Ib Level Research Articles

Occult Lymph Node Metastasis in cN0 Tongue Squamous Cell Carcinoma: A Prospective Observational Study

Tongue squamous cell carcinoma (TSCC) is prone to occult lymph node metastasis, and preoperative evaluation of cervical nodes is critical for determining treatment strategies. There is scarce report of detecting occult lymph node metastasis in TSCC by using multi-parameter magnetic resonance imaging (mpMRI), spectral computed tomography (spectral CT) or other diagnostic functional imaging. In this study, we aimed to analyze the incidence and risk factors of occult lymph node metastasis in cN0 TSCC by comparing preoperative imaging with postoperative pathology results. This study prospectively enrolled newly-diagnosed cN0 TSCC patients admitted to the Hunan Cancer Hospital between May, 2022 and December, 2022. All patients underwent primary resection and selective dissection of cervical lymph nodes. MpMRI and spectral CT scan of oral cavity and neck were performed prior to surgery. Preoperative evaluation of lymph node metastasis was conducted by two senior radiologists independently. The location of cervical lymph nodes was assigned based on the 2013 consensus guidelines. A total of 26 cN0 TSCC patients (6 cT1 stage, 13 cT2 stage, and 7 cT3 stage) were enrolled. The median age was 53 (range, 36-64), and there were 25 males. Among all patients, 13 patients underwent unilateral cervical lymph node dissection, while 13 patients underwent bilateral cervical lymph node dissection. A total of 208 lymphatic drainage areas were resected, and 1003 lymph nodes were removed. There were 7 of pT1, 12 of pT2, 7 of pT3 based on postoperative pathological stages. Besides, there are 21 cases staged pN0, 2 cases staged pN1, 2 cases staged pN2, and 1 case staged pN3. Among the 26 patients, 5 (19.23%) cases had occult lymph node metastasis. A total of 8 metastatic lymph nodes (4 in ipsilateral Ib level, 1 in contralateral Ib level, 3 in IIa level ipsilateral side) were detected in the whole group. No lymph node metastasis was detected in level IIb, III and IV. The median maximum diameter of metastatic lymph nodes was 12 mm (range 5 to 15 mm), and 1 extra-nodal extension was observed. Moreover, all occult lymph node metastases occurred in patients with a primary invasion depth of ≥ 5 mm (29.41%, 5/17). The incidence of occult lymph node metastasis in cN0 TSCC remains high under functional imaging diagnostic technology. Preventive neck dissection is necessary for patients with cN0 disease, especially those with primary tumor invasion depth exceeding 5 mm.

Occult lymph node metastasis in cN0 tongue squamous cell carcinoma: A prospective observational study.

e18066 Background: Tongue squamous cell carcinoma (TSCC) is prone to occult lymph node metastasis, and preoperative evaluation of cervical nodes is critical for determining treatment strategies. There is scarce report of detecting occult lymph node metastasis in TSCC by using multi-parameter magnetic resonance imaging (mpMRI), spectral computed tomography (spectral CT) or other diagnostic functional imaging. In this study, we aimed to analyze the incidence and risk factors of occult lymph node metastasis in cN0 TSCC by comparing preoperative imaging with postoperative pathology results. Methods: This study prospectively enrolled newly-diagnosed cN0 TSCC patients admitted to the Hunan Cancer Hospital between May, 2022 and December, 2022. All patients underwent primary resection and selective dissection of cervical lymph nodes. MpMRI and spectral CT scan of oral cavity and neck were performed prior to surgery. Preoperative evaluation of lymph node metastasis was conducted by two senior radiologist independently. The location of cervical lymph nodes was assigned based on the 2013 consensus guidelines. Results: A total of 26 cN0 TSCC patients (6 cT1 stage, 13 cT2 stage, and 7 cT3 stage) were enrolled. The median age was 53 (range, 36-64), and there were 25 males. Among all patients, 13 patients underwent unilateral cervical lymph node dissection, while 13 patients underwent bilateral cervical lymph node dissection. A total of 208 lymphatic drainage areas were resected, and 1003 lymph nodes were removed. There were 7 of pT1, 12 of pT2, 7 of pT3 based on postoperative pathological stages. Besides, there are 21 cases staged pN0, 2 cases staged pN1, 2 cases staged pN2, and 1 case staged pN3. Among the 26 patients, 5 (19.23%) cases had occult lymph node metastasis. A total of 8 metastatic lymph nodes (4 in ipsilateral Ib level, 1 in contralateral Ib level, 3 in IIa level ipsilateral side) were detected in the whole group. No lymph node metastasis was detected in level IIb, III and IV. The median maximum diameter of metastatic lymph nodes was 12 mm (range 5 to 15 mm), and 1 extra-nodal extension was observed. Moreover, all occult lymph node metastases occurred in patients with a primary invasion depth of ≥ 5 mm (29.41%, 5/17). Conclusions: The incidence of occult lymph node metastasis in cN0 TSCC remains high under functional imaging diagnostic technology. Preventive neck dissection is necessary for patients with cN0 disease, especially those with primary tumor invasion depth exceeding 5 mm.

