Objective:To evaluate the diagnostic value of HPV detection in squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site.Methods:Clinical data of 6 patients who were initially diagnosed with squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site and eventually diagnosed with HPV-related oropharyngeal squamous cell carcinoma were collected, and the process of diagnosis was analyzed.Results:Upon the initial admission, all patients were diagnosed with squamous cell carcinoma of the cervical lymph node metastasis with positive p16 expression, positive HPV-16 subtype and negative EBER expression. No obvious primary lesion was found after comprehensive examination. Subsequently, four of them underwent ipsilateral tonsollar blind biopsy ( n=2) and ipsilateral tonsillectomy ( n=2). All these four patients were pathologically diagnosed with tonsillar squamous cell carcinoma. For the other two cases, MRI detected the thickening complicated with enhancement of ipsilateral wall of oropharynx and tongue root after follow-up for D149 and D545 , respectively. Biopsy confirmed the diagnosis of squamous cell carcinoma of the tonsil and tongue root, respectively. Conclusion:For patients with HPV-positive squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site, the possibility that the primary lesion originates from the oropharyngeal site, especially the tonsil and tongue root, should be highly suspected.

The incidence of human papillomavirus (HPV)-positive oropharyngeal cancer is growing year by year. Compared with the other head and neck squamous cell carcinoma, HPV-positive oropharyngeal cancer has unique biological characteristics and better prognosis. According to the 8 th edition TNM staging of UICC/AJCC, HPV-positive and HPV-negative oropharyngeal cancer have been classified separately. In 2018, College of American Pathologists and American Society of Clinical Oncology released the guidelines on the HPV testing in head and neck cancer. Several published clinical trials have demonstrated that de-intensified chemoradiation might be efficacious treatment of HPV-positive oropharyngeal cancer.

Objective: To study the effect of microgroove surface modification of titanium and zirconia on the biological behavior of gingival fibroblasts in order to find suitable surface materials for the transmucosal part of the dental implant. Methods: Twenty specimens were divided into four groups: smooth titanium (Ti-S), smooth zirconia (ZC-S), microgroove titanium (Ti-MG) and microgroove zirconia (ZC-MG) (five specimens in each group). Microgroove modification of titanium and zirconia surfaces was carried out by using fine machining chip system in the last two groups. The width of groove ridge was 60 μm, the width of groove was 60 μm, the depth of groove was 10 μm. The surface morphologies (the groove width and depth) were observed by scanning electron microscope (SEM), the surface roughness, static contact angle and elemental of specimens in each group were detected by SEM, atomic force microscope (AFM), optical contact angle measuring device and energy-dispersion X-ray analysis (EDX). Morphology of human gingival fibroblast (HGF) that arranged along the groove was analyzed using laser scanning confocal microscope by immunofluorescence staining. Differences in cell proliferation were analyzed and compared using cell counting kit. Expression level of intergrin α₅, β₁ and collagen Ⅰ mRNA were compared among different groups by quantitative real-time PCR for 6 h and 3 d. Results: The surface roughness of smooth titanium group and smooth zirconia group was (63.23± 2.55) and (26.78±3.11) nm, respectively. Microgroove zirconia group showed the best hydrophilicity: the static contact angle was 51.2°±2.0°. HGF was arranged along the groove surface, and cell proliferation results showed that proliferation on microgroove zirconia was more significant than that on other groups from 6 h to 7 d (P<0.05). Intergrin α₅ mRNA has the highest expression in microgroove zirconia (P<0.05) in the early adhesion (6 h), and there was no significant difference in the surface expression of intergrin β₁ and collagen Ⅰ mRNA in the early adhesion (6 h) of each group. However, in the late adhesion (3 d), intergrin α₅, β₁ and collagenⅠ mRNA expression in microgroove surface groups were higher than those of the smooth groups (P<0.05). Conclusions Microgroove zirconia surface has small roughness and good hydrophilicity, which can guide HGF to line up in the groove, and this is beneficial to the HGF proliferation and the expression of structural proteins and functional proteins.

