Concurrent chemoradiotherapy for unresectable hilar choloangiocarcinoma: A single-institution experience

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Background: Hilar cholangiocarinoma (Klatskin tumor) is a rare malignancy which is best managed with surgical resection. The majority of patients, however, is unresectable at the time of diagnosis and generally has a poor outcome. The purpose of this study was to retrospectively evaluate the role of chemoradiotherapy (CCRT) for patients with unresectable hilar choloangiocarcinoma at a single institution.

Methods: Between 2001 and 2008, a total of 33 patients with unresectable, nonmetastatic hilar cholangiocarcinoma treated at Taipei Veterans General Hospital were reviewed. All patients were to receive 3D-CRT with a median dose of 50.4 Gy (range, 39.6- 60) at 1.8-2 Gy per fraction per day. Sixteen patients also received bolus 5-fluorouracil (5-FU) CCRT (500 mg/m2/d for 3 days repeated every 2 weeks during radiotherapy for 6 weeks). Survivals were estimated by the Kaplan-Meier method and compared by log-rank test.

Results: There were 21 males and 12 females, with a median age of 71 years (range, 29 - 81). The median follow-up time was 10.4 months (range, 1 – 42.3) for all patients with the 1- and 2-year survival rates of 45% and 12%, respectively. The median overall survival (OS) and progression-free survival (PFS) were 13.5 months and 10.2 months for the CCRT group, and 10.4 months and 6.5 months for the RT alone group (p = 0.36 and p = 0.28, respectively). Adverse events were similar in thetwo groups with 14 patients (42%) developed grade 1-2 gastrointestinal toxicity during RT. Locoregional progression was observed in 26 patients (79%) and distant metastases in 9 patients (27%). All patients experienced disease progression and had died at time of analysis.

Conclusions: The outcome remains poor for unresectable hilar cholangiocarcinoma despite aggressive combined modality treatment. Although not statistically significant, our data showed CCRT provides longer OS and PFS in patients with unresectable hilar cholangiocarcinoma compared to RT alone. Locoregional progression is the main problem for this disease and the efficacy of adding chemotherapy or biologic agents needs to be further investigated.

No significant financial relationships to disclose.

Survival by anatomic site, histologic type, and tumor stage in stomach and esophageal cancer patients from the U.S. SEER Cancer Registry

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Background: Data on the association of tumor characteristics and survival for stomach cancer (SC) and esophageal cancer (EC) patients (pts) are limited. The objective of this study was to describe survival in United States. SC and EC pts by anatomic site, histologic type, and tumor stage.

Methods: SC and EC pts were identified in the Surveillance, Epidemiology and End Results (SEER) Cancer Registry. SC was classified by anatomic site (cardia and non-cardia/other) and histologic type (intestinal, diffuse, other per Lauren criteria). EC was classified into anatomic site (middle/upper third, abdominal/lower third, overlapping lesions, NOS) and histologic type (adenocarcinoma (AC), squamous cell carcinoma (SQ), other). Frequency distribution and median survival were examined in these subgroups.

Results: From 2004-2006, >15,500 SC and > 9,800 EC cases were diagnosed. SC: (29% cardia) and (24% diffuse, 66% intestinal, 10% other). Compared with non-cardia/other pts, cardia pts tended to be male (77% vs 56%), white (88% vs 66%), intestinal type (77% vs 61%) and present with earlier stage disease (stage I-IIIa: 48% vs 42%). With the exception of stage I/II pts, survival was longer in cardia than non-cardia/other pts. The difference was most striking in stage IIIb/IV pts (7 months (mos) cardia vs 4 mos non-cardia/other). Compared to intestinal type, diffuse type tended to be younger (median age: 64 vs 72 yrs), more female (49% vs 34%), and present with more stage IIIb/IV disease (50% vs 39%). No difference in survival by histologic type was observed when accounting for stage. EC: (26% middle/upper, 58% lower, 5% overlapping, 11% NOS) and (57% AC, 34% SQ, 9% other). Among pts with AC histology 78% occurred in the lower third; in SQ most occurred in upper/middle third (56%). Compared to SQ, AC tended to be male (85% vs 63%), white (95% vs 67%), and present with stage IV disease (34% vs 25%). For all stages combined, survival was longer for AC pts (11 mos AC, 9 mos SQ, 4 mos other). This difference was most apparent among early stage (I-III) pts.

