Background and purpose:Currently, subjective questionaire is the most frequently used methods to evaluate swallowing dysfunctions after radiotherapy in nasopharyngeal carcinoma patients, while lacking of effective objective examinations. This study aimed to explore effective methods to evaluate swallowing dysfunctions after radiotherapy in nasopharyngeal carcinoma patients, and gain knowledge of the incidence and severity of swallowing dysfunctions. Methods: From Oct. 2013 to Dec. 2013, 128 consecutive outpatients with previously treated nasopharyngeal carcinoma received esophageal barium lfuoroscopy examination at there regularly follow-ups to evaluate swallowing function. Among these patients, 89 were primary treated with intensity modulated radiation therapy (IMRT) and 39 with conventional radiotherapy (CRT). In this study, each patient received esophageal barium lfuoroscopy examination for 3 times with thin, thick and pasty barium and were dynamically observed using X-ray fluoroscopy from front and lateral direction. Swallowing dysfunctions were defined as follows:①The bolus could not be swallowed and blocked in the mouth;②The dilute barium diverted to the glottis or trachea;③Residual barium delayed in the pyriform sinus and vallecula;④The movement of the hyoid bone or epiglottis were restricted;⑤Bolus prolong through the pharynx;⑥Barium slowed down when went though the esophageal entrance. Results:Of the 128 patients, incidence of dysphagia was 60.2%for the entire cohort, 52.8%for IMRT group and 76.9%for CRT group. Incidence of dysphagia for IMRT group was signiifcantly lower than CRT group (P=0.018). Dysphagia incidence within 1 year, 1 to 2 years and more than 2 years after RT were 63.1%, 33.3%and 69.0%, respectively (P=0.019). Conclusion:There was a high incidence of swallowing dysfunction for the nasopharyngeal carcinoma patients treated with radiotherapy and dysphagia incidence decreased when treated with IMRT. Esophageal barium lfuoroscopy examination is objective method to evaluate the incidence and severity of the swallowing dysfunction.

Objective To analyze the long-term efficacy,prognostic factors and radiation sequela of nasopharyngeal carcinoma(NPC)treated with radiotherapy at the end of last century.Methods From January 1995 to December 1998,1706 newly diagnosed NPC patients treated with radiotherapy were included in the retrospective clinical analysis.There were 1081 patients treated with radiotherapy alone,625 with two to three circles of chemotherapy(5-Fu and DDP)before radiotherapy,23 with thermotherapy during radiotherapy and 162 with braehytherapy by 192Ir after external beam radiation.Results The 5-year overall survival. local control survival and disease-free survival rates were 67.60%.84.20%and 64.22%.respectively.The 5-year survival of patients with stage Ⅰ,Ⅱ,Ⅲand Ⅳ(the Fuzhou Staging,1992)were 100%,75.93%,66.47%and 49.34%.respectively.Cox regression analysis showed that the TNM classification,radiotherapy discontinuance,chemotherapy,sex,age and anemia before radiotherapy were the significant factors of survival.Conclusions Our experience shows that the main factors for the long term survival of NPC patients after radiotherapy are early TNM stage,young age,female,non-anemia before radiotherapy, radiotherapy continuance and chemotherapy.

