Zhangfeng Wang

DJ-1: a novel independent prognostic marker for survival in glottic squamous cell carcinoma.

DJ‐1 is frequently overexpressed in a large variety of solid tumors, but the DJ‐1 expression in laryngeal squamous cell cancer and its clinical/prognostic significance is unclear. We aimed to evaluate DJ‐1 protein expression in glottic squamous cell carcinoma (GSCC) and to correlate this with clinicopathological data including patient survival. The expression of DJ‐1 in GSCCs (60) and adjacent normal tissue (44) was assessed by immunohistochemistry and western blot analysis. In addition, the role of DJ‐1 was investigated in tumorigenesis by transfecting DJ1‐specific siRNA into laryngeal squamous cell carcinoma (LSCC) Hep‐2 cells. Our data showed that positive expression of DJ‐1 was found in 85% of GSCCs. In univariate survival analysis of the GSCC cohorts, a highly significant association between DJ‐1 expression with shortened patient overall survival (5‐year survival rate 92.9%vs 66.6%; P = 0.001; log rank test) was demonstrated. In multivariate analyses, DJ‐1, tumor grading, and pT status were significant prognostic parameters for shortened patient overall survival. Furthermore, siRNA targeting DJ‐1 can effectively inhibit DJ‐1 expression, resulting in enhanced apoptosis and less proliferation of Hep‐2 cells. We concluded that DJ‐1 overexpression might be a novel independent molecular marker for poor prognosis (shortened overall survival) of patients with GSCC.

Immunohistochemical detection of pepsin in laryngeal mucosa for diagnosing laryngopharyngeal reflux

To investigate whether the pepsin immunohistochemical (IHC) staining of the laryngeal mucosa epithelia is an available test for diagnosing laryngopharyngeal reflux (LPR) in clinic.

Deep Neck Infection: A Review of 130 Cases in Southern China

AbstractThe study aims to present our experience of the clinical course and management of deep neck infection and try to determine if the characteristics of this kind of infection were similar between the children and adults in southern China.Patients diagnosed with deep neck infection in the Division of Otolaryngology in the First Affiliated Hospital of Sun Yat–sen University between January 2002 and December 2011 were screened retrospectively for demographic characteristics, presenting symptoms, antibiotic therapy before admission, the history of antibiotics abuse, leucocyte count, etiology, bacteriology, disease comorbidity, imaging, treatment, complications, and outcomes.One hundred thirty patients were included and 44 (33.8%) were younger than 18 years old (the children group), 86 patients (66.2%) were older than 18 years old (the adults group). Fever, trismus, neck pain, and odynophagia were the most common symptoms in both groups. Forty children (90.9%) and 49 adults (57.0%) had been treated with broad-spectrum antibiotic therapy before admission. Thirty one children (70.5%) and 24 adults (27.9%) had a history of antibiotics abuse. In children group, the site most commonly involved was the parapharyngeal space (18 patients, 40.9%). In adults group, the site most commonly involved was multispace (30 patients, 34.9%). In children group, the most common cause was branchial cleft cyst (5 patients, 11.4%) and the cause remained unknown in 31 patients (70.5%). In adults group, the most common cause was pharyngeal infection (19 patients, 22.2%). All of the 27 patients with associated disease comorbidity were adults and 17 were diabetes mellitus (DM). Streptococcus viridans was the most common pathogen in both children and adults groups. Eighty six (66.2%) underwent surgical drainage and complications were found in 31 patients (4 children, 27 adults).Deep neck infection in adults is easier to have multispace involvement and lead to complications and appears to be more serious than that in children. Understanding the different characteristics between the children and adults with deep neck infection may be helpful in accurate evaluation and proper management.

Tumorigenesis role and clinical significance of DJ-1, a negative regulator of PTEN, in supraglottic squamous cell carcinoma

BackgroundDJ-1 can induce the tumor cell proliferation and invasion via down-regulating PTEN in many malignant tumors, and correlated to prognostic significance. However, the tumorigenesis role and clinical significance of DJ-1 in supraglottic squamous cell carcinoma (SSCC) is unclear. We aimed to evaluate the DJ-1 the relationship between DJ-1 and clinicopathological data including patient survival.MethodsThe expression of DJ-1 and PTEN in SSCCs (52) and adjacent non-cancerous tissues (42) was assessed by immunohistochemistry (IHC), and the relationship between DJ-1 and clinicopathological data was analyzed.ResultsDJ-1 was detected mainly in SSCCs (88.5%) and less frequently in adjacent non-cancerous tissues (21.0%). PTEN expression was detected in 46.2% of SSCCs and in 90.5% of adjacent non-cancerous tissues. DJ-1 expression was linked to nodal status (P = 0.009), a highly significant association of DJ-1 expression with shortened patient overall survival (5-year survival rate 88.0% versus 53.9%; P = 0.007; log rank test) was demonstrated.ConclusionsOur data suggested that DJ-1 over-expression was linked to nodal status, and might be an independent prognostic marker for patients with SSCC.

