Salvage neck surgery in recurrent nodal NPC: Do all patients require a comprehensive neck dissection in the modern MRI era?

OBJECTIVE: The standard treatment for regional failure in nasopharyngeal carcinoma (NPC) is the radical neck dissection (RND). Our study sought to determine if magnetic resonance imaging (MRI) may accurately predict nodal involvement to allow selected levels of neck dissection to be preserved. STUDY DESIGN AND SETTING: We analysed retrospectively all NPC patients in our centre undergoing neck dissections as salvage therapy for nodal recurrence. Nodal involvement based on the preoperative MRI was assessed and compared with postoperative histopathology. METHODS: This is a retrospective study conducted on patients in our centre with recurrent NPC from February 2002 to February 2017. Patients were identified from the database of the otolaryngology oncology division at our institution. Of these, 28 patients met all our inclusion and exclusion criteria. We calculated sensitivity and specificity as well as average number of nodes per patient. RESULTS: In our study, we calculated the false negative and false positive rates of preoperative MRI neck by levels. Overall sensitivity of MRI picking up disease by level was 76% and specificity was 86%. CONCLUSION: Based on our study, we will be missing a total of 10 (7.1%) diseased neck levels in eight (28.5%) patients. MRI alone, therefore, does not provide enough information to allow safe selective preservation of neck levels in surgical salvage of neck recurrences in NPC.

Inverse 18O labeling mass spectrometry for the rapid identification of marker/target proteins.

Systematic analysis of proteins is essential in understanding human diseases and their clinical treatments. To achieve the rapid and unambiguous identification of marker or target proteins, a new procedure termed "inverse labeling" is proposed. With this procedure, to evaluate protein expression of a diseased or a drug-treated sample in comparison with a control sample, two converse labeling experiments are performed in parallel. The perturbed sample (by disease or by drug treatment) is labeled in one experiment, whereas the control is labeled in the second experiment. When mixed and analyzed with its unlabeled counterpart for differential comparison using mass spectrometry, a characteristic inverse labeling pattern of mass shift will be observed between the two parallel analyses for proteins that are differentially expressed. In this study, protein labeling is achieved through 18O incorporation into peptides by proteolysis performed in [18O]water. Once the peptides are identified with the characteristic inverse labeling pattern of 18O/16O ion intensity shift, MS data of peptide fingerprints or peptide sequence information can be used to search a protein database for protein identification. The methodology has been applied successfully to two model systems in this study. It permits quick focus on the signals of differentially expressed proteins. It eliminates the detection ambiguities caused by the dynamic range of detection on proteins of extreme changes in expression. It enables the detection of protein modifications responding to perturbation. This strategy can also be extended to other protein-labeling methods, such as chemical or metabolic labeling, to realize the same benefits.

Paralytic and insecticidal toxins from the funnel web spider, Hololena curta.

One peptide and ten acylpolyamine toxins (curtatoxins) were purified and identified from venom of Hololena curta. The acylpolyamines consist of six different polyamines which are amidated with three different aromatic acids: (3-indolyl)acetic, (4-hydroxy-3-indolyl)acetic and 2.5-dihydroxybenzoic acids. These acylpolyamines instantly paralyze lepidopteran larvae following injection. The most potent insecticidal peptide in H. curta venom contains 38 amino acids and is lethal at 4 micrograms/g when injected into Manduca sexta larvae.

Structures of paralytic acylpolyamines from the spider Agelenopsis aperta.

The structures are given for five paralytic acylpolyamines from the venom of the funnel web spider, Agelenopsis aperta. The acyl moieties are derived from (3-indolyl)acetic acid, (4-hydroxy-3-indolyl)acetic acid, and 4-hydroxybenzoic acid. The polyamine portions of the toxins are novel. Three toxins (AG489, AG505, and AG452) contain 1, 5, 9, 13, 18, 22-hexaazadocosane which is unique as a natural polyamine because of its length and hydroxylation at the 5-aza position. The polyamine portions of two other alpha-agatoxins (AG488 and AG504) are unusual also, containing guanidinooxy moieties.