Eksperimentasi Model Pembelajaran JUCAMA Ditinjau Dari Gaya Belajar Terhadap Prestasi Belajar Mahasiswa Mata Kuliah Berbicara di Prodi PBSI IKIP PGRI Bojonegoro

Focus this is research to determine which are the achievements of better speaking learning: (1), learning model JUCAMA or Conventional, (2) Visual, auditory, or kinesthetic, (3) On models learning JUCAMA, which are the achievements of better speaking learning, visual, auditory, or kinesthetic.This type of research is quasi-experimental with 2 × 3 factorial design. The population of this research is all students of PBSI IKSI PGRI Bojonegoro Study Program, which consists of nine classes with a total of 288 students. Sampling was done by cluster random sampling, selected three classes, namely the level of I-A, IB, and IC. The sample consisted of 93 students, with details of 31 IA students as an experiment, 31 IB level students as a control, and 31 IC level students as a trial. Data collection instruments using learning style questionnaires, and learning achievement tests that have been validated by the validators. The test instrument was tested in PBSI level I study program after being tested and then analyzed its reliability, distinguishing features and difficulty levels. The prerequisite tests include the normality test using the Lilliefors method and the variance homogeneity test using the Bartlett method. With α = 0.05, it can be concluded that the sample comes from populations that are normally distributed and have a homogeneous variance.In this study it can be concluded that: (1) students with learning JUCAMA had speaking learning achievement better than the students with conventional learning, (2) achievement of learning speaking students who have a visual learning style is better than the speaking learning achievement of students who have auditory and kinesthetic learning styles. While the speaking achievement students who have learning styles of auditory as well as students who have a kinesthetic learning style, (3) On learning JUCAMA, there is no difference between speaking achievement in each learning style. Keyword: jucama, learning style, learning achievement, speaking

Bacterial nanocellulose as a plastic material for closure of defects of the dura mater: literature review

Objective . To analyze publications devoted to the possibility of using bacterial nanocellulose as a plastic material for defects in the dura mater associated with spine and spinal cord pathology. Material and Methods . The PubMed database was searched with keywords “bacterial cellulose properties” and “bacterial cellulose”. The search was limited to articles published in English- and Russian-language journals in 2009–2019. The limitation was caused by the need for up-to-date evaluation of the properties of bacterial nanocellulose. The search with keywords “bacterial cellulose properties” returned a list of 963 articles and with key words “bacterial cellulose” – a list of 3908 articles. The Google search engine was also used, in which articles were found actually reflecting properties of bacterial nanocellulose without which complete understanding of its nature is impossible. After assessing the found data, 76 articles were selected that reflect this issue to the fullest extent. More than fifty percent of the reviewed articles were published within the last 10 years. Evidence level: IV; recommendation grade: C, though randomized trials with evidence level Ib and recommendation level A are used. Results . Implants made of bacterial nanocellulose are able to perform the function of the extracellular matrix by providing a barrier function, creating conditions for the circulation of metabolites and oxygen, and preventing the achievement of excess cell concentration. Conclusion . The use of bacterial nanocellulose as an implant for closure of the dura mater defects associated with the spinal cord pathology is a promising direction in neurosurgery, since nanocellulose does not cause adhesions to the nervous tissue and performs a barrier function.

