[Comparison of efficacy between sorafenib and sunitinib as first-line therapy for metastatic renal cell carcinoma and analyze prognostic factors for survival]

Objective: To investigate the efficacy and drug related adverse reactions of sorafenib and sunitinib as first-line tyrosine-kinase inhibitors (TKIs) for patients with metastatic renal cell carcinoma (mRCC) and analyze the clinical prognostic factor for survival. Methods: The data of 271 patients with metastatic renal cell carcinoma who had complete clinicopathological data were retrospectively analyzed, including 174 cases in sorafenib group and 97 cases in sunitinib group, to access patients' overall survival (OS) and progression-free survival (PFS). Prognostic values of all characteristics were determined by using univariate and multivariate Cox regression models. Results: The objective response rates (ORR) of the sorafenib and sunitinib groups were 14.9% and 19.6%, respectively, and the disease control rates (DCR) were 85.1% and 88.6%, respectively. No significant difference was found between the sorafenib and sunitinib group in ORR (P=0.325) or DCR (P=0.408). The most common grade 3 to 4 adverse events in the sorafenib group were hand-foot syndrome (6.7%), diarrhea (2.3%), and rash (2.3%). The most common grade 3 to 4 adverse events in the sunitinib group were neutropenia (6.2%), hand-foot syndrome (6.2%), and thrombocytopenia (4.6%). During the follow-up, 97 cases death occurred and 81 cases disease progression occurred in sorafenib group. The median PFS was 12 months (95% CI: 9-15 months), and the median OS was 25 months (95% CI: 21-29 months) in sorafenib group. While 74 cases death occurred and 40 cases disease progression occurred in sunitinib group, the median PFS was 12 months (95% CI: 10-12 months) and the median OS was 23 months (95% CI: 20-32 months) in sunitinib group. No significant difference was found between the sorafenib and the sunitinib group in PFS (P=0.771) or OS (P=0.548). Multivariate analysis showed Fuhrman grades (HR=1.358, 95%CI: 1.004-1.835), number of metastatic sites (HR=1.550, 95%CI: 1.143-2.101) and MSKCC risk grade (Intermediate risk group: HR=1.621, 95%CI: 1.117-2.232; Poor risk group: HR=2.890, 95%CI: 1.942-4.298) were independent prognostic factors for PFS. Fuhrman grades (HR=2.135, 95%CI: 1.533-2.974), number of metastatic sites (HR=1.774, 95%CI: 1.279-2.461) and MSKCC risk grade (Intermediate risk group: HR=1.415, 95%CI: 1.002-1.998; Poor risk group: HR=3.161, 95%CI: 2.065-4.838) were independent prognostic factors for OS. Conclusions: The results of this study indicate that sorafenib and sunitinib are both effective as the first-line TKIs for mRCC patients and sorafenib has comparable efficacy to sunitinib. But they have differences in the incidence of adverse effects. Fuhrman grades, number of metastatic sites and MSKCC risk grade are independent prognostic factors for mRCC patients.

MUC1- and Survivin-based DNA Vaccine Combining Immunoadjuvants CpG and interleukin-2 in a Bicistronic Expression Plasmid Generates Specific Immune Responses and Antitumour Effects in a Murine Colorectal Carcinoma Model

DNA vaccination is a promising cancer treatment due to its safety, but poor immunogenicity limits its application. However, immunoadjuvants, heterogeneous prime-boost strategies and combination with conventional treatments can be used to improve the antitumour immune effects. A CpG motif and interleukin-2 (IL-2) cytokine are often used as adjuvants. In this study, a DNA vaccine containing a CpG motif was constructed to evaluate its adjuvant effect. The results show that the cytotoxicity of the DNA vaccine was increased fivefold, and survival lifetime was prolonged twofold by the CpG motif adjuvant. To simplify the industrial production process, a bicistronic plasmid was constructed to carry the fusion genes of survivin/MUC1 (MS) and IL-2 and with a CpG motif in its backbone. The results showed that the antitumour effect of the bicistronic vaccine was the same as that of the two vaccine co-injected regime. Furthermore, the vaccine could suppress metastatic tumour foci by 69.1% in colorectal carcinoma-bearing mice. Moreover, the vaccine induced survivin- and MUC1-specific immune responses in splenocytes and induced the immune promoting factor CCL-19 and GM-CSF upregulated, while metastatic-associated factor MMP-9 and immunosuppressing factor PD-L1 downregulated in tumour tissue. When combining the vaccine with the chemotherapy drug oxaliplatin, the survival was prolonged by about 2.5-fold. In conclusion, the DNA vaccine containing a CpG motif in bicistronic form showed good effects on colorectal cancer by inhibiting both tumour growth and metastasis, and combination with oxaliplatin could improve its antitumour effects.