Objective To investigate the clinical typing of nasopharyngeal carcinoma in patients treated by intensity-modulated radiation therapy (IMRT).Methods A retrospective analysis was performed on 333 patients with nasopharyngeal carcinoma who were initially treated in our hospital from 2003 to 2006 ;they had no distant metastasis and received IMRT.These patients were divided into 4 clinical types according to their prognosis:type Ⅰ (without local-regional recurrence and without distant metastasis),type Ⅱ (with local-regional recurrence and without distant metastasis),type Ⅲ (without local-regional recurrence and with distant metastasis),and type Ⅳ (with local-regional recurrence and with distant metastasis).Results Of all the patients,70.0％ (233) were of type Ⅰ,12.9％ (43) of type Ⅱ,16.5％ (55) of type Ⅲ,and 0.6％ (2) of type Ⅳ.Of 57 patients with stage Ⅰ-Ⅱ nasophayngeal carcinoma,86％ (49) were of type Ⅰ,11％ (6) of type Ⅱ,4％ (2) of type Ⅲ,and 0％ (0) of type Ⅳ,and of 276 patients with stage Ⅲ-Ⅳ nasopharyngeal carcinoma,66.7％ (184) were of type Ⅰ,13.4％ (37) of type Ⅱ,19.2％ (53) of type Ⅲ,and 0.7％ (2) of type Ⅳ,with significant differences between the two patient groups (P =0.007).Of the 69 patients who received IMRT alone,80％ (55) were of type Ⅰ,12％ (8) of type Ⅱ,9％(6) of type Ⅲ,and 0％ (0) of type Ⅳ; of the 218 patients who received IMRT combined with neoadjuvant plus concurrent chemotherapy,68.8％ (150) were of type Ⅰ,13.8％ (30) of type Ⅱ,16.5％(36) of type Ⅲ,and 0.9％ (2) of type Ⅳ; of the 46 patients who received IMRT combined with neoadjuvant plus adjuvant chemotherapy,61％ (28) were of type Ⅰ,11％ (5) of type Ⅱ,28％ (13) of type Ⅲ,and 0％ (0) of type Ⅳ.Conclusions In patients with early and advanced nasopharyngeal carcinoma,type Ⅰ is the most common,and type Ⅳ is the least common;type Ⅱ is more frequent than type Ⅲ in early patients,while type Ⅲ is more frequent than type Ⅱ in advanced patients.The percentage of type Ⅰ patients increases,while that of type Ⅱ-Ⅳ patients decreases,as compared with the data of those treated by conventional radiotherapy.

Objective To evaluate the dosimetric characteristics of hippocampal formation (HF) in the intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods Fifty-nine NPC patients underwent IMRT.Simultaneous integrated boost technology was used to determine the doses for the target areas.The dose ranges of the HF were collected by dose-volume histogram.The influence of T stage on the exposure doses ( Dmax,Dmean,D20,V10,V20,V30,and V40 ) were compared.Results The maximum dose for the HF (Dmax) ranged from 11.1 to 78.2 Gy(F =24.2,P ＜0.05) and the Dmean ranged from 3.2 to 44.6 Gy ( F =16.3,P ＜ 0.05 ).The Dmax and Dmean of the T1-2 stage patients were (40.8 ±9.4) Gy and ( 12.5 ±5.1 ) Gy,respectively,both significantly lower than those of the T3-4 stage patients [ (58.6± 14.8) Gy,(20.9± 9.3 ) Gy].The mean exposed volume of the T4 stage patients was significantly larger than that of the T1 and T2 stages patients.Conclusions In the IMRT of NPC,the HF receives rather high irradiation dose.T stage is the main factor influencing the dose,especially T3 and T4 stages deserve serious attention.

Objective To investigate the characteristics of primary liver carcinoma (PLC) in patients with hepatitis B and to analyze the influencing factors. Methods The clinical data of 308 patients with hepatitis B in our hospital from March 2016 to March 2019 were selected to investigate the occurrence of PLC. Univariate analysis and Logistic regression were used to analyze the influencing factors of PLC in patients with hepatitis B. Results The results of this survey showed that 116 of the 308 patients with hepatitis B had PLC (37.66%). The single factor analysis showed that age, diabetes mellitus, family history of PLC, smoking, drinking, eating habits, hepatitis B virus load, e antigen, antiviral therapy, fatty liver and cirrhosis were the influencing factors of PLC in patients with hepatitis B (P < 0.05). Logistic regression analysis showed that age > 50 years old, diabetes mellitus, family history of PLC, smoking, drinking, poor diet, positive HBV load, positive e antigen, ineffective antiviral therapy, fatty liver and cirrhosis were independent risk factors for PLC in patients with hepatitis B (P < 0.05). Conclusion Patients with hepatitis B were at high risk of PLC. They were affected by various factors. It is important to strengthen the preventative care of patients over 50 years old, with diabetes mellitus, family history of PLC, smoking, drinking, poor diet, hepatitis B virus load positive, e antigen positive, ineffective antiviral therapy, fatty liver, cirrhosis and so on.

