Postoperative 125I brachytherapy delivered by digital model obturators for recurrent or locally advanced maxillary cancers

OBJECTIVES/HYPOTHESIS

We aimed to evaluate the feasibility and effectiveness of postoperative (125) I brachytherapy delivered by use of digital model obturators for recurrent or locally advanced maxillary cancers.

STUDY DESIGN

Retrospective study.

METHODS

From 2006 to 2008, 12 patients (seven females; median age, 65 years; range, 22-86 years) with recurrent or locally advanced maxillary cancers showing positive margins after surgery underwent (125) I brachytherapy by use of digital model obturators and interstitial implants. The radioactivity was 18.5 to 33.3 MBq per seed, and the prescription dose was 80 to 160 Gy. Functional outcome of patients was evaluated by the Performance Status Scale (PSS) for head and neck cancer before and after brachytherapy.

RESULTS

The (125) I seeds and dosages were well distributed in the radiation fields, and all patients had higher PSS scores after than before treatment with obturators. During a median follow-up of 53 months (range, 28-62 months), local control at 3 and 5 years was 83.3% and 66.7%, respectively, with a mean local control time of 53.5 ± 3.79 months. Overall survival at 3 and 5 years was 91.7% and 71.4%, respectively, with a mean survival time of 56.6 ± 2.99 months. Two patients died due to local recurrence, and one patient died due to lung metastasis. No patient had severe complications during follow-up.

CONCLUSIONS

(125) I brachytherapy delivered by digital model obturator is effective in treating maxillary cancers with positive margins after maxillectomy for advanced or recurrent cancer. The method may improve the quality of life of patients with maxillary defects. Laryngoscope, 2012.

New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication

Tumour necrosis factor-alpha (TNF-a) antagonists have advanced the treatment of inflammatory arthropathies, and are even considered for use in refractory sarcoidosis with some success. Paradoxically, cases of new onset sarcoidosis-like diseases are increasingly reported in patients receiving TNF-a antagonists. Here, we report three cases of sarcoid-like granulomatosis that developed during treatment with TNF-a antagonists. Review of the Biologics clinic data base at Westmead, Sydney, Australia identified three patients whom, during anti-TNF therapy, developed non-caseating granulomas consistent with sarcoidosis. These three cases are described with review of the literature from 2000 to 2009 using PubMed. One hundred and sixty-nine patients within our data base were reviewed for the period 2003–2009. Sarcoidosis-like granulomas developed in three patients within a period of 3 to 36 months of treatment with etanercept and/or adalimumab. All cases demonstrated non-infective, non-caseating granulomas on renal or lymph node biopsy. Improvement was seen in two cases upon cessation of TNF-a antagonist and steroid therapy. Interestingly, clinical deterioration was noted upon re-challenge with the same TNF-a antagonist in one patient. To date, a total of 37 cases of sarcoid-like granuloma development after anti-TNF therapy have been reported in the literature. Development of sarcoidosis-like granulomatosis in patients treated with TNF-a antagonists is a phenomenon previously under-recognised. All three anti-TNF agents have been observed to cause this phenomenon, suggesting a ‘class effect’ rather than being drug specific.

Design & control of a 3D stroke rehabilitation platform

An upper limb stroke rehabilitation system is developed which combines electrical stimulation with mechanical arm support, to assist patients performing 3D reaching tasks in a virtual reality environment. The Stimulation Assistance through Iterative Learning (SAIL) platform applies electrical stimulation to two muscles in the arm using model-based control schemes which learn from previous trials of the task. This results in accurate movement which maximises the therapeutic effect of treatment. The principal components of the system are described and experimental results confirm its efficacy for clinical use in upper limb stroke rehabilitation.

The relationship between CAG repeat length polymorphism and infertility in Southern Chinese Han women

OBJECTIVE

To research the relationship between polymorphism of trinucleotide (CAG)n repeat alleles of the Exon 1 of androgen receptor gene and women with polycystic ovary syndrome (PCOS), or with endometriosis.