To study the effect of microgroove surface modification of titanium and zirconia on the biological behavior of gingival fibroblasts in order to find suitable surface materials for the transmucosal part of the dental implant. Methods Twenty specimens were divided into four groups: smooth titanium (Ti?S), smooth zirconia (ZC?S), microgroove titanium (Ti?MG) and microgroove zirconia (ZC?MG) (five specimens in each group). Microgroove modification of titanium and zirconia surfaces was carried out by using fine machining chip system in the last two groups. The width of groove ridge was 60 μm, the width of groove was 60 μm, the depth of groove was 10 μm. The surface morphologies (the groove width and depth) were observed by scanning electron microscope (SEM), the surface roughness, static contact angle and elemental of specimens in each group were detected by SEM, atomic force microscope (AFM), optical contact angle measuring device and energy?dispersion X?ray analysis (EDX). Morphology of human gingival fibroblast (HGF) that arranged along the groove was analyzed using laser scanning confocal microscope by immunofluorescence staining. Differences in cell proliferation were analyzed and compared using cell counting kit. Expression level of intergrin α5, β1 and collagenⅠ mRNA were compared among different groups by quantitative real?time PCR for 6 h and 3 d. Results The surface roughness of smooth titanium group and smooth zirconia group was (63.23± 2.55) and (26.78±3.11) nm, respectively. Microgroove zirconia group showed the best hydrophilicity: the static contact angle was 51.2°±2.0°. HGF was arranged along the groove surface, and cell proliferation results showed that proliferation on microgroove zirconia was more significant than that on other groups from 6 h to 7 d (P<0.05). Intergrin α5 mRNA has the highest expression in microgroove zirconia (P<0.05) in the early adhesion (6 h), and there was no significant difference in the surface expression of intergrin β1 and collagenⅠmRNA in the early adhesion (6 h) of each group. However, in the late adhesion (3 d), intergrin α5, β1 and collagenⅠmRNA expression in microgroove surface groups were higher than those of the smooth groups (P<0.05). Conclusions Microgroove zirconia surface has small roughness and good hydrophilicity, which can guide HGF to line up in the groove, and this is beneficial to the HGF proliferation and the expression of structural proteins and functional proteins.

Objective To compare the effect between the supine and prone patient positions upon target dose coverage during intensity-modulated radiotherapy (IMRT) for rectal cancer, aiming to provide clinical reference for the selection of position for rectal cancer patients. Methods Twenty-four patients diagnosed with rectal cancer receiving postoperative adjuvant radiotherapy were selected and divided into the supine (n=12) and prone position groups(n=12). Before and during the IMRT(1-4 weeks),all patients received CT scans, which were defined as:Plan,1W,2W,3W and 4W,respectively. The organs at risk were delineated based on CT scan images. Plan,1W, 2W, 3W and 4W CT scan images were fused. The CTV and PTV from Plan CT scan were copied to the 1-4W CT scan images,and the therapeutic plans from Plan CT scan were copied as well. The target dose coverage was assessed and the failure rate of target dose coverage was calculated. The couch-position data for each patient during each cycle of IMRT were recorded by using the MOSAIQ network and the overall deviation (S) of couch position was calculated. Results The failure rates of CTV and PTV target dose coverage in the prone position group were higher than those in the supine position group (18.60% VS 0%, 69.76% VS 53.65%).The S value was significantly correlated with the target dose coverage (r=-0.683,P=0.000). The S value in the prone position group was(1.23±0.76) cm,significantly greater than(0.28±0.18) cm in the supine position (P=0.001),and the most significant deviation was noted in the y (head and foot) and z (frontal and dorsal) directions (P=0.003 and 0.003). Compared with the supine group,the V5and V10 of the small intestine were significantly less (P=0.003 and 0.004) and the chronic toxicity (NTCPC) was considerably reduced(P=0.041) in the prone position group. Conclusions A better target dose coverage can be maintained during IMRT with a supine position during rectal cancer IMRT, whereas the positioning repeatability is worsened with a prone position due to use of the belly board, thereby affecting the target dose coverage. Although the prone position combined with belly board can reduce the tolerated dosage of the small intestine,effective measures should be taken to guarantee the patient positioning repeatability.

Emerging clinical evidence revealed that postoperative adjuvant chemoradiotherapy (CRT) could improve the clinical outcome for resected head and neck squamous cell carcinoma in high-risk patients. The irradiation targets and doses should be determined by the primary tumor site, clinical stage, pathology reports, and the evaluation of postoperative imaging. Adjuvant concurrent CRT with cisplatin is the current standard treatment for high-risk postoperative head and neck squamous cell carcinoma patients. However, the effect of concurrent CRT with other chemotherapeutic agents and (or) epidermal growth factor receptor (EGFR) monoclonal antibody in these patients is inconclusive. Human papillomavirus (HPV)-positive oropharyngeal cancer has the unique biological characteristics, and the indications and treatment models of postoperative adjuvant CRT for these patients are still unclear. Further study is needed.