Tannerella forsythia and coating color on the tongue dorsum, and fatty food liking associate with fat accumulation and insulin resistance in adult catch-up fat

BACKGROUND/OBJECTIVES

We aimed to determine the alteration of Tannerella forsythia and coating color on the dorsal tongue, and fatty food liking in catch-up fat in adult (CUFA), as well as the probable associations between fat accumulation, insulin resistance (IR) and these changes.

SUBJECTS/METHODS

T. forsythia on the tongue dorsum, fatty food liking, fat accumulation and insulin sensitivity were investigated in CUFA humans and rats, and tongue-coating color was observed in CUFA individuals. We further determined the changes of fatty food liking, fat accumulation and IR in T. forsythia-infected rodents by oral lavage.

RESULTS

Increases in fat accumulation, IR, percentage of subjects with yellow tongue coating and that with T. forsythia detected were observed in CUFA individuals. Additionally, the fat ranking scores were significantly lower and the hedonic ratings of low-fat options of sampled food were lower, while the ratings of high-fat options were remarkably higher in CUFA subjects. Additionally, T. forsythia level elevated in CUFA rats, and fatty food liking, fat accumulation and IR increased in CUFA and T. forsythia-infected animals, with the increases in T. forsythia infection and fatty food liking preceding the occurrence of fat accumulation and IR.

CONCLUSIONS

T. forsythia and yellow coating on the dorsal tongue and fatty food liking associate fat accumulation and IR in CUFA. Moreover, we tentatively put forward that T. forsythia, which is very important in yellow tongue-coating microbiota, and its consequent increases in fatty food liking, might be crucial in the development of fat accumulation and IR in CUFA.

Genetic analysis of a hybrid sterility gene that causes both pollen and embryo sac sterility in hybrids between Oryza sativa L. and Oryza longistaminata

Oryza longistaminata originates from African wild rice and contains valuable traits conferring tolerance to biotic and abiotic stress. However, interspecific crosses between O. longistaminata and Oryza sativa cultivars are hindered by reproductive barriers. To dissect the mechanism of interspecific hybrid sterility, we developed a near-isogenic line (NIL) using indica variety RD23 as the recipient parent and O. longistaminata as the donor parent. Both pollen and embryo sac semi-sterility were observed in F₁ hybrids between RD23 and NIL. Cytological analysis demonstrated that pollen abortion in F₁ hybrids occurred at the early bi-nucleate stage due to a failure of the first mitosis in microspores. Partial embryo sacs in the F₁ hybrids were defective during the functional megaspore formation stage. Most notably, nearly half of the male or female gametes were aborted in heterozygotes S40ⁱS40^l, regardless of their genotypes. Thus, S40 was indicated as a one-locus sporophytic sterility gene controlling both male and female fertility in hybrids between RD23 and O. longistaminata. A population of 16 802 plants derived from the hybrid RD23/NIL-S40 was developed to fine-map S40. Finally, the S40 locus was delimited to an 80-kb region on the short arm of chromosome 1 in terms with reference sequences of cv. 93-11. Eight open reading frames (ORFs) were localized in this region. On the basis of gene expression and genomic sequence analysis, ORF5 and ORF8 were identified as candidate genes for the S40 locus. These results are helpful in cloning the S40 gene and marker-assisted transferring of the corresponding neutral allele in rice breeding programs.

