Prognostic Value of Left Ventricular Longitudinal Function and Myocardial Fibrosis in Patients With Ischemic and Non-Ischemic Dilated Cardiomyopathy Concomitant With Type 2 Diabetes Mellitus: A 3.0 T Cardiac MR Study.

BACKGROUND: Poorly controlled type 2 diabetes mellitus (T2DM) is known to result in left ventricular (LV) dysfunction, myocardial fibrosis, and ischemic/nonischemic dilated cardiomyopathy (ICM/NIDCM). However, less is known about the prognostic value of T2DM on LV longitudinal function and late gadolinium enhancement (LGE) assessed with cardiac MRI in ICM/NIDCM patients. PURPOSE: To measure LV longitudinal function and myocardial scar in ICM/NIDCM patients with T2DM and to determine their prognostic values. STUDY TYPE: Retrospective cohort. POPULATION: Two hundred thirty-five ICM/NIDCM patients (158 with T2DM and 77 without T2DM). FIELD STRENGTH/SEQUENCE: 3T; steady-state free precession cine; phase-sensitive inversion recovery segmented gradient echo LGE sequences. ASSESSMENT: Global peak longitudinal systolic strain rate (GLPSSR) was evaluated to LV longitudinal function with feature tracking. The predictive value of GLPSSR was determined with ROC curve. Glycated hemoglobin (HbA1c) was measured. The primary adverse cardiovascular endpoint was follow up every 3 months. STATISTICAL TESTS: Mann-Whitney U test or student's t-test; Intra and inter-observer variabilities; Kaplan-Meier method; Cox proportional hazards analysis (threshold = 5%). RESULTS: ICM/NIDCM patients with T2DM exhibited significantly lower absolute value of GLPSSR (0.39 ± 0.14 vs. 0.49 ± 0.18) and higher proportion of LGE positive (+) despite similar LV ejection fraction, compared to without T2DM. LV GLPSSR was able to predict primary endpoint (AUC 0.73) and optimal cutoff point was 0.4. ICM/NIDCM patients with T2DM (GLPSSR < 0.4) had more markedly impaired survival. Importantly, this group (GLPSSR < 0.4, HbA1c ≥ 7.8%, or LGE (+)) exhibited the worst survival. In multivariate analysis, GLPSSR, HbA1c, and LGE (+) significantly predicted primary adverse cardiovascular endpoint in overall ICM/NIDCM and ICM/NIDCM patients with T2DM. CONCLUSIONS: T2DM has an additive deleterious effect on LV longitudinal function and myocardial fibrosis in ICM/NIDCM patients. Combining GLPSSR, HbA1c, and LGE could be promising markers in predicting outcomes in ICM/NIDCM patients with T2DM. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: 5.

Dynamic changes in cardiac morphology, function, and diffuse myocardial fibrosis duration of diabetes in type 1 and type 2 diabetic mice models using 7.0 T CMR and echocardiography.

Background: Diabetes mellitus (DM) is associated with an increased risk of cardiovascular disease (CVD). Hence, early detection of cardiac changes by imaging is crucial to reducing cardiovascular complications. Purpose: Early detection of cardiac changes is crucial to reducing cardiovascular complications. The study aimed to detect the dynamic change in cardiac morphology, function, and diffuse myocardial fibrosis(DMF) associated with T1DM and T2DM mice models. Materials and methods: 4-week-old C57Bl/6J male mice were randomly divided into control (n=30), T1DM (n=30), and T2DM (n=30) groups. A longitudinal study was conducted every 4 weeks using serial 7.0T CMR and echocardiography imaging. Left ventricular ejection fraction (LV EF), tissue tracking parameters, and DMF were measured by cine CMR and extracellular volume fraction (ECV). Global peak circumferential strain (GCPS), peak systolic strain rate (GCPSSR) values were acquired by CMR feature tracking. LV diastolic function parameter (E/E') was acquired by echocardiography. The correlations between the ECV and cardiac function parameters were assessed by Pearson's test. Results: A total of 6 mice were included every 4 weeks in control, T1DM, and T2DM groups for analysis. Compared to control group, an increase was detected in the LV mass and E/E' ratio, while the values of GCPS, GCPSSR decreased mildly in DM. Compared to T2DM group, GCPS and GCPSSR decreased earlier in T1DM(GCPS 12W,P=0.004; GCPSSR 12W,P=0.04). ECV values showed a significant correlation with GCPS and GCPSSR in DM groups. Moreover, ECV values showed a strong positive correlation with E/E'(T1DM,r=0.757,P<0.001;T2DM, r=0.811,P<0.001). Conclusion: The combination of ECV and cardiac mechanical parameters provide imaging biomakers for pathophysiology, early diagnosis of cardiac morphology, function and early intervention in diabetic cardiomyopathy in the future.

