Management of squamous cell carcinoma of the temporal bone: long-term results and factors influencing outcomes.

OBJECTIVE: Temporal bone squamous cell carcinoma (TBSCC) is a rare, aggressive tumor. Surgery, alone or combined with radiotherapy, represent the mainstay of treatment. To report our experience in the treatment of TBSCC and evaluate the disease-specific survival, identifying the factors influencing this outcome. MATERIALS AND METHODS: A retrospective study was performed on 66 patients between 1993 and 2018. Patients were staged according to the University of Pittsburgh-modified TNM staging system. Nine cases (13.6%) were Stage I, 7 cases (10.6%) Stage II, 20 cases (30.3%) Stage III and 30 cases (45.5%) Stage IV. Twenty-four patients underwent lateral temporal bone resection (LTBR) and 42 patients underwent subtotal temporal bone resection (STBR). RESULTS: One hundred percent of Stage I and II patients showed no evidence of disease (NED) after a median follow-up of 101 months (range 1-289 months). NED resulted in 88.2% of Stage III (mean follow-up 80.3 months; range 8-257) and 46.4% of stage IV (mean follow-up 50.6 months; range 3-217). Pittsburgh Stage or involvement of mastoid, facial nerve, medial wall of the middle ear, temporomandibular joint and middle fossa dura emerged as negative prognostic factors. The highest mortality rate occurred in the first 2 years after treatment, due to local recurrence. CONCLUSIONS: Prognosis of TBSCC can be excellent in early stage tumors, employing a LTBR. In more advanced cases, prognosis is poor. STBR with adjuvant radiotherapy represents the treatment of choice, offering acceptable survival rates. Given the rarity of the pathology, many controversies still exist concerning optimal management.

Expression of ENaC, SGK1 and Nedd4 isoforms in the cochlea of guinea pig.

It has been demonstrated that the epithelial sodium channel (ENaC) may play critical roles in (re)absorbing Na+ from apical plasma membrane in various tissues and cells. Moreover, the serum glucocorticoid-inducible kinase 1 (SGK1) and the ubiquitin-protein ligase neural precursor cell-expressed, developmentally downregulated isoforms Nedd4 are involved in ENaC regulation in response to hormones such as aldosterone, vasopressin and insulin. The aim of the study was to investigate the cellular localizations of ENaC subunits, SGK1, and Nedd4 isoforms in the cochlea of guinea pig. Ten adult guinea pigs were sacrificed and their cochleas were collected. The expression patterns of ENaC subunits, SGK1 and Nedd4-2 isoforms in the guinea pig cochlea were studied by immunohistochemistry with the specific polyclonal rabbit antibodies against rat α-, ß- and γ-ENaC, SGK1, Nedd4-1/2 and Nedd4-2. The results showed that all these proteins were extensively expressed in various regions of the cochlea. They were found in the spiral ligament, organ of Corti, spiral limbus, spiral ganglion and Reissner's membrane with different staining patterns. The results indicated that a Na+ transport system may exist in the cochlea of guinea pig consisting of ENaC, SGK1 and Nedd4, which may work in concert to transport Na+ and to maintain homeostasis in inner ear as it does in other epithelia.

Effects of Taishan Robinia pseudoacacia Polysaccharides on immune function in chickens.

To determine the immune function of Taishan Robinia pseudoacacia Polysaccharide (TRPPS) on chickens, 240 chickens were selected as experimental animals and treated with various doses of TRPPS by hypodermic injection before immunized NDV inactivated vaccine. The results indicated that any dose of TRPPS could significantly promote the development of the immune organs, increase the quantity of leukocyte and the ratio of lymphocyte, and improve the antibody titers against Newcastle disease. Meanwhile, it also increased the magnitude of SIgA in duodenum. However, the dose of 200 mg/ml showed to be the most effective. Therefore, in terms of improving immunologic function and production performance, TRPPS could be used as a vaccine immunopotentiator for immune responses.

Reconstruction of hypopharynx and cervical oesophagus for treatment of advanced hypopharyngeal carcinoma and recurrent laryngeal carcinoma.

OBJECTIVE: To review our treatment strategy and outcomes in reconstructing the hypopharynx and cervical oesophagus with five techniques for advanced hypopharyngeal carcinoma and recurrent laryngeal carcinoma. METHODS: Thirty-one patients treated between 1996 and 2007 were analysed retrospectively. Defects of the hypopharynx and cervical oesophagus were reconstructed using the remaining laryngeal mucosa flap, pectoralis major myocutaneous flap, forearm free flap, jejunal free flap or latissimus dorsi myocutaneous flap. RESULTS: All patients were treated successfully. Postoperative pharyngocutaneous fistulas occurred in four patients, one of whom died from haemorrhage of carotid artery 1 month after surgery, and the other three resolved spontaneously. Dysphagia occurred in three patients, which was caused by food mass occlusion, or oesophageal stricture and stoma stricture. The 3- and 5-year survival rates were 59.3% and 43.5%, respectively. CONCLUSION: A consensus treatment strategy for reconstructing the defect following hypopharyngectomy and cervical oesophagectomy has not been established. Every technique has its advantages and disadvantages. The treatment of choice depends upon the location and size of the carcinoma as well as the patient's characteristics and the doctor's experience.