Objective To study three contouring approaches of the bowel and evaluate the bowel dose volume with cervical cancer patient.Methods Twelve patients were selected,prescribed dose 45 Gy/ 25f.For each patient we contoured the bowel according to three different definitions:bowel loops,bowel bag and peritoneal space.Then we generated three rival plans each considering a different bowel definition and to evaluate dose differences of the HI,CI of PTV and D D V5-V45 of bowel loops with paired t-test.Results Comparison between BL and BB plan,Dmax,HI and CI of PTV,V5-V45 of bowel loops were not significantly different (P =0.171,0.076,0.192,P =0.315-0.855),D of PTV and Dmax of bowel loops had difference (P=0.017,0.038).Comparison between BL and PS plan,Dmax,D HI and CI of PTV and Dmax of bowel loops had differences (P=0.033,0.044,0.046,0.041,0.013),V5-V45 of bowel loops were not significantly different (P=0.416-0.977).If the bowel loops V40 ≤ 15％,and bowel bag and peritoneal space V40≤20％.Conclusions All definitions provided a very similar dose volume of bowel loops.Taking into account HI and CI of PTV and max dose of bowel loops,BB seems better than PS.

Objective To investigate the difference in normal tissue complication probability (NTCP) of lower cranial nerves (LCNs) between target volumes recommended by Radiation Therapy Oncology Group (RTOG) and China in intensity-modulated radiotherapy (IMRT) for T1-2 nasopharyngeal carcinoma (NPC),and to provide the evidence of dose-volume effect for the protection of LCNs in IMRT for NPC.Methods A total of 20 patients with T1-2 NPC who were treated from 2013 to 2015 were enrolled,and LCNs were delineated on CT images.Target volume delineation and treatment plan designing were performed according to the method recommended by RTOG0225 (RTOG target volume delineation method) or the Chinese Working Committee for Clinical Staging of NPC in 2010 (Chinese target volume delineation method),and the differences in the dose to LCNs and NTCP were calculated.Results In the RTOG and Chinese methods for target volume delineation,Dmax to the left and right LCNs was 7 450±273 cGy/7294±309 cGy and 7 361± 160 cGy/7 190±395 cGy,respectively (P=0.018 and 0.042),Dmean was 6735±285 cGy/6 660±333 cGy and 6 446±429 cGy/6 299±467 cGy,respectively (both P=0.000),and the NTCP was 60％±10％/57％±13％ and 51％±15％/45％±17％,respectively (both P=0.000).Conclusions It is feasible to precisely delineate target volume with the LCNs as a routine OAR and predict NTCP in IMRT for T1-2 NPC.The NTCP of the LCNs is closely associated with target volume dose and irradiated volume.The dose to the LCNs and NTCP determined by the Chinese target volume delineation method are significantly lower than those determined by the RTOG method.

Fibroblasts ; pathology ; Humans ; Neoplasms ; pathology

Objective To investigate the effect of human lung cancer-associated fibroblasts (CAF) on the radiosensitivity of lung cancer cells when CAF is placed in direct contact co-culture with lung cancer cells.Methods Human lung CAF was obtained from fresh human lung adenocarcinoma tissue specimens by primary culture and subculture and was then identified by immunofluorescence staining.The CAF was placed in direct contact co-culture with lung cancer A549 and H1299 cells,and the effects of CAF on the radiosensitivity of A549 and H1299 cells were evaluated by colony-forming assay.Results The human lung CAF obtained by adherent culture could stably grow and proliferate,and it had specific expression of α-smooth muscle actin,vimentin,and fibroblast activation protein,but without expression of cytokeratin-18.The plating efficiency (PE,％) of A549 cells at 0 Gy irradiation was (20.0 ± 3.9) ％ when cultured alone versus (32.3 ± 5.5) ％ when co-cultured with CAF (t =3.16,P ＜ 0.05),and the PE of H1299 cells at 0 Gy irradiation was (20.6 ± 3.1) ％ when cultured alone versus (35.2 ± 2.3) ％ when co-cultured with CAF (t =6.55,P ＜0.05).The cell survival rate at 2 Gy irradiation (SF2) of A549 cells was 0.727 ±0.061 when cultured alone versus 0.782 ± 0.089 when co-cultured with CAF (t =0.88,P ＞ 0.05),and the SF2 of H1299 cells was 0.692 ±0.065 when cultured alone versus 0.782 ± 0.037 when co-cultured with CAF (t =2.08,P ＞0.05).The protection enhancement ratios of human lung CAF for A549 cells and H1299 cells were 1.29 and 1.25,respectively.Conclusions Human lung CAF reduces the radiosensitivity of lung cancer cells when placed in direct contact co-culture with them,and the radioprotective effect may be attributed to CAF promoting the proliferation of lung cancer cells.