Performance and Operational Feasibility of Epstein-Barr Virus-Based Screening for Detection of Nasopharyngeal Carcinoma: Direct Comparison of Two Alternative Approaches.

PURPOSE: Two Epstein-Barr virus (EBV)-based testing approaches have shown promise for early detection of nasopharyngeal carcinoma (NPC). Neither has been independently validated nor their performance compared. We compared their diagnostic performance in an independent population. METHODS: We tested blood samples from 819 incident Taiwanese NPC cases (213 early-stage, American Joint Committee on Cancer version 7 stages I and II) diagnosed from 2010 to 2014 and from 1,768 controls from the same region, frequency matched to cases on age and sex. We compared an EBV antibody score using immunoglobulin A antibodies measured by enzyme-linked immunosorbent assay (EBV antibody score) and plasma EBV DNA load measured by real-time PCR followed by next-generation sequencing (NGS) among EBV DNA-positive individuals (EBV DNA algorithm). RESULTS: EBV antibodies and DNA load were measured for 2,522 (802 cases; 1,720 controls) and 2,542 (797 cases; 1,745 controls) individuals, respectively. Of the 898 individuals positive for plasma EBV DNA and therefore eligible for NGS, we selected 442 (49%) for NGS testing. The EBV antibody score had a sensitivity of 88.4% (95% CI, 86.1 to 90.6) and a specificity of 94.9% (95% CI, 93.8 to 96.0) for NPC. The EBV DNA algorithm yielded significantly higher sensitivity (93.2%; 95% CI, 91.3 to 94.9; P = 1.33 × 10-4) and specificity (98.1%; 95% CI, 97.3 to 98.8; P = 3.53 × 10-7). For early-stage NPC, the sensitivities were 87.1% (95% CI, 82.7 to 92.4) for the EBV antibody score and 87.0% (95% CI, 81.9 to 91.5) for the EBV DNA algorithm (P = .514). For regions with a NPC incidence of 20-100/100,000 person-years (eg, residents in southern China and Hong Kong), these two approaches yielded similar numbers needed to screen (EBV antibody score: 5,656-1,131; EBV DNA algorithm: 5,365-1,073); positive predictive values ranged from 0.4% to 1.7% and 1.0% to 4.7%, respectively. CONCLUSION: We demonstrated high sensitivity and specificity of EBV antibody and plasma EBV DNA for NPC detection, with slightly inferior performance of the EBV antibody score. Cost-effectiveness studies are needed to guide screening implementation.

The Study of Alternative Fire Commanders' Training Program during the COVID-19 Pandemic Situation in New Taipei City, Taiwan.

In Taiwan, firefighters are responsible for transporting confirmed coronavirus cases to hospitals or epidemic prevention hotels. During the epidemic, in order to reduce the chance of cross-infection between the general public and the fire brigade, traditional collective mobilization training was limited. As a solution, this study combines a fire command course (C1) and a VR simulation for training fire station captains (VRST) and then applies the pre- and post-test evaluation approaches and the after-class questionnaire to summarize the learning effectiveness. The results show that, from a total of 244 captains that were trained, the after-training scores are significantly better when compared with the scores before training (p < 0.05, Cohen's d > 0.8). Additionally, the post-test scores collected during the epidemic (n = 158) have no significant difference compared to the ones taken before the outbreak (2019, n = 86) in terms of sizing up, decision making, and safety management. The training results are still improving. The after-class questionnaire showed that most trainees believed that VRST helped to improve their confidence as incident commanders (ICs) (mean = 4.63, top box = 66.98%), with the novice and suburban groups exhibiting more significant improvements in command ability after the training. After the pandemic, VRST can continue as a regular training method for ICs. Because of the intervention of VRST, the differences in the command experience between different IC groups can be compensated for.

Using Smartphones for Indoor Fire Evacuation.

Fire smoke reduces the visibility of emergency direction signs, rendering them ineffective for providing appropriate guidance along evacuation routes in a fire situation. This is problematic because civilians may select evacuation routes that expose them to smoke or fire in a burning building. This study proposed using a smartphone voice-guided evacuation system (SVGES) to provide alternative evacuation routes for civilians trapped at a fire scene. To verify the efficacy of the SVGES, experiments were conducted with 26 participants in a simulated fire scenario. The experimental results showed that when using the SVGES, the participants chose the safest evacuation route with a 100% successful evacuation rate.

A COVID-19 Lockdown Tabletop Exercise in New Taipei City, Taiwan.

