MRI appearances of stage IE/IIE extranodal NK/T-cell lymphoma, nasal type, in the upper aerodigestive tract

BACKGROUND

The clinical symptoms of NK/T-cell lymphoma at presentation are nonspecific and may mimic those of other benign nasal diseases such as rhinitis and nasal polypus. However, radiologic studies regarding this aggressive clinical course entity are limited.

AIM

To review 123 newly diagnosed MRI appearances in patients with extra-nodal NK/T-cell lymphoma, nasal type, in a large cohort and determine the characteristic imaging findings.

SUBJECTS AND METHODS

We investigated the magnetic resonance imaging (MRI) findings of patients with newly diagnosed stage IE/IIE extranodal NK/T-cell lymphoma, nasal type, in the upper aerodigestive tract.

RESULTS

Most nasal cavity patients (63.4%) showed extra nasal cavity involvements. The polypoid pattern was most frequently seen (55.3%), followed by the infiltrative (27.6%) and combined (17.1%) patterns. The polypoid pattern tended to develop in the nasal cavity group, while the infiltration pattern was more common in the non-nasal cavity group (63.4% vs. 60.0%, p < 0.001). Homogeneous iso-intensity was seen in 97.6%, 88.6% and 56.1% of cases on T1-, T2-weighted images and post-contrast images, respectively. Bone destruction and necrosis were observed in 44.7% and 56.3% of patients. Both tumour necrosis and bone destruction were related to tumour size (p = 0.008, 0.001). Only 12.2% of patients had cervical lymphadenopathy Multi-region involvement, irregular growth pattern, predisposition to necrosis and bone destruction, and little lymphadenopathy are valuable for diagnosis and can be used to differentiate these tumours from other malignant tumours.

CONCLUSIONS

Our large cohort study of MRI of NK/T cell lymphoma, nasal type, revealed the features of this lymphoma on MRI including some radiologic signs never reported earlier; these findings are invaluable for early diagnosis and may aid future studies aiming to predict the prognosis and response to therapy.

Enzymatic formation of a novel cell-adhesive hydrogel based on small peptides with a laterally grafted l-3,4-dihydroxyphenylalanine group

We rationally designed a bioadhesive supramolecular hydrogel by introducing L-3,4-dihydroxylphenylalanine (DOPA) groups while properly integrating the enzymatic reactions and self-assembly processes. The effective presence of the catechol groups successfully promoted the adhesion and proliferation of human fibroblast cells.

HMGB3 characterization in gastric cancer

Gastric cancer is a major health problem worldwide; it is the second most common cause of cancer death in the world. Recent studies indicate that the high-mobility group (HMG) of chromosomal proteins is associated with cancer progression. However, HMGB3 has been little studied. We analyzed the co-expression network between HMGB3 and differentially-expressed genes in the GSE17187 database, identifying the relevant transcription factors, and the conserved domain of HMGB3 to understand the underlying regulation mechanisms involved in gastric cancer. Thirty-one relationships between 11 differentially-expressed genes were included in a co-expression network; many of these genes have been identified as related to cancer, including TBX5 and TFR2. Further analysis identified nine transcription factors, these being GATA3, MZF1, GATA1, GATA2, SRY, REL, NFYB, NFYC, and NFYA, which could interact with HMGB3 to regulate target gene expression and consequently regulate gastric cancer cell proliferation, migration and invasion. The HMG-box domain was very similar in various species, with only a few amino acid changes, indicating conserved functions in HMG-box. This information helps to provide insight into the molecular mechanisms of HMGB3 in human gastric cancer.

A homozygous mutation in a consanguineous family consolidates the role of ALDH1A3 in autosomal recessive microphthalmia

Anomalies of eye development can lead to the rare eye malformations microphthalmia and anophthalmia (small or absent ocular globes), which are genetically very heterogeneous. Several genes have been associated with microphthalmia and anophthalmia, and exome sequencing has contributed to the identification of new genes. Very recently, homozygous variations within ALDH1A3 have been associated with autosomal recessive microphthalmia with or without cysts or coloboma, and with variable subphenotypes of developmental delay/autism spectrum disorder in eight families. In a consanguineous family where three of the five siblings were affected with microphthalmia/coloboma, we identified a novel homozygous missense mutation in ALDH1A3 using exome sequencing. Of the three affected siblings, one had intellectual disability and one had intellectual disability and autism, while the last one presented with normal development. This study contributes further to the description of the clinical spectrum associated with ALDH1A3 mutations, and illustrates the interfamilial clinical variation observed in individuals with ALDH1A3 mutations.

