Therapy of tacrolimus combined with corticosteroids in idiopathic membranous nephropathy

We evaluated the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN). One hundred seventy-seven biopsy-proven IMN patients were recruited in this retrospective clinical study. Sixty patients received TAC (target blood concentration of 4–8 ng/mL) and 117 patients received daily cyclophosphamide (CYC, 100 mg) combined with prednisone. Remission rates at the end of the first, second and third month in the TAC group were significantly higher than that in the CYC group (1st: 35.0 vs 19.7%, P<0.05; 2nd: 56.7 vs 38.5%, P<0.05; 3rd: 76.7 vs 59.0%, P<0.05). In the first 3 months, daily urinary protein and serum albumin in the TAC group obtained a better improvement than that in the CYC group (P<0.05). At the end of the sixth and the twelfth month, the remission rates, daily urinary protein and serum albumin were all comparable between the two groups (P>0.05). No significant difference of relapse rate between the groups was found (16.3 vs 12.0%, P>0.05). Patients were more likely to develop glucose intolerance in the TAC group. The TAC regimen obtained more benefits in treating IMN patients, especially in the first 3 months, than the CYC regimen.

[Effect of zoledronate on protein interaction between Ca(2+)/calmodulin-dependent protein kinaseⅡ and calmodulin and expression of downstream genes during osteoclast differentiation]

Objective: To investigate the effect of zoledronate on protein interaction between Ca(2+)/calmodulin-dependent protein kinaseⅡ(CaMKⅡ) and calmodulin and protein expression of nuclear factor of activation of T cells-1 (NFATc1) and tartrate resistant acid phosphatase (TRAP) during osteoclast differentiation. Methods: Mouse RAW264.7 cells were divided into group A and B and were cultured. Group A was induced with 50 mg/L receptor activator of NF-κB ligand (RANKL) for osteoclastogenesis, and group B was treated with 1×10(-6) zoledronate for two days from day 2. Co-immunoprcipitation (Co-IP) and reverse Co-IP were used to detect the protein-binding between CaMKⅡ and calmodulin. Western-blotting and immunofluorescent cytochemistry were also used to detect the protein level of NFATc1 and TRAP in both groups. Osteoclast formation was also analyzed. Results: In group B, the number of osteoclasts, number and size of dentin resorption lacunaes were 11.3±1.5, 8.7±2.1 and (5 034.4±775.4) μm(2) respevtively, which were significantly lower than those (37.7±5.7, 23.0±4.0 and [15 042.7±1 906.0] μm(2)) in group A (P<0.01). Co-IP and reverse Co-IP examination indicated that protein-binding between CaMKⅡ and calmodulin significantly decreased by 59.8% and 50.9% in group B compared with group A (P<0.01). The protein level of calmodulin and CaMKⅡ in total cellular proteins also significantly decreased by 52.1% and 51.5% in group B compared with group A (P<0.01). NFATc1 and TRAP protein decreased by 52.4% and 38.9% in group B than in group A (P<0.01), respectively. Conclusions: Zoledronate could significantly inhibit protein-binding between CaMKⅡ and calmodulin and down-regulate protein level of NFATc1 and TRAP.

Preliminary in vitro analysis of mechanism of cardiac microvascular endothelial barrier function

To preliminarily clarify the mechanism of cardiac microvascular endothelial barrier function leading to heart failure, primary HMVEC-D cells were selected and cultured for amplification. The cells were infected with adenovirus vector containing the ADP-ribosylation factor 6 (Arf6) Q67L gene. Full-length and functional fragments of myeloid differentiation primary response 88 and ARF nucleotide-binding site opener genes were established and transfected into HEK293T cells. GTP-Arf6 pull-down experiment, fluorescent quantitative real-time PCR, immuno-coprecipitation, and transendothelial electrical resistance analysis were conducted. Interleukin-1β (IL-1β) induced increase in vascular permeability, whereas inhibitor SC514 blocked IL-1β-induced transfer of nuclear factor-κB into the nucleus, from the cytoplasm. Increase in amount of activated Arf6 promoted reduction in transendothelial electrical resistance. In addition, SecinH3 significantly inhibited increase in vascular permeability, and the progression of heart failure was significantly relieved. Cardiac microvascular endothelial barrier function can lead to heart failure. However, IL-1β induced increase in vascular permeability, which nullified the function of cardiac microvascular endothelial barrier. These findings are closely related to the activation of the Arf6-VE-cadherin signaling pathway.

