Dosimetric and clinical toxicity comparison of critical organ preservation with three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and RapidArc for the treatment of locally advanced cancer of the pancreatic head

PURPOSE

We compared dosimetry and clinical toxicity for 3-dimensional conformal radiotherapy (3D-crt), intensity-modulated radiotherapy (imrt), and RapidArc (Varian Medical Systems, Palo Alto, CA, U.S.A.) in locally advanced pancreatic cancer (lapcc). We hypothesized that the technique with better sparing of organs at risk (oars) and better target dose distributions could lead to decreased clinical toxicity.

METHODS

The study analyzed 280 patients with lapcc who had undergone radiotherapy. The dosimetry comparison was performed using 20 of those patients. Dose-volume histograms for the target volume and the oars were compared. The clinical toxicity comparison used the 280 patients who received radiation with 3D-crt, imrt, or RapidArc.

RESULTS

Compared with 3D-crt, RapidArc and imrt both achieved a better conformal index, homogeneity index, V95%, and V110%. Compared with 3D-crt or imrt, RapidArc reduced the V10, V20, and mean dose to duodenum, the V20 of the right kidney, and the liver mean dose. Compared with 3D-crt, RapidArc reduced the V35, and V45 of duodenum, the mean dose to small bowel, and the V15 of right kidney. The incidences of grades 3 and 4 diarrhea (p = 0.037) and anorexia (p = 0.042) were lower with RapidArc than with 3D-crt, and the incidences of grades 3 and 4 diarrhea (p = 0.027) were lower with RapidArc than with imrt.

CONCLUSIONS

Compared with 3D-crt or imrt, RapidArc showed better sparing of oars, especially duodenum, small bowel, and right kidney. Also, fewer acute grades 3 and 4 gastrointestinal toxicities were seen with RapidArc than with 3D-crt or imrt. A technique with better sparing of oars and better target dose distributions could result in decreased clinical toxicities during radiation treatment for lapcc.

Key factors of therapeutic effects for surgery in patients with cirrhotic portal hypertension

OBJECTIVE

In the clinical management of cirrhotic portal hypertension, surgery is often necessary; however, the operative mortality rate is high.

PATIENTS AND METHODS

Data from 161 patients, who underwent surgery for cirrhotic portal hypertension, were analyzed, and 24 potential predictors of surgical outcome were assessed. A Kruskal-Wallis rank sum test was used for single-factor comparisons, and multivariate logistic regression for multifactor comparisons to identify key factors for poor surgical outcomes and calculate their scores.

RESULTS

Six predictors of poor surgical outcomes were identified: postoperative bleeding within 30 h of > 2 L, with a score of 3; severe liver atrophy (an anteroposterior diameter of the left lobe of ≤ 55 mm and an oblique diameter of the right lobe ≤ 110 mm), with a score of 3; a base excess of <-3 mmol/L, with a score of 3; a platelet count of <3 T/L, with a score of 2; an amount of intraoperative bleeding of > 2 L, with a score of 2; and a red blood cell count of < 3 G/L, with a score of 1. For patients with good outcome (n = 147), all patients had a score of ≤ 3, except one patient who had a score of 4. With respect to patients who died (n = 14), all had a score of ≥ 5, except one patient who had a score of 4. A significant difference was observed between the two groups (p < 0.05). The mortality was 100% in patients with a score of ≥ 7.

CONCLUSIONS

Six key factors for poor surgical outcomes were identified in this study. Operative mortality appears to be significantly increased in patients with a score of 5-6. Surgery should be contraindicated in patients with a score of ≥ 7. To reduce mortality, close attention should be paid to preoperative and intraoperative treatment and prevention to achieve a score of < 4.

Using functional magnetic resonance imaging to explore the possible mechanism of the action of acupuncture at Dazhong (KI 4) on the functional cerebral regions of healthy volunteers

Acupuncture at right Dazhong (KI 4) mostly affects functional magnetic resonance imaging signal in the right inferior frontal gyrus, right insular lobe, right thalamus, right middle frontal gyrus and right orbitofrontal cortex, which are associated with governing executive functions, emotional activities and social behaviour.

