Can self-imposed prevention measures mitigate the COVID-19 epidemic?

Yuming Guo and colleagues discuss the research by Teslya et al that highlights the importance of personal preventative measures in avoiding a second wave of the COVID-19 epidemic.

Association of genetic and environmental factors with dental caries among adolescents in south China: A cross-sectional study

AIM

The objective of this study was to investigative genetic and environmental factors that contribute to caries susceptibility among adolescents in south China.

MATERIALS AND METHODS

A cross-sectional study was conducted among 1055 adolescents aged 13-14 years old in south China. The International Caries Detection and Assessment System (ICDAS) was used to identify caries. Environmental variables were analysed by regression models. Twenty-three single nucleotide polymorphisms (SNPs) in 14 genes were identified from saliva samples. Regression analysis was used for the evaluation of effects of SNP markers using the minor allele as the effect allele.

RESULTS

Our results suggest that gender, Cariostat score and Plaque Index were associated with dental caries. After the adjustment by age and gender, the G allele in AMBN (rs13115627) nominally was a protective factor for caries under additive model (P=0.028; OR=0.782; 95% CI, 0.627-0.974). However, the association did not meet the Bonferroni correction significance cut-off for multiple testing.

CONCLUSION

Gender, Cariostat score and Plaque Index were associated with dental caries in this population. No selected SNPs showed a significant association with dental caries under either additive model or dominance model.

Long-term outcomes and safety after reirradiation in locally recurrent nasopharyngeal carcinoma in a non-endemic area

PURPOSE

To determine outcomes and toxicities after reirradiation for locally recurrent nasopharyngeal carcinoma (rNPC) and to apply a prognostic index in a non-endemic region.

METHODS

We retrospectively reported progression-free survival (PFS), overall survival (OS), and treatment-related toxicities in patients treated with curative intent for locally rNPC. We applied the prognostic model for OS and grade 5 radiotherapy (RT)-related toxicities published by Li et al. and evaluated its prognostic accuracy by receiver operating characteristic (ROC) curve analysis.

RESULTS

Between 2005 and 2018, 33 patients were treated for rNPC in our institution. Median follow-up was 60 months. The mean time to local recurrence was 75 months. Six (18%) patients had a persistent grade 3 toxicity from a previous RT course. The median re-RT dose was 66 Gy. After re-RT, 13 patients had local failure and 3 patients had metastatic recurrence. Median PFS was 18 months with a 5-year PFS rate of 29%. Median OS was 35 months with a 5-year OS rate of 37%. Grade 3 or higher toxicities rate was 74%. There were 21% grade 5 toxicities. The median time to a grade 5 toxicity was less than 6 months following re-RT. The prognostic nomogram was not predictive for OS or grade 5 toxicities.

CONCLUSION

Reirradiation of rNPC is an effective treatment but is associated with a high rate of life-threatening toxicity. Stratification of patients based on their risk of developing severe toxicity is needed to select patients who will most likely benefit from re-RT.

Louis E. 0817 Abnormal REM Sleep Atonia Control In Patients With Chronic Post-traumatic Stress Disorder

Introduction

Post-traumatic stress disorder (PTSD) is characterized by persistent mental and emotional stress following one or more significant physical or psychological traumatic incidents earlier in life. Vivid recall of the events, including traumatic nightmares, and prominent sleep disturbance are usual in PTSD. Previous studies have suggested that PTSD may share some clinical features with idiopathic REM sleep behavior disorder (iRBD) including altered REM sleep without atonia (RSWA) levels. Our group has previously found evidence for altered RSWA control in patients with psychiatric disease, including a pilot sample of PTSD patients with iRBD. We aimed to comparatively analyze RSWA levels between patients with PTSD, PTSD and RBD (PTSD+RBD), iRBD, and controls.

Methods

We selected 18 PTSD, 18 PTSD+RBD, 15 iRBD, and 51 healthy control patients matched for age and sex from the Mayo Clinic Center for Sleep Medicine’s polysomnography database for RSWA quantification. RSWA amounts in the submentalis (SM) and anterior tibialis (AT) were quantitatively analyzed as a percentage of REM sleep duration, in accordance with previously published methods. Non-parametric analyses were performed to compare RSWA, patient demographics, and PSG data across groups. Significance was set at p < 0.016.