OBJECTIVES: This exercise aimed to validate New Taipei City's strategic plan for a city lockdown in response to coronavirus disease (COVID-19). The main goal of all solutions was the principle of "reducing citizen activity and strengthening government control." METHODS: We created a suitable exercise, creating 15 hypothetical situations for 3 stages. All participating units designed and proposed policy plans and execution protocols according to each situation. RESULTS: In the course of the exercise, many existing policies and execution protocols were validated. These addressed (1) situations occurring in Stage 1, when the epidemic was spreading to the point of lockdown preparations; (2) approaches to curb the continued spread of the epidemic in Stage 2; and (3) returning to work after the epidemic was controlled and lockdown lifted in Stage 3. Twenty response units participated in the exercise. Although favorable outcomes were obtained, the evaluators provided comments suggesting further improvements. CONCLUSIONS: Our exercise demonstrated a successful example to help policy-making and revision in a large city of over 4 million people during the COVID-19 pandemic. It also enhanced participants' subject knowledge and familiarity with the implementation of a city lockdown. For locations intending to go into lockdown, similar tabletop exercises are an effective verification option.

Study of Relationships between Ceiling Smoke Leakage Rate and Evacuation Time in the Ward.

With reference to the requirements of CNS 15038 and testing principles, this study proposes a set of equipment for measuring the leakage volume of ceilings and provides detailed assembly specifications for future users. In this study, a total of 405 tests were conducted as part of a set of experiments for measuring the leakage volume of ceilings, using various ceiling materials, ceiling sizes, and construction methods, in conjunction with the principles of fluid mechanics, to propose a method for evaluating the leakage volume of ceilings of various sizes and materials. Two cases-bottom-up airflow and top-down airflow-were considered. According to our research findings, in the case of bottom-up airflow, the pressure difference, panel weight, and panel size were correlated with the leakage volume; the more significant the pressure difference, the larger the leakage volume; the heavier the panel weight, the more minor the leakage volume; and the larger the panel size, the more significant the leakage volume. On the other hand, in the case of top-down airflow, different leakage volumes were observed for different ceiling materials, even if the ceiling size was identical. On the other hand, when the ceiling material was the same, and the ceiling size was different, there was not a positive relationship between the leakage volume and a larger panel size; instead, the leakage volume observed for the largest panel was the smallest. Finally, in this study we propose a volumetric leakage assessment table for assessing a ceiling as a whole, which can be utilized by engineers in the future to calculate the smoke leakage value and to estimate the smoke fall time for ward escape designs.

Wayfinding of Firefighters in Dark and Complex Environments.

Firefighters searching in dark and complex environments might lose their orientation and endanger themselves at the fireground. This study conducted experiments in the Training Facility of the New Taipei City Fire Department (NTFD), Taiwan. The objective of the experiments was to analyze the profile of each firefighter by a 13-factor self-report survey and their wayfinding time in dark and complex environments (DCEs). The results showed that age might be a marginally significant factor, and fear of confinement might be a significant factor that could affect firefighters' wayfinding time in the DCEs. The findings could provide strategies for improving the safety of firefighters working in such environments.

Machine Learning to Predict the Progression of Bone Mass Loss Associated with Personal Characteristics and a Metabolic Syndrome Scoring Index.

A relationship exists between metabolic syndrome (MetS) and human bone health; however, whether the combination of demographic, lifestyle, and socioeconomic factors that are associated with MetS development also simultaneously affects bone density remains unclear. Using a machine learning approach, the current study aimed to estimate the usefulness of predicting bone mass loss using these potentially related factors. The present study included a sample of 23,497 adults who routinely visited a health screening center at a large health center at least once during each of three 3-year stages (i.e., 2006-2008, 2009-2011, and 2012-2014). The demographic, socioeconomic, lifestyle characteristics, body mass index (BMI), and MetS scoring index recorded during the first 3-year stage were used to predict the subsequent occurrence of osteopenia using a non-concurrence design. A concurrent prediction was also performed using the features recorded from the same 3-year stage as the predicted outcome. Machine learning algorithms, including logistic regression (LR), support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGBoost), were applied to build predictive models using a unique feature set. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, and F1 score were used to evaluate the predictive performances of the models. The XGBoost model presented the best predictive performance among the non-concurrence models. This study suggests that the ensemble learning model with a MetS severity score can be used to predict the progression of osteopenia. The inclusion of an individual's features into a predictive model over time is suggested for future studies.