The problem with treating sinusitis against the background of allergic rhinitis

Both allergic rhinitis (AR) and sinusitis are widespread diseases that significantly worsen the patient’s quality of life, lead to significant financial costs and are associated with a huge health burden. When treating any AS, it is necessary to follow three basic principles: address the cause of the disease; eradicate the pathogen; restore drainage of sinuses, aerate and restore CO. The efficacy and speed in the treatment of sinusitis, which arose against the background of allergic inflammation, are comparable to those in the use of oral GCS (Ib level, persuasion scale A). The H1-histamine receptor blocker and competitive histamine antagonist ebastine is one of the most effective and safe latest-generation antihistamine.

Post ASCO update 2016—lung cancer

The aim of this short review is to summarize the most important data relating to the field of thoracic tumors presented at the 2016 ASCO annual meeting. For small cell lung cancer (SCLC) the treatment algorithms once again remain unchanged. The CONVERT study was not able to show superiority of a modern chemoradiotherapy regimen using once daily fractionation over the historical standard of hyperfractionated chemoradiotherapy. With rovalpituzumab tesirine a promising new agent is in development, leading to encouraging treatment results in patients with pretreated, extensive SCLC disease on phase IB level. Regarding nonsmall cell lung cancer (NSCLC) a phase II trial was able to confirm high efficacy of the combination dabrafenib/trametinib if a BRAF-V600E mutation is detectable. These data should lead to more widespread implementation of BRAF mutation testing in routine diagnostic work-up. In the J‑ALEX trial alectinib outperformed crizotinib in the first-line treatment of Asian patients with ALK-rearranged metastatic NSCLC. However, further data from ongoing studies will be necessary to better define the optimal sequencing of treatments for this genetically defined subgroup of patients.

Sparing Bilateral Ib and Contralateral High Level II Nodes in Node-Positive (n+) Oropharyngeal Carcinoma (OPC) Improves Quality of Life on a Prospective Self-Reported Xerostomia Questionnaire

It remains unclear whether sparing level IB and/or contralateral high level II in N+ OPC can reduce toxicity without resulting in unwarranted failures. The purposes of this study are two-fold: (1) to report the loco-regional control (LRC) rates and (2) to prospectively evaluate quality of life outcomes correlating with dosimetric parameters amongst patients in whom we spared level IB and/or high contralateral level II. Between Apirl 2009 and October 2011, 222 patients with N+ OPC received definitive IMRT at our center. The median age was 57. There were 78% T1-2 and 21% T3-4. There were 17% N1, 81% N2, and 2% N3. Primary sites were: tonsil (42%), base of tongue (50%), and other (8%). Among patients with known HPV status, 92% were HPV positive. Median dose was 70 Gy. Treatment plans were retrospectively reviewed for coverage of bilateral level IB and contralateral high level II nodes. Patients were divided into 4 cohorts: sparing of bilateral level IB (s-IB) vs no sparing of bilateral level IB (ns-IB); sparing of contralateral high level II (s-II); no sparing of contralateral high level II (ns-II). A prospective, previously validated, self-reported xerostomia questionnaire (XQ) was collected during patient visits. Dosimetric analysis of the salivary glands was performed. Cohort s-IB and cohort s-II had 44 and 88 patients, respectively. With a median follow-up of 21.2 months, the 2-year LRC for cohort s-IB, cohort ns-IB, cohort s-II, and cohort ns-II were 97.7%, 92.6%, 95.0% and 92.7%, respectively. The cohort with IB spared (s-IB) showed significant improvement in xerostomia outcomes in comparison to cohort ns-IB based on XQ summary scores (38.8 vs 49.3; p = 0.037); where lower scores indicate better salivary function. The mean dose in ipsilateral and contralateral submandibular glands (SMG) for cohort s-IB vs ns-IB were 64.9 Gy vs 70.3 Gy; p < 0.001 and 46.6 Gy vs 54.7 Gy; p = 0.001, respectively. Additionally, dose was reduced to the oral cavity for s-IB (36.9 Gy vs 46.1 Gy; p < 0.001). Doses to the contralateral SMG correlated with XQ summary scores (p = 0.001). The cohort with high level II spared (s-II) showed significant improvement in xerostomia outcomes when compared with cohort ns-II based on XQ summary scores (39.4 vs 51.7; p = 0.006). The mean dose to the contralateral parotid for cohort s-II vs ns-II was 19.2 Gy vs 26.2 Gy; p < 0.001. Late xerostomia graded by CTCAE was also reduced in cohort s-II (1.3 vs 1.7; p < 0.001). Sparing of IB and contralateral high level II nodes in N+ OPC improves patient quality of life based on prospective self-reported xerostomia questionnaires by reducing dose to salivary organs. Sparing these nodal stations in appropriately selected patients does not comprise local-regional control.

