Calibration-free, high-precision, and robust terahertz ultrafast metasurfaces for monitoring gastric cancers.

Optical sensors, with great potential to convert invisible bioanalytical response into readable information, have been envisioned as a powerful platform for biological analysis and early diagnosis of diseases. However, the current extraction of sensing data is basically processed via a series of complicated and time-consuming calibrations between samples and reference, which inevitably introduce extra measurement errors and potentially annihilate small intrinsic responses. Here, we have proposed and experimentally demonstrated a calibration-free sensor for achieving high-precision biosensing detection, based on an optically controlled terahertz (THz) ultrafast metasurface. Photoexcitation of the silicon bridge enables the resonant frequency shifting from 1.385 to 0.825 THz and reaches the maximal phase variation up to 50° at 1.11 THz. The typical environmental measurement errors are completely eliminated in theory by normalizing the Fourier-transformed transmission spectra between ultrashort time delays of 37 ps, resulting in an extremely robust sensing device for monitoring the cancerous process of gastric cells. We believe that our calibration-free sensors with high precision and robust advantages can extend their implementation to study ultrafast biological dynamics and may inspire considerable innovations in the field of medical devices with nondestructive detection.

Pattern and prognostic value of lymph node metastasis in sinonasal mucosal melanoma.

OBJECTIVE: To analyze the pattern of lymph node (LN) metastasis and its effect on prognosis in sinonasal mucosal melanoma (SNMM). METHODS: This retrospective study was conducted based on the Surveillance, Epidemiology, and End Results (SEER) Program data. Survival outcomes were analyzed using the Kaplan-Meier method. Factors were compared between groups using log-rank test and Fisher's exact test, and prognostic factors were screened using the Cox proportional hazards model. Propensity score matching (PSM) was conducted to examine the treatment differences after accounting for sex, age, race, T stage, N stage, and M stage. RESULTS: Level I (57.1%) and level II (53.6%) nodes were the most common sites of lymph node metastasis, followed by level III (17.9%) and IV (17.9%) nodes. T stage, M stage, and tumor size were associated with LN metastasis. The 5-year overall survival rates for patients without and with LN metastasis were 35.2% and 5.3%, respectively. CONCLUSIONS: Level I and II lymph nodes may be the sentinel nodes of SNMM, Advanced T stage and increasing tumor size could promote LN metastasis. LN metastasis may promote distant metastasis and remains an important prognostic factor for patients with SNMM.

Endoscopic anatomical study of the trans-lateral molar approach to the infratemporal fossa.

BACKGROUND: The infratemporal fossa (ITF) is located deep in the skull base. Recently, the endoscopic transoral approach has enabled maxillofacial surgeons to access the ITF using a less invasive approach compared to the traditional transfacial and endonasal endoscopic approaches. OBJECTIVE: The present study aims to provide maxillofacial surgeons with new data concerning direct endoscopic measurement and precise anatomical topography features of the endoscopic trans-lateral molar approach to ITF by comparing the endoscopic and regional anatomy of ITF. A clinical case receiving the proposed surgical approach is used to determine the feasibility of this technique. METHOD: The anatomical data were obtained by measuring the bone anatomical landmarks and analyzing the CT imaging data using GE's Advance Windows 4.1 software on 25 subjects (50 sides). Morphological pictures of the regional anatomy and endoscopic anatomy were obtained from 6 (12 sides) adult cadaver heads, and the anatomical features were described. The present study reports the management of one case using the proposed surgical approach. RESULTS: The proposed surgical approach clearly revealed neurovascular, muscular, and surgical landmarks in the ITF. The surgical case supports the minimally invasive treatment approach, which could rapidly access the ITF and completely excise benign tumors. CONCLUSION: The anatomical studies and surgical case presentation helps us understand the spatial relationship of surgical landmarks of the surgical approach to the ITF for the treatment of benign lesions in the deep cranial base area.

Cochlea sparing with a stratified scheme of dose limitation employed in intensity-modulated radiotherapy for nasopharyngeal carcinoma: A dosimetry study.

