Haitao Wu

Localization of the sentinel lymph node in tongue VX2 carcinoma via indirect CT lymphography combined with methylene blue dye injection

Conclusions: Indirect computed tomography lymphography (CT-LG) combined with blue dye injection can locate the sentinel lymph node (SLN) in tongue carcinoma. Objective: To localize the SLN in tongue VX2 carcinoma using indirect CT-LG combined with methylene blue injection. Methods: Eighteen rabbits were placed into three groups: metastasis, hyperplasia, and control. Indirect CT-LG was performed with an iohexol injection into the tongue submucosa. CT images were acquired at 1, 5, and 15 min after injection. Methylene blue was injected into the same area 24 h after indirect CT-LG, followed by SLN identification and histopathological examination. Results: SLNs were visualized with an identification rate of 100%. SLN location identified using CT lymphography was confirmed by methylene blue dye. Control and hyperplastic enhanced SLNs were round or oval without any filling defects. Control rabbits had enhanced SLN attenuation values of 689.2 ± 55.4 HU, 278.4 ± 33.5 HU, and 71.7 ± 9.2 HU at 1, 5, and 15 min after injection, respectively. Hyperplastic rabbits had values of 877.4 ± 69.4 HU, 352.5 ± 43.3 HU, and 80.2 ± 11.5 HU. Filling defects were only observed in the ipsilateral metastatic SLNs of the metastasis group. CT attenuation values of the metastatic SLNs were 687.4 ± 55.6 HU, 535.1 ± 86.6 HU, and 282.3 ± 19.4 HU at 1, 5, and 15 min, respectively, after iohexol injection. Metastatic lymph node attenuation values were significantly greater than those of the control or hyperplastic nodes at 5 (p < 0.001) and 15 min (p < 0.001) after injection.

Long-term observation of indirect lymphography using gadolinium-loaded polyethylenimine-entrapped gold nanoparticles as a dual mode CT/MR contrast agent for rabbit lingual sentinel lymph node identification.

Abstract Conclusions: The rabbit lingual sentinel lymph node (SLN) could be long-term visualized by indirect lymphography using gadolinium-loaded polyethylenimine-entrapped gold nanoparticles (Gd-Au PENPs) as CT/MR dual-modal contrast agent. Objective: To investigate duration and intensity of rabbit lingual SLN enhancement using Gd-Au PENPs as a CT/MR dual-modal contrast agent. Methods: Twelve rabbits were randomly divided into indirect CT lymphography (CT-LG) and MR lymphography (MR-LG) groups. In each group, two rabbits received unilateral injection and four received bilateral injection of Gd-Au PENPs in the sub-mucosa of the tongue. Then the enhancement characteristics of SLN were investigated. Results: The enhanced SLNs were observed in 100% in all rabbits by indirect CT-LG and MR-LG simultaneously at 1 min after injection. Then SLN enhancement was improved rapidly and the first peaks were observed at 25 min for CT-LG and 1 h for MR-LG, respectively, then SLN enhancement decreased gradually to a minimum at 2 h for CT-LG and 3 h for MR-LG. Afterwards, the enhancement intensity increased again and second peaks were observed at 24 h for both CT-LG and MR-LG. Hereafter, the intensity dropped slowly and weak enhancement was also observed at the 40th week for CT-LG and 31st day for MR-LG. Black-stained SLNs were visualized in 100% at autopsy in all rabbits.

Short-Term Dynamic Observation of the Color Change and Enhancement Effect of Polyethylenimine-Entrapped Gold Nanoparticles Used for Indirect Lymphography.

Aims: To dynamically observe the color change and enhancement effect of gadolinium-loaded polyethylenimine-entrapped gold nanoparticles (Gd-Au PENPs) as a dual-mode CT/MRI contrast agent for sentinel lymph node (SLN) identification. Methods: In 6 rabbits, Gd-Au PENPs were injected into the right side tongue submucosa, after which the color change of cervical draining lymph nodes was observed. Then the draining lymph nodes were examined by CT/MRI scan. Another 6 rabbits were randomly divided into a CT lymphography (CT-LG) and a MRI lymphography (MRI-LG) group and examined by CT/MRI scan 1 and 30 min after injection. Then SLNs were identified under the guidance of CT/MRI-LG. Results: The ipsilateral afferent lymphatic vessels, cervical draining lymph nodes and efferent lymphatic vessels were stained black orderly and constantly after Gd-Au PENPs injection. Thirty minutes after injection, all cervical lymph nodes were excised to be examined by CT/MRI scan, and only the black-stained draining lymph nodes were enhanced. The 6 rabbits with CT/MRI-LG showed clear enhancement of SLNs. With indirect lymphography, the black-stained SLNs were easily visualized at autopsy. In all rabbits, the identification rate of lingual SLNs was 100%. Conclusions: Rabbit lingual SLNs could be identified with indirect lymphography using Gd-Au PENPs as a dual-mode contrast agent.