Results

Patients with PTSD had significantly higher RSWA than controls in all RSWA density measures (p < 0.016 for all). All measures of RSWA, excluding average SM duration, were significantly greater in PTSD+RBD patients compared with controls (p < 0.016 for all). Within the PTSD group, patients on antidepressants did not have significantly higher RSWA in any of the measures. PTSD+RBD patients had significantly higher SM Phasic, AT Any, SM+AT Any, and Tonic RSWA measures than PTSD patients (p < 0.016 for all).

Conclusion

PTSD patients have significantly higher RSWA than controls, with PTSD+RBD patients having higher RSWA levels than PTSD patients. These data provide the first evidence for abnormal RSWA control in patients with chronic PTSD. This provides evidence of a unique biology in PTSD that could imply a future risk for neurodegenerative disease in PTSD similar to RBD patients. Further prospective studying will need to be performed on patients with PTSD to understand the unique biology.

Support

 

What Is Required to Prevent a Second Major Outbreak of SARS-CoV-2 upon Lifting Quarantine in Wuhan City, China

Background

The Chinese government implemented a metropolitan-wide quarantine of Wuhan city on 23^rd January 2020 to curb the epidemic of the coronavirus COVID-19. Lifting of this quarantine is imminent. We modelled the effects of two key health interventions on the epidemic when the quarantine is lifted.

Methods

We constructed a compartmental dynamic model to forecast the trend of the COVID-19 epidemic at different quarantine lifting dates and investigated the impact of different rates of public contact and facial mask usage on the epidemic.

Results

We projected a declining trend of the COVID-19 epidemic if the current quarantine strategy continues, and Wuhan would record the last new confirmed cases in late April 2020. At the end of the epidemic, 65,733 (45,722-99,015) individuals would be infected by the virus, among which 16,166 (11,238-24,603, 24.6%) were through public contacts, 45,996 (31,892-69,565, 69.7%) through household contact, and 3,571 (2,521-5,879, 5.5%) through hospital contacts (including 778 (553-1,154) non-COVID-19 patients and 2,786 (1,969-4,791) medical staff). A total of 2,821 (1,634-6,361) would die of COVID-19 related pneumonia in Wuhan. Early quarantine lifting on 21^st March is viable only if Wuhan residents sustain a high facial mask usage of ≥85% and a pre-quarantine level public contact rate. Delaying city resumption to mid/late April would relax the requirement of facial mask usage to ≥75% at the same contact rate.

Conclusions

The prevention of a second epidemic is viable after the metropolitan-wide quarantine is lifted but requires a sustaining high facial mask usage and a low public contact rate.

Integrated approach for triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis is highly effective and cost-effective: an economic evaluation

BACKGROUND

The Regional Framework for Triple Elimination of Mother-to-Child Transmission (EMTCT) of HIV, Hepatitis B (HBV) and Syphilis in Asia and the Pacific 2018-30 was endorsed by the Regional Committee of WHO Western Pacific in October 2017, proposing an integrated and coordinated approach to achieve elimination in an efficient, coordinated and sustainable manner. This study aims to assess the population impacts and cost-effectiveness of this integrated approach in the Cambodian context.

METHODS

Based on existing frameworks for the EMTCT for each individual infection, an integrated framework that combines infection prevention procedures with routine antenatal care was constructed. Using decision tree analyses, population impacts, cost-effectiveness and the potential reduction in required resources of the integrated approach as a result of resource pooling and improvements in service coverage and coordination, were evaluated. The tool was assessed using simulated epidemiological data from Cambodia.