Scaled Particle Theory for Multicomponent Hard Sphere Fluids Confined in Random Porous Media

The formulation of scaled particle theory (SPT) is presented for a quite general model of fluids confined in a random porous media, i.e., a multicomponent hard sphere (HS) fluid in a multicomponent hard sphere or a multicomponent overlapping hard sphere (OHS) matrix. The analytical expressions for pressure, Helmholtz free energy, and chemical potential are derived. The thermodynamic consistency of the proposed theory is established. Moreover, we show that there is an isomorphism between the SPT for a multicomponent system and that for a one-component system. Results from grand canonical ensemble Monte Carlo simulations are also presented for a binary HS mixture in a one-component HS or a one-component OHS matrix. The accuracy of various variants derived from the basic SPT formulation is appraised against the simulation results. Scaled particle theory, initially formulated for a bulk HS fluid, has not only provided an analytical tool for calculating thermodynamic properties of HS fluid but also helped to gain very useful insight for elaborating other theoretical approaches such as the fundamental measure theory (FMT). We expect that the general SPT for multicomponent systems developed in this work can contribute to the study of confined fluids in a similar way.

[Effect of air pollution on health service demand of the elderly and middle-age patients with hypertension, cardiovascular and cerebrovascular diseases: based on analysis of data from CHARLS]

OBJECTIVE

To study the association of air pollution with health service demand of the elderly and middle-age patients with cardiovascular and cerebrovascular diseases, and to provide a scientific basis for development of environmental protection policy and health service policy of the Chinese government.

METHODS

This study included survey data on self-evaluated health, outpatient service demand and inpatient service demand of the patients with hypertension, heart disease and stroke in 62 cities of 17 provinces from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2013, and combined it with the data on the annual concentrations of inhalable particulate matter (PM(10)), sulfur dioxide(SO(2)) and nitrogen dioxide (NO(2)) of those provinces and cities. Conditional Logistic regression was carried out to assess the possible effects of air pollutants on self-evaluated health and health service utilization.

RESULTS

The results showed that turning points existed in the effects of concentrations of NO(2) and SO(2) on the health service demand of the patients with hypertension, heart disease and stroke. The inpatient service demand of the hypertension patients increased with NO(2) concentration when it was lower than 35.1 μg/m(3) and decreased with NO(2) concentration for higher value. Self-evaluated health of the patients with heart disease and stroke decreased with SO(2) concentration when it was lower than 63.8 μg/m(3) and increased with SO(2) concentration for higher value. In addition, no evidence was found for the association between PM(10) and health service demand.

CONCLUSION

Air pollution may have effects on health service demand of the patients with hypertension,cardiovascular and cerebrovascular diseases, and different air pollutants at high or low concentration may have different health effects.

Thermodynamic temperature assignment to the point of inflection of the melting curve of high-temperature fixed points

The thermodynamic temperature of the point of inflection of the melting transition of Re-C, Pt-C and Co-C eutectics has been determined to be 2747.84 ± 0.35 K, 2011.43 ± 0.18 K and 1597.39 ± 0.13 K, respectively, and the thermodynamic temperature of the freezing transition of Cu has been determined to be 1357.80 ± 0.08 K, where the ± symbol represents 95% coverage. These results are the best consensus estimates obtained from measurements made using various spectroradiometric primary thermometry techniques by nine different national metrology institutes. The good agreement between the institutes suggests that spectroradiometric thermometry techniques are sufficiently mature (at least in those institutes) to allow the direct realization of thermodynamic temperature above 1234 K (rather than the use of a temperature scale) and that metal-carbon eutectics can be used as high-temperature fixed points for thermodynamic temperature dissemination. The results directly support the developing mise en pratique for the definition of the kelvin to include direct measurement of thermodynamic temperature.