Clinical analysis of the cranial complications of endoscopic sinus surgery

Abstract Conclusions: The most frequently affected sites of cranial complications of endoscopic sinus surgery (ESS) are the boundary between the anterior and posterior ethmoid roof, the frontal recess, and the cribriform plate. Being aware of cranial complications in time and provision of appropriate treatment may minimize the serious consequences. Objectives: To investigate the reasons for cranial complications secondary to ESS and to find optimal prevention of cranial complications of ESS. Methods: The cranial complications of 19 patients were retrospectively reviewed. Eight patients underwent surgery in our hospital and the others underwent surgery in eight other hospitals, and were then transferred to our hospital for further examination and management of their complications. Results: The type of cranial complications involved defects of the skull base (n = 19), cerebrospinal fluid leak (n = 14), frontal lobe injury (n = 3), subarachnoid hemorrhage (n = 1), meningitis (n = 2), and concomitant pneumocephalus (n = 3). In 10 cases, the boundary between the anterior and posterior ethmoid roof was damaged. The frontal recess was involved in five cases and the cribriform plate was damaged in three patients. All of the complications resolved completely after treatment.

Middle Frontal Horizontal Partial Laryngectomy (MFHPL): A Treatment for Stage T1b Squamous Cell Carcinoma of the Glottic Larynx Involving Anterior Vocal Commissure

Objective The therapeutic effect of middle frontal horizontal partial laryngectomy (MFHPL) in treating stage T1b squamous cell carcinoma of the glottic larynx involving anterior vocal commissure (AVC) was compared with that of the anterior frontolateral vertical partial laryngectomy (AFVPL). The feasibility and practical significance of MFHPL in clinical application was discussed in the present study. Methods From January 1996 to January 2010, a total of 65 patients diagnosed with stage T1bN0M0 glottic laryngeal cancer were treated with MFHPL or AFVPL. The postoperative complications, glottic reconstruction, recurrence rate, voice quality and survival rates were evaluated and compared between two treatments. Results AFVPL and MFHPL were performed in 34 and 31 patients, respectively. Flexible fiberoptic laryngoscopy revealed that in the MFHPL-treated patients the reconstructed glottis was spacious and symmetric. In contrast, AFVPL treatment resulted in irregular glottic area with poor symmetry and tubular glottis. The incidence of postoperative laryngeal stenosis significantly differed between the MFHPL- and AFVPL-treated groups (P = 0.025). No significant difference was detected in the 3- and 5-year overall- or tumor-free survival rates between two treatments. The Voice Handicap Index (VHI) and maximum phonation time (MPT) after surgery were 51.0±12.99 and 12.42±3.44 sec in the AFVPL-treated group; while in the MFHPL-treated patients they were 31.81±7.48 and 7.65±1.98 sec, respectively. Both differences in VHI (P = 0.012) and MPT (P = 0.024) were significant between two treatments. Conclusions MFHPL was comparable to AFVPL with respect to postoperative complications, recurrence rate and survival rates, but possessed advantages over AFVPL in terms of the incidence of laryngeal stenosis and voice quality. Our study indicated that MFHPL has a potential value in clinical practice of treating stage T1b squamous cell carcinoma of the glottic larynx involving AVC.

Supracricoid partial laryngectomy with cricothyroidopexy: A treatment for anterior vocal commissure laryngeal squamous carcinoma†

The clinical efficiency and functional outcomes of supracricoid partial laryngectomy (SCPL) with cricothyroidopexy (CTP) were compared with those of the traditional SCPL with cricohyoidoepiglottopexy (CHEP) in treating laryngeal squamous carcinoma involving anterior vocal commissure (AVC).

Study of the Histopathologic Characteristics and Surface Morphologies of Glottic Carcinomas With Anterior Vocal Commissure Involvement.