[Dynamic alteration of microRNA in high phosphorus induced calcification of vascular smooth muscle cell]

OBJECTIVE

To study the change of microRNA during the early stage of high phosphorus induced vascular smooth muscle cell (VSMC) calcification and its related mechanism.

METHODS

The in vitro calcification model was created through stimulating VSMC cell line A7r5 with high Pi (2.6 mmol/L) for 7 d. The calcification was validated through ocresolphthalein complexone colorimetry to detect the cellular calcium content, real-time PCR to measure the calcification-related gene expression and alizarin red staining to observe the formation of calcium nodules. Based on the cell calcification model, microRNA microarray array was applied to screen the profiles of microRNA expression in VSMC following high Pi stimulation for different periods (0, 3 and 12 h). The array data were analyzed by TAM tool to explore the activated signaling pathway.

RESULTS

The calcium content of A7r5 cells induced by high Pi was increased 9.6 times high as cells without Pi treatment (P<0.05). VSMC contractile phenotype genes (SM-α actin, SM22) were down-regulated (P<0.05), while calcification-related genes (BMP2, MSX2, Runx2) were up-regulated (P<0.05) in VSMC stimulated by high Pi. The calcium nodules were obviously formed in cells after 7 d high Pi treatment. In microarray experiment, 680 individual microRNAs were detected in high Pi-treated VSMCs at different time points (0, 3 and 12 h). Among these genes, miR-183, miR-664 and miR-9* were increased whereas miR-542-5P, let-7f and miR-29a were decreased in time-dependent manners. Twenty-six kinds of signaling pathways, including cell apoptosis, differentiation and proliferation, were significantly activated. All these activated pathways were associated with calcification.

CONCLUSION

This study implies that microRNA changed in high Pi-induced VSMCs may involve in the process of calcification.

Study of clinical diagnosis of cervical glandular intraepithelial neoplasia

OBJECTIVE

To preliminarily evaluate the clinical significance of different methods in diagnosis of cervical glandular intraepithelial neo- plasia (CGIN).

MATERIALS AND METHODS

Clinical manifestations, ThinPrep cytologic test (TCT), cervical biopsy, and pathological features of 106 patients with CGIN admitted to Beijing Obstetrics and Gynecology Hospital between 2008 and 2011 were retrospectively analyzed.

RESULTS

Among 146 cases diagnosed with CGIN, 87 (59.6%) had L-CGIN and 59 (40.4%) H-CGIN. Thirty-seven patients (25.6%) were found to have simple CGIN and 109 (74.6%) had CGIN complicated with cervical intraepithelial neoplasia (CIN). TCT revealed atypical glandular cells (AGC) in 20 patients (13.7%), six of whom had L-CGIN (6.9%) and 14 (23.7%) had H-CGIN with statistical significance between two groups (p < 0.05). TCT detected AGC in 13 cases (35.1%) with simple CGIN and seven with mixed CGIN (6.4%) (P<0.05). Endocervical curettage (ECC) revealed AGC abnormality in ten cases (25.6%). Cervical biopsy under colposcope revealed 32 patients (22.9%) had CGIN, including 15 L-CGIN (18.3%), and 17 H-CGIN (29.3%) with no statistical significance (p > 0.05). Among those diagnosed with CGIN by colposcope-assisted cervical biopsy, 19 (51.4%) had simple CGIN and 13 (11.9%) mixed CGIN (p < 0.05).

CONCLUSION

Preoperative diagnostic rate of simple CGIN was higher than CGIN complicated with CIN.

Evaluation of the GenoType(®) MTBDRplus line probe assay on sputum-positive samples in routine settings in China

BACKGROUND

Rapid molecular methods have been recommended for early detection of drug-resistant tuberculosis (TB).

OBJECTIVE

To evaluate the performance of the GenoType(®) MTBDRplus assay in routine settings in China.

METHODS

Sputum-positive samples were collected consecutively from 1 April to 31 December 2010. MTBDRplus results were compared to those of conventional drug susceptibility testing (DST). The McNemar χ(2) test and κ coefficient were used to assess performance.