Adjusting Quality Control Chart Limits for WBC, RBC, Hb, and PLT Counts to Reduce Daily Control Risks in Hospital Laboratory.

BACKGROUND: To continuously improve medical quality and provide clinicians with more accurate blood test reports, this study collected blood quality control data in 2017 from a medical examination laboratory in a teaching level hospital located in Taoyuan City, Taiwan. MATERIAL AND METHODS: The quality control data were arranged and analyzed from daily complete blood count (CBC), including white blood cells (WBC), red blood cells (RBC), hemoglobin (Hb), and platelets (PLT) recorded by a laboratory blood analyzer. Using the empirical Bayesian method, we estimated the variation of concentrations of the last and current batches to establish a novel control chart with adjusted upper and lower limits for the current batch, and then compared results with the traditional Shewhart method. The average run length (ARL) and sensitivity of the empirical Bayesian method were explored. RESULTS: The study found that ARL showed a qualified capability for the four blood routine tests when using the empirical Bayesian method. Compared to the Levey-Jennings control chart, the novel control chart presents an alert earlier when a deviation occurs and shows a fake alert later when there is no deviation. CONCLUSION: The parallel tests showed that the longer the time is, the better the test's proficiency. We concluded that the empirical Bayesian method could be applied effectively to improve the capability of daily control in CBC laboratory tests.

Occupational Assessments of Risk Factors for Cardiovascular Diseases in Labors: An Application of Metabolic Syndrome Scoring Index.

Unlike a traditional diagnosis of metabolic syndrome (MS), a numerical MS index can present individual fluctuations of health status over time. This study aimed to explore its value in the application of occupational health. Using a database of physiological and biochemical tests and questionnaires, data were collected from 7232 participants aged 20 to 64 years who received occupational health screenings at a health screening institution in 2018. Using confirmatory factor analysis, five components of MS were used to design an MS severity scoring index, which was then used to evaluate the risks of occupation factors. Waist circumference was the largest loading factor compared with the other MS components. Participants who worked in the traditional industrial, food processing, or electronic technology industries had higher MS severity than those in the logistics industry. Those who worked as a manager or over five years had a relatively high severity. The research showed that assessments based on an MS severity score are applicable when the risk factors of suboptimal health are involved. By monitoring the scores over time, healthcare professionals can propose preventive strategies in time, thus enhancing the effectiveness of occupational health examination services.

Cigarette smoking increases the risk of nasopharyngeal carcinoma through the elevated level of IgA antibody against Epstein-Barr virus capsid antigen: A mediation analysis.

BACKGROUND: The study aims are to evaluate the associations between nasopharyngeal carcinoma (NPC) risk and cigarette smoking and to explore the effects of cigarette smoking on Epstein-Barr virus (EBV) infection for NPC risk. METHODS: 1235 male NPC cases and 1262 hospital-based male controls matched to cases were recruited across six collaborative hospitals between 2010 and 2014. Using a standardized questionnaire, information on cigarette smoking and other potential risk factors for NPC was obtained. Blood was collected and used for anti-EBV VCA IgA and anti-EBV EA-EBNA1 IgA testing using standard methods. Unconditional logistic regression analysis was used to estimate odds ratio (OR) with 95% confidence interval (CI) for each risk factor after adjusting for confounders. RESULTS: 63.6% of cases and 44.0% of controls reported ever smoking cigarettes. After full adjustment, current smokers had a significant 1.60-fold (95% CI = 1.30-1.97) and former smokers a borderline significant 1.27-fold (95% CI = 1.00-1.60) increased NPC risk compared to never smokers. NPC risk increased with increasing duration, intensity, and pack-years of cigarette smoking but not with age at smoking initiation. Among controls, anti-EBV VCA IgA seropositivity rate was higher in current smokers than never smokers (14.0% vs 8.4%; OR = 1.82; 95% CI = 1.19-2.79). Mediation analyses showed that more than 90% of the cigarette smoking effect on NPC risk is mediated through anti-EBV VCA IgA. CONCLUSION: This study confirms the association between long-term cigarette smoking and NPC and demonstrates that current smoking is associated with seropositivity of anti-EBV VCA IgA antibodies.

Lrp, a global regulator, regulates the virulence of Vibrio vulnificus.

