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[Abstra ct] Objective To investigate the long-term efficacy and adverse effects of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods A total of 869 patients with biopsy-proven NPC without distant metastasis who underwent the whole course of IMRT from 2009 to 2010 were enrolled.Of all the patients, 84.8%received cisplatin-based chemotherapy.The prescribed dose to the primary lesion in the nasopharynx was 66-70Gy in 30-32 fractions, and the dose to the positive lymph nodes in the neck was 66 Gy in 30-32 fractions.The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for difference analysis and univariate prognostic analysis , and the Cox proportional hazards model was used for multivariate prognostic analysis .Rseu lts The 5-year overall survival( OS ) , local recurrence-free survival, regional recurrence-free survival, distant metastasis-free survival, and disease-free survival ( DFS ) were 84.0%, 89.7%, 94.5%, 85.6%, and 76.3%, respectively.In the patients with locally advanced NPC,concurrent chemotherapy tended to reduce distant metastasis (83.6%vs.75.7%, P=0.050) and improve OS (82.6%vs.77.0 %, P=0.082).Induction chemotherapy tended to improve OS ( 80.7% vs.71.4%, P=0.057 ) , and the induction chemotherapy containing docetaxel or gemcitabine tended to improve OS (83.3%vs.72.2%, P=0.058).The patients who received a boost after the initial radiotherapy had a significantly lower DFS rate than those who did not (52.2%vs.71.1%, P=0.004).The concurrent chemotherapy increased the incidence rates of long-term xerostomia and trismus, while a high dose of cisplatin increased the incidence rates of xerostomia and hearing impairment.Conclusions IMRT for NPC provides satisfactory long-term efficacy.Concurrent chemotherapy combined with IMRT tends to reduce the incidence of distant metastasis, and other values need further investigation.The boost therapy after radiotherapy may be associated with poor prognosis.Chemotherapy increases the incidence of long-term toxicities.
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Objective To investigate the risk factors for acute kidney injury (AKI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI),and to establish a prediction score system for AKI.Methods Totally 296 patients with NSTEMI,who were admitted to the emergency room and further transferred to the Cardiovascular Department in Shantou Central Hospital,were enrolled during January 2011 to April 2014.All patients were divided into AKI group and non-AKI group.Demographics,clinical data and laboratory examinations were collected before and after AKI.AKI risk factors and its OR values were determined after statistically analyzed data by One-Way ANOVA,multivariate logistic regression analysis.Prediction score system for AKI was further established by area under the ROC curve and Hosmer-Lemeshow goodness of fit tests.Results For total 296 patients,the incidence of AKI was 18.4％,including 35 (64.8％) patients in stage Ⅰ,12 (22.2％) patients in stage Ⅱ and 7 (13.0％) patients in stage Ⅲ.Logistic analysis showed that age,heart function (Killip),anemia,the time to emergency department after AMI attack,and absence β-blocker were independent factors associated with AKI.Prediction score system was established which the highest score was 13.A risk score of 3.5 points was determined by Youden' s index,as the optimal cut-off for predict AKI.Patients with ≤3.0 points were considered at low risk,and ≥4.0 points were considered at high risk for AKI.The prediction score system of AKI showed adequate discrimination (area under ROC curve was 0.806) and calibration (Hosmer-Lemeshow statistic test,P =O.503).Conclusions Age,heart function (Killip),anemia,the time to emergency department after AMI attack,and absence β-blocker were independent factors associated with AKI.The clinical prediction score system may help clinicians to make pre-intervention for NSTEMI patients with high AKI risk.
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Background and purpose:In 2013, the ofifcial journal of European Society of Radiotherapy &Oncology (ESTRO) -Radiotherapy & Oncology published the updated version of Consensus Guidelines of Delineation of the neck node levels for head and neck tumors, which contributed to the standardization of description of neck nodal metastasis, as well as reduction of treatment variations from various institutions. This study applied this updated guidelines to analyze the patterns of lymph node metastasis of nasopharyngeal carcinoma and explore the prognostic value of the radiologic characteristics of nodes, in order to provide evidence for future revision of N staging system. Methods:A total of 656 patients from Jan. 2009 to Dec. 2010 were retrospectively recruited to analysis. All were pathologically diagnosed as non-metastatic nasopharyngeal carcinoma, treated with intensity-modulated radiotherapy. All patients received a pretreatment MRI scan. We retrospectively reviewed the MRI imaging of 656 patients and mapped the lymph node metastasis using the 2013 International Consensus Guidelines.Results:Median follow-up was 46.9 months. Four-year local recurrence-free survival, nodal recurrence-free survival, distant metastasis-free survival, disease-free survival and overall survival was 91.3%, 95.1%, 87.7%, 78.5% and 92.8%, respectively. The most common metastatic node levels were levelⅡ (76.2%) and levelⅦa (65.1%), followed by levelⅢ (50.4%),Ⅴa(17.5%) andⅣa (11.7%). There was a very low incidence of node skipping (1.0%). Cervical nodal necrosis was observed in 46.4%of patients with positive nodes and extracapsular spread was noted in 74.4% of them. Univariate analysis showed that bilateral nodal involvement, greatest dimension of positive nodes (≥6 cm), central nodal necrosis, T stage and N stage were prognostic factors for disease-free survival and distant metastasis-free survival (P<0.05). Extracapsular spread showed a trend to correlate with poor distant metastasis-free survival (P=0.060). The involvement of lower neck levels (below the caudal border of cricoid cartilage) did not have a signiifcant impact on disease-free survival and distant metastasis-free survival. In multivariate analysis, T stage and greatest dimension of nodes (≥6 cm) were independent prognostic factors for distant metastasis-free survival (P<0.05). T stage, greatest dimension of nodes (≥6 cm) and central nodal necrosis were independent prognostic factors of disease-free survival (P<0.05).Conclusion:This study demonstrates the patterns of lymph node metastasis of nasopharyngeal carcinoma based on 2013 International Consensus Guidelines. Bilateral nodal involvement, greatest dimension of positive nodes and central nodal necrosis had prognostic values on disease-free survival and distant metastasis-free survival. In our study, the involvement of lower neck levels was not proved to be a prognostic factor for disease-free survival and distant metastasis-free survival.
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Objective To investigate the effect of cortical 8-opioid receptor (DOR) on oxygen-glucose deprivation-induced (OGD-induced) neuronal injury. Methods Primary cultured cortical neurons incubated with selective DOR agonist (TAN-67) and antagonist (naltrindole) or PKC inhibitor (chelerythrine, CHE) were exposed to OGD. Lactate dehydrogenase (LDH) release was detected after 24 h reperfusion. The expression levels of DOR were measured by Western blot. Results Compared with OGD group, TAN-67 significantly decreased OGD-indueed LDH release, and increased the expression levels of DOR, while nahrindole aggravated neuronal injury and decreased the DOR protein expression. CHE could abolish the LDH down-regulation induced by TAN-67 plus OGD (P< 0.05, compared with TAN-67 treated group). Conclusions DOR activation protects neurons against OGD injury. PKC might take part in the neuroprotection pathways of DOR.