[Localization of sentinel lymph node with radionuclide in clinically N0 laryngeal and hypopharyngeal cancers].

OBJECTIVE: To analyze the characteristic of the radioactive lymph node with metastatic disease and to explore the method of the localization of sentinel lymph node (SLN) with radionuclide in N0 clinically laryngeal and hypopharyngeal cancer. METHODS: Fourty-five patients with T1-T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. For each patient a peritumoral submucosal injection of 99mTc-labeled sulfur colloid (99mTc-SC) was performed and lymph node mapping was performed by lymphoscintigraphy two hours afterward. The SLN was localized by a handheld gamma probe intraoperatively 10-12 hours after the injection. All hot lymph nodes accumulating activity were harvested and initially termed sentinel nodes. Selective neck dissections were performed for all patients. The specimen of SLN was sent to the pathologist for the following analysis: formal paraffin embedded section, consecutive section and immunohistochemistry assay. The results was compared to the remaining lymphadenectomy specimen. Resection of the primary tumour depended on the location and the T classification. RESULTS: SLNs were identified in 41 of 45 patients with 51 necks, SLNs had occult metastases in 13 cases, 15 necks with SLN-positive of these 13 cases, there was one false negative case, they were found in non-SLNs of neck specimens. Each neck side was considered a single case. SLN identification rate was 92.7%, sensitivity was 93.7%, false-negative rate was 6.3%, and accuracy was 98.0%. In 11 (73.3%) of these SLN-positive necks, the SLN with the highest counts contained tumor; harvesting the first-three nodes with the highest radioactive counts, which could all patients with occult metastatic disease. CONCLUSIONS: Excision of the first-three SLNs with the highest radioactive counts can accurately judge the presence or absence of the cervical lymph nodes metastases in patients with the clinically N0 laryngeal and hypopharyngeal cancer.

[Expression of alpha, beta and gamma subunits of epithelial sodium channel in the cochlea and endolymphatic sac of guinea pig].

OBJECTIVE: To investigate the distribution and role of alpha, beta and gamma subunits of epithelial sodium channel (ENaC) in the cochlea and endolymphatic sac of guinea pig. METHODS: The expression of alpha-, beta- and gamma-ENaC subunits proteins was studied by immunohistochemistry with the specific polyclonal rabbit antibodies against the alpha, beta and gamma subunits of rat ENaC. Alpha-ENaC mRNA was detected by in situ hybridization with digoxin labeled cDNA probe. RESULTS: All three subunits of ENaC, alpha-, beta- and gamma-, were widely distributed in the labyrinth. In the cochlea, strong labeling of alpha-ENaC protein was found in the spiral limbus, and to a less extent, in the spiral ligament, organ of Corti and Reissner's membrane. The immunoreactivity of beta-ENaC was observed in the spiral ligament, spiral limbus, spiral ganglion, organ of Corti and Reissner's membrane with a less intensity than that of alpha-ENaC. Gamma-ENaC was presented primarily in the superior part of the spiral ligament, spiral limbus, spiral ganglion, and weakly in the organ of Corti and Reissner's membrane. In the endolymphatic sac, intensive immunoreactivities of all three subunits were seen in the epithelial cells and the subepithelial cells at similar intensity. Alpha-ENaC mRNA was localized in the spiral limbus, the inferior part of spiral ligament, stria vascularis, and epithelial cells and subepithelial cells of endolymphatic sac. CONCLUSION: Different subunits of the ENaC expressed in various cell regions of the cochlea and endolymphatic sac in distinct patterns may form the functional sodium channel to regulate the endolymph, thus serve to maintain homeostasis in inner ear.

Expression patterns of Nedd4 isoforms and SGK1 in the rat cochlea.