RESULTS

The current prevention programme for 370,000 Cambodian pregnant women was estimated at USD$2.3 ($2.0-$2.5) million per year, including the duration of pregnancy and up to 18 months after delivery. A model estimate of current MTCT rates in Cambodia was 6.6% (6.2-7.1%) for HIV, 14.1% (13.1-15.2%) for HBV and 9.4% (9.0-9.8%) for syphilis. Integrating HIV and syphilis prevention into the existing antenatal care framework will reduce the total time required to provide this integrated care by 19% for health care workers and by 32% for pregnant women, resulting in a net saving of $380,000 per year for the EMTCT programme. This integrated approach reduces HIV and HBV MTCT to 6.1% (5.7-6.5%) and 13.0% (12.1-14.0%), respectively, and substantially reduces syphilis MCTC to 4.6% (4.3-5.0%). Further introduction of either antiviral treatment for pregnant women with high viral load of HBV, or hepatitis B immunoglobulin (HBIG) to exposed newborns, will increase the total cost of EMTCT to $4.4 ($3.6-$5.2) million and $3.3 ($2.7-$4.0) million per year, respectively, but substantially reduce HBV MTCT to 3.5% (3.2-3.8%) and 5.0% (4.6-5.5%), respectively. Combining both antiviral and HBIG treatments will further reduce HBV MTCT to 3.4% (3.1-3.7%) at an increased total cost of EMTCT of $4.5 ($3.7-$5.4) million per year. All these HBV intervention scenarios are highly cost-effective ($64-$114 per disability-adjusted life years averted) when the life benefits of these prevention measures are considered.

CONCLUSIONS

The integrated approach, using antenatal, perinatal and postnatal care as a platform in Cambodia for triple EMTCT of HIV, HBV and syphilis, is highly cost-effective and efficient.

[Comparative study on the EPLAD of profoundly deaf children with hearing aid fittings or cochlear implantations at the same age]

Objective:The purpose of the current study was to provide good clinical values for rehabilitation exercises and counseling of hearing impaired children by comparing the early prelingual auditory development（EPLAD） of children with hearing aid fittings or cochlear implantations at the same age. Method:Longitudinal evaluation of EPLAD, profoundly deaf children, who received hearing aid fittings or cochlear implantations at 2 years of age, were recruited in this study, and would be tested with Infant-toddler meaningful auditory integration scale（IT-MAIS） at 3, 6 and 12 months after intervention. One hundred and four children were recruited in this study and divided into two groups based on the types of devices: Cochlear implant group（CI group） and Hearing aid group（HA group）. Each child could be permitted to miss follow-up one time. Result:The IT-MAIS scores of children in both groups improved with increasing wear time. The scores in CI group showed a statistically significant improvement between each interval after switch-on（P=0.000）. However, there was just a statistical difference between overall scores at 3 and 12 months after fitting in HA group（P=0.042）. In addition, the IT-MAIS scores of the two groups were statistically significant at 6 and 12 months after switch-on/fitting（P=0.026, P=0.005）. Simultaneously, the mean overall score of children in CI group at 12 months after switch-on approached the average level of unaided peers with mild hearing loss. However, the mean score at 12 months after fitting was close to the average level of unaided peers with moderate hearing loss. Conclusion:Both of CI and HA could improve EPLAD of profoundly deaf children. However, the EPLAD of CI children could improve faster in the first year after switch-on. And the results would also provide more comprehensive clinical values for rehabilitation and counseling of hearing impaired children by comparing to normal and unaided hearing impaired children.

[Long-term efficacy of bioprosthetic anal fistula plug in the treatment of transsphincteric anal fistula]

Objective: To evaluate the long-term healing rate of transsphincteric anal fistula treated with anal fistula plug procedure and the risk factors affecting the healing of anal fistula. Methods: A retrospective case-control study was conducted to analyze the clinical data of 207 patients with transsphincteric anal fistulas who received anal fistula plug procedure at the Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from August 2008 to September 2012. Inclusion criteria: (1) consistent with the diagnosis of transsphincteric anal fistula: the anal fistula passed through the internal and external sphincter; (2) complete data; (3) initial treatment with anal fistula plug procedure. Exclusion criteria: (1) acute rectal or perianal infection or poorly controlled focal infection; (2) recent incision and drainage of perianal abscess or spontaneous rupture of abscess; (3) patients with malignant tumor; (4) patients with Crohn's disease or ulcerative colitis; (5) patients with heart, liver, brain, lung or renal insufficiency; (6) cachexia due to various chronic wasting diseases; (7) patients could not tolerate surgery. Patients were followed up for anal fistula healing. The cumulative healing rate of patients with transsphincteric anal fistula was plotted using the Kaplan-Meier method, and the factors affecting anal fistula healing were explored by univariate and multivariate logistic regression analysis. Results: There were 186 males and 21 females with age of 15 to 69 (mean 38) years. The duration of anal fistula was 3-60 (mean 15) months. Three patients had a history of previous episodes of perianal abscess and underwent incision and drainage of perianal abscess (all more than 3 months). During follow-up ending on October 31, 2018, 72 patients (34.8%) were lost to follow-up. Among 135 patients who were successfully followed up, the average follow-up period was 96 (75-124) months. Seventy-five patients had anal fistula healing, with healing rate of 55.6%. Kaplan-Meier survival curve showed that the healing time of anal fistula was prolonged and finally stabilized at 55.6%. In the patients who failed initial treatment with anal fistula plug packing, there were 6 cases whose anal fistula healed spontaneously without other treatment. Among them, 3 cases healed spontaneously 2 years and 3 cases 3 years after operation without recurrence. From 2008 to 2012, the annual healing rates of anal fistula plug treatment were 3/6, 61.5% (24/39), 42.1% (24/57), 12/15 and 12/18, respectively. Multivariate logistic regression analysis showed that the duration of anal fistula≥6 months (OR=3.187, 95% CI: 1.361-7.466, P=0.008) was an independent risk factor for anal fistula healing after treatment with anal fistula plug. Conclusion: The long-term efficacy of anal fistula plug procedure in the treatment of transsphincteric anal fistula is positive, and this procedure should be implemented as soon as possible.

