Efficacy of scleral buckling for the treatment of rhegmatogenous retinal detachment using a novel foldable capsular buckle.

AIM: To evaluate the effectiveness and safety of scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD) using a novel foldable capsular buckle (FCB). METHODS: This was a series of case observation studies. Eighteen patients (18 eyes) who visited our ophthalmology department between August 2020 and August 2022 and were treated for RRD with scleral buckling using FCB were included. The procedure was similar to conventional scleral buckling, while a balloon-like FCB was placed onto the retinal break with balanced salt solution filling for a broad, external indentation instead of the silicone buckle. The retinal reattachment rate, best corrected visual acuity (BCVA), intraocular pressure (IOP), refractive dioptre and astigmatism degree, and complications were evaluated and recorded. RESULTS: There were 7 males and 11 females aged 19-58y. The average time course of RRD was 12d, ranging from 7-20d. The retinal break was located in the superior quadrants in 8 eyes and in the inferior quadrants in 10 eyes, with macula-off detachments in 12 eyes. The patients were followed-up for at least 6mo. The final retinal reattachment rate was 100%. The BCVA was significantly improved compared with the baseline (P<0.05). There was no significant change in refractive dioptre or astigmatism degree at each follow-up (all P>0.05). Three patients had transiently high IOPs within one week after surgery. Mild diplopia occurred in 5 patients after surgery and then disappeared after the balloon fluid was removed. CONCLUSION: The success rate of FCB scleral buckling for RRD is satisfactory. This procedure can be expected to be applied in new, uncomplicated cases of RRD.

Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022).

Background In mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. Results The panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-na?ve PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. Conclusions Six evidence-based recommendations support optimal care for PCV patients' management.

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma.

AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty (UCP) vs Ahmed glaucoma drainage valve implantation (ADV) in addition to intravitreal anti-vascular endothelial growth factor (VEGF) for treatment of fundus disease-related neovascular glaucoma (NVG). METHODS: A total of 43 patients (45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients (15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients (30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure (IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded. RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively (P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0% (27/30) in the ADV group and 86.7% (13/15) in the UCP group at the last follow-up of 6mo (P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups (both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation (P<0.05). CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.

Safety profile of 0.0015% tafluprost eye drops in China: a post-marketing observational study.

AIM: To investigate the treatment pattern and safety of tafluprost for glaucoma and ocular hypertension (OH) in clinical practice in China. METHODS: This post-marketing observational study included patients who received tafluprost to lower intraocular pressure (IOP) within 30d between September 2017 and March 2020 in 20 hospitals in China. Adverse drug reactions (ADRs) during tafluprost treatment and within 30d after the treatment were collected. RESULTS: A total of 2544 patients were included in this study, of them 58.5% (1488/2544) had primary open angle glaucoma (POAG), 21.9% (556/2544) had OH and 19.7% (500/2544) used tafluprost for other reasons. Of 359 ADRs occurred in 10.1% (258/2544) patients, and no serious adverse event occurred. The most common ADR was conjunctival hyperemia (128 ADRs in 124 patients, 4.9%). Totally 1670 participants (65.6%) combined tafluprost with carbonic anhydrase inhibitors (CAIs; 37.1%, 620/1670), sympathomimetics (33.5%, 559/1670), ß-blockers (33.2%, 555/1670), other prostaglandin analogs (PGAs; 15.6%, 260/1670) and other eye drops (15.1%, 253/1670). The highest incidence of conjunctival hyperemia was noted in patients who received tafluprost in combination with other PGAs (23 ADRs in 23 patients, 8.8%, 23/260) and the lowest was in combination with CAIs (16 ADRs in 16 patients, 2.6%, 16/620). Tafluprost was applied in primary angle-closure glaucoma (41.6%, 208/500), after glaucoma surgery (17.8%, 89/500) and after non-glaucoma surgery (15.8%, 79/500). CONCLUSION: Tafluprost is safe for POAG and OH, and tolerable when combined with other eye drops and under various clinical circumstances.

Diabetes onset at an earlier age and high HbA1c levels as risk factors of diabetic retinopathy.

