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Objective: This study aimed to evaluate the clinical features and treatment outcomes of the value of response-adapted treatment following radiotherapy and induction chemotherapy follwing subsequent comprehensive therapy in patients with resectable locally advanced hypopharyngeal carcinoma. Methods: This cohort study was conducted from September 2010 to September 2020 in our hospital, 231 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included. For the IC-directed ART strategy, IC is used to select good candidates to receive radical RT or CCRT, and others undergo surgery. He response-adapted strategy was determined based on the primary tumor response, which was evaluated at a dose of 50 Gy. If the response reached complete response or partial response（more than 80% tumor regression）, patients received radical RT or CCRT; otherwise, they received surgery, if possible, at 4 to 6 weeks after RT. The end points of the study were OS（overall survival）, progression free survival（PFS）, locoregional recurrence-free survival（LRRFS） and LDFS. Results: In IC-directed group, 75.0%（57/76） patients reached PR after 2 cycles of induction chemotherapy. While in RT-directed group, 70.3%（109/155） patients reached large PR at dose of 50 Gy. The median interquartile range follow-up period of the whole cohort was 63.8 months. The 5-year OS, PFS, LRRFS and SFL of the whole cohort were 47.9%、39.6%、44.3% and 36.2%, respectively. In evaluations based on the different treatment strategies, the 5-year OS and SFL were 51.3% versus 37.0%（ HR 0.67; 95% CI 0.43-1.05; P =0.07） and 27.8% versus 39.8%（ HR 0.68; 95% CI 0.46-0.99; P =0.04） between IC-directed and RT-directed groups. In additional, surgery complications did not significantly differ between these two groups. Conclusion: In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, and higher laryngeal preservation compared with IC-directed strategies. This approach could provide a feasible laryngeal preservation strategy in patients with resectable locally advanced hypopharyngeal carcinoma., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To analysis the clinical features and prognosis in oropharyngeal carcinoma with secondary primary tumor. Methods: A retrospective analysis was performed on 468 pathologically confirmed oropharyngeal cancer as the primary tumor patients with p16 status, excluded distant metastasis, and admitted to the Chinese Academy of Medical Sciences from January 2010 to December 2020. The clinical features and prognosis of the secondary primary tumor were analyzed. Results: Among 468 patients with oropharyngeal cancer treated at initial diagnosed, 222 cases were P16-negative. With a median follow-up time of 64.3 months, 66 cases developed second primary cancer, with an incidence of 29.3%, among which 63.6%（42/66） were synchronous and 36.4%（24/66） were heterochronous, esophagus was the most commonly involved site. The 5-year OS of p16-negative oropharyngeal carcinoma with synchronous second primary cancer, without second primary cancer and with heterogeneous second primary cancer were 26.3% and 57.3% and 73.2%（ P =0.001）; The second primary cancer accounted for 11.2%（12/107） of the deaths in the whole group, among them, the heterochronous second primary accounted for 75.0%（9/12）. There were 246 patients with p16 positive, with a median follow-up time of 52.4 months, 20 patients developed second primary cancer（8.1%）. Among them, 65.0%（13/20） were synchronous and 35.0%（7/20） were heterochronous. Esophagus was the most commonly involved site. The 4-year OS of p16-positive with synchronous, heterochronous and non-second primary cancer group were 51.9%, 80.7% and 83.3%. Secondary primary cancer accounted for 3.8%（2/52） of all deaths in p16 positvie group. Conclusion: The incidence of second primary cancer of p16 positive and negative oropharyngeal carcinoma were different. The esophagus was the most commonly involved site regardless of p16 status. Regardless of p16 status, the survival of patients with synchronous second primary cancer was worse than those without second primary cancer. For p16-negative oropharyngeal carcinoma, the prognosis was better in patients with heterogeneous second primary cancer, the second primary cancer is one of the main causes of death., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To explore the organ damage character and complications of blunt trauma in the neck, and the advantage and disadvantage of CT and ultrasound for blunt trauma in the neck., Method: The data of 7 neck blunt trauma cases was analyzed. Cricoarytenoid joint reduction, tracheotomy, exploratory surgery of neck were performed respectively for these cases., Result: Of the 2 cases with vocal cord paralysis, one had his vocal cords fixed in the the para-median position. one had his vocal cords move freely. 2 cases of epiglottis edema had been cured. Among the 2 cases of thyroid area swelling and congestion, one died from respiratory failure, one was cured. One case died of carotid artery embolism., Conclusion: Circulation of the head should be noticed as well as keeping respiratory tract clear and anti-shock treatment. Some patient with negative laryngeal examinations might get worse in the following hours, and swelling of the neck, dyspnea, obnubilation may appear in these cases. Dynamic monitoring could be helpful for the diagnosis and treatment of neck blunt trauma.

