Comparative study of optical coherence tomograph and histological images of eustachian tube nasopharyngeal region and adjacent structures in vivo and ex-vivo miniature pigs.

OBJECTIVES: Optical Coherence Tomograph (OCT) imaging technology can be used to examine, in vivo, the human ET. At present, it is impossible to achieve the OCT scanning vivo and ex vivo in the same individual human body, or study the consistency between OCT images and histological images of the eustachian tube nasopharyngeal region and adjacent structures. The aim of this study was to determine the consistency between OCT images and histological sections in vivo and ex vivo in miniature pigs. METHODS: OCT imaging was performed on five adult miniature pigs in vivo and ex vivo. The images of the eustachian tube OCT (ET-OCT), nasopharynx OCT (NP-OCT) and histological cross sections were further studied. RESULTS: All five miniature pigs achieved the OCT scan successfully, acquiring ET-OCT and NP-OCT images in vivo and ex vivo on both sides. The acquired ET OCT images closely matched the histological images, revealing details of the cartilage, submucosa, glands, and mucosa. The lower segment of the ET wall mucosa had an abundance of glands and submucosal tissues, with more low-signal areas appearing in the ex vivo images. The NP-OCT images of the nasopharynx matched the details of the mucosa and submucosal tissues. The ex-vivo OCT images showed thicker mucosa and more scattered slightly lower signal areas compared to the vivo OCT images. CONCLUSIONS: ET-OCT images and NP-OCT images matched the histological structure of eustachian tube nasopharyngeal region structures in miniature pigs both in vivo and ex vivo. OCT images may be sensitive to changes in edema and ischemia status. There is a great potential for morphological assessment of inflammation, edema, injure, mucus gland status.

Autoimmune thyroiditis in patients with sudden sensorineural hearing loss.

Objective: This study aims to evaluate the association between autoimmune thyroiditis and Sudden Sensorineural Hearing Loss (SSNHL). Methods: Hundred and five patients with SSNHL were enrolled. Audiometric tests, serum thyroid autoantibodies (TPOAb, TgAb) were studied. Based on the thyroid autoantibody results, patients were divided into two groups: thyroid autoantibody-positive and negative. The relationship between thyroid autoimmunity and audiological characteristics was analyzed. Results: Twenty-six patients (24.8%) of the SSNHL had thyroid autoantibody elevated. The pure tone average (PTA) of patients with and without thyroid autoantibody is 60 ± 38.51 and 54.99 ± 33.87 dBHL, respectively. The PTA was significantly improved in both groups after treatment (p < 0.001), but the hearing gains were similar in both groups (p = 0.205). Hearing loss of 2000-8000 Hz was worse than 125-1000 Hz among thyroid autoantibody-positive patients (p < 0.05), but the hearing improvement of both groups have no significant difference. The hearing improvement of 125-1000 Hz is significantly better than 2000-8000 Hz among patients with thyroid autoantibody negative (p < 0.05). Conclusions: We speculate that a potential association between thyroid autoimmunity and SSNHL. Thyroid autoimmunity may be a pathogenesis factor of SSNHL and associated with more severe hearing loss of high-frequency hearing.

Investigations on the potential of optical coherence tomography as an imaging tool for eustachian tube.

The purpose of this study was to explore the feasibility of eustachian tube optical coherence tomography (ET-OCT) for imaging the pharyngeal region of the eustachian tube (ET). Ten subjects with ear complaints underwent ET-OCT guided by nasal endoscopy, and ET-OCT examination was performed on both sides of each subject's ETs. The process and resulting images were analysed. Ten subjects ranging from 21 to 73 years old (45 ± 14.77) were enrolled in this study. Eighteen ET-OCT imaging examinations were completed. The mean duration of each examination was 2.80 ± 1.62 min (ranging from 2 to 7 min). There were no adverse events or complications. In some subjects, the ET-OCT images clearly presented the microstructures of the ET wall, including the lumen, mucosa, submucosa, cartilage and plica. However, in some subjects, it showed different characteristics, such as an unclear hierarchy and secretions in the lumen. ET-OCT may help to distinguish the structural composition of the ET and elucidate related pathophysiological mechanisms. It is a valuable imaging tool suited for the ET, with potential diagnostic value in determining the morphology of the lumen, intraluminal mucosa and submucosal tissue in the pharyngeal region of the ET.

HOXB7 as a promising molecular marker for metastasis in cancers: a meta-analysis.

