Nasopharyngeal Neoplasms Research Articles

Planning target volume margin based on the image-guided radiotherapy in nasopharyngeal carcinoma

Objective To analyze set-up errors for irradiation of nasopharyngeal carcinoma by using kilo-voltage cone beam computed tomography (kV-KBCT) scanning, and to calculate the external margin from planning target volume (PTV) of nasopharyngeal carcinoma. Methods A total of 150 nasopharyngeal carcinoma patients in Meizhou People's Hospital from December 2014 to November 2016 were treated by image-guided radiation therapy (IGRT), kV-KBCT, CT image scanning matcthed by bone and grey alignment. PTV of nasopharyngeal carcinoma was also calculated. Results According to PTV formula, the external distance before radiotherapy guided by grey alignment was 0.5 mm in X-axis, 0.4 mm in Y-axis, 0.8 mm in Z-axis. While the distance was 0.1 mm in X-axis, 0.5 mm in Y-axis, 1.7 mm in Z-axis guided by bone alignment. After radiotherapy, the external distance guided by grey alignment was 0.4 mm in X-axis, 0.5 mm in Y-axis, 0.9 mm in Z-axis. While the distance was 0.1 mm in X-axis, 0.9 mm in Y-axis, 2.0 mm in Z-axis guided by bone alignment. There was no significant difference in set-up errors of 3 directions and 2 aligned ways before and after treatment. Conclusions The PTV within 3 mm is safe when IGRT is used for directing radiotherapy of nasopharyngeal carcinoma, and kV-KBCT is an effective image equipment. Key words: Nasopharyngeal neoplasms; Radiotherapy, computer-assisted; Cone-beam computed tomography; Set-up errors

Recombinant human granulocyte macrophage colony-stimulating factor for the prevention and treatment of oral mucositis induced by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma

Objective To observe the effect of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on the prevention and treatment of oral mucositis induced by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma. Methods A total of 64 patients with locally advanced nasopharyngeal carcinoma from April 2015 to April 2017 in the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled. The patients were randomly divided into the observation group (32 cases) and the control group (32 cases) according to the random number table method. Both groups were treated with intensity modulated radiotherapy (IMRT) and synchronized with TP regimen (docetaxel + cisplatin) chemotherapy for 2 cycles. Both groups were treated with mouthwash at the beginning of radiotherapy to prevent oral mucositis. The observation group was given rhGM-CSF mouthwash, and the control group was given compound borax mouthwash. The oral mucositis and the oral pain during the treatment and the end of the treatment were evaluated by using American Radiation Oncology Group (RTOG)grading criteria and visual analogue scoring method (VAS) grading criteria. The time of onset of oral mucositis and the total time of radiotherapy in both groups was also recorded. Results All the patients were treated with concurrent chemoradiotherapy. The total radiotherapy time in the observation group was less than that in the control group [(46.4±1.6) vs. (48.2±3.2) d, t=-2.720, P=0.009]. The clinical total effective rate was 93.8% (30/32) in the observation group and 96.9% (31/32) in the control group respectively (χ 2=0.35, P = 0.554). The occurrence of grade 1, 2 and 3 oral mucositis in the observation group was (20.9±2.5), (29.3±2.4), and (34.5±1.8) d respectively, which was latter than that in the control group [(16.3±2.0), (24.2±2.2) and (31.0±2.2) d] respectively (t = 8.125, P = 0.000; t = 8.840, P = 0.000; t = 6.944, P = 0.001). During concurrent chemoradiotherapy, the incidence of grade 3 oral mucositis in the observation group was lower than that in the control group [31.2% (10/32) vs. 56.2% (18/32); Z = -2.197, P = 0.028]. At the end of concurrent chemoradiotherapy, the total incidence of grade 2 and grade 3 oral mucositis in the observation group was lower than that in the control group [53.1% (17/32) vs. 81.2% (26/32); Z = -2.708, P = 0.007]. The incidence of moderate and severe oral pain caused by oral mucositis in the observation group was lower than that in the control group [46.9% (15/32) and 6.2% (2/32) vs. 59.4% (19/32) and 15.6% (5/32), respectively; Z = -2.009, P = 0.045]. Conclusion rhGM-CSF mouthwash can delay the occurrence of oral mucositis, reduce the incidence of oral mucositis and oral pain to effectively prevent and treat oral mucositis induced by concurrent chemoradiotherapy in patients with locally advanced nasopharyngeal carcinoma, which is worthy of clinical application. Key words: Nasopharyngeal neoplasms; Radiotherapy; Antineoplastic combined chemotherapy protocols; Stomatitis; Granulocyte macrophage colony-stimulating factors, recombinant

Diagnostic value of lymph node EBV-DNA detection in cervical lymph node metastasis of nasopharyn-geal carcinoma

