit in DFS,FLF,FDM from adjunctive chemotherapy to radiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma. But the differences were not significant. The chemoradiotherapy increased neither the incidence and severity of acute mucositis nor the late reaction.
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Purpose: The long term results and radiation sequelae of nasopharyngeal carcinoma treated by 60 Co external irradiation plus the high dose rate afterloading intracavity radiation (AIR) were analysed.Materials and Methods:From June 1981 to December 1988, 64 patients with nasopharyngeal cacinoma were treated by 60 Co external irradiation plus the high dose rate AIR. The AIR was given as a routine boost or for residual disease. The external irradiation dose varied from 55 to 70 Gy, whereas AIR dose ranged from 10 to 45 Gy. Results: All patients were followed up for mored than 5 years. The 5-year local control rate was 82.8%. The 5-year actuarial survival and disease free rates were 75.0%,68.8% respectively . 8 cases developed distant metastases, 6 cases recurred in the nasopharynx and/or neibouring structures and 1 case ocurred bone sarcoma of hard palate. The late radiation sequelae occured in 4 cases, 1 radiation necrosis of the bone in nasal cavity and 3 radiation perforations in hard and soft palate.Conclusion: We think that AIR for nasopharyngeal carcinoma is indicated for boosting the dose to the nasopharyngeal cavity with appropriated reduction in external irradiation dose ,and for residual disease after primary external radiotherpy. To reduce radiation sequelae applicator should be improved.
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15-20 years accounted for 11%,12%,14% and 10% , respectively. 260 patients had grade 3 and 4 other injuries, including 55 skin, 79 muscles/soft tissue, 36 mucosa, 79 xerostomia and 11 trismus. Among 320 patients who suffered from caries of teeth, it involved all teeth in 192 patients. Two patients had mandible necrosis. 225 patients had decline of hearing. Among 672 ears in 336 patients,194 ears had severe deafness. The overall side reaction occurrence rate was 84.5%. Conclusions Different late side reactions do exist in nasopharyngeal carcinoma patients(84.5%) with long-term survival after radiotherapy, and some patients suffer side reactions so serious as to affect their quality of life. Cranial nerve injuries are not rare, and it may occur anytime after radiation, but it dose not stop as the patients survive along.
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Objective To evaluate the limitation of image-based classification and delineation of cervical nodes proposed in 1999. Methods 259 consecutive nasopharyngeal carcinoma patients received contrast-enhanced transverse CT scan from July to November in 2003, the scanning range extended from the skull base to the inferior border of the clavicle, with thickness set at 5?mm per slice from the skull base to the oropharynx, and 1?cm per slice from the oropharynx to the clavicle. Interpretation of the images and assessment of the involved nodes distribution were performed by both radiation oncologists together with diagnostic radiologists according to 1999 image-based classification and delineation of the neck. Then we evaluated whether this classification could fully cover all the lymphatic drainage areas of the neck. Results 218 cases had nodal involvements. Nodal distributions were 0 in levelⅠA, 6 in levelⅠB, 136 in level ⅡA, 171 in level ⅡB, 78 in level Ⅲ, 20 in level Ⅳ, 33 in level VA, 27 in level VB,0 in level Ⅵ and Ⅶ, 5 in supraclavicle and 102 in retropharyngeal space, respectively. Among another 57 cases who belonged to none of the above levels, 2 cases had lesions in the preauricular area, the rest 55 medial to the border of internal carotid artery, 2?cm from inferior to the skull base to the hyoid bone. Conclusions The 1999 image-based classification of the neck nodes,being essentially rational, did not fully cover the retropharyngeal space. It would be better to shift the inferior boundary of the retropharyngeal space to the level of the hyoid bone.
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7000?cGy). The cumulative incidence of cranial nerve Ⅸ-Ⅻ palsies increased in patients with advanced N stage. Patients in the first group of treatment field had the highest risk to progress cranial nerve Ⅸ-Ⅻ palsies, followed by the second group, and the third group had the lowest risk. Only 1 in 34 patients with brachytherapy developed cranial nerve palsy. Conclusions Our retrospective data show that the radiation-induced cranial nerve palsy is a common complication in NPC patients after radiotherapy and the incidence seems to increase with the duration of the follow-up. Factors that potentially affect the injury of cranial nerve Ⅰ-Ⅶ and Ⅸ-Ⅻ are different, because of the different anatomy. Controlling the doses to the nasopharyngeal region and using faciocervical fields may help to lower the incidence of cranial nerve palsy.
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Objective To observe the findings of 1H magnetic resonance spectroscopy ( 1H MRS) and explore its value for diagnosis of radiation induced-temporal lobe necrosis in nasopharyngeal carcinoma (NPC). Methods Thirteen patients with definite clinical diagnosis of radiation induced temporal lobe necrosis in NPC underwent 1H MRS. All 1H MRS examinations were performed on a Singa Horizont 1.5 T whole body MR system with point resolved spectroscopy (PRESS) and chemical-shift selective saturation (CHESS) (TR=2000?ms,TE=144 ?ms). The voxel (2?cm ? 2?cm ? 2?cm) was positioned in both of the lesion and the contralateral side of the temporal lobe as the control (except for bilateral lesions). 2THZ]Results The interval between radiation and the examination ranged from 32 to 172 months ( median, 42 months). Eighteen lesions were observed in 13 patients (5 patients with bilateral lesions). 1H MRS was performed on 17 lesions and 8 control temporal lobes. The mean values of NAA/ Cr in the lesions and the control temporal lobes were 1.33?0.28、1.78?0.34 respectively(t=3.22, P=0.005). Three lesions showed NAA、Cho and Cr peak absent (2 lesions with Lip peak ). Among 8 patients with the control temporal lobes 1H MRS examined, Cho/Cr decreased in 6 patients (75%). Four lesions showed Lip , Lac and MI, respectively. Conclusions The radiation-induced temporal lobe necrosis shows abnormal features on 1H MRS. Significant decrease of NAA/ Cr as well as Cho/Cr are observed in most patients. 1H MRS may play a role in the diagnosis of radiation induced temporal lobe necrosis.