Application of intravoxel incoherent motion diffusion-weighted imaging for preoperative knowledge of lymphovascular invasion in gastric cancer: a prospective study.

PURPOSE: To investigate the potential of intravoxel incoherent motion diffusion-weighted imaging (IVIM) for preoperative prediction of lymphovascular invasion (LVI) in gastric cancer (GC). METHODS: This study prospectively enrolled 90 patients (62 males, 28 females, 60.79 ± 9.99 years old) who received radical gastrostomy. Abdominal MRI examinations including IVIM were performed within 1 week before surgery. Patients were divided into LVI-positive and -negative group according to pathological diagnosis after surgery. The apparent diffusion coefficient (ADC) and IVIM parameters, including true diffusion coefficient (D), pseudodiffusion coefficient (D*), and pseudodiffusion fraction (f), were compared between the two groups. The relationship between MRI parameters and LVI was studied by Spearman's correlation analysis. Multivariable logistic regression analysis was used to screen independent predictors of LVI. Receiver-operating characteristic curve analyses were applied to evaluate the efficacy. RESULTS: The ADC, D in LVI-positive group were lower, whereas tumor thickness and f parameter in LVI-positive group were higher than those in LVI-negative group, and they were statistically correlated with LVI (p < 0.05). D, f and tumor thickness were independent risk factors of LVI. The area under the curve of ADC, D, f, thickness, and the combined parameter (D + f + thickness) were 0.667, 0.754, 0.695, 0.792, and 0.876, respectively. The combined parameter demonstrated higher efficacy than any other parameters (p < 0.05). CONCLUSION: The ADC, D, and f can effectively distinguish LVI status of GC. The D, f and thickness were independent predictors. The combination of the three predictors further improved the efficacy.

Comparison of MRI and CT-Based Radiomics and Their Combination for Early Identification of Pathological Response to Neoadjuvant Chemotherapy in Locally Advanced Gastric Cancer.

BACKGROUND: Current radiomics for treatment response assessment in gastric cancer (GC) have focused solely on Computed tomography (CT). The importance of multi-parametric magnetic resonance imaging (mp-MRI) radiomics in GC is less clear. PURPOSE: To compare and combine CT and mp-MRI radiomics for pretreatment identification of pathological response to neoadjuvant chemotherapy in GC. STUDY TYPE: Retrospective. POPULATION: Two hundred twenty-five GC patients were recruited and split into training (157) and validation dataset (68) in the ratio of 7:3 randomly. FIELD/SEQUENCE: T2-weighted fast spin echo (fat suppressed T2-weighted imaging [fs-T2WI]), diffusion weighted echo planar imaging (DWI), and fast gradient echo (dynamic contrast enhanced [DCE]) sequences at 3.0T. ASSESSMENT: Apparent diffusion coefficient (ADC) maps were generated from DWI. CT, fs-T2WI, ADC, DCE, and mp-MRI Radiomics score (Radscores) were compared between responders and non-responders. A multimodal nomogram combining CT and mp-MRI Radscores was developed. Patients were followed up for 3-65 months (median 19) after surgery, the overall survival (OS) and progression free survival (PFS) were calculated. STATISTICAL TESTS: A logistic regression classifier was applied to construct the five models. Each model's performance was evaluated using a receiver operating characteristic curve. The association of the nomogram with OS/PFS was evaluated by Kaplan-Meier survival analysis and C-index. A P value <0.05 was considered statistically significant. RESULTS: CT Radscore, mp-MRI Radscore and nomogram were significantly associated with tumor regression grading. The nomogram achieved the highest area under the curves (AUCs) of 0.893 (0.834-0.937) and 0.871 (0.767-0.940) in training and validation datasets, respectively. The C-index was 0.589 for OS and 0.601 for PFS. The AUCs of the mp-MRI model were not significantly different to that of the CT model in training (0.831 vs. 0.770, P = 0.267) and validation dataset (0.797 vs. 0.746, P = 0.137). DATA CONCLUSIONS: mp-MRI radiomics provides similar results to CT radiomics for early identification of pathologic response to neoadjuvant chemotherapy. The multimodal radiomics nomogram further improved the capability. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: 2.