Objective To evaluate the diagnostic value of lymph node fine-needle aspiration (FNA) Epstein-Barr virus (EBV)-DNA concentration detection in nasopharyngeal carcinoma (NPC) cervical lymph node metastasis. Methods From August to December 2016, 36 cases of NPC and 9 cases of other tumors (not correlated with EBV infection) were enrolled in this study at the Sun Yat-sen University Cancer Center. All patients received magnetic resonance images (MRI), plasma and cervical lymph node FNA EBV-DNA detection. Results The median concentration of EBV-DNA in FNA fluid (1.39×105 copies/ml) in cervical lymph node metastasis was significantly higher than that in plasma (2.00×103 copies/ml), with a significant diffe-rence (χ2=16.723, P=0.004). The diagnosis sensitivity, specificity, accuracy of the lymph node FNA fluid of EBV-DNA were 86.2% (25/29), 71.4% (10/14) and 81.4% (35/43) respectively, which were better than those of MRI [72.4% (21/29), 50.0% (7/14) and 65.1% (28/43) respectively] and plasma EBV-DNA [55.2% (16/29), 71.4% (10/14) and 60.5% (26/43) respectively]. The area under the curve (AUC) of level Ⅰb cervical lymph node metastasis was calculated, and FNA fluid EBV-DNA (AUC=0.688) was better than MRI (AUC=0.583), with a significant difference (Z=2.476, P=0.008). The EBV-DNA concentration in FNA fluid in cervical lymph node metastasis of patients with other tumors (no correlated with EBV infection) was 0 copy/ml. Conclusion FNA fluid EBV-DNA may improve the diagnostic sensitivity of cervical lymph node metastasis in nasopharyngeal carcinoma, and help to explore the clinical target volume neck nodes at level Ⅰb cervical lymph node in radiotherapy. Key words: Nasopharyngeal neoplasms; Lymphatic metastasis; Biopsy, fine-needle; Epstein-Barr virus DNA

Effects of comprehensive psychological nursing intervention for patients with nasopharyngeal carcinoma during radiotherapy

Objective To explore the effects of comprehensive psychological nursing intervention on patients with nasopharyngeal carcinoma during radiotherapy, so as to provide references for alleviating their physical and mental pain and to improve their quality of life. Methods From July 2016 to April 2017, a total of 124 cases of nasopharyngeal carcinoma patients treated by radiotherapy from a ClassⅢGrade A hospital were recruited in the research, of which 63 cases from July to December 2016 were assigned as control group and 61 cases from January to April 2017 were assigned as intervention group. Routine nursing care was provided in the control group. On the basis of the routine nursing, individual combined with group intervention was applied in the intervention group according to the psychological and behavioral interventions before and during radiotherapy. The nursing intervention lasted from the beginning of the first radiotherapy till the end of the therapy course in both groups. By the end of the therapy, all the patients were investigated with Distress Thermometer (DT) and the short Quality of Life Scale for Nasopharyngeal Carcinoma with 13 items (QOL-NPC13) . Results The scores of DT in the control group and the intervention group were (8.08±0.58) and (5.30±1.11) respectively, and the difference was statistically significant (t=19.316, P<0.001) . The scores of body function, psychological spirit, social relationship, toxic side effect and the quality of life of the intervention group were all higher than those of the control group, the differences were statistically significant (Z=-4.674, -7.894, -4.755, -4.842, -8.114; P<0.001) . Conclusions Comprehensive psychological nursing intervention is helpful to relieve the psychological pain and improve the quality of life in patients with nasopharyngeal carcinoma undergoing radiotherapy. Key words: Nasopharyngeal neoplasms; Radiotherapy; Psychological nursing

Effect of patient support model on the mood, self-efficacy and quality of life of nasopharyngeal carcinoma patients

Objective To explore the effect of patient support model on the emotion and self-efficacy of patients with nasopharyngeal carcinoma (NPC) , so as to summarize the nursing model for NPC patients and improve their quality of life. Methods A sample of 86 NPC patients who admitted from October 2013 to October 2016 for the first time were selected by convenience sampling method and divided into observation group (n=43) and control group (n=43) randomly using the random number table. Both of the groups were given routine nursing care, at the same time, the patients in the observation group were given patient support mode nursing. Patients' mood, self-efficacy, self-management ability and quality of life were compared after two months' intervention. Results After the intervention, the SAS and SDS scores of the two groups were significantly improved than before, and the scores were lower in the observation group than those in the control group, with statistical differences (t=13.648, 25.306; P<0.001) . The level of patients' self-efficacy and self-management ability were improved after the intervention, and the scores of the observation group were higher than those of the control group (t=7.698, 6.838; P<0.001) . SF-36 scores of both groups were better than those before the intervention, and SF-36 score of the observation group was higher than that of the control group (t=10.456, P< 0.001) . Conclusions The patient support model can effectively improve the self-efficacy level of NPC patients for the first hospitalization, improve the negative emotions and improve the quality of life of patients. Key words: Nasopharyngeal neoplasms; Emotion; Patient support model; Self-efficacy