RESULTS

Of 427 smear-positive sputum samples collected, conventional DST and MTBDTplus confirmed drug resistance in 326. The sensitivities and specificities for MTBDRplus in detecting isoniazid (INH) and rifampicin (RMP) resistance were respectively 76.47%, 95.44%, 85.94% and 93.13%. The McNemar χ(2) test indicated no significant difference between the two methods (P = 0.106 for INH and P = 0.083 for RMP). The κ values for INH, RMP and multidrug resistance were respectively 0.75, 0.75 and 0.70.

CONCLUSIONS

Although the MTBDRplus assay was moderately concordant with conventional DST in detecting INH and RMP resistance, as a prospective rapid molecular method for MDR-TB detection, potential resistant mutations need to be incorporated to improve the accuracy of detection.

Angular sway propagation in One Leg Stance and quiet stance with Inertial Measurement Units for older adults

Postural stability degrades with age, threating the health and life quality of the older adults. One Leg Stance (OLS) is one of the standard and commonly adopted assessments for postural stability, and the postural sway in OLS has been demonstrated to be related with age. The propagation of postural sway between body segments could be a hint to the underlying mechanism of balance control. However, it is not yet fully understood. Therefore, the aim of this paper was to study the angular sways and their propagation of the head, trunk, and lower limb in healthy older adults. A cross-correlation of the normalized angular speeds was performed and the experiment with 68 older adults was conducted. The results showed that the head, hip and ankle joints affected the transfer of angular sway with a relatively lower correlation and longer latency.

Evaluation of the workload and drowsiness during car driving by using high resolution EEG activity and neurophysiologic indices

Sleep deprivation and/or a high workload situation can adversely affect driving performance, decreasing a driver's capacity to respond effectively in dangerous situations. In this context, to provide useful feedback and alert signals in real time to the drivers physiological and brain activities have been increasingly investigated in literature. In this study, we analyze the increase of cerebral workload and the insurgence of drowsiness during car driving in a simulated environment by using high resolution electroencephalographic techniques (EEG) as well as neurophysiologic variables such as heart rate (HR) and eye blinks rate (EBR). The simulated drive tasks were modulated with five levels of increasing difficulty. A workload index was then generated by using the EEG signals and the related HR and EBR signals. Results suggest that the derived workload index is sensitive to the mental efforts of the driver during the different drive tasks performed. Such workload index was based on the estimation the variation of EEG power spectra in the theta band over prefrontal cortical areas and the variation of the EEG power spectra over the parietal cortical areas in alpha band. In addition, results suggested as HR increases during the execution of the difficult driving tasks while instead it decreases at the insurgence of the drowsiness. Finally, the results obtained showed as the EBR variable increases of its values when the insurgence of drowsiness in the driver occurs. The proposed workload index could be then used in a near future to assess on-line the mental state of the driver during a drive task.

An electroencephalographic Peak Density Function to detect memorization during the observation of TV commercials

Nowadays, there is a growing interest in measuring the impact of advertisements through the estimation of cerebral reactions. Several techniques and methods are used and discussed in the consumer neuroscience. In such a context, the present paper provides a novel method to estimate the level of memorization occurred in subjects during the observation of TV commercials. In particular, the present work introduce the Peak Density Function (PDF) as an electroencephalographic (EEG) time-varying variable which is correlated with the cerebral events of memorization of TV commercials. The analysis has been performed on the EEG activity recorded on twenty healthy subjects during the exposition to several advertisements. After the EEG recordings, an interview has been performed to obtain the information about the memorized scenes for all the video clips watched by the subjects. Such information has been put in correlation with the occurrence of transient peaks of EEG synchronization in the theta band, by computing the PDF. The present results show that the increase of PDF is positively correlated, scene by scene, (R=0.46, p<;0.01) with the spontaneous recall of subjects. This technology could be of help for marketers to overcome the drawbacks of the standard marketing tools (e.g., interviews, focus groups) when analyzing the impact of advertisements.