AIM: To assess the effect of age at diabetes onset and uncontrollable high HbA1c levels on the development of diabetic retinopathy (DR) among Chinese type 2 diabetes mellitus (DM) patients. METHODS: This was a cross-sectional survey of diabetic patients in Subei district, China. Data covering physical measurements, fasting blood-glucose (FBG), glycosylated hemoglobin (HbA1c), blood lipid, urinary albumin/creatinine ratio (UACR), ocular fundus examination, and diabetes treatment records were collected. An independent sample t-test were used to analyze differences. A Logistic regression analysis was applied to study the independent risk factors of DR. RESULTS: A total of 1282 patients with type 2 DM were enrolled, and 191 cases had DR (14.9%). The age at diabetes onset, education level, alcohol consumption, HbA1c level, UACR level, and hypoglycemic drugs were independent influencing factors for DR. The older the onset of diabetes, the less likely to develop DR (OR: 0.958, 95%CI: 0.942-0.975, P=0.000). Patients were then divided in terms of age at diabetes onset as follows: <50y, 50-59y, 60-69y, and ≥70y. Compared with diabetes onset age <50y, 50-59y (OR: 0.463, 95%CI: 0.306-0.699, P=0.000), 60-69y (OR: 0.329, 95%CI: 0.203-0.535, P=0.000) and ≥70y (OR: 0.232, 95%CI: 0.094-0.577, P=0.002) were at a lower risk of DR. The prevalence of DR was highest in patients with diabetes onset age <50y (29.5%, P<0.05). The HbA1c level (8.67±1.97)% and proportion of insulin injection (52.5%) in patients with diabetes onset <40y were higher than in patients with older diabetes onset age (P<0.05). CONCLUSION: Diabetes onset at an earlier age and uncontrollable high HbA1c level could be independent risk factors for DR.

Successful treatment of fatal asthma combined with a silent chest: A case report.

Fatal asthma is a rare and potentially fatal disease. This disease requires suitable treatment to achieve rehabilitation, especially when accompanied by other complications, such as a silent chest and severe bronchial spasm. A 36-year-old man presented with a 10-year history of asthma that broke out into persistent asthma attacks and cardiac arrest, and was accompanied by a silent chest for 18 hours. He recovered and was discharged without any sequelae after being treated by a ventilator, hormones, epinephrine, analgesics, sedation, and muscle relaxants. Comprehensive treatment with a ventilator, hormones, epinephrine, analgesics, sedation, and muscle relaxants has a good effect on fatal asthma combined with a silent chest.

Analysis of missed diagnosis of orbital foreign bodies.

A clinical analysis of diagnosis was performed as well as the management of orbital foreign bodies, to investigate the methods to avoid missed diagnosis. A total of 15 cases of an orbital foreign body was reviewed, and for these cases, the clinical manifestation, imaging data and operative situation were studied. Among the patients, 4 cases turned out to have wooden, 3 metallic, 2 glass, 2 bones, and 4 other foreign bodies. Twelve cases had received debridement and suture before our management, and 1 foreign body was treated more than once. In conclusion, detailed traumatic history and imaging examination are necessary for the diagnosis of orbital foreign bodies, while prompt diagnosis, accurate location and professional surgical skills are important for the treatment.

High-risk factors of parotid lymph node metastasis in nasopharyngeal carcinoma: a case-control study.

BACKGROUND: Although parotid-sparing IMRT decreased the dose distribution of parotid, parotid region recurrence has been reported. Prophylactic irradiation in parotid area would be necessary in patients with high risk of parotid lymph node metastasis (PLNM). This study was to detect the high-risk factors of PLNM in nasopharyngeal carcinoma. METHODS: This was a 1:2 case-control study. All patients in this study were newly diagnosed NPC with N2-3 classification from January 2005 to December 2012. Cases were 22 sides with ipsilateral PLNM. Controls were 44 patients who were randomly selected from N2-3 disease in database. RESULTS: 20/1096 (1.82 %) NPC patients were found PLNM. Sum of the longest diameter for multiple lymph nodes (SLD) in level II was larger in case group than that in control group (6.0 cm vs. 3.6 cm, p = 0.003). Level II lymph node necrosis, level Va/b involvement, and rare neck areas involvement were more common in case group (p = 0.016, p = 0.034, and p < 0.001, respectively). RPN, level III, and level IV metastases showed no significant difference between the two groups. Multivariate analysis in logistic regression showed that only SLD ≥5 cm in II area (OR = 4.11, p = 0.030) and rare neck areas involvement (OR = 3.95, p = 0.045) were associated with PLNM in NPC patients. CONCLUSIONS: PLNM was an uncommon event in NPC patients. SLD ≥5 cm in level II and involvement in rare-neck areas may be potentially high-risk factors for PLNM. Sparing parotid in IMRT was not recommended for NPC patients with high risks of PLNM.