The influence of comprehensive psychological intervention on the immune function of patients with nasopharyngeal carcinoma

Objective To explore the influence of psychological intervention on the immune function of patients with nasopharyngeal carcinoma. Methods Forty nasopharyngeal carcinoma patients with concomitant radiochemotherapy were divided into intervention group and control group by random digits table method with 20 cases each. Among concomitant radiochemotherapy nasopharyngeal carcinoma patients, intervention group were treated with comprehensive psychological behavior, and control group received only concurrent radiotherapy and chemotherapy. Both groups were investigated by Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS). Natural killer cells activity were measured by flow cytometry. Results There were no significantly difference in score of SDS and SAS between two confirmed groups (P>0.05). After treatment, the score of SDS and SAS in intervention group were (45.26±3.83), (42.57±3.75) points, which were significantly lower than those of control group (52.68±3.66), (51.16±3.62) points, the difference was statistically significant(t=6.264, 7.370, P>0.05). Meanwhile, natural killer cell activity between two groups showed no significantly difference (P>0.05). However, the activity of natural killer cells in intervention group was 26.96±9.01, which was higher than that of control group 22.84±7.19, there were statistically significant difference between two groups (t=2.120, P<0.05).There was a positive correlation between the value difference of SDS scores, SAS scores and natural killer cell activity between two groups (r=0.238, P=0.006; r=0.527, P=0.003). Conclusions Comprehensive psychological intervention can significantly not only improve the depression and anxiety of nasopharyngeal carcinoma patients, but also enhance the activity of natural killer cells, which help maintain the leukocyte level of patients. Key words: Nasopharyngeal neoplasms; Psychological intervention; Natural killer cells; Immune function

Application of diffusion weighted imaging in the diagnosis and treatment of nasopharyngeal carcinoma

The judgment of early curative effect is important to the treatment of nasopharyngeal carcinoma and the prognosis of the patients. As a rapid imaging technique, magnetic resonance diffusion weighted imaging (DWI) is used to quantitatively analyze the changes of water molecules in the tissue by means of apparent diffusion coefficient (ADC), so as to diagnose the small lesions of nasopharyngeal carcinoma accurately, eva-luate the early curative effect and observe the prognosis. With the continuous improvement and progress of MRI and data analysis technology, DWI in the diagnosis and treatment of nasopharyngeal carcinoma shows a broader application prospect. Key words: Nasopharyngeal neoplasms; Diffusion magnetic resonance imaging; Diagnosis; Therapy; Apparent diffusion coefficient

Progress in the treatment of nasopharyngeal carcinoma

Nasopharyngeal carcinoma is a common malignant tumor. The efficiency of early stage patients with radiotherapy alone can reach 90%, the locally advanced patients still need the chemoradiotherapy treatment, molecular targeted therapy, traditional Chinese medicine therapy and so on. Intensity modulated radiotherapy has prominent advantages in nasopharyngeal carcinoma, which can significantly improve the curative effect and reduce the adverse reactions and also improve the quality of life. Key words: Nasopharyngeal neoplasms; Radiotherapy; Drug therapy; Medicine, Chinese traditional; Molecular targeted therapy

Correlation between the level of serum anterior gradient 2 and clinical pathological characteristics of nasopharyngeal carcinoma patients