Hearing loss is 1 of the major complications after radiotherapy in nasopharyngeal carcinoma (NPC) patients, how to minimize dose to cochlea in order to reduce the incidence of sensorineural hearing loss is a critical task. This study is to investigate a stratified scheme of cochlea sparing based on T stage in intensity-modulated radiotherapy. We designed a comparison between 2 plans of cochlea sparing plan (C-Plan) and regular noncochlea sparing plan (R-Plan) from 19 NPC patients with 2, 3, 8, and 6 cases of T1, T2, T3, and T4 stage, respectively. The outcomes showed that target coverage parameters and dose-volume histogram features were of no significant difference, with a significant difference in dose distribution between C-Plan and R-Plan in cochlea and eustachian, e.g., ipsilateral cochlea Dmean 4619.75 ± 1134.09 cGy in C-Plan and 5061.03 ± 1121.09 cGy in R-Plan (p = 0.000), contralateral cochlea Dmean 4386.73 ± 945.14 cGy in C-Plan and 4991.38 ± 961.21 cGy in R-Plan (p = 0.000). Meanwhile, there was no significant difference in dose distribution in spinal cord, brainstem, and other OARs. Our dosimetry study showed cochlea sparing in intensity-modulated radiotherapy for NPC reduced cochlea dose to different extent, so we suggested a stratified scheme of cochlea sparing based on T stage could be a useful and practical tool for both physicists and radiation doctors.

[Clinical study on lymph node metastasis regularity in 1456 patients with gastric cancer].

OBJECTIVE: To investigated the characteristics and regularity of lymph node metastasis around gastric cancer in order to provide reference for standardized and optimal surgical treatment. METHODS: A retrospective case series study was carried out on 1456 patients with gastric cancer undergoing surgical treatment at the Affiliated Tumor Hospital of Tianjin Medical University from March 2003 to August 2011. The number of harvested lymph node and metastasis status of various lymph node station were determined by routine pathological examination of specimens, including resected gastric tissue and dissected lymph node tissue, according to the 13th version of the Japanese Gastric Cancer Treatment Guidelines. Tumor T, N and M staging was performed to evaluate lymphatic metastasis status of different locations of gastric cancer according to the TNM staging criteria of the 8th edition of the American Joint Committee on Cancer (AJCC). The influence of gender, age, tumor diameter, Borrmann type, T staging and M staging, tumor differentiation degree, invasion of vessels, lymphatic vessels and nerves, radical surgical degree and other clinical factors on lymph node metastasis was analyzed. RESULTS: A total of 1062 cases(72.9%) had lymph node metastasis in the 1456 patients with gastric cancer. A total of 9766 lymph nodes were positive for metastasis. Lymph node metastasis occurred in 11 of 44 (25.0%) patients with early gastric cancer and in 1051 of 1412 (74.4%) patients with advanced gastric cancer. The largest number of lymph node metastases was found in No.3 station [653 cases (44.8%)], followed by No.6 [437 cases(30.0%)], No.7 [345 cases (23.7%)], No.1 [304 cases (20.9%)], No.4sb [290 cases (19.9%)]. No.14v lymph node metastasis was observed in 23 cases, of whom No.6 (16 cases, 69.6%), No.8a (15 cases, 65.2%) and No.3 (12 cases, 52.2%) developed simultaneous metastasis. As for different locations of gastric cancer, stations with more lymph node metastasis in 309 patients with proximal gastric cancer were No.3 (133 cases, 43.0%), No.1 (96 cases, 31.1%), No.2 (90 cases, 29.1%) and No.7 (89 cases, 28.8%); in 144 patients with middle gastric cancer were No.3 (68 cases, 47.2%), No.6 (50 cases, 34.7%), No.7 (40 cases, 27.8%) and No.4sb (38 cases, 26.4%); in 700 patients with distal gastric cancer were No.3(287 cases, 41.0%), No.6 (265 cases, 37.8%), No.4sb (138 cases, 19.7%) and No.8a (138 cases, 19.7%); in 303 cases with diffuse-type gastric cancer were No.3 (165 cases, 54.4%), No.6 (100 cases, 33.0%), No.7 (88 cases, 29.0%), No.1 (84 cases, 27.7%) and No.4sb (72 cases, 23.8%). The incidence of lymph node skip metastasis was 7.2% (105/1456) in whole group. Positive lymph node metastasis was associated with tumor size (RR=2.016, 95%CI: 1.550-2.621, P=0.000), tumor differentiation(RR=1.631, 95%CI:1.405-1.894, P=0.000), tumor T staging (RR=1.886, 95%CI: 1.629-2.184, P=0.000), tumor M staging (RR=3.671, 95%CI:1.265-10.660, P=0.017) and radical surgery(RR=3.819, 95%CI: 2.023-7.207, P=0.000). CONCLUSIONS: The main direction of peripheral lymph node drainage in gastric cancer is lesser curvature, and then the left gastric artery, the common hepatic artery and the peripheral lymph nodes of the celiac axis, and finally the peripheral lymph nodes of the abdominal aorta. Therefore the No.6 station lymph node adjacent to the perigastric area, the No.7, No.8 and No.9 lymph nodes should be the focus of the radical surgical dissection of gastric cancer. Tumor size, differentiation degree, invasion depth and distant metastasis have significant association with lymph node metastasis. For patients with adverse factors, radical surgery is necessary to ensure efficacy.