Conclusions: Survival in SC and EC was associated with staging, anatomic and histologic subtypes. Quantifying this provides insights for the design and interpretation of clinical development programs.

[Table: see text]

Factors associated with occupational strain among Chinese teachers: a cross-sectional study

OBJECTIVES

With the reform of the education system in China, teachers are suffering from more occupational strain, which is believed to impair their working state indirectly and affect their health. This study assessed occupational strain and explored the related factors among Chinese teachers.

STUDY DESIGN

Cross-sectional with cluster sampling.

METHODS

The study population was composed of 3570 school teachers working in 64 primary and middle schools in Heping District in Shenyang, China. Data were collected using a self-administered questionnaire (the Chinese version of the Occupational Stress Inventory scale). Multivariate linear regression analyses were performed to study the factors related to occupational strain.

RESULTS

The average score on the Personal Strain Questionnaire (PSQ) for the whole study population was 106.5 (107.5 in men and 106.3 in women). Teachers with chronic disease, a greater number of days of sick leave, recent experience of a stressful life event and divorced/separated/widowed status tended to suffer greater strain than their peers. Regression analyses showed that the PSQ score was significantly associated with role overload, role boundary, responsibility and physical environment, and inversely associated with recreation and rational coping. The most crucial predictors of occupational strain were chronic disease, days of sick leave, recent experience of a stressful life event and marital status. Being a class teacher was the strongest indicator of interpersonal strain. Self-care was associated with vocational strain and psychological strain, and inversely associated with physical strain.

CONCLUSIONS

Most teachers in this study experienced a high degree of occupational strain. Chronic disease, days of sick leave, recent experience of a stressful life event and divorced/separated/widowed status played prominent roles in occupational strain. In addition, role overload, role boundary, responsibility and physical environment induce occupational strain, while recreation and rational coping have a positive effect on occupational strain. Interventions such as proper management of chronic diseases and establishment of a balanced work-family life are crucial to reduce occupational strain. Recreation and training in coping abilities are needed to enhance positive working environments and attenuate the occupational strain imposed on teachers.

A predictive value of hyponatremia for poor outcome and cerebral infarction in high-grade aneurysmal subarachnoid haemorrhage patients

BACKGROUND

The clinical significance of hyponatremia has not been investigated in high-grade aneurysmal subarachnoid haemorrhage (aSAH) patients. Thus, we assessed the predictive value of hyponatremia for poor outcome or cerebral infarction in high grade patients (the World Federation of Neurological Surgeons Scale (WFNS) grade 4 or 5) after aSAH.

METHODS

Patients with WFNS grade 4 or 5 after aSAH were selected into this study between January 2005 and January 2008. In the same period, patients with WFNS grade 1, 2 or 3 after aSAH (low grade) were also chosen into this study. Hyponatremia was determined with serum sodium measurements obtained within 9 days after aSAH. Prognosis of patients was estimated with Glasgow Outcome Scale at 3 months. The relationship between hyponatremia and poor outcome and association of hyponatremia and cerebral infarction were analysed, respectively.

RESULTS

A total of 124 high-grade patients were included in this study. Of those, 78 patients developed hyponatremia. Hyponatremia developed in 32.3% of cases between days 1 and 3 after aSAH, and 30.6% developed hyponatremia after 3 days post-aSAH. Multivariable analysis revealed that hyponatremia was not correlated with poor outcome in high-grade aSAH patients. Furthermore, only late-onset hyponatremia was correlated with cerebral infarction in these patients. Meanwhile, there was no significant correlation between hyponatremia and poor outcome or cerebral infarction in 259 low-grade aSAH patients.