Association of Resting Heart Rate with Infrarenal Aortic Diameter: A Cross Sectional Study in Chinese Hypertensive Adults

OBJECTIVE

Elevated resting heart rate (RHR) has been shown to be a risk marker for cardiovascular disease. Results from studies on the effects of RHR in large arteries are limited to the functional changes of those arteries, while the association between RHR and aortic diameter remains largely understudied.

METHODS

This was a cross sectional study of hypertensive Chinese adults from rural areas. The maximum infrarenal aortic diameter (maxIAD) from renal arteries to the iliac bifurcation was obtained by ultrasound. MaxIADs in different RHR groups were compared in males and females separately because of the significant differences between sexes. Multiple regression analysis was used to determinate the correlation between RHR and maxIAD. Further interactions between three factors (BMI, smoking, and anti-hypertensive regimens) and RHR for maxIAD were examined using subgroup analysis.

RESULTS

19,200 subjects were enrolled in the study, with an average age of 64.8±7.4 years and 61.6% females. Only 22 cases (0.11%) were detected with AAA, with males (n = 17) presenting a higher AAA incidence than females (n = 5). In subjects ≥65 years, there were 18 (0.19%) AAA, and 15 (83.3%) had a history of smoking. In the total subjects, the mean maxIAD ranged from 15.7±2.1 mm to 15.2±2.2 mm as RHR changed from the lowest quartile to the highest (≥84 bpm) in males, with a similar tendency observed in females. The correlation coefficient of RHR on maxIAD was -0.17 in males and -0.12 in females. Further subgroup analysis revealed that smoking exaggerated the correlation between RHR and maxIAD, but only in females.

CONCLUSIONS

A low AAA incidence was observed in this hypertensive Chinese population. There was a negative association between RHR and maxIAD, potentially exaggerated by smoking, especially in females.

Production, characterization and immunogenicity of P particles derived from norovirus GII.4 genotype 2004 variant

Norovirus (NoV) is the main cause of nonbacterial infectious gastroenteritis. Due to the difficulty of culturing the virus, research on vaccine against NoV is focused on virus-like particles (VLPs). On the other hand, the P particles assembled from the P domains of NoV capsid protein become a promising vaccine candidate. GII.4 is the most prevalent genotype of NoV. While the immunogenicity of P particles derived from the GII.4 1996 variant has been investigated, the research on P particles of more recently prevalent variants is lacking. In this study, the P domain of the capsid protein of GII.4 genotype 2004 variant was expressed in Escherichia coli, purified and auto-assembled into P particles of 14-25 nm. Immunization with P particles induced specific serum antibodies with titers of 245,600 and 145,700 in mice and rabbits, respectively. The GII.4 NoV 2004 variant bound to type A, B and O secretor-positive saliva and immune sera blocked this binding, suggesting induction of neutralizing activity in such sera. Thus, this study demonstrated the immunogenicity of NoV P particles generated from E. coli and provided evidence supporting the development of this approach.

Prevalence and influencing factors of depressive symptoms among women of reproductive age in the rural areas of Hubei, China

OBJECTIVES

Depression is one of the most common mental disorders and a major public health problem in the Chinese population, especially among women. The current study aims to understand prevalence of depression symptoms and provide detailed epidemiological factors associated with depression among reproductive women in rural areas which was paid less attention in previous surveys.

STUDY DESIGN

Cross-sectional study.

METHODS

Face-to-face household interviews were conducted on 1058 women (age: 15-49 years) in rural areas from July 2012 to August 2012. Questionnaires were used to investigate the influencing factors of depression among women. Pearson's χ(2), logistic regression analysis and structural equation modelling (SEM) were applied to analyze the related factors.

RESULTS

The prevalence of depression among women was 30.7% [95% confidence interval (CI): 27.9%-33.5%]. Compared with non-depressed individuals, those with depression were more likely to be short of social support [odd ratio (OR): 0.940, P < 0.001) and have no one to talk with (OR: 0.366, P < 0.001), to be dissatisfied with the house (OR: 2.673, P < 0.001) and economy (OR: 2.268, P < 0.01) of their family, and to have great pressure (OR: 2.099, P < 0.01), negative life events (OR: 1.485, P < 0.05) and physical diseases (OR: 1.364, P < 0.05). Pressure status, social support assessment, and socio-economic status were negatively related to depression (correlation coefficient: -0.57, -0.27 and 0.17).