Kinomic Profiling Identifies Pathways of HER2 Targeted Therapy Resistance in HER2 Positive Breast Cancer Cell Lines

Common practice is to irradiate at least the ipsilateral IB level. However, elective irradiation of level IB increases dose to the larynx, oral cavity, and mandible, potentially increasing acute and long-term toxicity. This study reports regional control rates and long-term toxicity for employing a policy of withholding radiation to the level IB lymph nodes unless clinically indicated. Materials/Methods: Between 2003 and 2010, 95 patients with stage I IVB oropharyngeal cancer were treated with definitive IMRT with simultaneous-integrated boost technique. The median age was 59. The T and N stage distributions were: 28% T1, 40% T2, 22% T3, 10% T4, 9% N0, 15% N1, 16% N2a, 35% N2b, 11% N2c, and 14% N3. The primary sites were tonsil (52%), base of tongue (45%), and others (3%). Of 55 patients with HPV data, 89% were positive. Median dose to the gross tumor volume was 70 Gy. Ninety-four percent of patients had concurrent chemotherapy, and 12% had pre-radiation (RT) neck dissection. Indications for ipsilateral IB nodal coverage were: (1) a grossly enlarged level IB node, (2) primary or nodal tumor invasion of the ipsilateral level IB or submandibular gland (SMG), and (3) tumor involvement of the oral cavity or other structures that drain primarily to the ipsilateral level IB. Contralateral IB level was not covered in the absence of the above clinical factors in the contralateral neck. Adverse late effects were determined using the Common Terminology Criteria Adverse Event (CTCAE) v4.03. Results: Of 82 patients that did not have a pre-RT neck dissection, 28% (23/82) had ipsilateral level IB coverage and 1 had bilateral IB coverage. Of 23 patients with ipsilateral IB coverage, 13 were for SMG involvement, 5 for IB node involvement, 2 for oral cavity involvement, 2 for oral cavity +/SMG +/IB node involvement, and 1 for unknown reasons due to incomplete data. Of 11 patients that had a pre-RT neck dissection, none had the contralateral IB level covered. With a median follow-up of 2.7 years, only one patient failed in the neck (in the tracheostomy stoma site) at 11.3 months. At 2 years, regional control, local control, disease-free survival and overall survival were 99%, 99%, 89%, and 94%, respectively. No patients developed grade 3 xerostomia or grade 4 osteonecrosis. At 2 years, rates of grade 1-2 xerostomia, gastrostomy tube dependency, and grade 3 osteoradionecrosis were 15%, 4%, and 1%, respectively. Conclusions: Our data supports that in the absence of level IB and oral cavity involvement, the ipsilateral and the contralateral level IB nodal levels do not need to be covered in IMRT plans for oropharyngeal carcinoma. Author Disclosure: J.W. Jang: None. R.J. Parambi: None. L.S. Liliana: None. N.J. Liebsch: None. A.W. Chan: None.