Objective To determine the levels of serum anterior gradient 2 (AGR2) before and after treatment in nasopharyngeal carcinoma (NPC) patients, and investigate the relationship of AGR2 and clinical pathological characteristics of NPC patients. Methods The serum levels of AGR2 were detected by enzyme linked immunosorbent assay (ELISA) in 55 NPC patients (NPC group) before and after treatment, 30 patients with nasopharyngeal inflammation (inflammation group) and 20 healthy controls (health control group). The correlations between serum AGR2 before and after treatment and clinical pathological characteristics of NPC were analyzed. The NPC patients received radiotherapy and were followed up for 6 months, and the therapeutic effect was evaluated. Results The serum AGR2 levels in NPC group before treatment, inflammation group and health control group were (22.92±5.24)μg/L, (9.50±4.15)μg/L and (8.75±2.18)μg/L respectively, and the difference was statistically significant (F=268.400, P=0.000). The level of serum AGR2 in NPC group was obviously higher than that in inflammation group (t=14.241, P=0.000) and health control group (t=15.254, P=0.000). The level of serum AGR2 in NPC group after treatment was significantly lower than that before treatment [(15.15±10.33)μg/L vs. (22.92±5.24)μg/L, t=12.774, P=0.000]. In NPC patients, serum AGR2 levels of clinical Ⅲ-Ⅳ stage group before and after treatment were higher than those of clinical Ⅰ-Ⅱ stage group (t=5.938, P=0.000; t=0.759, P=0.032). Serum AGR2 levels of lymph node metastasis group before and after treatment were higher than those of no lymph node metastasis group (t=6.879, P=0.000; t=2.700, P=0.009). Serum AGR2 levels of carotid sheath and skull base involvement groups before treatment were higher than those of non-involvement groups (t=8.342, P=0.000; t=8.255, P=0.009). Serum AGR2 levels of cranial nerve involvement group before and after treatment were higher than those of non-involvement group (t=7.743, P=0.000; t=3.021, P=0.004). The serum AGR2 level after treatment in complete response patients [(13.86±2.93)μg/L] was significantly lower than that in partial response patients [(15.85±3.24)μg/L, t=2.267, P=0.028] and invalid patients [(20.65±6.59)μg/L, t=4.935, P=0.000]. The serum AGR2 level in partial response patients was significantly lower than that in invalid patients (t=3.196, P=0.004). Conclusion The level of serum AGR2 in NPC patients increases obviously. AGR2 plays an important role in the genesis and development of NPC, and can be used as a new marker of NPC for judging the clinical therapeutic efficacy and prognosis. Key words: Nasopharyngeal neoplasms; Pathology, clinical; Anterior gradient 2

Expression of C2orf40 protein and its clinical significance in human nasopharyngeal carcinoma

Objective To evaluate the protein expression of chromosome 2 open reading frame 40 (C2orf40) in nasopharyngeal carcinoma (NPC) tissues and cells, and to explore its association with cell diffe-rentiation and clinicopathological features. Methods A total of 122 patients with NPC between January 2001 and December 2003 were enrolled in Cancer Hospital of Shantou University Medical College. The paraffin-embedded tissue sections and medical records were collected. Twenty-five samples with chronic nasopharyngitis were used as controls. Tumor and control tissues from biopsies underwent immunohistochemical staining for C2orf40. C2orf40 expression was analyzed with clinicopathological variables. Besides, the protein expressions of C2orf40 were measured by Western blotting in three NPC cell lines, including CNE1, CNE2 and C666-1. Results Ninety-six percent (24/25) of control tissues showed positive expression, among which 88.0% showed dense staining. Otherwise, only 58.3% (71/122) of NPC samples were positive for C2orf40 protein and 82.0% showed weak staining. There was significantly difference between the two groups (U=255.500, P<0.001). It was inversely related to lymph nodes status (r=-0.058, P<0.001) and clinical stage (r=-0.202, P=0.026) by Spearman rank correlation test. In vitro, higher level of C2orf40 protein was found in well differentiated CNE1 cells, while lower levels were found in poorly differentiated cell lines CNE2 and C666-1. Conclusion Down-regulated C2orf40 expression is correlated with tumor cell differentiation, lymph nodes metastasis and clinical stage, and may be a molecular event in the occurrence and development of NPC. C2orf40 is likely to be a potential target of anticancer therapy. Key words: Nasopharyngeal neoplasms; Pathology, clinical; C2orf40

Study of signal transduction mechanisms of X-ray induced multidrug resistance in nasopharyngeal squamous cell carcinoma CNE1 cells

Objective To investigate the relationship between multidrug resistance of X-ray irradiated human nasopharyngeal squamous carcinoma cell line CNE1 and platelet endothelial cell adhesion molecule-1 (PECMA-1)/phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/Bcl-2 signaling pathway. Methods ①The CNE1 cells were cultured in incubator. Exponentially growing CNE1 cells were exposed to 50 Gy ionizing radiation administered in 25 fractions, 2 Gy per fraction, once every two days, and the CNE1/R cells were collected. ②CNE1/R cells were cultured for 24 h, and divided into three groups: the control group, experimental group one (CNE1/R cells were processed through 1∶600 PECAM-1 antibody for 24 h) and experimental group two (CNE1/R cells were processed through 10 μmol/L PI3K inhibitor LY294002 for 24 h). ③The half maximal inhibitory concentration (IC50) values of the control group and two experimental groups of CNE1/R cells were detected by methyl thiazolyl tetrazolium (MTT). ④The mRNA expressions of PI3K and Bcl-2 in the control group and experimental group one were measured by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). ⑤The mRNA expressions of AKT and Bcl-2 in the control group and experimental group two were measured by semi-quantitative RT-PCR. Results ①The IC50 of the control group, experimental group one and two were (2.99±0.02)μg/ml, (1.50±0.03)μg/ml and (1.60±0.05)μg/ml, and the difference among the three groups was statiatically signficant (F=4 381.263, P=0.000). The IC50 of the two experimental groups were obviously lower than that of the control group (t=116.885, P=0.000; t=73.006, P=0.000). ②The semi-quantitative values of PI3K in the control group and experimental group one were 1.66±0.01 and 0.90±0.05 (t=50.394, P=0.000), and the semi-quantitative values of Bcl-2 were 1.66±0.02 and 0.71±0.05 (t=183.165, P=0.000), and the differences were statistically significant. ③The semi-quantitative values of AKT of control group and experimental group two were 1.53±0.01 and 0.72±0.01 (t=135.281, P=0.000), and the semi-quantitative values of Bcl-2 were 1.66±0.02 and 0.63±0.02 (t=128.814, P=0.000), and the differences were statistically significant. Conclusion PECAM-1 induced multidrug resistance of human nasopharyngeal squamous cell carcinoma CNE1 cells may be related to the activity of Bcl-2 through the signal pathway of PI3K/AKT. Key words: Nasopharyngeal neoplasms; Drug resistance, neoplasm; Antigens, CD31; X-rays