Supraglottic squamous cell carcinomas have distinctive clinical features and prognosis based on subregion.

OBJECTIVE: To analyze the clinicopathologic characteristics and prognosis of patients with squamous cell carcinoma localized to different supraglottic subregions. METHODS: Clinicopathologic data were reviewed retrospectively for 111 patients with supraglottic squamous cell carcinoma who were diagnosed between January 1, 1995 and December 31, 2005 and were initially treated with surgery. DNA from human papillomavirus (HPV) 16 and (or /and) HPV 18 were detected in all the 111 supraglottic carcinoma specimens using in situ hybridization. Survival analysis was performed by Kaplan-Meier analysis, factors were compared using log-rank test, and prognostic factors were determined using Cox proportional hazards model. The relationship between subregions and clinicopathologic factors was analyzed using Chi-square tests. RESULTS: HPV prevalence differed between patients with aryepiglottic fold carcinoma and ventricle carcinoma (P < .05). The local-regional control rates, overall survival rates or cancer specific survival rates were significantly different between different subregions. Univariate analysis indicated that pTNM classification, pN spread, and subregion were associated with prognosis (P < .05). Multivariate analysis indicated that pTNM classification and subregion were associated with supraglottic carcinoma prognosis. The survival rate was better for patients with carcinoma of the epiglottis or ventricular bands compared to those with carcinoma in the aryepiglottic fold or ventricle (P = .012). CONCLUSIONS: Subregion may be a new prognostic factor for supraglottic squamous cell carcinoma. Different supraglottic carcinoma subregions have distinct clinical features such as HPV expression, lymph node metastasis rate, local-regional control and prognosis. Therefore, it is necessary to subdivide supraglottic squamous cell carcinomas into several subregion groups to individualize therapy.

[Pituitary adenoma with initial symptom of cerebrospinal fluid rhinorrhea: a case report].

Pituitary adenoma with cerebrospinal fluid rhinorrhea is rare clinically. In this paper, through the analysis of a pituitary adenoma patient with initial symptom of cerebrospinal fluid rhinorrhea, we look forward to provide evidence for clinical diagnosis, so that we can avoid misdiagnosis.

[Endoscopic minitrephination combined with endoscopic frontal sinusotomy for management of chronic frontal sinusitis].

OBJECTIVE: To evaluate the efficacy of endoscopic minitrephination combined with endoscopic frontal sinusotomy in the management of complex chronic frontal sinusitis. METHOD: Twenty-six patients suffering from chronic frontal sinusitis with complex frontal drainage approach were analyzed. Eleven patients (13 sides) received endoscopic minitrephination combined with endoscopic frontal sinusotomy, while the other 15 patients (18 sides) received endoscopic frontal sinusotomy only. Postoperatively all cases were followed up to evaluate the efficacy. RESULT: The ostia of frontal sinus were successfully opened in the group of patients received endoscopic minitrephination combined with endoscopic frontal sinusotomy without any complications. In the endoscopic frontal sinusotomy only group, three cases of complications were observed, one with the injury of anterior ethmoidal artery and the other two with the injury of papyraceous lamina. After 10 to 24 months of follow up postoperatively, the symptoms were relieved in all cases without recurrence. The combined surgery group with endoscopic minitrephination showed an endoscopic frontal sinus patency rate of 85%, and the endoscopic frontal sinusotomy only group exhibited an endoscopic frontal sinus patency rate of 83%. CONCLUSION: Endoscopic minitrephination combined with endoscopic frontal sinusotomy is a simple, convenient, safe and effective method for management of complex chronic frontal sinusitis.

Photobiomodulation by low-power laser irradiation attenuates Aß-induced cell apoptosis through the Akt/GSK3ß/ß-catenin pathway.

Apoptosis induced by amyloid ß peptide (Aß) is thought to associate with the pathogenesis of Alzheimer disease (AD). Accumulating evidence shows that low-power laser irradiation (LPLI) is capable of reducing Aß-induced apoptosis. However, the underlying mechanisms remain unclear. In this study, we report a novel molecular mechanism by which LPLI attenuates Aß(25-35)-induced apoptosis through the Akt/GSK3ß/ß-catenin pathway. We found that Akt activated by LPLI interacted with GSK3ß and phosphorylated it on Ser9 in the presence of Aß(25-35), which resulted in the inhibition of GSK3ß. Furthermore, LPLI increased the nuclear translocation of ß-catenin and enhanced its T cell factor/lymphocyte enhancer factor-dependent transcriptional activity via the Akt/GSK3ß pathway to promote cell survival upon treatment with Aß(25-35.) Our data demonstrate that LPLI has a prosurvival effect on Aß-induced apoptosis and may be an effective therapeutic strategy in treating AD by targeting GSK3ß.