MATERIALS AND METHODS

One hundred and forty-one control women and 74 women with PCOS and with endometriosis were recruited. The (CAG)n repeat alleles were genotyped with 3100 genetic analyser. The repeat number and frequency distributions of (CAG)n alleles were compared and analyzed statistically.

RESULTS

The results showed that mean repeat number of the (CAG)n was significantly lower in women with PCOS than in controls (p<0.001). The mean repeat number of the (CAG)n was significantly different between infertile women with endometriosis (p<0.05). However, the differences between infertile women with PCOS and fertile women with PCOS was not significant (p>0.05).

CONCLUSIONS

These data indicated that (CAG)n repeat polymorphism have some influence, but have not a straight relationship in infertile women with PCOS and with endometriosis in this research population.

Production of technical grade phosphoric acid from incinerator sewage sludge ash (ISSA)

The recovery of phosphorus from sewage sludge ash samples obtained from 7 operating sludge incinerators in the UK using a sulfuric acid washing procedure to produce a technical grade phosphoric acid product has been investigated. The influences of reaction time, sulfuric acid concentration, liquid to solid ratio and source of ISSA on P recovery have been examined. The optimised conditions were the minimum stoichiometric acid requirement, a reaction time of 120 min and a liquid to solid ratio of 20. Under these conditions, average recoveries of between 72% and 91% of total phosphorus were obtained. Product filtrate was purified by passing through a cation exchange column, concentrated to 80% H(3)PO(4) and compared with technical grade H(3)PO(4) specifications. The economics of phosphate recovery by this method are briefly discussed.

[Clinical application of computer-aided design and rapid prototyping technique for radioactive seeds contained maxillary device]

OBJECTIVE

To test a new method to manufacture a maxillary applicator containing radioactive seeds for brachytherapy of malignant neoplasms based on computer aided design (CAD) and rapid prototyping (RP).

METHODS

Six patients with maxillary malignancy which had eroded the inferior wall of orbit and skull base were included in this study. After excision of the tumors, head CT data of these patients were transmitted into the computer. Three-dimensional digital image of the patient's defected region was then obtained with special software processing based on Mimics 8.11 and Geomagic 7.0 and the resin cast of the defected region was manufactured by rapid prototyping. The elastic obturator was then made on this resin cast which can duplicate the undercut tissue of the defected region. After the obturator was completed, the radiotherapy plan was made. (125)I radioactive seeds were implanted into the tissues, and they were also implanted into the target area of the obturator which was used as a maxillary applicator at the same time. The number of radioactive seeds was then counted and the stability of radioactive seeds was determined by CT examination. All these 6 patients were followed-up for 12 months.

RESULTS

All the obturators had good retention and stability and fitted the designed target tissue very well. (125)I radioactive seeds in the form of the obturator applicator were stable. For all patients, the total number of radioactive seeds used was 189. Among them, 105 seeds, 55.6% of the total, were contained in obturator applicators. After the obturator applicators were used, the amount of radioactive seeds irradiating the target regions was significantly increased when compared with that of before. After follow-up of 12 months, there was no recurrence nor severe complications.

CONCLUSION

(125)I radioactive seeds contained maxillary applicator made by computer aided design and rapid prototyping can effectively improve the brachytherapy of (125)I when it is used for the post-operation radiotherapy of maxillary malignant tumors.

[The technic and dose evaluation of postoperative (125)I radioactive seeds brachytherapy for malignant tumors of maxilla]

OBJECTIVE

To evaluate the technique and effect of treating malignant tumors of maxilla with postoperative brachytherapy by digital model obturators containing (125)I radioactive seeds.

METHODS

Four patients with adnoid cystic carcinomas and two with squamous cell carcinomas in the maxilla were included in this study. All patients accepted (125)I seeds implantation after operation, and wore digital model obturators containing (125)I seeds. The prescription dose was 80 Gy. All patients were followed up every 2 months after treatment.