Effect observation of sodium cantharidate and vitamin B6 combined with concurrent chemoradiotherapy in treatment of locally advanced nasopharyngeal carcinoma

Objective To study the clinical efficacy of sodium cantharidinate and vitamin B6 injection combined with concurrent chemoradiotherapy in treatment of locally advanced nasopharyngeal carcinoma (LA-NPC). Methods 115 patients with LA-NPC in Shanxi Cancer Hospital were randomly assigned to observation group (61 cases) and control group (54 cases) from February 2014 to April 2016. The patients in the observation group were treated with sodium cantharidate and vitamin B6 injection combined with concurrent chemoradiotherapy. The patients in the control group were treated with concurrent chemoradiotherapy. The differences between the two groups were compared in respect of recent curative effect, the quality of life (QOL) and the adverse reactions. Results The recent effective rate was 93.44% (57/61) in the observation group and 79.63% (43/54) in the control group, and there was significant difference between the two groups (χ2= 4.818, P= 0.049). The improvement rate of QOL was 73.77% (45/61) in the observation group and 53.70% (29/54) in the control group, and there was significant difference between the two groups (χ2= 5.028, P= 0.032). The incidence rates of oral cavity mucous membrane inflammation, hematology toxicity, pharynx and esophagus adverse reactions, the gastrointestinal tract adverse reactions and skin fibrosis in the observation group were lower than those in the control group, and there were significant differences between the two groups (all P < 0.05). Conclusion The recent effect of sodium cantharidinate and vitamin B6 injection combined with concurrent chemoradiotherapy on the patients with LA-NPC is obvious. The comprehensive treatment can also reduce adverse reactions and improve the QOL. Key words: Nasopharyngeal neoplasms; Sodium cantharidinate and vitamin B6; Concurrent chemoradiotherapy

Study on application of bundles on prevention and treatment of oral mucositis caused by chemoradiotherapy for patients with nasopharyngeal carcinoma

Objective To explore and study the effect of bundles on prevention and treatment of oral mucositis caused by chemoradiotherapy for patients with nasopharyngeal carcinoma. Methods A total of 40 patients who met the inclusion criteria from June 2014 to December 2014 were selected as the control group, who adopted routine nursing measures, 40 patients who met the inclusion criteria from January 2015 to June 2015 were assigned to the observation group. Bundles on prevention and treatment of oral mucositis caused by chemoradiotherapy for patients with nasopharyngeal carcinoma were edited using a series of evidence-based approach, and it was used to manage the patients of observation group. Results While doing 21, 28, 33 friction of radiotherapy, the oral mucositis level of 0 degree, I degree, Ⅱdegree, Ⅲdegree and Ⅳ degree of the observation group were 8, 25, 7, 0, 0 cases; 3, 11, 24, 2, 0 cases; 0, 19, 13, 6, 2 cases respectively, which were lower than the control group whose degrees were 0, 31, 6, 3, 0 cases; 0, 18, 11, 10, 1 cases; 0, 9, 17, 9, 5 cases. The difference between the two groups was statistically significant (Z=-4.440, -3.441, -2.232, all P < 0.05 or 0.01). While doing 21, 28, 33 friction of radiotherapy, the throat pain level of 0 degree, I degree,Ⅱdegree, Ⅲdegree of observation group were 4, 31, 5, 0; 2, 22, 14, 2; 0, 26, 12, 2 cases respectively, which were lower than the control group whose degrees were 1, 22, 16, 1 cases; 0, 10, 23, 7 cases; 0, 10, 17, 13 cases. The difference between the two groups was statistically significant (Z=-3.137, -3.326, -3.518, all P <0.01). While doing 28, 33 friction of radiotherapy, the Self Rating Anxiety Scale of the observation group scored 56.76 ± 3.19, 58.72 ±5.41, which were lower than 60.58±2.46, 63.42±4.97 in the control group. The difference between the two groups was statistically significant (t=11.746, 10.561, all P <0.01). While doing 33 friction of radiotherapy, the self rating anxiety scale of the observation group was 60.56±3.73, which was lower than 63.43±4.77 in the control group. The difference between the two groups was statistically significant (t=-4.983, P < 0.01). The following entries: swallow, sensation, eating in public, dry mouth, sticky saliva, feel sick of the quality of life questionnaire of the observation group were higher than the control group while doing 33 friction of radiotherapy. All the differences were statistically significant (t=-3.873-5.130, P<0.05 or 0.01). Conclusions The bundles could effectively prevent and treat oral mucositis caused by chemoradiotherapy for patients with nasopharyngeal carcinoma. It could release the throat pain, anxiety and depression of the patients, as well as improve the quality of life to some extent. Key words: Nasopharyngeal neoplasms; Oral mucositis; Bundles