Assessment of Clinical Effect of Perioperative Comprehensive Nursing Intervention Pattern in 23G Minimally Invasive Vitreous Surgery.

BACKGROUND: We observed the clinical effects of comprehensive nursing intervention pattern in 23G minimally invasive vitreous surgery according to the comprehensive nursing intervention table developed by our hospital, which would supply a basis for its clinical application. METHODS: In this prospective study, we followed 120 patients undergoing 23G minimally invasive vitreous surgery from Xuzhou First People's Hospital from February 2013 to February 2015 and divided them into control and observation groups by a random number table (60 patients in each group). A regular nursing pattern was adopted for the control group, and a comprehensive nursing intervention pattern was adopted for the observation group. After that, a comparative analysis was made to identify the differences between the clinical effects of the two groups. RESULTS: Scores of cognition ratio, patient compliance and comfort level of patients in the observation group were higher than those of the control group were, and there was significant difference between the groups (P< 0.05). Complication incidence of the observation group is significantly lower than that of the control group (P<0.05). CONCLUSION: The comprehensive nursing intervention pattern developed by our hospital can improve clinical effects notably, which is of application value .We recommend it to be applied in eye diseases.

Intensity-modulated radiotherapy for cervical esophageal squamous cell carcinoma: clinical outcomes and patterns of failure.

The objective of the study was to report clinical outcomes and patterns of failure for these patients with cervical esophageal squamous cell carcinoma (CESCC) treated with intensity-modulated radiotherapy (IMRT). A total of 64 patients with CESCC treated with definitive IMRT from May 2005 to March 2012 in our center were analyzed. Forty-two patients received radiotherapy alone and 22 patients received concurrent chemoradiotherapy. The location and extent of locoregional failures were transferred to the pretreatment planning computed tomography for dosimetry analysis. For all patients, the overall 2-year local failure-free survival, regional failure-free survival, distant failure-free survival, and overall survival rate was 74.5, 88.0, 66.6 and 42.5 %, respectively. Twenty-eight patients had developed treatment failure. Of the 28 patients, 14, 5, and 18 had developed local failure, regional failure, and distant metastasis, respectively. All of the 14 local failures were considered in-field failures. Of the five regional failures, three were considered in-field failures and two were marginal failures. The most frequently observed acute toxicity was mainly Grade 1 or 2. The incidence of acute Grade 3 mucositis (including pharyngitis), skin reaction, and leukopenia was 4.7, 12.5 and 10.9 %, respectively. IMRT provides satisfactory locoregional control for CESCC. Distant metastasis remains the predominate pattern of failure and the predominate pattern of locoregional failures is in-field failure.

Nasopharyngeal carcinoma with intracranial extension in the era of intensity-modulated radiotherapy: case-control study using propensity score matching method.

The objective of the study was to evaluate long-term survival outcomes and toxicity of T4 classification nasopharyngeal carcinoma (NPC) with intracranial extension (IE group) or without intracranial extension (non-IE group) after intensity-modulated radiotherapy (IMRT) using the propensity score matching method. After generating propensity scores given the covariates of age, sex, N classification, and concurrent chemotherapy, 132 patients in each group were matched. The 5-year local failure-free survival rate and the 5-year overall survival rate in the IE group were lower than the patients in the non-IE group (74.6 vs. 88.9 %, p = .008; 51.1 vs. 71.9 %, p = .005). Grade 2 hypothyroidism was more common in the IE group (13.2 vs. 3.4 %, p = .029). For patients with T4 classification NPC after IMRT, patients with intracranial extension need more attention to the thyroid gland function and are more likely to experience local failure and death than patients without intracranial extension.

Concurrent chemotherapy for T4 classification nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy.