Genome-wide association study for growth and fatness traits in Chinese Sujiang pigs

Growth and fatness traits are complex and economically important traits in the pig industry. The molecular basis underlying porcine growth and fatness traits remains largely unknown. To uncover genetic loci and candidate genes for these traits, we explored the GeneSeek GGP Porcine 80K SNP chip to perform a GWAS for seven growth and fatness traits in 365 individuals from the Sujiang pig, a recently developed breed in China. We identified two, 17, one and 11 SNPs surpassing the suggestively significant threshold (P < 1.86 × 10^-5 ) for body weight, chest circumference, chest width and backfat thickness respectively. Of these SNPs, 20 represent novel genetic loci, and five and four SNPs were respectively associated with chest circumference and backfat thickness at a genome-wide significant threshold (P < 9.31 × 10^-7 ). Eight SNPs had a pleiotropic effect on both chest circumference and backfat thickness. The most remarkable locus resided in a region between 72.95 and 76.27 Mb on pig chromosome 4, harboring a number of previously reported quantitative trait loci related to backfat deposition. In addition to two reported genes (PLAG1 and TAS2R38), we identified four genes including GABRB3, ZNF106, XKR4 and MGAM as novel candidates for body weight and backfat thickness at the mapped loci. Our findings provide insights into the genetic architecture of porcine growth and fatness traits and potential markers for selective breeding of Chinese Sujiang pigs.

Roles of UGT2B7 C802T gene polymorphism on the efficacy of morphine treatment on cancer pain among the Chinese han population

Background

Morphine is a common analgesic often used to manage chronic pain, especially for patients with pain due to malignancies. Since UGT2B7 plays an important role in the metabolism of morphine, UGT2B7 gene mutation may influence the efficacy of morphine in patients with cancer being treated by this medication.

Aims

The aim of this study is to investigate the relationship between the polymorphisms of UGT2B7 and the efficacy of morphine treatment on cancer pain among the Chinese Han population.

Materials and Methods

A total of 120 patients with cancer pain were enrolled in this study. Morphine was administrated through patient-controlled analgesia infusion pump, and the visual analog score (VAS) was used for pain assessment at 0.5, 4, 6, 12, 24, 48, and 72-h post morphine treatment, respectively. The plasma concentration of morphine and genetic polymorphism of UGT2B7 C802T and G221T was analyzed, respectively.

Results

The frequencies of UGT2B7 C802T were CC: 13.33%, CT: 45% and TT: 41.67%, and the frequencies of UGT2B7 G221T were GG: 76.67%, GT: 22.5% and TT: 0.83%. Moreover, the VAS score of patients with either C802T CT or TT was significantly higher than that in patients with C802T CC. However, no difference of VAS scores was observed between patients carrying G221T GG and patients carrying G221T GT. The plasma concentration of morphine for patients with the C802T CC was significantly lower than that in patients carrying C802T CT or TT, while there was no significant difference in the level of morphine between patients with G221T GG and G221T GT.

Conclusion

The polymorphism of UGT2B7 C802T, but not UGT2B7 G221T, has been associated with the efficacy of morphine treatment on cancer pain among Chinese Han population.