CONCLUSIONS

The high prevalence of depression among reproductive women in rural areas is of particular concern. Factors associated with depression may assist health care administrations to identify and assess high-risk women and target strategies accordingly.

The neuropeptide vasoactive intestinal peptide: direct effects on immune cells and involvement in inflammatory and autoimmune diseases

Neuropeptides represent an important category of endogenous contributors to the establishment and maintenance of immune deviation in the immune-privileged organs such as the CNS and in the control of acute inflammation in the peripheral immune organs. Vasoactive intestinal peptide (VIP) is a major immunoregulatory neuropeptide widely distributed in the central and peripheral nervous system. In addition to neurones, VIP is synthesized by immune cells which also express VIP receptors. Here, we review the current information on VIP production and VIP-receptor-mediated effects in the immune system, the role of endogenous and exogenous VIP in inflammatory and autoimmune disorders and the present and future VIP therapeutic approaches.

Solid-phase extraction using molecularly imprinted polymer for determination of ochratoxin A in human urine

A rapid, selective and reliable sample preparation technique employing solid-phase extraction (SPE) based on molecularly imprinted polymer (MIP) for the determination of ochratoxin A (OTA) in human urine was described. After sample adjustment to pH 2.5 with 0.1 M HCl, the urine sample was loaded onto the MIP-SPE column, and after a wash step, OTA was eluted for measurement by ultra-high performance liquid chromatography coupled with fluorescence detection. Key parameters which affected the MIP-SPE extraction efficiency were optimized as was the detection method. Under the optimised conditions, the limits of detection and quantification for OTA in urine were 0.2 ng/ml and 0.6 ng/ml, respectively. The recoveries for OTA in urine, spiked at the 0.6, 6.0 and 60 ng/ml levels, ranged from 92.0 to 98.9%. Sixty urine samples were analysed, of which four were found to contain OTA at concentrations ranging from 0.022 to 0.083 ng/ml; the positive results were confirmed by liquid chromatography coupled with tandem mass spectrometry. OTA determination in urine is a good indicator for human exposure to the mycotoxin, and this is the first report on OTA contamination in Chinese people.

Two biomarker-directed randomized trials in European and Chinese patients with nonsmall-cell lung cancer: the BRCA1-RAP80 Expression Customization (BREC) studies

BACKGROUND

In a Spanish Lung Cancer Group (SLCG) phase II trial, the combination of BRCA1 and receptor-associated protein 80 (RAP80) expression was significantly associated with outcome in Caucasian patients with nonsmall-cell lung cancer (NSCLC). The SLCG therefore undertook an industry-independent collaborative randomized phase III trial comparing nonselected cisplatin-based chemotherapy with therapy customized according to BRCA1/RAP80 expression. An analogous randomized phase II trial was carried out in China under the auspices of the SLCG to evaluate the effect of BRCA1/RAP80 expression in Asian patients.

PATIENTS AND METHODS

Eligibility criteria included stage IIIB-IV NSCLC and sufficient tumor specimen for molecular analysis. Randomization to the control or experimental arm was 1 : 1 in the SLCG trial and 1 : 3 in the Chinese trial. In both trials, patients in the control arm received docetaxel/cisplatin; in the experimental arm, patients with low RAP80 expression received gemcitabine/cisplatin, those with intermediate/high RAP80 expression and low/intermediate BRCA1 expression received docetaxel/cisplatin, and those with intermediate/high RAP80 expression and high BRCA1 expression received docetaxel alone. The primary end point was progression-free survival (PFS).

RESULTS

Two hundred and seventy-nine patients in the SLCG trial and 124 in the Chinese trial were assessable for PFS. PFS in the control and experimental arms in the SLCG trial was 5.49 and 4.38 months, respectively [log rank P = 0.07; hazard ratio (HR) 1.28; P = 0.03]. In the Chinese trial, PFS was 4.74 and 3.78 months, respectively (log rank P = 0.82; HR 0.95; P = 0.82).

