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Unexpected fatal events in patients with head and neck cancers undergoing concurrent chemoradiation therapy are a clinical concern. Malnutrition, which is reported frequently in head and neck cancer patients, are associated with immunity derangement. The purpose of this study was to identify risk factors for early death of patients undergoing chemoradiation. We retrospectively analyzed the records of 194 stage III, IVA, and IVB head and neck cancer patients who were treated with chemoradiation between 2007 and 2009. We defined early death as death while receiving chemoradiation or within 60 days of treatment completion. Risk factors for early death were tested using univariate and multivariate analyses. Fourteen patients (7.2 %) experienced early death, 78.6 % of whom died of infection. Univariate analysis revealed significant correlations between early death and several pretreatment variables, including Eastern Cooperative Oncology Group performance status (PS) >1, hemoglobin <10 g/dL, albumin <3 g/dL, body mass index (BMI) <19 kg/m(2), and peripheral blood total lymphocyte count <700/μL. Multivariate analysis showed that PS >1, BMI <19 kg/m(2), and peripheral blood total lymphocyte count <700/μL were independent variables associated with early death. Poor performance status and malnutrition before chemoradiation independently predict early death in locally advanced head and neck cancer patients undergoing chemoradiation. Cautious management of head and neck cancer patients with these risk factors is required throughout chemoradiation period.

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PLN metastasis, PI, DSI, and LVSI were independent prognostic factors. Prospective studies of postoperative adjuvant therapy with prognostic score and nodal status stratification for cervical AC/ASC are necessary.

ABSTRACT. Setaria digitata and S. marshalli larvae were observed in the cerebrospinal cavity of 2 paralyzed cattle in Taiwan. The 2 affected cattle showed quadriplegia and lumbar paralysis, respectively. At necropsy, which was performed 7 days after the 7-mon th-old cattle became quadriplegic, three and nineteen S. marshalli larvae as well as two female adult worms were found in the cranial cavity, spinal cavity and peritoneal cavity of the cattle, respectively. Necropsy on the other 8-month-old cattle was also performed 3 days after it showed lumbar paralysis, and ten S. digitata larvae were found in the spinal cavity. In both cattle, many mononuclear inflammatory cells mixed with a few eosinophils were seen accumulated in the connective tissue around the root of the spinal nerves. Infiltration of eosinophils and mononuclear inflammatory cells into the epidura and arachnoidea of the brain were also observed. The major inflammatory cell was lymphocytes, but neutrophils and eosinophils were also present. The number of cells in the cerebrospinal fluid collected initially from the two affected cattle were 105/0.01 ml and 143/ 0.01 ml, respectively. This is the first report of cerebrospinal setariosis in cattle associated with S. marshalli. KEY WORDS: bovine cerebrospinal setariosis, cerebrospinal fluid, Setaria digitata, Setaria marshalli, Taiwan.J. Vet. Med. Sci. 65(9): 977-983, 2003 Setaria species are filarial parasites that are commonly found in the peritoneal cavity of cattle and other ungulates. The parasites are generally considered to be nonpathogenic in their natural hosts, but transmission of infective larvae through mosquito and other arthropod vectors to non-permissive hosts such as goats, sheep, or horses, can result in serious and often fatal neuropathological disorder commonly referred to as cerebrospinal nematodiasis [1,11]. Moreover, Setaria cervi (Rudolphi, 1819) [2], S. digitata (Linstow, 1906) [18,19], S. labiatopapillosa (Alessandrini, 1848) [3,14], S. marshalli (Boulenger, 1921) [8,16,18,19], and S. leichungwingi (Chen, 1935) [7] had been reported to parasitize in the peritoneal cavity of cattle without producing clinical signs. However, larvae of S. cervi, which normally parasitized in the deer peritoneal and thoracic cavities as adult worms, had been found in the cerebrospinal cavity of deer resulting in lumbar paralysis of the host [6,15,17]. Our literature search showed that no cases of cerebrospinal setariosis with S. marshalli infection in cattle had ever been reported. We report herein the discovery of S. marshalli and S. digitata larvae from the cerebrospinal cavity of 2 paralyzed cattle in Taichung, central Taiwan. Pathological findings and inflammatory cell counts of cerebrospinal fluid (CSF) of the affected cattle are also presented. MATERIALS AND METHODS Case history:In August and September of 2001, a 7-month-old (case 1) and an 8-month-old (case 2) HolsteinFriesian strain cattle were found to have quadriplegia and lumbar paralysis, respectively, in Taichung, central T...

Our findings indicate that commensal rodents and shrews found in the traditional wet markets of Taichung City are hosts to various zoonotic parasites and, therefore, pose a serious health risk to humans and domestic animals in Taiwan.