[The nodular fasciitis in the head and neck region with one case report].

The case of the nodular fasciitis was with a short history and rapid growth speed. The lesion was nodular, not encapsulated. Histologically, the fibroblasts proliferated actively, with some mitoses. The reality of the nodular fasciitis is the proliferation of fibroblasts and myofibroblasts. This disease is a benign lesion. It is very important to make a different diagnosis between this lesion and sarcomas. Ultrasonography and MRI are important assistants in diagnosis of nodular fasciitis. This disease could be effectively treated by local excision with a low recurrence rate and a satisfactory prognosis.

[The clinical characteristics of histiocytic necrotizing lymphadenitis: analysis of 11 cases].

OBJECTIVE: To study the clinical features of histiocytic necrotizing lymphadenitis. METHOD: Eleven patients with histiocytic necrotizing lymphadenitis were collected to analyze the clinical features, pathological features of biopsy lymph nodes, diagnosis and treatment. RESULT: Lymph node swelling of neck and persistent fever were detected in all patients. The leukocyte reduction and swiftness of ESR in serum were detected in most patients. The final diagnosis of histiocytic necrotizing lymphadenitis was confirmed by biopsy investigation of the pathology. The pathological features included distinctive necrosis, loss of lymph node structure, infiltration with histiocytes and lymphocytes, absence of neutrophils. All patients were treated with glucocorticoid for 2 to 4 months. The patients improved significantly and were not recurrence during follow up visit. CONCLUSION: There was no specific clinical manifestation of histiocytic necrotizing lymphadenitis and which easy to misdiagnoses. Diagnosis of histiocytic necrotizing lymphadenitis relies on the pathological examination of enlarged lymph nodes.

[Prevention of allograft vasculopathy by transfection of calcitonin gene-related peptide].

OBJECTIVE: To explore suppression of allograft vasculopathy (AV) by transfer of the calcitonin gene-related peptide (CGRP). METHODS: The descending thoracic aortas from 39 Lewis rats were grafted to the abdominal aortas of 39 F344 rats, and then the recipient rats were randomized into 3 groups: Group A transfected with Ad5-CGRP-EGFP, a gene construct containing sequences from the adenoviral oncoprotein, CGRP, and enhanced green fluorescent protein, Group B, transfected with Ad5-EGFP containing sequences from the adenoviral oncoprotein and enhanced green fluorescent protein, and Group C without transfection. Four and 8 weeks later the abdominal aortas of 6 recipient rats from each were collected respectively. The degree of vascular obstruction was observed by microscopy. Frozen tissue sections were made and the inverted phase contrast fluorescence microscopy was used to observe the green fluorescence showing the expression of CGRP and enhanced green fluorescent protein (EGFP). RT-PCR was used to detect the expression of CGRP. Immunohistochemistry was used to examine the expression of inducible nitric oxide synthase (iNOS) and vascular cell adhesion molecule-1 (VCAM-1). The apoptosis index (AI) was detected by TUNEL method. RESULTS: CGRP expression was positive in both Group A and B 4 weeks later and negative in both groups 8 weeks later. Group A is approximately normal in pathological morphology 4 weeks later. The vascular luminal occlusion score of Group A was lower than Groups B and C 4 weeks later, and significantly higher than that I the same group (P < 0.05), however, still lower than those of Groups B and C 8 weeks later. The AI 4 weeks later of Group A was significantly lower than those of Groups B and group C, however, there was no significance in AI among the 3 groups. Four weeks later the VCAM-1 expression levels in the tunicae intima, media, and adventitia of Group A were all significantly lower than those of Group B C 4 weeks later, however, the iNOS expression level of Group A was only significantly lower than those of Groups B and C in the tunica intima 4 weeks later. CONCLUSION: The expression of CGRP effectively suppresses the development of AV 4 weeks after the operation.

[Clinical analysis of the laryngeal injury].

OBJECTIVE: To explore the management of the laryngeal injury. METHOD: The forty five patients of laryngeal injury had been rescued. Twenty eight patients were treated with the tracheotomy and twenty four patients of them were treated with the laryngoplasty. RESULT: All the patients were survived. Tracheostomy tube of twenty eight patients was taken away without the cicatricial structure of larynx. CONCLUSION: With the reasonable management after the laryngeal injury, the injury could be cured in time without complications.