PURPOSE: To evaluate the prognosis of nasopharyngeal carcinoma (NPC) patients who developed bone-only metastasis after primary treatment and the stratification of these patients into different risk groups based on independent prognostic factors. MATERIALS AND METHODS: Eighty NPC patients who developed bone-only metastasis after definitive radiotherapy from October 2005 to December 2010 were enrolled. All these patients received palliative treatment for bone metastasis, including chemotherapy and/or radiotherapy. Clinical features, treatment modality, and laboratory parameters were examined with univariate and multivariate analyses. RESULTS: The median follow-up time was 15.5 months (range, 2-67 months) for the whole cohort. The median overall metastatic survival (OMS) time and the 2-year estimate OMS rate were 26.5 months and 52%, respectively. Multivariate analysis indicated that patients with short metastases-free interval, multiple bone metastases sites, high serum lactic dehydrogenase levels, and treated with radiotherapy or chemotherapy alone had significantly worse outcomes. Patients were stratified into three different risk groups based on the number of adverse factors present. The OMS curves of the three groups were all significantly different (p<0.001). CONCLUSION: Severl prognostic factors were found to be associated with worse outcomes. According to the number of adverse factors present, bone-only metastasis patients can be stratified into three risk groups with significantly different prognoses. Such grouping may help in improving the design of clinical trials and in guiding individualized treatment for NPC patients with bone-only metastasis.
Adolescent ; Adult ; Aged ; Bone Neoplasms/mortality/*secondary/therapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Nasopharyngeal Neoplasms/mortality/*pathology/therapy ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate ; Young Adult

ObjectiveTo explore the mechanism of Danggui Niantongtang （DGNTT） against adjuvant-induced arthritis （AA） in rats with wind-dampness-heat arthralgia （FSR） based on the variation of intestinal flora. MethodA total of 60 SD rats were randomized into normal （control） group， FSR group， low-， medium-， and high-dose DGNTT （5.67， 11.34， 22.68 g·kg^-1） groups， and methotrexate （MTX） group （1.35 mg·kg^-1）， with 10 rats in each group. The rats， except the control group， were injected with Mtb adjuvant and then exposed to artificial climatic chamber （hot and humid with wind） for 64 h for modeling. The rats were treated with water， DGNTT or MTX for 28 days from the day of injection. Arthritis index （AI） of rats was measured and paw volume was determined with a volume meter. The morphology of synovial tissues of the knees was observed based on hematoxylin-eosin （HE） staining and the changes of intestinal flora were analyzed based on 16S rRNA sequencing. ResultDGNTT can alleviate the hyperplasia of synovial tissue and inflammation of AA rats with FSR and inhibit the formation of pannus. The results of 16S rRNA sequencing showed that the relative abundance of Firmicutes， Lactobacillus， Prevotella 9， and Alloprevotella decreased （P<0.05， P<0.01） and the relative abundance of Bacteroidetes and Bacteroides increased （P<0.01） in FSR group compared those in the control group. Compared with the FSR group， all DGNTT groups and MTX group had high relative abundance of Lactobacillus （P<0.05， P<0.01） and low relative abundance of Bacteroidetes （P<0.01） and medium-dose and high-dose DGNTT groups and MTX group showed high abundance of Firmicutes， Prevotella 9， and Alloprevotella and low abundance of Bacteroides （P<0.05， P<0.01）. Spearman's correlation analysis suggested that the abundance of Bacteroides and Helicobacter was in positive correlation with AI （P<0.05）， while the abundance of Prevotella 9 and Candidatus Saccharimonas was in negative correlation with AI （P<0.01， P<0.05）. There was a negative correlation between the abundance of Prevotella 9 and paw volume （P<0.01）， and the abundance of Ruminococcaceae NK4A214 group， Christensenellaceae R-7 group， and Bacteroides was in negative correlation with spleen index （P<0.05）. The abundance of Prevotella 9 was in negative correlation with spleen index （P<0.01）. ConclusionDGNTT is effective for arthritis with FSR， as it can regulate the composition of intestinal flora in AA rats by increasing the abundance of probiotics and inhibiting the growth of pathogenic bacteria. The mechanism is the likelihood that it improves intestinal immune metabolism to ensure intestinal homeostasis.