Cochlear implantation combined with subtotal resection of temporal bone in treatment of nasopharyngeal carcinoma after radiotherapy of temporal bone necrosis

Objective To investigate the effects of cochlear implantation combined with subtotal resection of temporal bone in treatment of nasopharyngeal carcinoma after radiotherapy of temporal bone necrosis. Methods A prospective study method was used, and 76 cases of nasopharyngeal carcinoma after radiotherapy of temporal bone necrosis from February 2013 to October 2015 in our hospital for diagnosis and treatment were selected. According to the open control paired principle,the patients were equally divided into observation group and control group, each of 38 cases. Both groups received subtotal temporal bone resection in the treatment, and the observation group received cochlear implant therapy. The surgical effect and hearing improvement of two groups were observed. Results All patients successfully completed surgery. In the observation group, the patients showed normal reactions to intraoperative electrode detection and postoperative electrode impedance, without electrode slippage. There were no statistical differences between the two groups in postoperative pneumothorax and other complication (P > 0.05). The sound intensity level of hearing test in postoperative 1 month in the observation group and control group were (21.23±5.22) dB and (28.42±4.19) dB, which was significantly lower than that in the preoperative 1d [(38.24±4.98) dB and (38.12±5.00) dB], with significantly statistical difference (P < 0.05). The postoperative 1 month of hearing and speech score in the observation group were (87.24±2.98) points and (82.10±3.91) points respectively, which were significantly higher than those in the control group [(73.02±5.30) points and (71.84 ±3.11) points] (P < 0.05). The two groups of postoperative 1 months of hearing and speech scores were also significantly higher than those in the preoperative 1 d [observation group: (34.29±3.49) points and (32.10±5.30) points; control group: (33.20±4.14) points and (31.98±4.92) points] (P < 0.05). Conclusion Cochlear implantation combined with subtotal resection of temporal bone in treatment of nasopharyngeal carcinoma after radiotherapy of temporal bone necrosis shows high safety and success rate, which can promote the improvement of hearing and speech ability, and be widely used in clinic. Key words: Nasopharyngeal neoplasms; Temporal bone; Osteonecrosis; Cochlear implants; Subtotal resection; Hearing

Correlation between perfusion-weighted magnetic resonance imaging parameters and vascular endothelial growth factors, microvascular density, hypoxia-inducible factor 1α

Objective To investigate the relationship between perfusion-weighted magnetic resonance imaging (PWI) parameters and vascular endothelial growth factor (VEGF), microvascular density (MVD) and hypoxia-inducible factor 1α (HIF-1α) in nasopharyngeal carcinoma (NPC). Methods 94 NPC patients were prospectively studied, and the region of interest was noted by fiberscope. Before the treatment , the common magnetic resonance and PWI were used to obtain the images of region of interest and the relative parameters including transfer constant (Ktrans), rate constant of back flux (Kep), extravascular extracellular volume fraction(Ve), fractional plasm volume (fPV) were calculated, then the marking tissues were detected by biopsy. Immunohistochemical staining was conducted to detect the expressions of VEGF, MVD and HIF-1α, and the relationships between the parameters and proteins were analyzed. Results The positive rates of VEGF and HIF-1α in the NPC tissues were 71.27 % (67/94) and 30.85 % (29/94). There was a significant positive correlation between VEGF and MVD [VEGF-positve vs. VEGF-negtive: (31.273 ± 14.81)/mm2 vs. (23.633 ± 16.56)/mm2, r= 0.322, P= 0.037], but the expression of HIF-1α was not significantly correlated with the VEGF and MVD. The significantly positive correlation was found between VEGF and fPV (r= 0.339, P= 0.041), besides, there were no relations among the rest parameters. Conclusion PWI parameter fPV is positively related with VEGF, indicating that PWI could show angiogensis of NPC to some degree, and provide a guidance for predicting the radiosensitivity of NPC. Key words: Nasopharyngeal neoplasms; Magnetic resonance imaging; Perfusion imaging; Vascular endothelial growth factors; Hypoxia-inducible factor 1, alpha subunit; Microvascular density