Pluronic-PEI copolymers enhance exon-skipping of 2'-O-methyl phosphorothioate oligonucleotide in cell culture and dystrophic mdx mice

A series of small-size polyethylenimine (PEI)-conjugated pluronic polycarbamates (PCMs) have been investigated for the ability to modulate the delivery of 2'-O-methyl phosphorothioate RNA (2'-OMePS) in vitro and in dystrophic mdx mice. The PCMs retain strong binding capacity to negatively charged oligomer as demonstrated by agarose gel retardation assay, with the formation of condensed polymer/oligomer complexes at a wide-range weight ratio from 1:1 to 20:1. The condensed polymer/oligomer complexes form 100-300 nm nanoparticles. Exon-skipping effect of 2'-OMePS was dramatically enhanced with the use of the most effective PCMs in comparison with 2'-OMePS alone in both cell culture and in vivo, respectively. More importantly, the effective PCMs, especially those composed of moderate size (2k-5kDa) and intermediate hydrophilic-lipophilic balance (7-23) of pluronics, enhanced exon-skipping of 2'-OMePS with low toxicity as compared with Lipofectamine-2000 in vitro or PEI 25k in vivo. The variability of individual PCM for delivery of antisense oligomer and plasmid DNA indicate the complexity of interaction between polymer and their cargos. Our data demonstrate the potential of PCMs to mediate delivery of modified antisense oligonucleotides to the muscle for treating muscular dystrophy or other appropriate myodegenerative diseases.

Association between statin use and intracerebral hemorrhage: a systematic review and meta-analysis

BACKGROUND AND PURPOSE

Accumulating evidence suggests that statins exert neuroprotective effects, but whether their use affects the outcomes of intracerebral hemorrhage (ICH) remains controversial. Therefore, we performed a systematic review and meta-analysis to investigate whether statin use before spontaneous ICH affects unfavorable functional outcome or mortality.

METHODS

We searched the Cochrane Library, MEDLINE, EMBASE and China National Knowledge Infrastructure databases for studies examining the effects of pre-ICH statin use on unfavorable functional outcome, mortality or neuroimaging outcomes in consecutively recruited patients with spontaneous ICH, regardless of the duration or dose of statin treatment.

RESULTS

A total of 12 studies were included that examined the effects of pre-ICH statin use on post-ICH outcomes in 1652 subjects in the favors pre-statin group and 5309 in the favors no pre-ICH statin group. Meta-analysis of 11 studies suggested that pre-ICH statin use did not significantly affect mortality across all three time points tested [in-hospital, 30 days, 90 days; odds ratio (OR) 0.85, 95% confidence interval (CI) 0.70-1.03]. However, meta-analysis of seven studies showed that pre-ICH statin use did significantly decrease 90-day mortality (OR 0.72, 95% CI 0.59-0.88). Meta-analysis of six studies showed that pre-ICH statin use was not associated with significant changes in unfavorable functional outcome. Moreover, pre-ICH statin use did not significantly affect admission hematoma volume (standardized mean difference 7.75, 95% CI -5.59 to 21.09).

CONCLUSION

Available evidence suggests that statin use before spontaneous ICH does not increase short-term mortality, unfavorable functional outcome or post-ICH hematoma volume at admission.

Pattern and predictors of volumetric change of parotid glands during intensity modulated radiotherapy

OBJECTIVE

To describe the pattern and predictors of volumetric change of parotid glands during intensity modulated radiotherapy (IMRT) for oropharyngeal cancer.

METHODS

A cohort of patients undergoing weekly CT scans during dose-painted IMRT was considered. The parotid glands were contoured at the time of treatment planning (baseline) and on all subsequent scans. For a given patient, the parotid glands were labelled as higher (H) and lower (L), based on the mean dose at planning. The volume of each gland was determined for each scan and the percent change from baseline computed. Data were fit to both linear and quadratic functions. The role of selected covariates was assessed with both logistic regression and pair-wise comparison between the sides. The analyses were performed considering the whole treatment duration or each separate half.