Generation and characterization of polyclonal antibodies against mouse T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory domain by DNA-based immunization

Mouse T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory domain (TIGIT) is a newly identified surface protein expressed in regulatory, memory, natural killer (NK), and activated T cells. Several studies indicate that mouse TIGIT is a vital immunomodulator that can control the activities of both NK and T cells and plays an important role in transplantation tolerance. In this study, we designed a vector, TIGIT-pcDNA3.1 (+), that encodes the complete coding sequence of mouse TIGIT. The vector was intramuscularly injected into rats, and then the specific antisera were harvested and purified using a protein A/G PLUS-agarose affinity column. Western blot and immunohistochemistry analyses revealed that the antibodies generated by DNA immunization can bind with the mouse TIGIT. Using these antibodies in immunoblots, TIGIT was detected in lysates of mouse organs, T cells from mouse lymph nodes, and recombinant mouse fusion protein of TIGIT and Fc fragment. Immunohistochemistry analysis of normal mouse kidney showed that immunoreactivity was located on endothelial cells of glomerular capillary loops and peritubular capillaries. Our results demonstrated that the DNA immunization of rats through intramuscular injection was a simple and easily available method of producing polyclonal antibodies that can be used to detect and analyze mouse TIGIT expression in mouse systems.

Effect of argon protection on the biological activity of acid etched titanium surface

OBJECTIVE

As the contamination of implant surface seriously affects the early osseointegration of implants and reduces the survival rate of implants, it has attracted wide attention of researchers. The most oral titanium implants used in current clinical applications are stored in sealed packages. During the process of packaging, storage and usage, the implants inevitably contact air, which results in the surface contamination. As an inert gas, the argon has very inactive chemical properties and is routinely used as a protective gas to cut air pollution. In this study, we investigated whether argon protection can cut air pollution and maintain lasting surface biological activity of titanium implants.

MATERIALS AND METHODS

We prepared sandblasting etched titanium samples under air protection or under argon protection. The samples prepared under air protection were used as the control. With the scanning electron microscopy, the contact angle measurements and the X-ray photoelectron spectroscopy, we examined surface morphology, hydrophilicity, chemical structures and components of the implants prepared under two gas protections. By using beagles as the animal model, we assessed the bone guide of the implants prepared under argon protection and morphological changes of surrounding tissues.

RESULTS

While compared with those implants prepared under air protection, the surface morphology of implants prepared under argon protection did not change, which had preferable hydrophilicity, and there were differences in percentage of surface chemical elements and chemical structure. After 4 weeks, the bone-implant contact (BIC) in argon protection group was twice of the control group and the difference was statistically significant (p < 0.01). The Implant Niuchu experiments also proved that under argon protection, the implants would have good integration with the surrounding bone tissues.

CONCLUSIONS

This study revealed the implants prepared under argon can cut air pollution and have high bone guide property and biological activity.