A new classification of vocal fold leukoplakia by morphological appearance guiding the treatment

Abstract Objective: To provide a reference for classification and treatment of vocal cords leukoplakia. Methods: 640 cases of patients with vocal cords leukoplakia were divided into three groups based on the appearances. There were respectively 81 smooth flat lesions, 155 smooth hypertrophy lesions and 13 rough lesions were treated with conservative methods and 26, 153 and 212 cases were resected surgically for biopsy. Results: A majority of smooth flat leukoplakia lesions were cured by non-operational methods and no atypical hyperplasia. Most of rough lesions were invalid and even progressed treated with conservative therapy and were severe dysplasia or canceration. Although 67.6% smooth hypertrophy lesions were cured or improved by conservative methods and 47% lesions had no or mild dysplasia, over 30% of lesions were still invalid or progressed and over 50% had moderate, severe dysplasia and canceration. By statistical analysis, the appearance of leukoplakia was concordant with pathological changes. Conclusions: It is suggested that smooth flat vocal cords leukoplakia could be treated with conservative methods and rough lesions should be resected operationally, while for smooth hypertrophy vocal cords leukoplakia could be first followed-up and then adopt measures based on the appearance changes.

Nonsurgical Treatment for Vocal Fold Leukoplakia: An Analysis of 178 Cases

Objective To assess the effectiveness and identify vocal fold leukoplakia types appropriate for nonsurgical treatment. Methods The vocal fold leukoplakia in 178 patients was divided by gross appearance into three subtypes: flat and smooth, elevated and smooth, and rough. All patients received nonsurgical treatment including smoking and drinking cessation, voice rest, omeprazole, and Chinese medication therapy. The clinical response of three subtypes was assessed after a 6-month follow-up. Results Vocal fold leukoplakia subtypes included flat and smooth (n = 66; 37.1%), elevated and smooth (n = 103; 57.9%), and rough (n = 9; 5.0%). The rate of complete response was 80.3%, 66.0%, and 0.0% for the 3 lesion types, respectively (rough versus flat and smooth, P < 0.001; rough versus elevated and smooth, P < 0.001, Fishers exact test). The incidence of carcinoma in rough leukoplakia was significantly higher than that in smooth leukoplakia (44.4% versus 2.4%, P = 0.002, Fishers exact test). Clinical type was the only significant factor for clinical response of nonsurgical treatment (P = 0.005, ordinal logistic regression). Conclusions The effectiveness of nonsurgical treatment for smooth vocal fold leukoplakia is better in comparison to rough vocal fold leukoplakia. Smooth leukoplakia could be managed with nonsurgical treatment; more aggressive treatments should be considered for rough leukoplakia.

Curcumin Analogue CA15 Exhibits Anticancer Effects on HEp-2 Cells via Targeting NF-κB

Laryngeal carcinoma remains one of the most common malignancies, and curcumin has been proven to be effective against head and neck cancers in vitro. However, it has not yet been applied in clinical settings due to its low stability. In the current study, we synthesized 34 monocarbonyl analogues of curcumin with stable structures. CA15, which exhibited a stronger inhibited effect on laryngeal cancer cells HEp-2 but a lower toxicity on hepatic cells HL-7702 in MTT assay, was selected for further analysis. The effects of CA15 on cell viability, proliferation, migration, apoptosis, and NF-κB activation were measured using MTT, Transwell migration, flow cytometry, Western blot, and immunofluorescence assays in HEp-2 cells. An NF-κB inhibitor, BMS-345541, as well as curcumin was also tested. Results showed that CA15 induced decreased toxicity towards HL-7702 cells compared to curcumin and BMS-345541. However, similar to BMS-345541 and curcumin, CA15 not only significantly inhibited proliferation and migration and induced caspase-3-dependent apoptosis but also attenuated TNF-α-induced NF-κB activation in HEp-2 cells. These results demonstrated that curcumin analogue CA15 exhibited anticancer effects on laryngeal cancer cells via targeting of NF-κB.

Surgical management of primary parapharyngeal space tumors: a 10-year review.