Numerous studies on carcinoma have revealed that the expression level of HOXB7 in cancerous tissues was significantly higher than that in noncancerous tissues. Elevated expression of HOXB7 is associated with the susceptibility to lymph node metastasis and distant metastasis in various tumors. In this study, a meta-analysis was performed to involve majority of relevant articles and explore the association of HOXB7 expression level with metastasis in cancer patients. Literature retrieval was conducted by searching in a number of electronic databases (up to December 1, 2015). The meta-analysis was conducted with RevMan 5.3 software and Stata SE12.0. A total of 1,532 patients with carcinoma from 14 studies were included in analysis. The results of meta-analysis demonstrated that lymph node metastasis was observed more frequently in the patients group with high expression level of HOXB7 than in the patients group with low expression level of HOXB7 (odds ratio =2.17, 95% CI: 1.74-2.71, P<0.00001, fixed-effects model). In addition, a similar result was observed in the association between HOXB7 expression and distant metastasis; the odds ratio was 1.77 (95% CI: 1.09-2.88, P=0.02, fixed-effects model). This meta-analysis demonstrated that the overexpression of HOXB7 was significantly associated with metastasis in cancer patients, which may be served as a common molecular marker for indicating cancer metastasis.

Treatment and Prognosis of Anaplastic Thyroid Carcinoma: A Clinical Study of 50 Cases.

INTRODUCTION: Although anaplastic thyroid carcinoma (ATC) is rare, it is one of the most aggressive human cancers. The optimal multimodal therapy policy of ATC is still debated, and a standardized treatment strategy remains to be established. This study aimed to evaluate the management aspect and prognosis of ATC. MATERIALS AND METHODS: The data were analyzed retrospectively for 50 patients with ATC to evaluate the clinical characters, management and factors influencing survival. Survival analysis was performed by Kaplan-Merier method and log-rank test, and multivariate analysis was performed using Cox proportional hazard model. RESULTS: The 1-year and 2-year overall survival rates (OS) were 48.0% and 26.0% respectively in all patients, with the 2-year OS of 40.0% and 31.0% and 6.3% for stage IVA, IVB and IVC respectively (P <0.05). In stage IVA and IVB patients, combined surgery with radiotherapy improved overall survival, and the 2-year OS were 50.0% and 35.7% respectively in the group with combined surgery with radiotherapy and the group with surgery with only (P <0.05). Postoperative radiotherapy improved local control rate in stage IVA and IVB patients (P <0.05). However, surgery, radiotherapy or chemotherapy could not improve the survival of stage IVC patients. Multivariate analysis showed that distant metastases, surgery, radiotherapy and tumor residue could predict the prognosis. CONCLUSION: Combined surgery and radiotherapy could improve overall survival in stage IVA and IVB patients. Patients with ATC have a bad prognosis. Distant metastases, surgery, radiotherapy and tumor residue are the most important factors affecting the prognosis.

Different therapeutic strategies in primary salivary gland-type nasopharyngeal carcinomas.

PURPOSE OF REVIEW: Primary salivary gland-type nasopharyngeal carcinoma (PSGT-NPC) is an uncommon malignancy with aggressive behavior and poor prognosis. Its optimal treatment policy remains debated, even though recent evidence provides support for a multimodality approach. The aim of this study was to summarize the optimal management approaches and treatment outcomes of PSGT-NPCs. RECENT FINDINGS: As most of the PSGT-NPCs, such as adenoid cystic carcinoma, mucoepidermoid carcinoma and low-grade (well-differentiated) adenocarcinoma, have low sensitivity to radiation, combined surgical treatment and radiotherapy are still the main treatment approach for limited or resectable lesions. As a result of the fact that in well-differentiated PSGT-NPCs the occult neck metastasis rate is low (less than 20%), elective neck dissection is not recommended in patients with a node-negative neck. Since high-grade (poorly-differentiated) PSGT-NPCs are relatively sensitive to radiation, radiotherapy or chemoradiotherapy is currently considered as the main treatment policy for such patients. There is no evidence to indicate that chemotherapy would improve overall survival. Cranial nerve infiltration, residual tumor, and distant metastases are independent predictive factors of overall survival. SUMMARY: In most patients with PSGT-NPCs, especially for well-differentiated tumors, combined surgical treatment and radiotherapy should be recommended. For poorly-differentiated or unresectable tumors, radiotherapy or chemoradiotherapy is still considered the main treatment approach. Because of the rare incidence of PSGT-NPCs, the number of cases available for analysis is relatively small, and large multicentric studies should be conducted to further evaluate their optimal treatment policy.

Elective neck dissection in clinical stage I squamous cell carcinoma of the tongue: Does it improve regional control or survival time?

The objective of this study was to evaluate whether elective neck dissection could improve regional control or survival time in clinical stage I squamous cell carcinoma of the oral tongue (OTSCC). This was a retrospective study of patients with surgical treatment between January 1991 and December 2003. A total of 131 patients were included in the study, and all of them received operation of the primary site, while 88 cases underwent selective neck dissection simultaneously including level I-III neck dissection in 49 patients and level I-V neck dissection in 39 patients. In all these cases, the rate of occult neck metastases was 23.7%. The 4-year local control rates in patients with only primary site treatment, patients with level I-III neck dissection and patients with level I-V neck dissection were 81.0%, 83.6% and 89.1%, respectively. By univariate analyse, neck dissection did not increase regional control rate, disease free survival (DFS) or overall survival (OS). Multivariate analyses showed that neck dissection was not an independent factor for DFS or OS. This study showed that the occult neck metastases rate was 23.7% in clinical stage I OTSCC. Elective neck dissection did not significantly improve regional control, DFS and OS in clinical stage I patients. There is a need for accurate and valid methods to select the patients who would benefit from elective neck treatment.