OBJECTIVE: To evaluate concurrent chemotherapy for T4 classification nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT). METHODS: From July 2004 to June 2011, 180 non-metastatic T4 classification NPC patients were retrospectively analyzed. Of these patients, 117 patients were treated by concurrent chemoradiotherapy (CCRT) using IMRT and 63 cases were treated by IMRT alone. RESULTS: The median follow-up time was 58.97 months (range, 2.79-114.92) months. For all the patients, the 1, 3 and 5-year local failure-free survival (LFFS) rates were 97.7%, 89.2% and 85.9%, regional failure free survival (RFFS) rates were 98.9%, 94.4% and 94.4%, distant failure-free survival (DFFS) rates were 89.7%, 79.9% and 76.2%, and overall survival (OS) rates were 92.7%, 78.9% and 65.3%, respectively. No statistically significant difference was observed in LFFS, RFFS, DFFS and OS between the CCRT group and the IMRT alone group. No statistically significant difference was observed in acute toxicity except leukopenia (p = 0.000) during IMRT between the CCRT group and the IMRT alone group. CONCLUSION: IMRT alone for T4 classification NPC achieved similar treatment outcomes in terms of disease local control and overall survival as compared to concurrent chemotherapy plus IMRT. However, this is a retrospective study with a limited number of patients, such results need further investigation in a prospective randomized clinical trial.

Update report of T4 classification nasopharyngeal carcinoma after intensity-modulated radiotherapy: an analysis of survival and treatment toxicities.

OBJECTIVE: To evaluate the long-term survival outcomes and toxicity of a larger series of patients with non-metastatic T4 classification nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: From March 2004 to June 2011, 335 non-metastatic T4 classification NPC patients treated by IMRT were analyzed retrospectively. Treatment induced toxicities were scored according to the Common Terminology Criteria for Adverse Events version 3.0. RESULTS: With a median follow-up time of 53.6 months (range, 2.8-114.9 months), the 5-year local failure-free survival (LFFS), regional failure free survival (RFFS), distant failure-free survival (DFFS), and overall survival (OS) were 84.1%, 92.2%, 74.1%, and 63.0%, respectively. At their last follow-up visit, 118 patients (35.2%) had developed treatment failure. Distant metastasis was the major failure pattern after treatment. The most common toxicities were mainly in grade 1 or 2. Concurrent chemotherapy failed to improve survival rates for patients with T4 classification NPC. CONCLUSION: The results of T4 classification NPC treated by IMRT were excellent, and distant metastasis was the most commonly failure pattern. Treatment-related toxicities were well tolerable. The role of concurrent chemotherapy for T4 classification NPC needs to be further investigated in the era of IMRT.

Inherently poor survival of elderly patients with nasopharyngeal carcinoma.

BACKGROUND: The purpose of this study was to determine the features of the elderly patient with nasopharyngeal carcinoma (NPC). METHODS: The medical records of 212 patients with NPC, aged ≥65 years, and receiving radiotherapy were retrospectively reviewed. Comorbidity was rated using the Charlson Comorbidity Index (CCI). RESULTS: Twenty-four patients (11.3%) scored ≥3 and 188 patients (88.7%) scored <3 rated by CCI. The median actuarial irradiated dose of the nasopharynx was 72 Gy (range, 20-94 Gy) with 87.3% patients receiving >70 Gy. One hundred fifty-four patients had stage III/IV disease. The actuarial local control, cancer-specific survival (CSS), and overall survival (OS) rates at 5 years were 68.8%, 63.5%, and 47.0%, respectively. On multivariate analysis, stage (hazard ratio [HR], 1.489; 95% confidence interval [CI], 1.168-1.897; p = .001), the technique of radiotherapy (HR, 0.674; 95% CI, 0.476-0.953; p = .025), and anemia (HR, 3.081; 95% CI, 1.624-5.845; p = .001) were independent prognostic factors. CONCLUSION: The elderly patients with NPC may inherently predict poor outcomes.

Primary radiotherapy compared with primary surgery in cervical esophageal cancer.