RESULTS

85 patients, 170 glands and 565 scans were analysed. For all parotids except one, the quadratic function provided a better fit than the linear one. Moreover, according to both the logistic regression and pair-wise comparison, the cumulative mean dose of radiation is independently correlated with the parotid shrinkage during the first but not the second half of the treatment. Conversely, age and weight loss are predictors of relative parotid shrinkage during the entire course of the treatment.

CONCLUSION

Parotid gland shrinkage during IMRT is not linear. Age, weight loss and radiation dose independently predict parotid shrinkage during a course of IMRT.

ADVANCES IN KNOWLEDGE

The present study adds to the pathophysiology of parotid shrinkage during radiotherapy.

A phase 1 trial of imatinib, bevacizumab, and metronomic cyclophosphamide in advanced colorectal cancer

Background:

This phase 1 clinical trial was conducted to determine the safety, maximum-tolerated dose (MTD), and pharmacokinetics of imatinib, bevacizumab, and metronomic cyclophosphamide in patients with advanced colorectal cancer (CRC).

Methods:

Patients with refractory stage IV CRC were treated with bevacizumab 5 mg kg⁻¹ i.v. every 2 weeks (fixed dose) plus oral cyclophosphamide q.d. and imatinib q.d. or b.i.d. in 28-day cycles with 3+3 dose escalation. Response was assessed every two cycles. Pharmacokinetics of imatinib and cyclophosphamide and circulating tumour, endothelial, and immune cell subsets were measured.

Results:

Thirty-five patients were enrolled. Maximum-tolerated doses were cyclophosphamide 50 mg q.d., imatinib 400 mg q.d., and bevacizumab 5 mg kg⁻¹ i.v. every 2 weeks. Dose-limiting toxicities (DLTs) included nausea/vomiting, neutropaenia, hyponatraemia, fistula, and haematuria. The DLT window required expansion to 42 days (1.5 cycles) to capture delayed toxicities. Imatinib exposure increased insignificantly after adding cyclophosphamide. Seven patients (20%) experienced stable disease for >6 months. Circulating tumour, endothelial, or immune cells were not associated with progression-free survival.

Conclusion:

The combination of metronomic cyclophosphamide, imatinib, and bevacizumab is safe and tolerable without significant drug interactions. A subset of patients experienced prolonged stable disease independent of dose level.

Dosimetric predictors of dysphonia after intensity-modulated radiotherapy for oropharyngeal carcinoma

AIMS

To investigate dosimetric predictors of voice changes after whole-field intensity-modulated radiotherapy (IMRT).

MATERIALS AND METHODS

Patients treated with whole-field IMRT for oropharyngeal/unknown primary tumours were selected for the present retrospective study having grossly uninvolved larynx at the time of radiotherapy and at least one follow-up visit. Voice changes were prospectively scored at each follow-up examination according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.0 scale and self-reported by two items (HN4 and HN10) of the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-HN) questionnaire. Predictors of toxicity were investigated at logistic regression, including various patient and tumour characteristics, as well as individual dosimetric data.

RESULTS

With a median follow-up of 18 months (range 3-46 months), peak CTCAE dysphonia was graded as 2 in 13 patients (10.5%), whereas 45 patients (36.3%) reported peak grade 0-1 voice changes according to FACT-HN4. Communication (FACT-HN10) was barely affected. At multivariate analysis, the mean laryngeal dose was an independent predictor of both grade 2 CTCAE dysphonia (odds ratio = 1.10, 95% confidence interval 1.01-1.20, P = 0.025) and grade 0-1 FACT-HN4 voice changes (odds ratio = 1.11, 95% confidence interval 1.04-1.18, P = 0.001). Further stratification optimised by a receiver operating characteristic (ROC) analysis showed that, to minimise the risk of grade 0-1 FACT-HN4 voice changes, the mean dose to the larynx has to be kept ≤ 49.4 Gy.

CONCLUSION

Voice changes after whole-field IMRT are common, but mild, and are strictly correlated to the dose received by the uninvolved larynx; in order to minimise the risk of side-effects, the mean dose to the larynx should be kept ≤ 50 Gy.