Intensity Modulated Radiation Therapy and Level 1B Nodal Coverage for Oropharyngeal Carcinoma

The rate of pathologic level IB lymph node involvement in clinically node negative oropharyngeal cancer is very low, ranging from 0 to 3%. It is controversial whether or not this nodal level should be included in intensity modulated radiation therapy (IMRT) plans. Common practice is to irradiate at least the ipsilateral IB level. However, elective irradiation of level IB increases dose to the larynx, oral cavity, and mandible, potentially increasing acute and long-term toxicity. This study reports regional control rates and long-term toxicity for employing a policy of withholding radiation to the level IB lymph nodes unless clinically indicated.

679P - Identification of Risk Factors of Relapse after Curative Surgical Resection in Stage I Gastric Cancer

ABSTRACT Background The therapeutic benefit of adjuvant chemotherapy is well established in stage (by AJCC 6th edition) II or III gastric cancer (GC). However, it has not been proven in stage I GC. The aim of this study was to identify risk factors of relapse in stage I GC, and to find out patients at high risk of relapse. Methods We retrospectively reviewed the medical records of 2783 patients with pathologically confirmed stage I GC who underwent curative surgical resection alone in Asan Medical Center between 2003 and 2007. Clinicopathologic parameters of exploration included: age, sex, histologic differentiation, WHO classification, Lauren classification, size, location, multiplicity, stage, lymphovascular or perineural invasion, preoperative serum levels of tumor markers (CEA, CA 19-9, CA 72-4), and type of surgery. Then, we performed univariate and multivariate analysis to correlate each parameter with relapse-free survival (RFS) and overall survival (OS). Results With a median follow-up of 54 months (range, 0-60), 213 (7.7 %) patients experienced recurrence or death, and 5-year RFS and OS was 90% and 94%, respectively. In univariate analysis, RFS was significantly related with age, sex, differentiation, WHO and Lauren classification, size, stage, lymphovascular invasion, perineural invasion, and serum levels of CEA and CA 19-9. The multiplicity of tumor instead of size was significantly related with OS. In multivariate analysis, 6 factors (age over 65 years, male, stage Ib, lymphovascular invasion, perineural invasion, and elevated level of CEA) remained independent poor prognostic factors for RFS (p Conclusion In this study cohort, we identified 6 independent risk factors for relapse and death. The patients with more than two risk factors are expected to have significant risk of recurrence or death after curative resection, and should be considered as the future candidates of adjuvant treatment. Disclosure All authors have declared no conflicts of interest.

Energy band structure and the half‐filling of the intermediate band in the quantum‐dot solar cell

AbstractThe net generation balance equation is incorporated into the Poisson equation and the continuty equation to deduce the IB quasi‐Fermi EfIB and filling factor f. The QD state density is not enough high to pin the IB quasi‐Fermi level EfIB at the position of the IB level EIB so that EfIB depends on the QD position and the operation voltage. In the case of the quasi‐uniform absorption (the weak absorption and the same absorption coefficient constants of sub‐bandgap photons), a rough approximation is that EfIB approximately parallels to EIB, and clamps in some equilibrium position. In addition, in the case of the nonuniform absorption, the proper ratio αIC0/αVI0 can effectively enhance the conversion efficiency. (© 2011 WILEY‐VCH Verlag GmbH &amp; Co. KGaA, Weinheim)

I011 Management of patients treatment with hypertensive emergencies rewiew of the literature

Hypertensive emergency is common but a severe clinical outcome in hypertensive patients. The definition of the hypertensive emergency goal blood pressure is not consistent over the literature, but often involves a target organ damage in a situation of emergency. Treatment practice in hypertensives crisis is difficult because of the lack of evidence supporting the use of one drug over another and a consensuson the posology. After review of the medical literature, we found only four randomized trials comparing Nitroprussiate to Uradipil or Nifedipine, or nifedipine to captopril. Those trials included only few patients, and Ib or IIb probe level without long term morbidmortality data. In conclusion, the clinical practice is still far away from the Evidence-based Medicine. Clinical research must go further to prevent cerebral, cardiovascular or renal complications in hypertensive patients.