IMPORTANCE: The management of cervical esophageal cancer (CEC) is controversial. The advantages of radiotherapy (RT) for CEC are lower rates of acute morbidity and mortality compared with surgery and potential for larynx preservation. The advantage of surgery is that the transposed stomach may function better over the long term than an irradiated esophagus, which tends to become stenotic over time. Which one is the primary treatment of CEC? OBJECTIVE: To evaluate treatment outcomes of primary RT and primary surgery in patients with CEC. DESIGN, SETTING, AND PARTICIPANTS: This retrospective study conducted in a university hospital included 224 patients treated for CEC between 2001 and 2012. INTERVENTIONS: One hundred and sixty-one patients who received primary RT with or without subsequent surgery were assigned to the RT group, including 133 patients who received RT alone or RT with concurrent chemotherapy and 28 patients who received preoperative RT plus surgery. Sixty-three patients who received primary surgery with or without subsequent RT were assigned to the primary surgery group, including 27 patients who received surgery alone and 36 patients who received surgery plus postoperative RT. MAIN OUTCOMES AND MEASURES: The rates of overall 2-year local failure-free survival (FFS), regional FFS, distant FFS, and overall survival for patients undergoing primary RT and primary surgery were compared. A separate analysis using matched cases between the primary RT group and primary surgery group was conducted. RESULTS: The median follow-up time was 15.1 months. The rates of overall 2-year local FFS, regional FFS, distant FFS, and overall survival for patients undergoing primary RT and primary surgery were 69.9% and 68.6%, 79.5% and 69.8%, 74.3% and 62.5%, 49.3% and 50.7%, respectively (P > .05 for all). Matched-case analyses did not show any significant differences in measured survival rates between the treatment groups. CONCLUSIONS AND RELEVANCE: Given the similarities in rates of local FFS, regional FFS, distant FFS, and overall survival between the primary RT and primary surgery CEC treatment groups, we recommend primary RT for larynx preservation, with surgery offered subsequently for patients who do not respond to RT.

Recurrence of nasopharyngeal carcinoma in the parotid region after definitive intensity-modulated radiotherapy.

PURPOSE: To discuss the clinical characteristics and management of periparotid recurrence of nasopharyngeal carcinoma after definitive intensity-modulated radiotherapy. PATIENTS AND METHODS: The authors retrospectively reviewed the charts of 716 patients with nasopharyngeal carcinoma who underwent intensity-modulated radiotherapy at their center from January 2005 through December 2010. Disease recurred in a spared parotid gland in 10 patients (1.4%). After periparotid recurrence, 4 patients received surgery alone, 1 patient received radiotherapy alone, 2 patients received chemotherapy alone, 2 patients received surgery plus chemotherapy, and 1 patient received surgery plus radiotherapy. RESULTS: After a median follow-up of 42.6 months (19.8 to 86.0 months), 4 patients died of tumor progression. The median survival time after periparotid recurrence was 25.1 months (5.0 to 74.5 months). CONCLUSIONS: Periparotid recurrence is an uncommon pattern of failure after definitive intensity-modulated radiotherapy for nasopharyngeal carcinoma, and there were some long-term survivors in this patient population after salvage treatment.

Clinical characteristics and patterns of failure in the parotid region after intensity-modulated radiotherapy for nasopharyngeal carcinoma.

OBJECTIVE: To discuss the clinical characteristics and patterns of failure in the parotid region after intensity-modulated radiotherapy for nasopharygeal carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the charts of 716 patients with nasopharygeal carcinoma who underwent intensity-modulated radiotherapy in our centre from January 2005 to December 2010. Disease recurred in a spared parotid gland in 10 patients (1.4%). There were 2 females and 8 males with a median age of 38.5 (34-53) years. The most common presenting symptom was a swelling in pre-auricular region (7/10). Parotid glands were spared bilaterally in these patients. None of these patients had undergone previous radiotherapy or surgical treatment of the head and neck. The location of periparotid failures were transferred to the pretreatment planning computed tomography for dosimetry analysis. RESULTS: The median time from day 1 of radiotherapy to periparoid recurrence was 17.4 (4.4-40.5) months. The median survivial after periparoid recurrence was 25.1 (5.0-74.5) months. There were 9 (90%) patients with lateral retropharyngeal lymphadenopathy. Seven of the periparotid failures were marginal. Of the 7 marginal failures, 6 occurred at the ipslateral parotid of the primary tumor centre. The average mean dose of the ipslateral parotid was 38.1 (32.3-44.1) Gy. CONCLUSION: Periparotid recurrence is an uncommon pattern of failure after definitive intensity-modulated radiotherapy for nasopharygeal carcinoma. To reduce the risk of periparotid recurrence,one possible strategy is to lessen the dose constraint criteria to ipslateral parotid of the primary tumor centre especially for nasopharygeal carcinoma with lateral retropharyngeal lymphadenopathy.

Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for T4 nasopharyngeal carcinoma.