CONCLUSION: Our findings suggest that there exists a Na(+) transport system in the cochlea consisting of SGK1, Nedd4 isoforms and ENaC, which may work in concert to transport Na(+) and to maintain homeostasis in the inner ear as they do in other tight epithelia. OBJECTIVES: It has been well demonstrated that the epithelial sodium channel (ENaC) plays important roles in regulation of Na(+) reabsorption in the tight epithelia of kidney, colon and lung. Recent studies have provided multiple evidence that the serum glucocorticoid-inducible kinase1(SGK1) and the ubiquitin-protein ligase neural precursor cell-expressed, developmentally downregulated isoforms Nedd4 are involved in ENaC regulation in response to hormones such as aldosterone, vasopressin and insulin. The authors aimed to investigate the cellular localization of Nedd4 isoforms, Nedd4-1/2 and Nedd4-2, and SGK1 in the rat cochlea. MATERIALS AND METHODS: The expression patterns of Nedd4-1/2, Nedd4-2 and SGK1 in the rat cochlea were studied by immunohistochemistry with the specific polyclonal rabbit antibodies against the rat Nedd4-1/2, Nedd4-2 and SGK1. RESULTS: All three proteins were extensively expressed in various regions of the rat cochlea. They were found in the stria vascularis, spiral ligament, organ of Corti, spiral limbus, spiral ganglion and Reissner's membrane.

[Long-term results of small fenestra stapedectomy compared with large fenestra technique].

OBJECTIVE: To evaluate the postoperative long-term hearing results of small fenestra stapedectomy versus large fenestra techniques. METHODS: A retrospective review of 102 ears of 94 patients who had stapedectomy (small fenestra technique) performed by the same surgeon between 1972-1990 was conducted. Patients undergoing stapedectomy and stapedotomy were followed for 6.4 +/- 2.2 and 6.6 +/- 3.0 month in initial postoperative and 14.5 +/- 3.0 and 7.4 +/- 2.2 years in late postoperative, respectively. RESULTS: There were no statistically significant differences in initial or late postoperative pure-tone (PTA), PTA air-bone gap, speech reception threshold (SRT) between the two groups. Ears treated by stapedotomy showed statistically better initial postoperative air-conduction threshold and initial 4-KHz air-bone gap closure, but the gap difference was not significant with late follow-up. The successful outcomes in both groups were stable over long-term follow-up. Results were the same when comparing the two procedures in the patients having undergone both. CONCLUSIONS: These results show that, in the operation of an experienced surgeon for otosclerosis, either large or small fenestra technique provides satisfactory and stable long-term results.

Immunohistochemical localization of the epithelial sodium channel in the rat inner ear.

Endolymph in membranous labyrinth is a K+-rich and Na+-poor fluid, and perilymph is conversely Na+-rich and K+-poor. Electrolyte transport between endolymph and perilymph is important for regulation of volume and osmotic pressure of the labyrinth. The epithelial sodium channel (ENaC) is a good candidate protein for Na+ transport in the tight epithelia, which has been well demonstrated in other tissues such as kidney, colon and lung. The purpose of the present study was to investigate the cellular localization of ENaC subunits in the rat inner ear immunohistochemically with the specific polyclonal rabbit antibodies against the rat alpha-, beta- and gamma-ENaC. All three subunits of ENaC were extensively labeled in the cochlea including the stria vascularis, spiral ligament, organ of Corti, spiral limbus, Reissner's membrane and spiral ganglion, and in the vestibule including the sensory epithelia and stroma cells of the macula utriculi, macula sacculi and ampullary crest. In conclusion, our results suggest that functional ENaC in the labyrinth may work in concert with other Na+ and K+ transport molecules to regulate endolymph and to maintain homeostasis in the inner ear.

Expression of aquaporins in the cochlea and endolymphatic sac of guinea pig.

It has been shown that the aquaporin (AQP) family forms membrane pores selectively permeable for water and some small solutes such as glycerol and urea, and thus plays important roles in regulating the fluid in many organs involved in fluid transport such as kidney, lung and brain. The aims of the present study were to investigate the cellular localization and its significance of aquaporins (AQPs) in various subregions of the cochlea and endolymphatic sac of guinea pig. The expression patterns of AQP1, 2, 3 and 4 were immunolabeled with the specific polyclonal rabbit antibodies against the rat AQP1, 2, 3 and 4. Our immunohistochemical examination showed that in the cochlea, AQP1, 3 and 4 were widely distributed in various locations including stria vascularis, spiral ligament, the organ of Corti and spiral ganglion in the similar patterns except that AQP3 in the stria vascularis was lightly weaker than AQP1 and AQP4. AQP2 was labeled only in Reissner's membrane. In the endolymphatic sac, AQP1, AQP3 and AQP4 were strongly expressed in the epithelial cells and subepithelial cells similarly with the exception that AQP3 was lightly weaker than AQP1 and AQP4. No AQP2 immunoreactivity was detected in the endolymphatic sac. Theses results suggest that different members of the AQP family in the labyrinth may work in concert to regulate endolymph and to maintain homeostasis in the inner ear.