CONCLUSIONS

Hyponatremia does not predict poor outcome in all-grade aSAH patients. However, late-onset hyponatremia in high-grade aSAH patients is associated with cerebral infarction. Therefore, the appropriate management of hyponatremia could be beneficial in those patients.

The optimum number of retrieved lymph nodes for locally advanced rectal cancer following short-course preoperative radiotherapy: A study by fat clearance

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Background: The optimum number of retrieved lymph nodes following preoperative radiotherapy and surgery for locally advanced rectal cancer is still controversial. This study is designed to confirm the least number of retrieved lymph nodes for locally advanced rectal cancer following 30Gy/10f short-course preoperative radiotherapy.

Methods: From Aug 2002 to Mar 2010, two hundred and twelve patients with locally advanced rectal cancer received 30Gy/10f preoperative radiotherapy (BED: 36Gy), standardized total mesorectal excision and fat-clearance based pathological evaluation in Beijing Cancer Hospital. The size of retrieved lymph nodes (LNs) was recorded. The sequence of LNs was arranged by a descending sort by retrieved nodes' size and the serial number of the largest metastatic lymph node (mLN) was recorded. The serial number of the first largest mLN is regarded as the least number of LNs to distinguish ypN+ status. The cumulative accuracy of ypN stage by variable numbers of LNs was calculated and analyzed.

Results: There were total 4,669 retrieved LNs and 354 mLNs. The median retrieved LNs number was 21 (range 4-61). The ypN positive rate was 40.6%. The peak-value of quantitive distribution of LNs and mLNs was observed in 1-2mm and 3-4mm level. The incidence of retrieving mLNs shows an intensifying tendency for increasing size of LNs. The analysis for sequence of LNs sorting suggested that 85.4% of cases could confirm their ypN stage by the first largest LN. The cumulative accuracy ascended to 95.1% or 98.1% when the first 5 or 9 largest LNs were retrieved.

Conclusions: For rectal cancer following 30Gy/10f preoperative radiotherapy, retrieving 12 or more lymph nodes seems not to be mandatory for confirming ypN stage. The accuracy in confirming negative ypN stage when retrieving 5 or 9 largest nodes is sufficient for majority of patients. In those cases that could not retrieve 5 or more nodes by routine fixation, fat clearance is indispensable.

No significant financial relationships to disclose.

Identification of potential surrogate end points in randomized clinical trials of aggressive and indolent non-Hodgkin's lymphoma: correlation of complete response, time-to-event and overall survival end points

BACKGROUND

The correlation between efficacy end points in randomized controlled trials (RCTs) of systemic therapy for non-Hodgkin's lymphoma (NHL) was investigated to identify an appropriate surrogate end point for overall survival (OS).

METHODS

RCTs of previously untreated NHL published from 1990 to 2009 were identified. Associations between absolute differences in efficacy end points were determined using nonparametric Spearman's rank correlation coefficients (r(s)).

RESULTS

Thirty-eight RCTs representing 85 treatment arms for aggressive NHL and 20 RCTs representing 42 arms for indolent NHL were included. For aggressive NHL, differences in 3-year progression-free survival (PFS)/event-free survival (EFS) were high correlated with differences in 5-year OS {r(s) of 0.90 [95% confidence interval (CI) 0.73-0.96]} and linear regression determined that a 10% improvement in 3-year EFS or PFS would predict for a 7% ± 1% improvement in 5-year OS. For indolent histology disease, differences in complete response were strongly correlated with differences in 3-year EFS [r(s) 0.86 (95% CI 0.35-0.97)], but there was no correlation between 3-year time-to-event end points and 5-year OS.

CONCLUSIONS

Improvements in 3-year EFS/PFS are highly correlated with improvements in 5-year OS in aggressive NHL and should be explored as a candidate surrogate end point. Definition of these relationships may inform future clinical trial design and interpretation of interim trial data.