Primary esophageal adenosquamous carcinoma: a retrospective analysis of 24 cases

Primary adenosquamous carcinoma (ASC) of the esophagus is a rare kind of malignancy characterized by mixed glandular and squamous differentiation as well as a propensity for aggressive clinical behavior. Data on the evaluation of the clinicopathological features and the prognosis of patients suffering from this malignancy are few because of the rarity of this disease. We conducted a retrospective review of 24 patients with primary esophageal ASC among 6546 esophageal cancer patients who underwent transthoracic esophagectomy in our hospital. The clinicopathological presentation, diagnosis, treatment, and prognostic factors of the patients were respectively investigated. The Kaplan-Meier method and the log rank test were used to calculate and compare overall survival (OS). The Cox proportional hazards model was employed to identify independent prognostic factors. There were 18 males and 6 females with a median age of 60 years (range: 40-78 years). The clinical symptoms, macroscopic type, as well as the radiological and endoscopic features of esophageal ASC were similar to those of esophageal squamous cell carcinoma. Sixteen (88.9%) of the 18 cases who underwent preoperative esophagoscopic biopsy were misdiagnosed as adenocarcinoma or squamous cell carcinoma. The overall median follow-up period was 36 months, and the median survival time was 32 months. The 1, 3, 5-year OS rates were 75.0%, 48.5%, and 19.4%, respectively. Univariate analysis showed that gender (P=0.047), lymph node metastasis (P=0.007), and TNM stage (P=0.037) were important factors associated with OS of the 22 patients who underwent radical resection. Multivariate analysis showed that the pathological N stage was the only independent prognostic factor (P=0.031, hazard ratio [HR], 5.369, 95% confidence interval [CI], 1.167-24.700). These results suggest that esophageal ASC is an uncommon disease prone to be misdiagnosed by endoscopic biopsy. Surgical resection is the primary treatment, but the prognosis of ASC is usually poorer than conventional squamous cell carcinoma. Lymph node metastasis is an independent prognostic factor after radical resection.

Exogenous nitric oxide negatively regulates the S-nitrosylation p38 mitogen-activated protein kinase activation during cerebral ischaemia and reperfusion

AIMS

A number of studies have suggested that nitric oxide (NO) plays an important role in the reactive phosphorylation of p38MAPKα (p38). However, whether S-nitrosylation of p38 is activated by NO and the details remain unclear. The aim of the present work was to assess the activation of p38, the S-nitrosylation site and the p38 signalling pathway in rat hippocampus and in HEK293 cell induced by exogenous NO.

METHODS

Primary hippocampal cultures, HEK293 cells and rat model of cerebral ischaemia/reperfusion (brain ischaemia was induced by four-vessel occlusion procedure) were used in this study. Biotin-switch method and immunoblotting were performed to study the S-nitrosylation and phosphorylation of p38, and neuronal loss was observed by histology.

RESULTS

Endogenous NO increased p38 phosphorylation and S-nitrosylation, and the activation of p38 was dependent on the S-nitrosylation of Cys-211, which was critical for the NO-mediated activation of p38. The exogenous NO donor sodium nitroprusside, S-nitrosoglutathione, 7-nitroindazole, the inhibitor of the neuronal nitric oxide synthase, inhibited the activation of p38 signal pathway induced by cerebral ischaemia/reperfusion and attenuated the damage in rat hippocampal neurones. Moreover, the N-methyl-D-aspartate receptor (NMDAR) is probably involved in the p38 activation process of S-nitrosylation and phosphorylation.

CONCLUSION

Endogenous NO induces the S-nitrosylation and phosphorylation of p38 and mediates p38 signalling pathway by NMDAR, and as exogenous NO inhibits this process and is neuroprotective in rat cerebral ischaemia/reperfusion, it may make a contribution to stroke therapy.

Oesophageal squamous cell carcinoma: relationship between fluorine-18 fludeoxyglucose positron emission tomography CT maximum standardised uptake value, metabolic tumour volume, and tumour, node and metastasis classification

OBJECTIVES

We aimed to evaluate the relationships between primary tumour, maximum standardised uptake value, metabolic tumour volume and seventh edition American Joint Committee on Cancer (AJCC) classification in oesophageal squamous cell carcinoma (OSCC) patients.

METHODS

Fluorine-18 fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)-CT scans of 41 consecutive newly diagnosed OSCC patients were retrospectively reviewed. Maximum standard uptake value (SUV(max)) and metabolic tumour volume (MTV) were recorded. Two-tailed Spearman's correlation was used to analyse the relationships between the metabolic parameters and the AJCC staging system.

RESULTS

Positive correlations were observed between SUV(max), MTV and tumour (T) stage, in addition to node (N) stage and AJCC stage. Both metabolic parameters were independent variables that significantly affected the N stage and AJCC stage, and SUV(max) was the only independent variable that significantly affected the T stage.