Primary salivary gland type carcinoma of the nasopharynx: therapeutic outcomes and prognostic factors.

BACKGROUND: Primary salivary gland type nasopharyngeal carcinoma (SNPC) is a rare malignancy with diverse clinical behavior and different prognoses. Previous studies have reported on limited patient populations, and few long-term studies have outlined outcomes and prognostic factors. Furthermore, controversy exists as to the treatment policy of SNPC. The aim of this study was to define management approaches, therapeutic outcomes, and prognostic factors of SNPC. METHODS: The medical records of 67 patients with SNPC at 1 institution between 1977 and 2005 were reviewed. Patient records were analyzed for management approaches, outcomes, and prognostic factors. RESULTS: SNPC is a rare malignancy accounting for only 0.29% of nasopharyngeal malignancies, and the lymphatic metastases and distant metastases rates were 28.4% and 23.9%, respectively. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 41.1% and 57.1%, respectively; no significant differences were found in DFS or OS between different histological subtypes. A significant difference was found in OS between surgical treatment and nonsurgical treatment in T1-T2 patients with well-differentiated tumors. Multivariate analyses indicated that lymph node metastases, stage, and distant metastases were independent factors for DFS, whereas cranial nerve invasion, tumor residue, and distant metastases were independent factors affecting OS. CONCLUSIONS: SNPC is a malignancy with generally favorable prognosis. In T1-T2 patients with well-differentiated tumors, SNPC should be treated by combined surgical operation and radiotherapy. Cranial nerve invasion, tumor residue, and distant metastases were independent factors affecting OS.

[Establishment of mechanical middle ear model and the study of the acoustic characteristics of different ossicular prostheses].

OBJECTIVE: To design a tool for evaluating the sound transmission function of ossicular prosthesis and explore the impacts of ossicular prosthesis bead area and the effects of the mass of ossicular prosthesis on the sound transmission function in mechanical middle ear model. METHODS: Two latex membranes were used to represent the tympanic membrane and oval window membrane. The ossicular prosthesis was fitted between the artificial tympanic membrane and oval window membrane during the test. Pure tune signals were used to stimulate the vibration of tympanic membrane. The vibration of oval window membrane was recorded by a laser Doppler vibrometer. The ossicular transmission function was evaluated by comparing the vibration velocities of oval window membrane. Two groups of titanium ossicular prosthesis with different head area and mass respectively were fitted into a mechanical middle ear model to evaluate their sound transmission functions. RESULTS: The feeling threshold curve of mechanical middle ear model (MMEM) was similar to the hearing threshold curve of normal person. The transmission function of the prosthesis with small head area was better than that of prostheses with large head area at frequencies 1500-4000 Hz. The small-massed prostheses functioned better at higher frequencies and the large-massed prostheses functioned better at lower frequencies. But small-massed prostheses functioned better as a whole. CONCLUSIONS: The MMEM was an idea tool to evaluate the transmission functions of different ossicular prostheses. Both the head area and prosthesis mass had an influence on the transmission function of ossicular prosthesis. So while designing the ossicular prosthesis or performing ossiculoplasty, both the head area and prosthesis mass should he taken into consideration.

[Reconstruction and analysis of three-dimensional finite element model of human middle ear].

OBJECTIVE: To reconstruct a finite element model of human middle ear and measure characteristic dimensions of this model and calculate the mass properties of the ossicles. METHODS: The proposed method starts with the histologic section preparation of human temporal bone. Through tracing outlines of the middle ear components on the sections in AutoCAD2005, a set of exterior contours of the components is obtained. The three-dimensional solid model of middle ear, including tympanic membrane, ossicular bones, middle ear suspensory ligaments/muscles, are reconstructed using these contours in Unigraphics (UG). To prepare for finite element analysis (FEA) of the middle ear, all surfaces of the solid model are translated into ADINA, a commercial FE model package. Based on these surfaces, FE meshes of the middle ear are created, and material properties and boundaries are set up. The characteristic dimensions of this model are measured and the mass properties of the ossicles are calculated to confirm the accuracy of the geometric model constructed following the proposed method. RESULTS: The three-dimensional finite element model of the human middle ear that included tympanic membrane, ossicular bones and middle ear suspensory ligaments/muscles was reconstructed. The accuracy of this geometric model was confirmed with the outcome of the characteristic dimensions of this model and the mass properties of the ossicles. CONCLUSIONS: The proposed method not only provides an effective, convenient, economic, accurate way to reconstruct the three dimensional finite element model of human middle, but also provides a detailed knowledge of middle ear geometry that is required for finite element analysis.