A morphological study of corneal flap after thin-flap laser-assisted in situ keratomileusis by anterior segment optical coherence tomography

This prospective study assessed corneal flap morphology in 115 patients undergoing laser-assisted in situ keratomileusis (LASIK). Flaps were created using the Moria M2 90-μm or KM-5000D 110-μm microkeratomes. Flap thickness was measured using anterior segment optical coherence tomography at seven points in a 7-mm diameter zone 1 h, 1 day, 3 days, 1 week and 1 month after surgery. Flap accuracy, reproducibility, uniformity and changes over time were evaluated. The Moria M2 microkeratome created flaps with less accuracy in the centre than the KM-5000D microkeratome (114.06 ± 6.46 μm vs 128.39 ± 6.79 μm, respectively, at 1 week). For both microkeratomes, flap thickness varied between most of the peripheral areas and the central point. Both microkeratomes created flaps with good central predictability and reproducibility, but high variation and significant deviation from intended thickness were observed in peripheral flap thickness.

Diamagnetic levitation causes changes in the morphology, cytoskeleton, and focal adhesion proteins expression in osteocytes

Diamagnetic levitation technology is a novel simulated weightless technique and has recently been applied in life-science research. We have developed a superconducting magnet platform with large gradient high magnetic field (LG-HMF), which can provide three apparent gravity levels, namely, μg (diamagnetic levitation), 1g, and 2g for diamagnetic materials. In this study, the effects of LG-HMF on the activity, morphology, and cytoskeleton (actin filament, microtubules, and vimentin intermediate filaments) in osteocyte - like cell line MLO-Y4 were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) methods, hematoxylin-eosin (HE) staining, and laser scanning confocal microscopy (LSCM), respectively. The changes induced by LG-HMF in distribution and expression of focal adhesion (FA) proteins, including vinculin, paxillin, and talin in MLO-Y4 were determined by LSCM and Western blotting. The results showed that LG-HMF produced by superconducting magnet had no lethal effects on MLO-Y4. Compared to control, diamagnetic levitation (μg) affected MLO-Y4 morphology, nucleus size, cytoskeleton architecture, and FA proteins distribution and expression. The study indicates that osteocytes are sensitive to altered gravity and FA proteins (vinculin, paxillin, and talin) may be involved in osteocyte mechanosensation. The diamagnetic levitation may be a novel ground-based space-gravity simulator and can be used for biological experiment at cellular level.

Pressure-induced superconductivity in topological parent compound Bi2Te3

We report a successful observation of pressure-induced superconductivity in a topological compound Bi(2)Te(3) with T(c) of ∼3 K between 3 to 6 GPa. The combined high-pressure structure investigations with synchrotron radiation indicated that the superconductivity occurred at the ambient phase without crystal structure phase transition. The Hall effects measurements indicated the hole-type carrier in the pressure-induced superconducting Bi(2)Te(3) single crystal. Consequently, the first-principles calculations based on the structural data obtained by the Rietveld refinement of X-ray diffraction patterns at high pressure showed that the electronic structure under pressure remained topologically nontrivial. The results suggested that topological superconductivity can be realized in Bi(2)Te(3) due to the proximity effect between superconducting bulk states and Dirac-type surface states. We also discuss the possibility that the bulk state could be a topological superconductor.

A promising approach of reject water treatment using a tidal flow constructed wetland system employing alum sludge as main substrate

This study examined a novel reuse of alum sludge, an inescapable by-product of drinking water treatment process when aluminium salt is added as a coagulant, as the main medium in a laboratory-scale multi-stage constructed wetland (CW) system for reject water treatment. Such reject water is a main concern in municipal wastewater treatment plant (MWWTP) for increasing the organic and nutrient loading. A 'tidal flow' strategy was employed to enhance the wetland aeration to stimulate organic matters (OM) and ammoniacal-nitrogen (N) oxidation while the 'step feed' operation was adopted to supply the necessary amount of carbon source for denitrification. The results reveal that alum sludge acting as P adsorbent can secure the P removal. Meanwhile, high removals of N and OM can also be obtained due to the active bacteria growth on the alum sludge surface. The results show that average removal efficiencies of 65.4 +/- 12.3% for chemical oxygen demand (COD), 67.8 +/- 9.2% for five-day biochemical oxygen demand (BOD5), 33.6 +/- 17.0% for N and 99.5 +/- 0.49% for P can be achieved over a period of 190 days. This indicates that novel reuse of alum sludge as medium in CW system can provide a promising approach for reject water treatment. Therefore, it will significantly reduce the amount of pollutant feedback through reject water recycling in a MWWTP.