Antimicrobial Bacillus velezensis HC6: production of three kinds of lipopeptides and biocontrol potential in maize

AIMS

To study the antimicrobial agents of the Bacillus velezensis strain HC6 and assess the application potential of B. velezensis HC6 in maize.

METHODS AND RESULTS

We applied a dual culture technique to test the antimicrobial activity of B. velezensis HC6 against bacteria and fungi of common contaminated crops. Bacillus velezensis HC6 showed antagonistic action on pathogenic fungi, including Aspergillus and Fusarium, as well as pathogenic bacteria (especially Listeria monocytogenes). When applied in maize, B. velezensis HC6 could also inhibit the growth of multiple pathogenic fungi and reduce their production of aflatoxin and ochratoxin. Three kinds of antimicrobial lipopeptides, including iturin, fengycin and surfactin were identified in B. velezensis HC6 culture supernatant by high-performance liquid chromatography and MALDI-TOF mass spectrometry. Iturin and fengycin showed obvious antimicrobial activity to the tested fungal strains.

CONCLUSIONS

Bacillus velezensis HC6 produces three kinds of lipopeptides which showed antimicrobial activity against several common pathogenic fungi and bacteria. Bacillus velezensis HC6 is potential to be biocontrol bacteria in maize.

SIGNIFICANCE AND IMPACT OF THE STUDY

Bacillus velezensis HC6 shows obvious antimicrobial activity to important crops pathogenic fungi which usually produce mycotoxins that are harmful to animal and human health. We demonstrate that three different types of lipopeptides produced by B. velezensis contributed to the antimicrobial activity. Bacillus velezensis HC6 has the potential to be effective biocontrol agent in crops.

[Individualization of dose and fractionation of radiotherapy for head and neck cancers]

Head and neck cancers comprise a variety of tumours depending on the sub-site, for which target volumes and the prescribed doses need to be individualized according to each patient's history and presentation. This article aims at describing the main factors involved in decision-making regarding dose and volume, as well as ongoing research. Contouring and treatment guidelines, use of altered fractionation, major prognostic factors, the role of Human papillomavirus and of functional imaging will be presented and discussed.

[Endogenous Klebsiella pneumoniae endophthalmitis associated with Klebsiella pneumoniae pneumonia: 3 cases report and literature review]

Objective: To study the clinical features and the diagnosis and treatment of endogenous Klebsiella pneumoniae endophthalmitis associated with Klebsiella pneumoniae pneumonia. Methods: Three cases of endogenous Klebsiella pneumoniae endophthalmitis associated with Klebsiella pneumoniae with microbiological evidence were studied. The related literatures published from January 2008 to June 2018 were reviewed with "pneumonia" , "endogenous endophthalmitis" and "Klebsiella pneumoniae" as the keywords in CNKI, Wanfang, PubMed and Web of Science databases. Results: The 3 patients, all males, aged 54 years, 82 years and 48 years respectively. They all had a history of type 2 diabetes mellitus. Endophthalmitis occurred in one eye in all of them, and the patients had eye symptoms including eye pain, progressive loss of vision, periorbital area inflammation, conjunctivitis, weakening or disappearance of pupil light reflex, corneal edema and anterior chamber effusion. All of 3 cases had multiple patchy pulmonary lesions, and Klebsiella pneumoniae was proven to be the pathogen by blood culture. Two cases had pulmonary abscess and liver abscess, and one of them had brain abscess. A total of 28 literatures with 81 cases of endogenous Klebsiella pneumoniae endophthalmitis associated with Klebsiella pneumoniae pneumonia were retrieved from CNKI, WanFang, PubMed and Web of Science database. Conclusions: Klebsiella pneumoniae was one of the most common pathogens of pneumonia and endogenous endophthalmitis, which would seriously damage the lung and the eye. The early clinical features were not specific. Misdiagnosis or missed diagnosis might cause serious consequences. Eye pain and visual disturbance symptoms, ophthalmic examination, chest imaging, blood and aqueous humor etiology were of great value in the diagnosis of this disease.