CONCLUSION

Accrual was prematurely closed on the SLCG trial due to the absence of clinical benefit in the experimental over the control arm. However, the BREC studies provide proof of concept that an international, nonindustry, biomarker-directed trial is feasible. Thanks to the groundwork laid by these studies, we expect that ongoing further research on alternative biomarkers to elucidate DNA repair mechanisms will help define novel therapeutic approaches.

TRIAL REGISTRATION

NCT00617656/GECP-BREC and ChiCTR-TRC-12001860/BREC-CHINA.

Curative therapy for bladder cancer in routine clinical practice: a population-based outcomes study

AIMS

Definitive therapy of bladder cancer involves cystectomy or radiotherapy; controversy exists regarding optimal management. Here we describe the management and outcomes of patients treated in routine practice.

MATERIALS AND METHODS

Treatment records were linked to the Ontario Cancer Registry to identify all cases of bladder cancer in Ontario treated with cystectomy or radiotherapy in 1994-2008. Practice patterns are described in three study periods: 1994-1998, 1999-2003, 2004-2008. Logistic regression, Cox model and propensity score analyses were used to evaluate factors associated with treatment choice and survival.

RESULTS

In total, 3879 cases (74%) underwent cystectomy and 1380 (26%) were treated with primary radiotherapy. Cystectomy use increased over time (66, 75, 78%), whereas radiotherapy decreased (34, 25, 22%), P < 0.001. There was substantial regional variation in the proportion of cases undergoing radiotherapy (range 16-51%). Five year cancer-specific survival (CSS) and overall survival were 40 and 36% for surgical cases and 35 and 26% for radiotherapy cases (P < 0.001). In multivariate Cox model and propensity score analyses, there was no significant difference in CSS between surgery and radiotherapy (hazard ratio 0.99, 95% confidence interval 0.91-1.08); radiotherapy was associated with slightly inferior overall survival (hazard ratio 1.08, 95% confidence interval 1.00-1.16).

CONCLUSION

Utilisation of cystectomy for bladder cancer in routine practice has increased over time with no evidence of a significant difference in CSS between radiotherapy and cystectomy.

Development of new muscle contraction sensor to replace sEMG for using in muscles analysis fields

Nowadays, the technologies for detecting, processing and interpreting bioelectrical signals have improved tremendously. In particular, surface electromyography (sEMG) has gained momentum in a wide range of applications in various fields. However, sEMG sensing has several shortcomings, the most important being: measurements are heavily sensible to individual differences, sensors are difficult to position and very expensive. In this paper, the authors will present an innovative muscle contraction sensing device (MC sensor), aiming to replace sEMG sensing in the field of muscle movement analysis. Compared with sEMG, this sensor is easier to position, setup and use, less dependent from individual differences, and less expensive. Preliminary experiments, described in this paper, confirm that MC sensing is suitable for muscle contraction analysis, and compare the results of sEMG and MC sensor for the measurement of forearm muscle contraction.

Application of wireless inertial measurement units and EMG sensors for studying deglutition - Preliminary results

Different types of sensors are being used to study deglutition and mastication. These often suffer from problems related to portability, cost, reliability, comfort etc. that make it difficult to use for long term studies. An inertial measurement based sensor seems a good fit in this application; however its use has not been explored much for the specific application of deglutition research. In this paper, we present a system comprised of an IMU and EMG sensor that are integrated together as a single system. With a preliminary experiment, we determine that the system can be used for measuring the head-neck posture during swallowing in addition to other parameters during the swallowing phase. The EMG sensor may not always be a reliable source of physiological data especially for small clustered muscles like the ones responsible for swallowing. In this case, we explore the possibility of using gyroscopic data for the recognition of deglutition events.