RESULTS

The total number of seeds used in these six patients was 189, and 105 seeds were contained in obturators. Radioactive seeds and doses distributed very well as designed in all patients. No tumors recurred after follow up of 12-16 months and there were no severe complications.

CONCLUSIONS

It's an effective way to treat malignant tumors with positive excision margin in the maxilla by brachytherapy using digital model obturators which contain (125)I radioactive seeds.

Connexin expression and gap junctional coupling in human cumulus cells: contribution to embryo quality

Gap junctional coupling among cumulus cells is important for oogenesis since its deficiency in mice leads to impaired folliculogenesis. Multiple connexins (Cx), the subunits of gap junction channels, have been found within ovarian follicles in several species but little is known about the connexins in human follicles. The aim of this study was to determine which connexins contribute to gap junctions in human cumulus cells and to explore the possible relationship between connexin expression and pregnancy outcome from in vitro fertilization (IVF). Cumulus cells were obtained from IVF patients undergoing intra-cytoplasmic sperm injection (ICSI). Connexin expression was examined by RT-PCR and confocal microscopy. Cx43 was quantified by immunoblotting and gap junctional coupling was measured by patch-clamp electrophysiology. All but 5 of 20 connexin mRNAs were detected. Of the connexin proteins detected, Cx43 forms numerous gap junction-like plaques but Cx26, Cx30, Cx30.3, Cx32 and Cx40 appeared to be restricted to the cytoplasm. The strength of gap junctional conductance varied between patients and was significantly and positively correlated with Cx43 level, but neither was correlated with patient age. Interestingly, Cx43 level and intercellular conductance were positively correlated with embryo quality as judged by cleavage rate and morphology, and were significantly higher in patients who became pregnant than in those who did not. Thus, despite the presence of multiple connexins, Cx43 is a major contributor to gap junctions in human cumulus cells and its expression level may influence pregnancy outcome after ICSI.

[Application of computer aided design and rapid prototyping technology for defected maxilla restoration]

OBJECTIVE

To test a new cast-making method based on computer aided design (CAD) and rapid prototyping (RP) technology for defected maxilla.

METHODS

Head CT data of 12 patients with defected maxilla were transmitted into a computer. Three-dimensional digital image of the patient's defected maxilla was then obtained based on Mimics 8.11 and Geomagic 7.0 and the plastic cast of the defected region was manufactured by prototyping. The obturator was made on this plastic cast that duplicated the undercut tissue of defected area. The prominent part of the obturator was made of elastic heat-curing resin and it was helpful to gain the retention through the engagement between the obturator and the tissue undercut. After the obturator was finished, the upper removable partial denture was fabricated in conventional method. The combination of these two parts was achieved using magnetic attachment. Clinical effects of obturator and removable partial denture were evaluated and the nasalance value of 5 patients before and after insertion of the obturator was measured using nanometer.

RESULTS

The obturator and removable partial denture could be seated into place separately. They all had good retention and stability. After the obturator was seated in place, the nasalance of non-nasal and vowel text decreased from (46.53 +/- 13.86)% to (22.60 +/- 8.52)% (P < 0.001).

CONCLUSIONS

The cast-making method based on CAD and RP technology for cast-making of defected maxilla is feasible and practical.

Local blockade of Rydberg excitation in an ultracold gas

In the laser excitation of ultracold atoms to Rydberg states, we observe a dramatic suppression caused by van der Waals interactions. This behavior is interpreted as a local excitation blockade: Rydberg atoms strongly inhibit excitation of their neighbors. We measure suppression, relative to isolated atom excitation, by up to a factor of 6.4. The dependences of this suppression on both laser irradiance and atomic density are in good agreement with a mean-field model. These results are an important step towards using ultracold Rydberg atoms in quantum information processing.