Abstract Conclusions: Most neoplasms of the parapharyngeal space are benign. The transcervical surgical approach is the preferred procedure in most cases. Intra-operative endoscopic exploration offers a new surgical management technique to reduce operative complications and post-operative recurrence rates. Objectives: To present the authors’ experience in the treatment of primary parapharyngeal space tumors with emphasis on surgical approaches and employment of endoscopy to detect residual tumors through conventional approaches. Method: One hundred and sixty-seven patients treated surgically over a 10-year period were retrospectively reviewed. A comparison of the surgical approaches in a relevant case series was also conducted. Results: All of the patients underwent pre-operative imaging before surgery, and intra-operative endoscopic detection was selectively used for large, deep tumors. Complete resection of the tumor was used in 158 patients (95%), with a transcervical surgical approach applied in 144 cases (84%). Of 167 tumors, 150 (90%) were benign and 17 (10%) were malignant, with neurilemmoma/schwannoma as the most frequent pathology (42%). Surgical complications were reported in 26 patients (15%), most commonly unilateral paralysis of the vocal cords (6%). Two patients (1%) presented with recurrence, on average 2.5 years (range = 1–4 years) after initial excision, and the mean follow-up time was 3.8 years (range = 10 months–10 years).

Relationship between laryngoscopic and pathological characteristics of vocal cords leukoplakia

Abstract Background: To explore the relationship between the morphological characteristics and pathological diagnosis of vocal cords leukoplakia. Methods: A total of 1635 vocal cords were collected. The morphology were classified into three types (Type I, II, III): flat and smooth; bulge and smooth; bulge and rough. The pathological reports were classified into five groups: no dysplasia, mild dysplasia, moderate dysplasia, severe dysplasia and cancerization. The number of the patients or vocal cords in each type and group was counted and their ratio was compared. Results: In Type I, the number of vocal cord in Group A group was 2.2 and 2.6 times of the one in Type II and Type III respectively. In Type II, the mild, moderate dysplasia ratio was higher than those in Type I. In Type III group the ratio of severe dysplasia was 2.6 and 5.5 times of the one in Type II and Type I respectively. The ratio of Group E in Type III was 2.7 and 7.9 times of the one of Type II and Type I. The result was significant (pearson Chi-square value was 517.6, p = .00). Conclusions: The pathological results of vocal cord leukoplakia can be evaluated by morphology in most cases.

A morphological classification for vocal fold leukoplakia

INTRODUCTION There is still no general method for discriminating between benign and malignant leukoplakia and identifying vocal fold leukoplakia. OBJECTIVE To evaluate the reliability of a morphological classification and the correlation between morphological types and pathological grades of vocal fold leukoplakia. METHODS A total of 375 patients with vocal fold leukoplakia between 2009 and 2015 were retrospectively reviewed. Two observers divided the vocal fold leukoplakia into flat and smooth, elevated and smooth, and rough type on the basis of morphological appearance. The inter-observer reliability was evaluated and the results of classification from both observers were compared with final pathological grades. Clinical characteristics between low risk and high risk group were also analyzed. RESULTS The percentage inter-observer agreement of the morphological classification was 78.7% (κ=0.615, p<0.001). In the results from both observers, the morphological types were significantly correlated with the pathological grades (p1<0.001, p2<0.001, Kruskal-Wallis test; r1=0.646, p1<0.001, r2=0.539, p2<0.001, Spearman Correlation Analysis). Multivariate analysis showed patients age (p=0.018), the size of lesion (p<0.001), and morphological type (p<0.001) were significantly different between low risk group and high risk group. Combined receiver operating characteristic curve analysis of significant parameters revealed an area under the receiver operating characteristic curve of 0.863 (95% CI 0.823-0.903, p<0.001). CONCLUSIONS The proposed morphological classification of vocal fold leukoplakia was consistent between observers and morphological types correlated with pathological grades. Patients age, the size of lesion, and morphological type might enable risk stratification and provide treatment guidelines for vocal fold leukoplakia.

Conservative Treatment versus Surgery for Laryngeal Contact Granuloma: A Prospective Study

Aims: To confirm the efficacy of conservative treatment for laryngeal contact granuloma and identify factors influencing treatment outcome. Methods: In this prospective study, patients with laryngeal contact granuloma were divided into a group receiving conservative treatment and a group undergoing surgery. Efficacy was assessed by analyzing the complete response after a 48-week follow-up. The association of treatment outcome with clinical factors was then evaluated. Results: In total, 61 patients, 43 in the group receiving conservative treatment and 18 in the group undergoing surgery, were analyzed, and the complete response rate was 72.1% and 38.9%, respectively. Both univariate analysis and multivariate analysis revealed that treatment modality (p1 = 0.015, p2 = 0.043), voice abuse (p1 = 0.010, p2 = 0.010), and the size of the granuloma (p1 = 0.031, p2 = 0.020) were significantly associated with the complete response of laryngeal contact granuloma. Kaplan-Meier curves showed that alcohol consumption (p = 0.031), voice abuse (p < 0.001), and granuloma size (p = 0.025) were significantly related to the complete response of conservative treatment. Conclusions: This prospective study strengthens the argument for conservative treatment (instead of surgery) as the first choice for laryngeal contact granuloma. The results also suggest that voice abuse, alcohol consumption, and the size of the granuloma may predict treatment outcome.