Abstract This article explores the features and the role of the anterior vocal commissure (AVC) structure and the surface morphologies of glottic carcinomas with AVC involvement to provide a reference for the selection of transoral carbon dioxide (CO2) laser surgery. A total of 31 cases of glottic carcinomas with AVC involvement from May 2012 to January 2014 were included. All patients underwent electronic laryngoscopic examinations and computed tomography scans to determine the surface morphology. After surgery, the tumor specimens were resected integrally, and axial serial sections parallel to the plane of vocal cords were taken to explore the features and possible invasion paths of the glottic carcinomas with AVC involvement. The rates of involvement of the supraglottis and subglottis were 71.4% and 14.8%, respectively, via the AVC. The involvement of the superficial layer of the unilateral or bilateral vocal cords without involvement of the vocal muscle in the AVC region (IVM) or the cartilage was present in 15 cases (48.4%). The involvement of the superficial layer of the unilateral and bilateral vocal cords occurred in 16 cases (51.6%) with the IVM in 13 cases and the involvement of the intermediate lamina of the thyroid cartilage (ITC) in 8 cases. The involvement of the ITC was associated with the involvement of the vocal muscle of the AVC region (P < 0.05). Among the pushing carcinomas, 15 of 21 (71.4%) presented with well-defined tumor mass, and 8 of 10 (80.0%) infiltrating carcinomas presented with multiple tumor nests that were often surrounded by fibrosis (P < 0.05). The AVC is an important path of invasion of subglottic in glottic carcinomas but less so for suparglottic. The Broyles’ ligaments acted as a barrier against the spread of the tumors to the thyroid cartilage, but this role was obviously weaken by the involvement of the vocal muscle of the AVC region. The infiltrating carcinomas presented with multiple tumor nests in fibrous tissue. When CO2 laser microsurgery is considered as a treatment option, these facts should be kept in mind.

Clinical Characteristics and Endoscopic Endonasal Removal of Foreign Bodies within Sinuses, Orbit, and Skull Base

Background: Foreign bodies within the sinuses, orbit, and skull base (FBSOS) are rare; hence, diagnosis and management guidelines are lacking. Endoscopic sinus surgery (ESS) removal is preferred because of the less invasiveness and minimal morbidity. This study was designed to summarize clinical experience with ESS management of FBSOS. Methods: We retrospectively reviewed clinical manifestations, imaging findings, treatment, and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center. The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS. Results: There were 23 male and five female patients, with median age of 11 years. FBSOS were located within the sinuses (86%), orbit (75%), and skull base/intracranial region (46%). Wooden FBSOS had a significantly higher risk of infection (78%) compared with nonwooden FBSOS (5%, P < 0.05). Contrast-enhanced computed tomography (CT) plus three-dimensional reconstruction was sensitive in all cases. Twenty-seven (96%) FBSOS were removed by ESS alone, while 1 (4%) FBSOS was removed using the combined ESS and lateral cervical approach. Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid (CSF) leak and received endoscopic CSF leak repair. Twelve (43%) patients suffered complications (meningitis, diplopia, and vision loss). Conclusions: ESS is a minimally invasive, safe, and promising surgical approach for FBSOS removal. Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance. Wooden FBSOS had higher risk of infection, thus antibiotics are recommended.

Analysis of Postsurgical Health-Related Quality of Life and Quality of Voice of Patients With Laryngeal Carcinoma.

AbstractThis study aims to analyze the postsurgical health-related quality of life (HRQOL) and quality of voice (QOV) of patients with laryngeal carcinoma with an expectation of improving the treatment and HRQOL of these patients.Based on the collection of information of patients with laryngeal carcinoma regarding clinical characteristics (age, TNM stage, with or without laryngeal preservation and/or neck dissection, with or without postoperative irradiation and/or chemotherapy, etc.), QOV using Voice Handicap Index (VIH) scale and HRQOL using EORTC QLQ-C30 and EORTCQLQ-H&N35 scales, the differences of postsurgical HRQOL related to their clinical characteristics were analyzed using univariate nonparametric tests, the main factors impacting the postsurgical HRQOL were analyzed using regression analyses (generalized linear models) and the correlation between QOV and HRQOL analyzed using spearman correlation analysis.A total of 92 patients were enrolled in this study, on whom the use of EORTC QLQ-C30, EORTC QLQ-H&N35 and VHI scales revealed that: the differences of HRQOL were significant among patients with different ages, TNM stages, and treatment modalities; the main factors impacting the postsurgical HRQOL were pain, speech disorder, and dry mouth; and QOV was significantly correlated with HRQOL.For the patients with laryngeal carcinoma included in our study, the quality of life after open surgeries were impacted by many factors predominated by pain, speech disorder, and dry mouth. It is suggested that doctors in China do more efforts on the patients’ postoperative pain and xerostomia management and speech rehabilitation with the hope of improving the patients’ quality of life.