Estrogen enhances the functions of CD4(+)CD25(+)Foxp3(+) regulatory T cells that suppress osteoclast differentiation and bone resorption in vitro

Cross-talk has been shown to occur between the immune system and bone metabolism pathways. In the present study, we investigated the impact of CD4(+)CD25(+)Foxp3(+) regulatory T (Treg) cells on osteoclastogenesis and bone resorption. Treg cells that were isolated and purified from peripheral blood mononuclear cells (PBMCs) of healthy adults inhibited both the differentiation of osteoclasts (OCs) from human embryo bone marrow cells (BMCs) and the pit formation in a dose-dependent manner. In cell cocultures, the production levels of both interleukin-10 (IL-10) and transforming growth factor-beta 1 (TGF-β1) were proportionally upregulated as the ratio of Treg cells to BMCs was increased, and the inhibition of OC differentiation and bone resorption by Treg cells was completely reversed by anti-IL-10 and anti-TGF-β1 antibodies. Treatment of BMC and Treg cell cocultures with 17β-estradiol (E2) at concentrations between 10⁻⁷ and 10⁻⁹ mol/l suppressed OC differentiation and bone resorption more efficiently than it did in cultures of BMCs alone; this enhanced suppression occurred via the stimulation of Treg cell IL-10 and TGF-β1 expression. These data suggest that Treg cells suppress OC differentiation and bone resorption by secreting IL-10 and TGF-β1. E2 enhances the suppressive effects of Treg cells on OC differentiation and bone resorption by stimulating IL-10 and TGF-β1 secretion from these cells. Therefore, Treg cell-derived IL-10 and TGF-β1 are likely involved in the regulation of E2 on bone metabolism and represent potential therapeutic targets for the treatment of postmenopausal osteoporosis (PMO).

Dynamic changes of the ecological environment quality in a river basin: a case study of the main stream of Songhua river basin

This paper reports the investigation and analysis of the status and dynamic changes of ecological environment quality in the main stream of Songhua river basin. The evaluation index system was established and the eco-environment quality in the year of 2000 and 2008 was studied in depth. Based on our research, the trend of dynamic changes of the eco-environment quality and its origins have been further discussed: In the year of 2000, the range of evaluation index covered from 0.31 to 0.47. Harbin and Yichun was relatively better than the rest of study areas. In the year of 2008, except districts of Daqing and Qitaihe, the environmental quality of Songhua river basin has entirely improved, wherein the evaluation index of the eco-environment covered from 0.31 to 0.57. Particularly, the eco-environment quality of Hegang and Shuangyashan has obtained significant improvement, whereas the improvement of Jiamusi was not obvious. According to the evaluation results, the environmental quality in the study area has an upward trend with the average growth rate 0.13% per year.

Towards the development of a novel construction solid waste (CSW) based constructed wetland system for tertiary treatment of secondary sewage effluents

This study was conducted to examine the possibility of using construction solid waste (CSW), an inevitable by-product of the construction and demolition process, as the main substrate in a laboratory scale multi-stage constructed wetland system (CWs) to improve phosphorus (P) removal from secondary sewage effluent. A tidal-flow operation strategy was employed to enhance the wetland aeration. This will stimulate aerobic biological processes and benefit the organic pollutants decomposition and nitrification process for ammoniacal-nitrogen (NH(+)(4)-N) removal. The results showed that the average P concentration in the secondary sewage effluent was reduced from 1.90 mg-P/L to 0.04 mg-P/L. CSW presents excellent P removal performance. The average NH(+)(4)-N concentration was reduced from 9.94 mg-N/L to 1.0 mg-N/L through nitrification in the system. The concentration of resultant nitrite and nitrate in the effluent of the CSW based CWs ranged from 0.1 to 2.4 mg-N/L and 0.01 to 0.8 mg-N/L, respectively. The outcome of this study has shown that CSW can be successfully used to act as main substrate in CWs. The application of CSW based CWs on improving N and P removals from secondary sewage effluent presents a win-win scenario. Such the reuse of CSW will benefit both the CSW disposal and nutrient control from wastewater. More significantly, such the application can transfer the CSW from a 'waste' to 'useful' material and can ease the pressure of construction waste solid management. Meanwhile, the final effluent from the CSW-based CWs can be used as non-potable water source in landscape irrigation, agriculture and industrial process.