A retrospective study of thoracic endovascular aortic repair timing in patients with uncomplicated type B dissection who have a smoking history.

Objective: To determine the optimal timing of thoracic endovascular aortic repair (TEVAR) for patients with uncomplicated type B dissections who have a smoking history. Methods: Data from 308 consecutive patients with uncomplicated type B dissections, who have a smoking history and onset-to-TEVAR time within 90 days, were analyzed. The patients were divided into two groups: Acute and subacute phases. Univariate and multivariate regression analyses were performed. Smooth curve fitting and threshold analysis were performed to characterize the relationship between the onset-to-TEVAR time and follow-up deaths. Results: There were no significant differences between the two groups. Smooth curve fitting and threshold effect analysis showed that if early TEVAR was performed within 9.4 days from onset, there was better long-term survival and there was no significant difference after 9.4 days. Conclusion: By studying the relationship between onset-to-TEVAR time and all-cause mortality, we found that early TEVAR may have a lower all-cause mortality rate during follow-up in uncomplicated type B dissection patients who have a smoking history and within 90 days from onset.

Dynamic contrast-enhanced and diffusion-weighted MR imaging in early prediction of pathologic response to neoadjuvant chemotherapy in locally advanced gastric cancer.

PURPOSE: To investigate the efficacy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the early prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC). METHODS: Fifty patients with LAGC who were treated with NAC followed by radical gastrectomy were enrolled. Uncontrasted and DCE-MRI were performed within 1 week before NAC. According to tumor regression grading (TRG), patients were labeled as responders (TRG = 0 + 1) and non-responders (TRG = 2 + 3). Apparent diffusion coefficients (ADC) and DCE-MRI kinetics (Ktrans, Ve, and Kep) were compared between the two groups. Logistic regression analysis was performed to screen independent factors to predict the NAC efficacy. The relationship between MRI parameters and TRG was studied by Spearman's correlation analysis. Receiver-operating characteristic curve analyses were applied to evaluate the efficacy. RESULTS: ADC, Ktrans, and Kep values were higher in responders than in non-responders (p < 0.05) and correlated with TRG (p < 0.05). The ADC and Kep values were independent markers for predicting TRG. The area under the curve, sensitivities, specificities of ADC, Ktrans, Kep, and ADC + Kep were 0.813, 0.699, 0.709, 0.886;73.64%, 65.54%, 63.21%, 70.37%; 86.47%, 54.97%, 79.47%, 95.65%; respectively. ADC + Kep demonstrated a higher efficacy than Ktrans and Kep (p = 0.012, 0.011), but without improvement compared with ADC (p > 0.05). CONCLUSION: Both DWI and DCE-MRI can effectively predict the pathologic response to NAC in LAGC. A combination of ADC and Kep increased the efficacy, and ADC is the most valuable imaging parameter.

Thoracic endovascular aortic repair (TEVAR) to retrieve a stented elephant trunk graft entrapped in the false lumen of dissection patients.

A stented elephant trunk graft entrapped in the false lumen during Sun's procedure (total arch replacement combined with stented elephant trunk implantation) is a serious complication with an extremely high mortality rate. This article describes a case of a patient who was successfully saved with the use of thoracic endovascular aortic repair.

Performance and mechanism of Chlorella in swine wastewater treatment: Roles of nitrogen-phosphorus ratio adjustment and indigenous bacteria.

The effects of adjusting the nitrogen-phosphorus (N/P) ratio of wastewater and indigenous bacteria on swine wastewater treatment by Chlorella sp. HL were investigated. The optimal N/P ratio of Chlorella in swine wastewater was 20 by adjusting the phosphorus concentration. The participation of indigenous bacteria increased total extracellular polymeric substances content, which was beneficial to maintain the stability of the algal-bacterial consortium, and improved the algal density and the removal rate of total nitrogen, total phosphorus, and chemical oxygen demand by 47.8%, 24.0%, 30.7%, and 326.7%, respectively. Proteobacteria was the dominant phylum with the relative abundance of 71.58% in the algal-bacterial system at optimal N/P ratio, and Brevundimonas, Chryseobacterium, and Pseudomonas played positive roles in the establishment of symbiotic systems at the genus level. These results provide a theoretical basis for the construction of an efficient algal-bacterial symbiotic system in swine wastewater treatment and support for commercial scale-up.

Microalgae-based swine wastewater treatment: Strain screening, conditions optimization, physiological activity and biomass potential.