BACKGROUND: An attenuated mutant (designated NY303) of Vibrio vulnificus, which causes serious wound infection and septicemia in humans, was isolated fortuitously from a clinical strain YJ016. This mutant was defective in cytotoxicity, migration on soft agar and virulence in the mouse. The purpose of this study was to map the mutation in this attenuated mutant and further explore how the gene thus identified is involved in virulence. METHODS: The whole genome sequence of mutant NY303 determined by next-generation sequencing was compared with that of strain YJ016 to map the mutations. By isolating and characterizing the specific gene-knockout mutants, the gene associated with the phenotype of mutant NY303 was identified. This gene encodes a global regulator, Lrp. A mutant, YH01, deficient in Lrp was isolated and examined in vitro, in vivo and ex vivo to find the affected virulence mechanisms. The target genes of Lrp were further identified by comparing the transcriptomes, which were determined by RNA-seq, of strain YJ016 and mutant YH01. The promoters bound by Lrp were identified by genome footprinting-sequencing, and those related with virulence were further examined by electrophoretic mobility shift assay. RESULTS: A mutation in lrp was shown to be associated with the reduced cytotoxicity, chemotaxis and virulence of mutant NY303. Mutant YH01 exhibited a phenotype resembling that of mutant NY303, and was defective in colonization in the mouse and growth in mouse serum, but not the antiphagocytosis ability. 596 and 95 genes were down- and up-regulated, respectively, in mutant YH01. Many of the genes involved in secretion of the MARTX cytotoxin, chemotaxis and iron-acquisition were down-regulated in mutant YH01. The lrp gene, which was shown to be negatively autoregulated, and 7 down-regulated virulence-associated genes were bound by Lrp in their promoters. A 14-bp consensus sequence, mkCrTTkwAyTsTG, putatively recognized by Lrp was identified in the promoters of these genes. CONCLUSIONS: Lrp is a global regulator involved in regulation of cytotoxicity, chemotaxis and iron-acquisition in V. vulnificus. Down-regulation of many of the genes associated with these properties may be responsible, at least partly, for loss of virulence in mutant NY303.

Survival benefit of surgical approach for advanced oropharyngeal and hypopharyngeal cancer: A retrospective analysis.

BACKGROUND: Head and neck cancer is increasingly being managed through nonsurgical approaches. Evidence comes from studies that have mainly examined patients with laryngeal cancer. Few studies, with limited sample size, have focused on the comparative outcomes of surgical and nonsurgical approaches in patients with advanced oropharyngeal or hypopharyngeal cancer. METHODS: Using a national cancer database, we identified 1603 and 1512 patients with clinical stage III/IVA oropharyngeal and hypopharyngeal cancer, respectively, treated between 2004 and 2009. The study cohort was followed until 2012, and analyzed through Kaplan-Meier survival analysis and Cox regression. RESULTS: Overall, 31.4% of patients with advanced oropharyngeal cancer and 42.2% of patients with hypopharyngeal cancer received surgery as their primary treatment. Receiving primary surgery for advanced oropharyngeal and hypopharyngeal cancer was associated with higher survival rates after controlling for potential confounders. CONCLUSION: We recommend that surgery be considered a first-line treatment for advanced oropharyngeal and hypopharyngeal cancers.

Arecoline N-oxide: its mutagenicity and possible role as ultimate carcinogen in areca oral carcinogenesis.

The areca nut is the most widely consumed psychoactive substance in Taiwan, India, and Southeast Asia. It is considered to be an environmental risk factor for the development of oral submucous fibrosis and cancer. Arecoline, the major alkaloid of areca nut, has been known to cause cytotoxicity and genotoxicity in various systems. However, the active compound accounting for arecoline-induced damage in normal human oral cells is still uncharacterized. The present study was undertaken to identify the active metabolite of arecoline that might induce damage in human oral tissues and cause mutagenicity in Salmonella typhimurium tester strains TA 100 and TA 98. It is interesting to find that the major metabolite of arecoline, arecoline N-oxide, is moderately mutagenic to these Salmonella tester strains. This mutagenicity was potently inhibited by sulfhydryl compounds, namely, glutathione, N-acetylcysteine, and cysteine, whereas methionine is inactive in this inhibition. The mutagenicity of arecoline N-oxide was strongly inhibited by the N-oxide reducing agent titanium trichloride. The possible role of arecoline N-oxide in the induction of oral carcinogenesis by areca nut chewing is discussed.

Design-based guidelines for the semantic perception of emergency signs.