Application of ultrasound for green extraction of proteins from spirulina. Mechanism, optimization, modeling, and industrial prospects

A green and innovative method, manothermosonication (MTS), for proteins extraction from dry Arthrospira platensis cyanobacteria assisted by ultrasound was designed in this work. Manothermosonication (probe, 20 kHz) was compared to a conventional process performed in the same conditions without ultrasounds. The extraction was carried out with a continuous flow rate at 15 mL/hour. Extraction parameters were optimized using a central composite design. Moreover, mathematic modelling and microscopic investigations were realized to allow a better understanding of ultrasound physical and structural effects on spirulina filaments and mass transfer phenomena over time. Crude extract and sections stained with toluidine blue were analyzed with optical and scanning electron microscopies. According to experimental results, MTS promoted mass transfer (high effective diffusivity, D_e) and enabled to get 229% more proteins (28.42 ± 1.15 g/100 g DW) than conventional process without ultrasound (8.63 ± 1.15 g/100 g DW). With 28.42 g of proteins per 100 g of dry spirulina biomass in the extract, a protein recovery rate of 50% was achieved in 6 effective minutes with a continuous MTS process. Microscopic observations showed that acoustic cavitation impacted spirulina filaments by different mechanisms such as fragmentation, sonoporation, detexturation. These various phenomena make extraction, release and solubilization of spirulina bioactive compounds easier.

New concept of the Axin2 rs2240308 polymorphism and cancer risk: an updated meta-analysis

Previous meta-analyses reported that the variant T allele of Axin2 rs2240308 is associated with a decreased cancer risk. However, more recent findings have been inconsistent. Therefore, we carried out an updated meta-analysis to examine whether this polymorphism is still associated with a decreased cancer risk. Twelve articles, including 14 case-control studies (2,215 cases and 2,481 controls), were included in our study. Surprisingly, different from previous meta-analyses, no significant association between Axin2 rs2240308 polymorphism and cancer risk was observed (dominant model: OR=0.85; 95% CI=0.68-1.06). In further stratified analyses, rs2240308 was significantly associated with a decreased cancer risk only in Asians (dominant model: OR=0.76; 95% CI=0.66-0.88), while for Caucasians the variant showed no significant association with cancer risk (dominant model: OR=1.09; 95% CI=0.67-1.76). Moreover, the rs2240308 variant exhibited a significant association with a decreased risk of lung cancer and prostate cancer. These findings provided new evidence that differed from previous meta-analyses; Axin2 rs2240308 may not modify general cancer susceptibility. Similar with previous meta-analyses, our analysis indicated that Axin2 rs2240308 may modify cancer susceptibility in an ethnicity- and/or type-specific manner. These findings indicate that further replication studies with large sample sizes are warranted to re-evaluate the relationship between Axin2 rs2240308 and cancer risk, especially in Caucasians.

A randomized trial of induction docetaxel-cisplatin-5FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma (GORTEC 2006-02)

Background

Concomitant chemotherapy (CT)-radiotherapy (RT) is a standard of care in locally advanced nasopharyngeal carcinoma (NPC) and a role for induction CT is not established.

Methods

Patients with locally advanced NPC, WHO type 2 or 3, were randomized to induction TPF plus concomitant cisplatin-RT or concomitant cisplatin-RT alone. The TPF regimen consisted of three cycles of Docetaxel 75 mg/m2 day 1; cisplatin 75 mg/m2 day 1; 5FU 750 mg/m2/day days 1-5. RT consisted of 70 Gy in 7 weeks plus concomitant cisplatin 40 mg/m2 weekly.

Results

A total of 83 patients were included in the study. Demographics and tumour characteristics were well balanced between both arms. Most of the patients (95%) in the TPF arm received three cycles of induction CT. The rate of grade 3-4 toxicity and the compliance (NCI-CTCAE v3) during cisplatin-RT were not different between both arms. With a median follow-up of 43.1 months, the 3-year PFS rate was 73.9% in the TPF arm versus 57.2% in the reference arm [hazard ratio (HR) = 0.44; 95% confidence interval (CI): 0.20-0.97, P = 0.042]. Similarly the 3 years overall survival rate was 86.3% in the TPF arm versus 68.9% in the reference arm (HR = 0.40; 95% CI: 0.15-1.04, P = 0.05).

Conclusion

In conclusion, several important aspects can be emphasized: the compliance to induction TPF was good and TPF did not compromise the tolerance of the concomitant RT-cisplatin phase. The improved PFS and overall survival rates needs to be confirmed by further trials.