Using microalgae to treat swine wastewater (SW) can achieve wastewater purification and biomass recovery at the same time. The algae species suitable for growth in SW were screened in this study, and the response surface combined with the desirability function method was used for multi-objective optimization to obtain high algal biomass and pollutant removal. Chlorophyll fluorescence parameters and biomass composition were analyzed to evaluate the cell physiological activity and its application potential. Chlorella sp. HL was selected as the most suitable species for growth in SW, and after 9 d of cultivation, the maximum specific growth rate and highest algal density were achieved 0.51 d-1 and 2.43 × 107 cells/mL, respectively. In addition, the removal of total phosphate and chemical oxygen demand were reached 69.13% and 72.95%, respectively. The optimum conditions for maximum algal density and highest pollutant removal were determined as the light intensity of 58.73 µmol/m2/s, inoculation density of 5.0 × 106 cells/mL, and a light/dark ratio of 3 using response surface model, and the predicted overall desirability value was 0.96. The potential maximum quantum yield of PSII (Fv/Fm) of Chlorella sp. HL in the early stage of cultivation was 0.60-0.70, while under high light and long photoperiod, the value of Fv/Fm and performance index of Chlorella decreased, trapped and dissipated energy flux per reaction center increased. The higher heating value of 18.25 MJ/kg indicated that the Chlorella cultivated in SW could be a good feedstock for biofuel production.

Predicting Parametrial Invasion in Cervical Carcinoma (Stages IB1, IB2, and IIA): Diagnostic Accuracy of T2-Weighted Imaging Combined With DWI at 3 T.

OBJECTIVE: The objective of our study was to retrospectively evaluate the efficacy of combined analysis of T2-weighted imaging and DWI in the diagnosis of parametrial invasion (PMI) in cervical carcinoma. MATERIALS AND METHODS: The clinical records of 192 patients with cervical carcinoma who met the study requirements were reviewed for this retrospective study. The signal intensities of suspicious PMI tissue were assessed on T2-weighted images, DW images, and apparent diffusion coefficient maps independently by two experienced radiologists. The radiologist observers predicted the presence of PMI by scoring T2-weighted imaging alone and then by scoring T2-weighted imaging and DWI combined. The results were compared with histopathologic findings. RESULTS: Histopathologic findings revealed PMI in 24 of 192 study subjects. In positively predicting the presence of PMI, T2-weighted imaging and DWI combined scored significantly better than T2-weighted imaging alone, as proven by high sensitivity (T2-weighted imaging alone vs T2-weighted imaging and DWI combined: observer 1, 75.0% vs 83.3% [p = 0.477]; observer 2, 66.7% vs 91.7% [p < 0.05]), high specificity (T2-weighted imaging alone vs T2-weighted imaging and DWI combined: observer 1, 84.5% vs 98.8% [p < 0.001]; observer 2, 85.7% vs 98.8% [p < 0.001]), and high accuracy (T2-weighted imaging alone vs T2-weighted imaging and DWI combined: observer 1, 83.3% vs 96.9% [p < 0.001]; observer 2, 83.3% vs 97.9% [p < 0.001]). The area under the ROC curve was also significantly higher for T2-weighted imaging and DWI combined (observer 1, 0.911; observer 2, 0.952) than for T2-weighted imaging alone (observer 1, 0.798; observer 2, 0.762). Although the interobserver agreement was good for T2-weighted imaging (κ = 0.695) and excellent for T2-weighted imaging and DWI combined (κ = 0.753), the improvement failed to achieve statistical significance (p = 0.28). CONCLUSION: Combined analysis of T2-weighted imaging and DWI enhances the accuracy of diagnosing PMI in patients with cervical cancer compared with T2-weighted imaging alone.

Effects of genome doubling on expression of genes regulating grain size in rice.