CONCLUSION

The metabolic parameters derived from (18)F-FDG PET-CT were positively correlated with T, N and AJCC stage in primary OSCC. Our findings may suggest a complementary role of these parameters to seventh-edition AJCC staging in the prognostication of OSCC patients.

Chondroitin sulfate and/or glucosamine hydrochloride for Kashin-Beck disease: a cluster-randomized, placebo-controlled study

OBJECTIVE

To evaluate the efficacy and safety of chondroitin sulfate and/or glucosamine hydrochloride in alleviating symptoms and improving the dysfunction of Kashin-Beck disease (KBD) patients.

METHODS

We undertook a cluster-randomized, placebo-controlled trial in 251 patients with KBD. Participants were randomly allocated to comparing (1) chondroitin sulfate, (2) glucosamine hydrochloride, (3) a combination of chondroitin sulfate and glucosamine hydrochloride, or (4) placebo, for 6 months duration. The primary outcome measures of interest were 20% and 50% reductions in pain from baseline, measured by pain subscale in the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. Secondary outcome measures included parameters in the WOMAC Index such as pain, stiffness, and physical function, as well as patients' quality of life by the 12-item Short-Form General Health Survey. The trial registration number is ChiCTR-TRC-11001480 (http://www.chictr.org/).

RESULTS

A combination therapy of chondroitin sulfate and glucosamine hydrochloride was effective in reducing WOMAC pain by 20% (differences of 23.4%, P=0.006) and 50% (differences of 15.7%, P=0.016), WOMAC pain (P=0.032), WOMAC stiffness (P=0.043), and WOMAC total score (P=0.035). Chondroitin sulfate used alone was also found to be effective in reducing WOMAC total score and stiffness score (P=0.038 and P=0.023, respectively). No significant positive effects in improving WOMAC Index scores were observed with glucosamine hydrochloride alone.

CONCLUSION

The findings of this study indicate that a combination of chondroitin sulfate and glucosamine hydrochloride was more effective than placebo in treating KBD.

Prognostic significance of SUV on PET/CT in patients with localised oesophagogastric junction cancer receiving neoadjuvant chemotherapy/chemoradiation:a systematic review and meta-analysis

OBJECTIVE

The objective of this study was to comprehensively review the evidence for use of pre-treatment, post-treatment and changes in tumour glucose uptake that were assessed by 18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET) early, during or immediately after neoadjuvant chemotherapy/chemoradiation to predict prognosis of localised oesophagogastric junction (AEG) cancer.

METHODS

We searched for articles published in English; limited to AEG; (18)F-FDG uptake on PET performed on a dedicated device; dealt with the impact of standard uptake value (SUV) on survival. We extracted an estimate of the log hazard ratios (HRs) and their variances and performed meta-analysis.

RESULTS

798 patients with AEG were included. And the scan time for (18)F-FDG-PET was as follows: prior to therapy (PET1, n=646), exactly 2 weeks after initiation of neoadjuvant therapy (PET2, n=245), and pre-operatively (PET3, n=278). In the two meta-analyses for overall survival, including the studies that dealt with reduction of tumour maximum SUV (SUV(max)) (from PET1 to PET2/PET3 and from PET1 to PET2), the results were similar, with the overall HR for non-responders being 1.83 [95% confidence interval (CI), 1.41-2.36] and 2.62 (95% CI, 1.61-4.26), respectively; as for disease-free survival, the combined HR was 2.92 (95% CI, 2.08-4.10) and 2.39 (95% CI, 1.57-3.64), respectively. The meta-analyses did not attribute significant prognostic values to SUV(max) before and during therapy in localised AEG.

CONCLUSION

Relative changes in FDG-uptake of AEG are better prognosticators. Early metabolic changes from PET1 to PET2 may provide the same accuracy for prediction of treatment outcome as late changes from PET1 to PET3.