Safe dose reduction of steroid pre-medication for docetaxel in head and neck neoplasm treatment.

CONCLUSION: The results suggest that the rate of severe hypersensitivity reactions did not increase when the dexamethasone pre-medication dose was reduced to 11 mg prior to docetaxel infusion. OBJECTIVES: Dexamethasone is commonly used to prevent the adverse effects of docetaxel in head and neck neoplasm treatment. The recommended dexamethasone dose is 8 mg orally twice daily for 3 days for each injection of docetaxel. This pre-medication reduces the incidence of adverse effects to 1-2% of treated patients. However, many adverse events have been observed with long-term steroid use. In an attempt to balance the benefits and harms of steroid prophylaxis without affecting the safety of docetaxel, this study tried to reduce the duration and dose of dexamethasone. METHODS: In this study, a total of 336 patients underwent docetaxel-containing protocols (TP or TPF regimens) to treat head and neck neoplasms. Docetaxel was given in doses of 70 mg/m(2) once every 3 weeks. Dexamethasone (0.75 mg/tablet) pre-medication was given in different doses (45, 24, 18, and 11 mg); the minimum dose included 6 mg orally in the morning and 5 mg intravenously immediately before docetaxel infusion. RESULTS: Severe hypersensitivity reactions were experienced by none of 30 patients who received 45 mg (7.5 mg orally twice for 3 days) dexamethasone pre-medication in 125 cycles, none of 20 patients who received 24 mg (6 mg orally twice for 2 days) dexamethasone in 77 cycles, and none of 20 patients who received 18 mg (4.5 mg orally twice for 2 days) dexamethasone in 79 cycles. Three of 266 patients who received 11 mg dexamethasone in 1054 applications developed a severe hypersensitivity reaction with bronchospasm and hypotension, two of the 266 patients developed a severe rash, and four developed severe oedema.

[Clinical analysis of sudden sensorineural hearing loss in patients with different ages].

OBJECTIVE: To investigate the clinical materials of sudden sensorineural hearing loss (SSNHL) in different ages of patients, and explore their clinical characteristics and prognosis. METHODS: A retrospective review was conducted by the clinical symptoms, predisposing factors and prognosis in SSNHL patients with different ages in the past two years (from 2008 to 2010). All patients were divided into three groups according to age, including Group 1 (0-18 years old), Group 2 (19-59 years old), and Group 3 (over 60 years old). RESULTS: Part of patients (28.1%) had a clear history of virus infection in Group 1. Some patients (18.7%) had obvious history of emotional fluctuations or fatigue before the onset of SSNHL. Three groups of patients with "aural fullness" symptom accounted for 3.1%, 41.3% and 29.4% respectively. The proportions of patients with profound hearing loss in three groups were 62.5%, 40.0% and 33.3% respectively. Most patients improved hearing level during systemic internal medicine treatment. However, many patients (68.8%) in Group 1 showed poor therapeutic effect. CONCLUSIONS: SSNHL in different age stages has different clinical features. We can improve the personalized treatment program to this disease through the classification and grading treatment.

Four systems involved with congenital abnormalities: a new type of syndromic hearing loss - ADOC Wang's syndrome?

Syndromic hearing impairment encompasses hundreds of phenotypes. We identified a young female patient affected by the unique combination of dysplasia of the auricular system, patent ductus arteriosus (PDA), choroideremia, and enamel hypoplasia. The patient was treated with PDA ligature and left exploratory tympanotomy. Impairment in all four systems suggests a correlation with the neural crest. It is presumed that all of the features result from the same origin, probably through autosomal recessive inheritance or a novel mutation during the embryonic period. When audio-dento-oculo-cardio systems are involved, we suggest that this new syndrome can be named 'ADOC Wang's syndrome', summarizing the disorders of the four systems and indicative of the founding person (Dr Wang, the first and corresponding author of the paper).

[Clinical analysis of adenoid cystic carcinoma of external auditory canal].

OBJECTIVE: To explore methods of treatment for adenoid cystic carcinoma of external auditory canal, and discuss the correlating factors that effect prognosis. METHODS: A retrospective analysis of 19 cases of adenoid cystic carcinoma of external auditory canal treated from 1988 to 2004 was carried out. Based on University of Pittsburgh TNM staging system of external auditory canal carcinoma, 19 cases were classified into groups as 5 cases in T1, 2 in T2, 6 in T3, and 6 in T4. Local resection was performed in cases in stage T1 and T2, while radical mastoidectomy or temporal bone resection was performed in stage T3 and T4. Radiotherapy was applied after operation. Relapsed cases with isolated metastasis were treated by surgery. Multiple metastasis were treated with radiotherapy. RESULTS: The follow-up time is from 6 months to 19 years, and the median is 44 months. There're 8 cases with more than 5 years' follow-up. Twelve patients relapsed and 7 had metastasis but 4 died. The cases with positive incisal edge after first operation relapsed even treated with radiotherapy. In recurrent cases, 9 cases received more than 2 operations, 8 more than 3, and 4 received 4 operations. CONCLUSIONS: The adenoid cystic carcinoma of external auditory canal grows insidiously, and relapses frequently. But the patients can live long with neoplasm implanted. A wide surgical excision combined with post operative radiotherapy was proposed, and negative incision edge should be confirmed. Recurrent cases can be treated with several operations to elongate survival. Multiple relapses will cause metastasis more frequently. Metastasis is the main reason to cause death.

[Study on trans-differentiation of adult human myoblasts into neural precursor cells and its implantation in rats].

OBJECTIVE: To investigate the feasibility of inducing adult human myoblasts into neural precursor cells. METHODS: The myoblasts were isolated with mixed digestive enzyme from minced human temporal muscle samples, cultured and purified clonally. The 3rd passage cells were incubated with serum free medium including basic fibroblast growth factor (bFGF), epidermal growth factor (EGF) and leukemia inhibitory factor (LIF). Morphological change was investigated during incubation period. Immunofluorescence cytochemistry and RT-PCR analysis were used to assess cell differentiation and trans differentiation. RESULTS: After the induction, cells became non-adherent aggregates as neurospheres. The myoblast-derived neurospheres was immuno-positive for nestin. In differentiation condition, they looked like neurons and glial cells and expressed neuronal (microtubule associated protein 2, MAP-2), astrocytic (Glial fibrillary acidic protein, GFAP) and oligodendrocytic (Galactocerebroside, Galc) markers by immunocytochemistry. The result by RT-PCR was coincident with immunocytochemistry. The myoblast-derived neurospheres expressed MAP-2 and GFAP after they were transplanted into the brain of rats with cerebral ischemia. CONCLUSION: Adult human myoblasts can be inducted to trans-differentiate into neural precursor cells.