The goal of this study is to study and report the clinical outcomes and patterns of failure after intensity-modulated radiotherapy (IMRT) for T4 nasopharyngeal carcinoma (NPC). A total of 70 patients treated with IMRT between 2004 and 2009 were eligible for study inclusion. According to the staging system of 2010 AJCC, all the primary tumors were attributed to T4 stage, while the distribution of disease by N stage was N0 in 2, N1 in 23, N2 in 39, N3a in 1, and N3b in 5. The location and extent of locoregional failures were transferred to the pretreatment planning computed tomography for dosimetry analysis. The median follow-up period was 26.8 (range, 4-78) months. The overall 2-year local failure-free survival, regional failure-free survival, distant failure-free survival, and overall survival rate was 82.1%, 92.3%, 73.8%, and 82.5%, respectively. Thirty-three patients had developed treatment failure. Of the 33 patients, 11, 2, and 15 had developed local failure, regional failure, and distant metastasis, respectively, 2 had developed locoregional failure, 1 had developed distant metastasis and failure at the primary, and 2 had developed distant metastasis and failure at the primary and nodal site. Eight of the locoregional failures were marginal. The results of treating T4 NPC with IMRT were excellent. Advanced T4 disease remained difficult to treat. One possible strategy is to lessen the dose constraint criteria of selected neurologic structures. Distant metastasis remains the most difficult treatment challenge for patients with T4 NPC at present, and more effective systemic chemotherapy should be explored.

Characteristics of CO2 release from forest soil in the mountains near Beijing.

CO2 release from forest soil is a key driver of carbon cycling between the soil and atmosphere ecosystem. The rate of CO2 released from soil was measured in three forest stands (in the mountainous region near Beijing, China) by the alkaline absorption method from 2004 to 2006. The rate of CO2 released did not differ among the three stands. The CO2 release rate ranged from - 341 to 1,193 mg m(-2) h(-1), and the mean value over all three forests and sampling times was 286 mg m(-2) h(-1). CO2 release was positively correlated with soil water content and the soil temperature. Diurnally, CO2 release was higher in the day than at night. Seasonally, CO2 release was highest in early autumn and lowest in winter; in winter, negative values of CO2 release suggested that CO2 was absorbed by soil.

[Endoplasmic reticulum stress participates in the cell apoptosis process in experimental retinal detachment].

OBJECTIVE: To determine whether the endoplasmic reticulum stress participates into the apoptosis process of the retina during experimental retinal detachment-by detecting the level of mRNA and protein of the GADD153, the marker of endoplasmic reticulum stress. METHODS: Completely random design is applied. Experimental retinal detachment was created in the left eyes of 77 wistar rats by injecting hyaluronic acid into the subretinal space. Rats were sacrificed at 1/2 d, 1 d, 2 d, 4 d, 8 d, 16 d and 32 d after creation of retinal detachment. Apoptosis of retinal cells was detected by TdT-mediated fluorescein-16-dUTP nick-end labeling (TUNEL) assay. GADD153 mRNA expression in the retina was determined using semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). The GADD153 protein expression was determined using western blotting. Retinal sections were studied by immunofluorescence labeling and confocal microscopy. The SPSS 10.0 software was applied to analyze data; Kruskal wallis test was applied to analyze the data about the apoptotic rate of retinal cells and the expression of GADD153 mRNA; One-way ANOVA test was applied to analyze the data about expression of GADD153 protein. P < 0.05 represents statistically significant difference. RESULTS: TUNEL positive staining cells were mainly presented in photoreceptor cell layer, peaked at 24 days and markedly decreased at 8 days after retinal detachment. The difference of apoptotic retinal cell rate between groups is significant (chi2 = 22.423, P < 0.05); The expression of retinal GADD153 mRNA was significantly increased at 1/2 d, 1 d, 2 d, 4 d after retinal detachment (chi2 = 27.223, P < 0.05); The expression of retinal GADD153 protein was significantly increased at these days (F = 16.052, P < 0.05). GADD153-positive cells were located in the photoreceptor cell layer. CONCLUSIONS: GADD153, the maker of endoplasmic reticulum stress mediated apoptosis, is activated and over-expressed, associated with the occurrence of apoptosis during retinal detachment. Endoplasmic reticulum stress participates into the apoptosis process during retinal detachment.