The current study applies semantic differential to explore the semantic perception of emergency signs, in an attempt to analyze the meanings of emergency signs in regard to the psychological exigencies of the general public. The results indicate that problems concerning recognition accuracy have been observed, but also that the evaluation of the semantic meaning of the signs is positive. However, a number of emotional factors also emerge, indicating that if improvements should be made to the existing emergency signs, it would better facilitate evacuation in the event of an emergency. As for the design guidelines, the emergency signs should be readily recognizable and have a single meaning. Multiple symbolic meanings should be eliminated. Concrete design guidelines include: (a) safety movement, (b) clarity, and (c) safety. To avoid confusion in sign recognition, in addition to the improvements made based on the abovementioned guidelines, educational promotional activities carried out by the government would also prove very beneficial.

Use of combined molecular biomarkers for prediction of clinical outcomes in locally advanced tonsillar cancers treated with chemoradiotherapy alone.

BACKGROUND: Environmental exposures to tobacco, alcohol, human papillomavirus (HPV) and/or Epstein-Barr virus (EBV), all of which can perturb multiple cell cycle proteins or tumor suppressors, have been implicated in the pathogenesis of different subsets of head and neck cancers. The aim of this study was to investigate to which extent the virus infection by itself, and/or the altered cell cycle proteins, contributes to prognosis in locally advanced tonsillar squamous cell carcinomas (TSCCs) treated with concurrent chemoradiotherapy (CCRT) alone. METHODS: Serial tumor tissue arrays from archival samples were tested for the presence of HPV genome integration or EBV episome by means of DNA sequencing, real-time polymerase chain reaction (PCR), and in situ hybridization. Alterations of cell cycle proteins (p53, pRb, and p21) were evaluated by immunohistochemical staining. The association of viral presence with altered cell cycle proteins was correlated to clinical outcomes. RESULTS: Of the 46 patients with the same T2N2bM0 stage IVA among consecutive patients with TSCC, 23 (50%) had integrated HPV DNA and only 1 (2%) had EBV episome. The HPV types detected were almost all HPV-16. A reduced expression pattern of p53, pRb, and p21 was noted in HPV-positive tumors, and the incremental number of alterations in the 3 proteins was significantly associated with HPV-negative tumors. The presence or absence of HPV together with the number of altered expression of the 3 cell cycle markers resulted in further identification of 4 biologically and clinically distinct subgroups with different outcomes after CCRT. CONCLUSIONS: Use of combined biomarkers of oncogenic HPV and tumor suppressors of p53, pRb, and p21 in advanced TSCC provides prognostic molecular classification superior to the TNM stage system and identifies low-risk patients for organ preservation by CCRT alone and high-risk patients who might benefit from planned tonsillectomy and neck dissection before or after CCRT.

Using virtual reality to determine how emergency signs facilitate way-finding.

In this study, virtual reality was the tool used to construct an experimental space. Three scenarios - one without emergency signs, another with an old-version emergency sign, and the third with a new-version emergency sign - were created, after which 107 subjects, divided into three groups, engaged in an emergency escape game to determine if and how various emergency signs aid in way-finding in the event of an emergency. Under the presupposition that the minimum time needed for an emergency escape without any mistake occurring was 40s, we found that the average way-finding time in the scenario without any emergency signs was 123.8s, for the scenario with the new-version signs 84.8s, and for the scenario with the old-version signs 75.6s; statistically, this demonstrated that the absence of signs results in slower escape than either old signs (p=0.001) or new signs (p=0.005). These findings indicate that signs do help way-finding greatly. Males were found to exhibit better way-finding skills than females (p<0.001). Construction workers and fire safety personnel, as a combined group, did not fare better than others with less presumed prior experience with building plans or emergency exit procedures. In addition, when faced with both an emergency direction sign and an exit door, almost half of the subjects (42% of the participants) were chosen to take the door instead of following the direction posted on the sign. Finally, we found that, at T-intersections, the majority of participants (60%) chose to turn left versus right.

Genetic alterations of HOXA10 and their effect on the severity of endometriosis in a Taiwanese population.

Endometriosis is one of the most common gynaecological diseases and evidence has suggested that it may be inherited as a complex genetic trait. HOXA10, a homeobox gene, is expressed in the developing uterus and participates in endometrium development and may contribute to endometriosis. In this study, the HOXA10 gene was analysed in 112 patients with endometriosis and in 54 women without endometriosis, as diagnosed laparoscopically. The entire HOXA10 gene was amplified using polymerase chain reaction followed by single-strand conformation polymorphism analysis and sequencing. Association between the polymorphism and the clinical parameters of endometriosis were examined. There were 7.23% patients with HOXA10 genetic alterations; however, there was no significant increase in the endometriosis patients compared with the controls. Most of these DNA variants were found to be novel mutations that reside within the HOXA10 homeobox domain. Six variants generate amino acid changes in the protein and one harbours a premature stop codon. It was found that patients with HOXA10 polymorphism were associated with a lower serum cancer antigen-125, a lower American Fertility Society score and less severe obliterated cul-de-sac. It is postulated that genetic alterations in the homeobox domain might lead to less specificity for HOXA10 protein binding to a DNA molecule.