Rice is one of the most important staple crops. It has been the major focus in breeding program to improve grain yield. A unique feature of tetraploid rice is the increased grain size and weight compared to diploid. Therefore, investigating the effects of genome doubling on expression of genes regulating grain size is important for yield improvement in rice breeding program. In this study, we analyzed differential expression of six genes regulating grain size in young panicles of various developmental stages between diploid and tetraploid rice. Transgenic approaches were employed to explore the dosage effects on gene expression and grain size. The results showed that genome duplications did not influence the developmental patterns of rice growth, but enhanced plant height, leaf width and grain size. The grain length and width in Indica tetraploid increased significantly, but the grain length showed more obvious change than width in Japonica tetraploid. The expression levels were affected not only by the developmental stages, but also by genetic background. Upon genome doubling, the positive regulation gene GS5 and HGW expression levels were generally higher in tetraploid than the corresponding diploid. Negative regulation gene GS3 in Indica tetraploid tended to be down-regulated or silenced, but increased in Japonica tetraploid. Another negative regulation GW2 was up-regulated in Indica tetraploid and silenced in Japonica tetraploid. The extra copies of GW2 in diploid transgenic lines exerted a gene dosage effect that resulted in the higher expression level than that of wild type diploid and tetraploid, which causes small grain formation in transgenic lines. Our results will help to understand the function of genes regulating the grain size in the diploid and tetraploid, and provide a theoretical basis for yield improvement.

Research Advances in the Role of RAS-GTPase-activating Proteins in Tumors.

A variety of molecules are involved in tumorigenesis,during which the RAS pathway-related molecules play key roles. RAS gene mutations exist in about 30% of human tumors;in some tumors(e.g. pancreatic adenocarcinomas),the mutation rates may rise to 75%-95%. Even in tumors without RAS mutations,the RAS pathway-related molecules can also be highly activated. RAS-GTPase-activating proteins(RASGAPs)are a group of tumor suppressors. They normally turn off RAS pathway by catalyzing the hydrolysis of RAS-GTP. However,the mutation or hypermethylation of their promoters will inactivate their roles and thus provide an alternative mechanism of activating Ras. This article reviews the research advances in the role of RASGAPs in the development of tumors.

Pulse signal analysis of patients with coronary heart diseases using Hilbert-Huang transformation and time-domain method.

OBJECTIVE: To explore characteristic of pulse signal to distinguish patients with coronary heart diseases (CHD) from patients without CHD and healthy adults, and accordingly evaluate the potential role of pulse signal to diagnosis CHD. METHODS: Totally 407 patients enrolled from 4 collaborating medical centers were assigned to a CHD group (205 patients) and a non-CHD group (202 patients). The healthy control group (62 adults) enrolled from Shanghai University of Traditional Chinese Medicine. Pulse signals were collected using the synchronous multiplex pulse signal acquisition system. The pulse signals were analyzed and extracted using Hilbert-Huang transformation (HHT) and time-domain, respectively. The time-domain parameters of pulse signal were processed by the analysis of variance (SNK test). RESULTS: Special patterns in the CHD group pulse signal were found in this study: (1) time-domain parameters of pulse signal, h1, h3, h4, h3/h1, ts, t4/t were increased and w was wider; (2) 44% of C2 waves in HHT were chaotic and disordered and 72% of C waves were exhibited irregularly with average amplitude over 10 g-forces, which were all significantly different from controls. CONCLUSION: Characteristic wave and time-domain parameters of pulse signal were extracted using HHT and time-domain which could be served as a non-invasive approach for assessing patients with CHD.

Effect of intravenous gadolinium-DTPA on diffusion-weighted imaging of brain tumors: a short temporal interval assessment.

PURPOSE: To determine the effect of intravenous administration of gadolinium (Gd) contrast medium (Gd-DTPA) on diffusion-weighted imaging (DWI) for the evaluation of normal brain parenchyma vs. brain tumor following a short temporal interval. MATERIALS AND METHODS: Forty-four DWI studies using b values of 0 and 1000 s/mm(2) were performed before, immediately after, 1 min after, 3 min after, and 5 min after the administration of Gd-DTPA on 62 separate lesions including 15 meningioma, 17 glioma and 30 metastatic lesions. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) values of the brain tumor lesions and normal brain tissues were measured on pre- and postcontrast images. Statistical analysis using paired t-test between precontrast and postcontrast data were obtained on three brain tumors and normal brain tissue. RESULTS: The SNR and CNR of brain tumors and the SNR of normal brain tissue showed no statistical differences between pre- and postcontrast (P > 0.05). The ADC values on the three cases of brain tumors demonstrated significant initial increase on the immediate time point (P < 0.01) and decrease on following the 1 min time point (P < 0.01) after contrast. Significant decrease of ADC value was still found at 3min and 5min time point in the meningioma group (P < 0.01) with gradual normalization over time. The ADC values of normal brain tissues demonstrated significant initial elevation on the immediately postcontrast DWI sequence (P < 0.01). CONCLUSION: Contrast medium can cause a slight but statistically significant change on the ADC value within a short temporal interval after the contrast administration. The effect is both time and lesion-type dependent.