Effect of Aspergillus flavus contamination on the inherent quality of Glycyrrhiza uralensis

Glycyrrhiza uralensis is a common edible plant of the Chinese Materia Medica (CMM). Such a herb might be naturally contaminated with toxicogenic fungi producing various mycotoxins that can cause serious harm to humans. So far, studies have focused mainly on mycotoxin detection in CMM, but the effect of mycotoxin production on the inherent quality of CMM has not been investigated and elucidated. In the present study, sterilised G. uralensis was inoculated and incubated with Aspergillus flavus for several days to investigate the effect of aflatoxins accumulation on the inherent quality of G. uralensis. Changes in content of aflatoxin B1, B2, G1 and G2, and the herb's four bioactive components, i.e. glycyrrhizic acid, liquiritin apioside, liquiritin and liquiritigenin, were detected using ultra performance liquid chromatography coupled with fluorescence and photodiode array detection, respectively. The results showed that incubation of G. uralensis with A. flavus for 10 days resulted in the accumulation of aflatoxins, especially aflatoxin B1 and B2, and the reduction of the four bioactive components. From the negative correlation between the content of aflatoxins and bioactive components, it can be concluded that fungal contamination does not only result in harmful mycotoxins in CMM, but also influences its inherent quality.

Factors associated with referral to medical oncology and subsequent use of adjuvant chemotherapy for non-small-cell lung cancer: a population-based study

BACKGROUND

Adjuvant chemotherapy (act) for non-small-cell lung cancer (nsclc) is associated with improved survival in the general population, but may be underutilized. We explored the factors associated with referral to medical oncology and subsequent use of act among all patients with resected nsclc in Ontario, Canada.

METHODS

The Ontario Cancer Registry was used to identify all incident cases of nsclc diagnosed in Ontario during 2004-2006. We linked electronic records of treatment and of physician billing to identify surgery, act, and medical oncology consultation. A multivariate logistic regression model was used to evaluate factors associated with referral to medical oncology and subsequent use of act.

RESULTS

Among 3354 cases of nsclc resected in Ontario during 2004-2006, 1830 (55%) were seen postoperatively by medical oncology, and 1032 (31%) were treated with act. Patients more than 70 years of age were less likely than younger patients to have a consultation [odds ratio (or): 0.4; p < 0.001]. A higher proportion of cases with stage ii or iii nsclc than with stage i disease were referred (ors: 2.7, 2.0 respectively; p < 0.005). We observed substantial geographic variation in the proportion of surgical cases referred (range: 32%-88%) that was not explained by differences in case mix. Among cases referred to medical oncology, older patients (age 60-69 years, or: 0.4; age 70+ years, or: 0.1; p < 0.001) with greater comorbidity (Charlson comorbidity index: 3+; or: 0.5; p < 0.05) and a longer postoperative stay (median length of stay: 7+ days; or: 0.7; p = 0.001) were less likely to receive act. Use of act was greater in patients with stage ii or iii than with stage i disease (ors: 3.0, 2.7 respectively; p < 0.001); use also varied with geographic location (range: 46%-63%).

CONCLUSIONS

The initial decision to refer to medical oncology is associated with age and stage of disease, and those factors have an even greater effect on the decision to offer act. Comorbidity and postoperative length of stay were not associated with initial referral, but were associated with use of act in patients seen by medical oncology.

Assessment of mental fatigue during car driving by using high resolution EEG activity and neurophysiologic indices

Driving tasks are vulnerable to the effects of sleep deprivation and mental fatigue, diminishing driver's ability to respond effectively to unusual or emergent situations. Physiological and brain activity analysis could help to understand how to provide useful feedback and alert signals to the drivers for avoiding car accidents. In this study we analyze the insurgence of mental fatigue or drowsiness during car driving in a simulated environment by using high resolution EEG techniques as well as neurophysiologic variables such as heart rate (HR) and eye blinks rate (EBR). Results suggest that it is possible to introduce a EEG-based cerebral workload index that it is sensitive to the mental efforts of the driver during drive tasks of different levels of difficulty. Workload index was based on the estimation of increase of EEG power spectra in the theta band over prefrontal areas and the simultaneous decrease of EEG power spectra over parietal areas in alpha band during difficult drive conditions. Such index could be used in a future to assess on-line the mental state of the driver during the drive task.