Evaluation of the significance of EBV nucleic acid and serology tests in the management of EBV-related diseases

Objective To investigate the relationship between Epstein-Barr virus (EBV) DNA and EBV serology markers and evaluate the clinical application values in different diseases. Methods Plasma samples from 397 diagnosed EBV infection-associated patients and 120 health donors from May 2014 to November 2015 in Wuhan Tongji Hospital were collected. Real-time fluorescent quantitative PCR was performed to detect the levels of EBV-DNA in peripheral blood mononuclear cell and plasma. ELISA was used to detect VCA IgA, VCA IgM, VCA IgG, EA(D) IgG and EBNA IgG antibodies in plasma. The positive rate of EBV-DNA and EBV antibodies were counted in each group according to the detection threshold.Kappa statistic and Spearman sank correlation test were used to analysis the correlation and uniformity between EBV-DNA and EBV serology indicators. Results The positive rate of VCA IgG in patient and health control was 94.2% (374/397) and 93.3% (112/120) respectively (χ2=0.125, P=0.67); The positive rate of EBNA IgG in patient and health control was 95.4% (379/397) and 95.0% (114/120) respectively (χ2=0.045, P=0.807); but the positive rate of VCA IgM was 5.5% (22/397) and 0% (0/120) respectively (χ2=6.9, P<0.01); The positive rate of VCA IgA was 43.3% (172/397) and 9.2% (10/120) respectively (χ2=49.5, P<0.01); The positive rate of EA(D) IgG was 42.0% (167/397) and 7.5% (9/120) respectively (χ2=49, P<0.01). The positive rate of EBV-DNA was 65.5% (260/397) and 16.7% (20/120) respectively (χ2=88.5, P<0.01); The positive rate of EBV-DNA in plasma was 45.8% (182/397) and 5.0% (6/120) respectively (χ2=66.4, P<0.01). Furthermore, the uniformity and Spearman correlation analysis showed that there was no significant correlation between EBV-DNA and EBV serology indicators. The correlation analysis between PBMC EBV-DNA and VCA IgM, VCA IgA, EA(D) IgG showed the Kappa was 0.073, 0.147, 0.073, respectively; the correlation analysis between plasma EBV-DNA and VCA IgM, VCA IgA, EA(D) IgG showed the Kappa was 0.144, 0.369, 0.288, respectively. Thus, the patients were divided into different groups according to the discharge diagnosis, it was observed that the positive rates of EBV-DNA is more than 90% in extra-nodal NK/T cells lymphoma, EBV-associated hemophagocytic lymphoid tissue hyperplasia, chronic active EBV infection and infectious mononucleosis. In nasopharyngeal carcinoma patients, the positive rate of EBV antibodies (VCA IgA and EA(D) IgG) were higher than the detection of EBV-DNA. Conclusions There was no significant correlation between EBV-DNA and EBV serology markers for the same sample. The clinical application values of EBV DNA and EBV serology markers were not identical in nasopharyngeal carcinoma, extra-nodal NK/T cells lymphoma, infectious mononucleosis and EBV-associated hemophagocytic lymphoid tissue hyperplasia. (Chin J Lab Med, 2017, 40: 195-200) Key words: Herpesvirus 4, human; DNA, viral; Serologic tests; Nasopharyngeal neoplasms; Lymphoma

Application effect of systematic rehabilitation intervention in postradiotherapy dysphagia of patients with nasopharyngeal carcinoma

Objective To analyze the application effect of systematic rehabilitation intervention in postradiotherapy dysphagia of patients with nasopharyngeal carcinoma. Methods Totally 60 patients with nasopharyngeal carcinoma and postradiotherapy dysphagia admitted in our hospital from June 1st, 2013 to Feburary 28th, 2016 were selected and divided into the treatment group and the control group according to random number table, with 30 cases in each group. Patients in the control group were treated with conventional rehabilitation exercises, combined with routine care and conventional drug therapy, while those in the treatment group were treated with systematic rehabilitation intervention model, including rehabilitation exercises and swallowing apparatus. Improvement of swallowing function and satisfaction toward the nursing were compared between two groups. Results There were 14 effective cases and 16 ineffective cases in the control group. Two cases in the treatment group were cured. There were 23 effective cases and five ineffective cases in the treatment group. The total efficiency of the treatment group (83.33%) was significantly higher than that of the control group (46.67%) (χ2=2.159, P<0.05) . The experimental results of drinking water and improvement of limitation of mouth opening in the treatment group were obviously better than that in the control group (Z=5.012, 7.018; P<0.05) . Satisfaction in the treatment group (86.67%) was obviously higher than that in the control group (43.33%) (χ2=6.321, P<0.05) . Conclusions Systematic rehabilitation intervention in postradiotherapy dysphagia of patients with nasopharyngeal carcinoma can significantly improve patients' swallowing difficulties. Key words: Nasopharyngeal neoplasm; Deglutition disorders; Systematic rehabilitation intervention; Postradiotherapy