Exploratory research on reading cognition and escape-route planning using building evacuation plan diagrams.

The purpose of evacuation plan diagrams is for readers to comprehend and then plan an evacuation route. However, comprehending such diagrams involves complex issues that have yet to be addressed by research. This study aims to investigate how Taiwanese people interpret evacuation plan diagrams in their buildings. Issues of interest include the amount of time that it takes for a member of the general public to read a diagram and the time that they spend planning their escape route. Correlated and influencing factors are analyzed. The floor plan of an actual department store was used as the diagram for cognitive testing. A method of stimulated measurement was conducted over the Internet. The results of the experiment showed that the time it takes to plan an escape route is about 1.1 to 2 times longer than its reading time. This indicates that there is a significant time difference between diagram interpretation and stimulated planning. It was found that the longer it takes to read a diagram, the longer it takes to plan an escape route. In addition, to understand the difference between interpretations by the general public versus those with an architectural background, an analysis showed that the general public takes two to three times longer than architectural professionals to read a diagram and plan an escape route. Consequently, improvements in reading diagrams could help in the planning of a more efficient escape route. Furthermore, through our analysis, we found that the design of diagram symbols must satisfy conventional use and also that diagrams must avoid the use of metaphorical and abstract symbols. Diagrams that follow our guidelines will generally result in more effective and efficient conveyance of the intended message, thereby assisting in an emergency.

A prognostic scoring system for locoregional control in nasopharyngeal carcinoma following conformal radiotherapy.

PURPOSE: This study established a prognostic scoring system for nasopharyngeal carcinoma (NPC), which estimates the probability of locoregional (LR) control following definitive conformal radiotherapy. METHODS AND MATERIALS: Patients with nondisseminated NPC at initial presentation (n = 630) were enrolled in this study. All patients had magnetic resonance imaging of the head and neck and were treated with conformal radiotherapy. Among them, 93% had concurrent chemotherapy, and 76% had postradiation chemotherapy. The extent of the primary tumor, age at diagnosis, primary tumor size, tumor and nodal classification, histology, and serum lactate dehydrogenase (LDH) level before treatment were included in the analysis for building a prognostic scoring system. The end point for this study was LR control. RESULTS: The prognostic score was defined as the number of adverse prognostic factors present at diagnosis. Four factors had similarly independent prognostic effects (hazard ratio, 2.0-2.6): age >40 years, histologic WHO type I-II, serum LDH level > or =410 U/L, and involvement of two or more sites of the following anatomic structures, i.e., sphenoid floor, clivus marrow, clivus cortex, prevertebral muscles, and petrous bone. The score predicted the 5-year probability of LR control as follows: 0 (15% of the patients), 100%; 1 (42% of the patients), 93%; 2 (29% of the patients), 83%; 3 or higher (13% of the patients), 71%. CONCLUSION: This scoring system is useful in the decision-making for individual patients and the design of clinical trials to improve LR control for advanced-stage NPC.

Nasopharyngeal biopsy imprint cytology: a retrospective analysis of 191 cases.

Patients with nasopharyngeal carcinoma (NPC) are common in Taiwan. To provide efficient management to patients, the surgeons often perform cytological imprints immediately after biopsies of lesions suspicious for NPC. The results of cytological assessment of imprints usually are reported within 30 min after biopsies. The patients with positive cytological results can then be arranged for further examinations during the same visit. We reviewed 191 imprints and corresponding biopsies from 187 patients during 1997-2004 at Koo Foundation Sun Yat-Sen Cancer Center, Taipei. The cytological diagnoses were categorized into four groups: negative (62 cases), suspicious (8 cases), positive (116 cases), and inadequate specimen (5 cases). There were 18 false-negative and 1 false-positive diagnoses. All suspicious cases were positive histologically. Our results showed a sensitivity of 87.2% and a specificity of 97.8%. The accuracy was 89.8%. Therefore, nasopharyngeal imprint cytology is a sensitive and specific method for rapid diagnosis of nasopharyngeal cancer at an outpatient setting.