Background: Clusterin (CLU) is a multifunctional protein which attracts much attentions in recent years due to its function and variation in tumor formation and development. So far, there have no reports on its variation in lung cancer and its relationship with sensitivity of anti-cancer drugs. This study was to compare the expression of clusterin in wild Anip973 and Anip973/CDDP, thus to investigate the correlation of clusterin expression to tumorigenesis, tumor development and drug resistance in non-small cell lung cancer (NSCLC)., Methods: Western blot and RT-PCR were used to compare the clusterin expression at protein level and mRNA level in Anip973/CDDP with that in wild Anip973. Flow cytometry was employed to detect and analyze the relationship between clusterin and cell cycle, p53 or Bax., Results: Clusterin protein expression levels were significantly higher in those Anip973/CDDP than those in wild Anip973. The p53 expression levels were higher in Anip973/CDDP than in Anip973 (P<0.01). The expression of Bax showed no significant difference between Anip973 and Anip973/CDDP (P>0.05). As to drug resistant lung cancer cell lines, Anip973/CDDP had more cells in G0-G1 stage while less cells in S stage or G2-M stage than non-resistant cell line., Conclusions: Clusterin is associated with resistance to CDDP in NSCLC. The abnormal expression of clusterin and p53 in Anip973/CDDP indicated that both clusterin and p53 might be involved in drug resistance in NSCLC.

Objective: To investigate the operative techniques and clinical results of sural neurocutaneous vascular flap pedicled on the relatively higher and main perforating branch of peroneal artery in repairing small and medium-sized soft tissue defects in ankle., Methods: From July 2004 to February 2007, 14 patients (9 males and 5 females, aged 19-53 years) with small and medium-sized soft tissue defects in ankle were treated, including 4 cases of skin necrosis caused by surgery for achilles tendon rupture, 3 soft tissue defects due to car accident, 2 crush injury due to falling heavy objects, 2 chronical infectious ulcer, 2 skin necrosis caused by surgery for calcaneus fracture and 1 melanoma resection in heel. Ranging from 4 cm x 2 cm to 9 cm x 5 cm and combing with exposure of either tendon or bone, the defects were in ankle areas (12 cases) and weight-bearing heel (2 cases). The time from injury to hospitalization was 12 days to 13 months, except 3 cases of emergency hospitalization. After thorough debridement, the sural neurocutaneous vascular flaps (13 cm x 5 cm - 36 cm x 6 cm ) pedicled on the perforating branch of peroneal artery was harvested to repair the defects. The donor sites were sutured directly., Results: Postoperatively all the flaps survived, and all the donor sites and wounds healed by first intention. Over a 7-23 month follow-up period, the texture, appearance and color of the flaps in all cases were good, with two-point discrimination of 7-12 mm.The function of ankle obtained satisfactory recovery with normal in-shoe gait., Conclusion: With a reliable blood supply, simple operative procedure, sound repair of wound and satisfactory recovery of limb function, the sural neurocutaneous vascular flap pedicled on the relatively higher and main perforating branch of peroneal artery is applicable for the repair of small and medium-sized defects in the ankle and weight-bearing area of heel, especially for patients who have no satisfactory perforating branch in lower position.

Objective: To explore an economical protocol for esophageal stenosis treatment at home and evaluate the effects of portable esophageal dilator., Method: Sixty-seven patients with esophageal stenosis were treated at home by themselves with portable esophageal dilator, which was designed by Prof Wang HT, one of the authors. Twenty-nine cases of esophageal stenosis were caused by chemical damage, 23 cases by esophageal tumor, 13 postoperation cases with hypopharyngeal and upper esophageal tumor and two cases by laryngeal thyroid gland recurrent tumor. Stricture happened at esophageal entrance and upper segment in 15 cases, at middle in 32 cases, both at middle and upper in 17 cases and at whole length of esophagus in three cases. Stricture was not complete atresia and dilators could insert into esophagus in all patients., Result: Significant effects were found in 43 patients and good effects in 24 patients. Seven deaths were caused by remote metastasis of recurrent cancer resulting in multiple organ failure or large blood vessels bleeding resulting of tumor erosion. Follow-up visit ranged from the shortest period of four months to the longest period of five years and 1 month, 9.8 months on average., Conclusion: Family portable dilator and self-catering dilation is an effective and safe method for treating esophageal stenosis. It is so simple, convenient, painless with low expense that it is especially useful in countryside hospitals and undeveloped rural areas.