The preliminary research on the risk factors of the Ib level lymphatic nodes metastasis in recurrent nasopharyngeal carcinoma

The preliminary research on the risk factors of the Ib level lymphatic nodes metastasis in recurrent nasopharyngeal carcinoma

Locoregional Failure Analysis in Head-and-Neck Cancer Patients Treated with IMRT

Analysis of locoregional failure in head-and-neck cancer (HNC) following intensity-modulated radiation therapy (IMRT), with focus on the location of locoregional failures in relation to the chosen planning target volumes (PTVs) and dose distributions. Between January 2002 and May 2006, 280 HNC patients were subjected to IMRT at the authors' institution. Mean follow-up was 23.2 months (3-59.3 months). Definitive IMRT was performed in 75% of all patients. In 71%, simultaneous cisplatin-based chemotherapy was given. 70% of patients presented with T3/4, T1-2 N2c/3 or recurred disease. Locoregional failure patterns were analyzed. 2-year local, nodal, distant, disease-free, and overall survival rates were 80%, 87%, 87%, 73%, and 82%, respectively. 46 local (16%) and 31 nodal (11%) failures have been observed so far. Local tumor persistence was seen in 23/46 cases (50%), and nodal persistence in 12/31 (39%), respectively. One marginal local failure developed in a patient referred for a recurred oral cavity tumor. Three nodal failures developed outside the PTVs at unexpected locations. All other failures have been confirmed "in field". No failure occurred in level Ib or upper level II. Local failure occurred mainly following definitive IMRT for large tumors, nodal failure only in nodally positive patients with nodal high-risk features. The dose-volume concept as used here has shown to be adequate, with disease failure developing at the site of the initial gross tumor manifestation inside the boost volume.

Quantitative defect of glycoprotein Ib in severe cirrhotic patients.

A decrease of platelet agglutination induced by ristocetin has been described in cirrhotic patients. In order to investigate the relationship of such phenomenon with a putative defect on platelet membrane glycoprotein Ib, we have studied the quantitative and functional status of Gp Ib in eleven severe alcoholic cirrhotic patients, and the ability of their formalin-fixed platelets to agglutinate in the presence of normal plasma plus ristocetin. Interestingly, we found a significant decrease of immunoreactive GP Ib molecules (9,978 +/- 1,534 vs. 17,064 +/- 404 molecules per platelet) and ristocetin-dependent binding of vWF (9,113 +/- 1,338 vs. 13,992 +/- 1,968 molecules per platelet) (P < 0.01) in comparison to the levels found in a control group of healthy subjects. Immunoblotting analysis of platelet lysates confirmed the reduction of GP Ib level in cirrhotic patients, but showed no modification on the precipitation pattern of this glycoprotein. The ristocetin-induced platelet agglutination (light transmission %) was also significantly lower in patients with cirrhosis (48 +/- 7.6 vs. 92 +/- 3.6, P < 0.01), and correlated with the binding of normal vWF (r = 0.863, P = 0.0013). Patients with bleeding times longer than 7 min and/or clinical history of bleeding episodes showed the lowest values of platelet agglutination and GP Ib level. In conclusion, our present results indicate that liver cirrhosis is associated with a relevant decrease of functional GP Ib molecules on the platelet surface. This reduction might be related to the prolongation of bleeding time and to the bleeding diathesis observed in cirrhotic patients.