Comparison of computed tomography versus magnetic resonance imaging in assessing radiofrequency ablation margins after radiofrequency ablation in patients with hepatocellular carcinomas.

OBJECTIVE: To assess the diagnostic value of magnetic resonance imaging (MRI) in the follow-up of patients with hepatocellular carcinomas treated with radiofrequency ablation (RFA) and to compare it with that of computed tomography (CT). METHODS: From December 2009 to September 2011, 40 patients (47 hepatocellular carcinomas) were treated with RFA after transcatheter arterial chemoembolization and underwent MRI and CT for follow-up. RFA margins were assessed on a five-point scale with receiver operating characteristic curve analysis. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were evaluated. RESULTS: The interobserver agreement rate for MRI was significantly higher (Kappa=0.935) than for CT (Kappa=0.714; P < 0.05). The scores of 1 and 5 points for MRI, which confirms the presence or absence of residual tumor, accounted for 89.4% (84/94), while for CT accounting for only 31.9% (30/94). The area under the receiver operating characteristic curve of MRI was significantly higher than that of CT (P < 0.05), as were the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of detection rate (mean, 100%, 96.4%, 76.9%, 100%, and 96.8% for MRI, respectively, vs. 30.0%, 57.1%, 10.3%, 87.7%, and 63.8% for CT). CONCLUSION: MRI is superior to CT in assessing the RFA margins in terms of the diagnostic accuracy and detection rate .

Atypical polypoid adenomyomas progressed to endometrial endometrioid adenocarcinomas.

INTRODUCTION: Atypical polypoid adenomyoma (APA) is an uncommon uterine tumor which is composed of atypical endometrial glands and cellular smooth-muscle stroma. At present APA is categorized as a benign lesion and treated conservatively in the literatures. However, there are also several cases reported that progressed to endometrial endometrioid adenocarcinoma (EEC) till now. Here, we present two more rare cases of APA that may have undergone progression to EEC. MATERIALS: Two patients who had APA 6 and 4 years ago, respectively, and had ECC were reported. METHODS: The history of the two patients and the literatures were retrospectively reviewed. CONCLUSIONS: The truth that APA may have a chance to progress to carcinoma suggests that APA is at least an indicator lesion for the development of EEC, and highlights that clinicians should carefully monitor the patients, and a meticulous follow-up examination is mandatory.

Is severe dysplasia the same lesion as carcinoma in situ? 10-Year follow-up of laryngeal precancerous lesions.

CONCLUSION: Our results showed that the behavior of moderate dysplasia lesions was more like that of severe dysplasia lesions, while severe dysplasia was very different from carcinoma in situ (CIS). CIS should be managed more aggressively than the other lesions. Mild dysplasia could not be viewed as a precancerous lesion of the larynx. OBJECTIVE: This study aimed to identify the possibilities of the precancerous lesions of larynx (including mild dysplasia, moderate dysplasia, severe dysplasia, and CIS) progressing to invasive carcinomas and to highlight the importance of adequate management and follow-up strategies for these patients. METHODS: A retrospective study of patients who had these preinvasive lesions in the larynx over a 10-year period was performed. RESULTS: These patients were followed for a minimum period of 2 years from the initial diagnosis. In all, 86 patients were identified the cohort. Of these, 17 (19.8%) patients developed carcinoma: 0 of 22 with mild dysplasia, 5 of 25 (20%) with moderate dysplasia, 2 of 14 (15%) with severe dysplasia, and 10 of 25 (40%) patients with CIS progressed to invasive cancers (p = 0.001). Over 50% of cases progressed 3 years after the original biopsy. Only 1 of 86 (1%) died of the disease.

Squamous cell carcinoma in the larynx in a 7-year-child.

Squamous cell carcinoma (SCC) involving the larynx in childhood is very rare, especially in the ages younger than 10 years. Most of the reported cases are transformed from the recurrent respiratory papillomatosis (RRP) with human papilloma virus (HPV) infection. Due to the RRP long course, the rarity and the unspecific symptoms of the cancer, they usually are diagnosed at late stages. Controversy exists regarding the causes and the treatments of these kinds of diseases. Here, we reviewed the related reports and presented a case of 7-year-old boy who had an advanced well-differentiated SCC of the larynx which transformed from RRP with HPV genotyping test negative. The patient underwent only the resection of involved tissues and no other treatments. Except for hoarseness in his voice, the boy is going well and has had an uneventful course of 10 years following operative treatment.