Evaluation of low-cost cathode catalysts for high yield biohydrogen production in microbial electrolysis cell

As an ideal fuel due to the advantages of no pollution, high combustion heat and abundant sources, hydrogen gas can be produced from organic matter through the electrohydrogenesis process in microbial electrolysis cells. But in many MECs, platinum is often used as catalyst, which limits the practical applications of MECs. To reduce the cost of the MECs, Ni-based alloy cathodes were developed by electrodepositing. In this paper hydrogen production using Ni-W-P cathode was studied for the first time in a single-chamber membrane-free MEC. At an applied voltage of 0.9 V, MECs with Ni-W-P cathodes obtained a hydrogen production rate of 1.09 m3/m3/day with an cathodic hydrogen recovery of 74%, a Coulombic efficiency of 56% and an electrical energy efficiency relative to electrical input of 139%, which was the best result of reports in this study. The Ni-W-P cathode demonstrated a better electrocatalytic activity than the Ni-Ce-P cathode and achieved a comparable performance to the Pt cathode in terms of hydrogen production rate, Coulombic efficiency, cathodic hydrogen recovery and electrical energy efficiency at 0.9 V.

In-situ studies of cartilage microtribology: roles of speed and contact area

The progression of local cartilage surface damage toward early stage osteoarthritis (OA) likely depends on the severity of the damage and its impact on the local lubrication and stress distribution in the surrounding tissue. It is difficult to study the local responses using traditional methods; in-situ microtribological methods are being pursued here as a means to elucidate the mechanical aspects of OA progression. While decades of research have been dedicated to the macrotribological properties of articular cartilage, the microscale response is unclear. An experimental study of healthy cartilage microtribology was undertaken to assess the physiological relevance of a microscale friction probe. Normal forces were on the orderof50 mN. Sliding speed varied from 0 to 5 mm/s, and two probes radii, 0.8 mm and 3.2 mm, were used in the study. In-situ measurements of the indentation depth into the cartilage enabled calculations of contact area, effective elastic modulus, elastic and fluid normal force contributions, and the interfacial friction coefficient. This work resulted in the following findings: 1) at high sliding speed (V=1-5 mm/s), the friction coefficient was low (μ = 0.025) and insensitive to probe radius (0.8 mm 3.2 mm) despite the 4-folddifference in the resulting contact areas; 2) The contact area was a strong function of the probe radius and sliding speed; 3) the friction coefficient was proportional to contact area when sliding speed varied from 0.05mm/s-5mm/s; 4) the fluid load support was greater than 85% for all sliding conditions (0% fluid support when V=0) and was insensitive to both probe radius and sliding speed. The findings were consistent with the adhesive theory of friction; as speed increased, increased effective hardness reduced the area of solid-solid contact which subsequently reduced the friction force. Where the severity of the sliding conditions dominates the wear and degradation of typical engineering tribomaterials, the results suggest that joint motion is actually beneficial for maintaining low matrix stresses, low contact areas, and effective lubrication for the fluid-saturated porous cartilage tissue. Further, the results demonstrated effective pressurization and lubrication beneath single asperity microscale contacts. With carefully designed experimental conditions, local friction probes can facilitate more fundamental studies of cartilage lubrication, friction and wear, and potentially add important insights into the mechanical mechanisms of OA.