Diagnostic value of combined detection of serum DKK1 and EB virus VCA-IgA for nasopharyngeal carcinoma

Objective To explore the diagnostic value of the combined detection of serum Dickkopf-1(DKK1) and EB viral capsid antigen immunoglobulin A (VCA-IgA) in patients with nasopharyngeal carcinoma (NPC). Methods Serum levels of DKK1 and VCA-IgA were measured by enzyme-linked immunosorbent assay (ELISA) for the 80 patients with NPC and 65 normal controls. Receiver operating characteristic (ROC) curve was used to calculate the diagnostic value. Results The serum levels [M(QR)] of DKK1 in patients with NPC were significantly higher than those in normal controls [580.773(429.146)pg/ml vs. 316.174(252.965)pg/ml], with a significant difference (Z=4.846, P<0.000 1). ROC curves showed that the optimum diagnostic cutoff for serum DKK1 was 611.981 pg/ml, with an area under curve (AUC) of 0.734 (95%CI: 0.654-0.815, 50.0% sensitivity, 96.9% specificity). Measurement of VCA-IgA demonstrated an AUC of 0.714 (95%CI: 0.631-0.798, 47.5% sensitivity, 95.4% specificity). The combined detection of DKK1 and VCA-IgA demonstrated an AUC of 0.849 (95%CI: 0.783-0.914, 76.3% sensitivity, 95.4% specificity). For patients with early-stage NPC, the detection effect of combined detection of DKK1 and VCA-IgA was much better than that in normal controls, with a significant difference (χ2=23.784, P<0.001). Conclusion Serum DKK1 has potential diagnostic value for NPC. Combined detection of DKK1 and VCA-IgA may aid the early diagnosis of NPC. Key words: Nasopharyngeal neoplasms; Diagnosis; Dickkopf-1; EB viral capsid antigen immunoglo-bulin A

Research progress of nutritional risk screening in patients with nasopharyngeal carcinoma

To review the common tools of nutritional risk screening, the importance of nutritional risk screening, the selection of nutritional risk screening and nutritional intervention time in patients with nasopharyngeal carcinoma, and discuss the existing deficiency of nutritional risk screening in patients with nasopharyngeal carcinoma, so as to provide basis for clinical nutritional research in patients with nasopharyngeal carcinoma. Key words: Review; Nasopharyngeal neoplasms; Nutrition assessment

Virus-associated neoplasms of the nasopharynx and sinonasal tract: diagnostic problems

A significant fraction of nasopharyngeal and sinonasal tumors are associated with Epstein-Barr virus (EBV) or human papillomavirus (HPV). Nasopharyngeal carcinoma (NPC) and extranodal NK/T-cell lymphoma harbor EBV in practically all cases, although a small proportion of cases of the former harbor HPV. Sinonasal inverted papillomas harbor HPV in about 25% of cases. Sinonasal squamous cell carcinomas harbor transcriptionally active HPV in about 20% of cases, and limited data suggest that this subset has a better prognosis than the HPV-negative subset. This review addresses the diagnostic issues of the EBV-associated tumors. Difficulties in diagnosis of NPC may be encountered when there are prominent crush artifacts, many admixed lymphoid cells masking the neoplastic cells, or numerous interspersed granulomas, whereas benign cellular components (epithelial crypts and germinal centers) and reactive lymphoid hyperplasia can potentially be mistaken for NPC. Immunostaining for pan-cytokeratin and/or in situ hybridization for EBER can help in confirming or refuting a diagnosis of NPC. The main diagnostic problem of extranodal NK/T-cell lymphoma is recognition of the neoplastic nature of those examples predominated by small cells or showing a mixture of cells. The identification of a destructive infiltrate (dense expansile infiltrate; angiocentric growth) and definite cytologic atypia (clear cells; many medium-sized cells) would favor a diagnosis of lymphoma, which can be supported by immunohistochemistry (most commonly CD3+, CD5−, CD56+) and in situ hybridization for EBER. In conclusion, among nasopharyngeal and sinonasal neoplasms, demonstration of EBV may aid in diagnosis, particularly NPC and extranodal NK/T-cell lymphoma. Demonstration of HPV does not have a role yet in diagnosis, although this may change in the future.