Abstract P1-14-07: Association between quantitative values of estrogen receptor expression level and pathological complete response in human epidermal growth factor 2-negative breast cancer: Should the clinical definition of triple-negative breast cancer be redefined?

Background: The American Society of Clinical Oncology/College of American Pathologists recommended that the cut-off for negative status of estrogen receptor (ER) should be &lt;1% positively staining cells, although a 10% cut-off has often been used clinically. Prior studies reported that patients with ER ranging from 1% to 9% showed survival outcomes and molecular features similar to those of patients with ER positivity of &lt;1%; however, those studies did not take into account patients' human epidermal growth factor 2 (HER2) status. This means we have yet to clarify the exact clinical definition of triple-negative breast cancer (TNBC) on the basis of response to preoperative chemotherapy. Previous studies reported that hormone receptor–positive tumors were less sensitive to systemic chemotherapies. On the basis of these facts, we hypothesized that in patients with HER2-negative breast cancer ER expression level as a continuous variable has an inverse linear association with pathological complete response (pCR) rate. Our primary objective was to determine whether a quantitative value of ER between 0% and 10% is predictive of pCR rate in HER2-negative patients treated with neoadjuvant chemotherapy. Secondary objective was to find the ideal cut-off value of ER expression.

Methods: We included newly diagnosed stage I-III HER2-negative breast cancer patients with available ER (0%≤ER&lt;10%) who were treated with neoadjuvant systemic chemotherapy. ER status was determined by immunohistochemical (IHC) staining; HER2 status was determined by IHC and/or FISH. We used univariate and multivariate logistic regression models to determine the association between baseline variables and pCR. A backward stepwise method was used to select the covariates for the multivariate analysis. Recursive partitioning and regression tree method were used to identify the potential significant cut-off of ER.

Results: The analysis included 1155 patients with newly diagnosed HER2-negative invasive breast cancer. The univariate logistic regression analysis showed that ER as a continuous variable was not a statistically significant factor for predicting pCR (ER: OR=0.98, 95%CI: 0.9-1.07, P=0.68). In the multivariate analysis, ER status again was not a significant factor for predicting pCR (OR=0.97, 95%CI 0.9-1.06, P=0.55). ER as a categorical variable, there was no significant difference of the pCR rate between 0&lt;ER&lt;1 and 1≤ER&lt;10 groups (OR=1.27, 95%CI: 0.62-2.62, P=0.52). Among ER&gt; 0 (n=229), the recommended cut-off value of ER was 5.5. However, the odds ratio of pCR rate divided by this value of 5.5 was not significant (ER≤5 vs ER&gt;5; OR 1.94 95%CI 0.54-6.95 P=0.31).

Conclusion: Evaluating ER (&lt;10%) as a continuous variable showed no association with pCR rate, and no cut-off of ER was identified with which to stratify patients into groups more or less likely to achieve pCR. A potential meaningful cut-off ER value might exist between 10% and 100% in HER2-negative patients. We will explore whether a meaningful cut-off ER value exists that will change the pCR rate and possibly lead to redefining the clinical definition of TNBC.

Citation Format: Fujii T, Kogawa T, Dong W, Moulder S, Litton JK, Tripathy D, Lim B, Shen Y, Ueno NT. Association between quantitative values of estrogen receptor expression level and pathological complete response in human epidermal growth factor 2-negative breast cancer: Should the clinical definition of triple-negative breast cancer be redefined?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-07.

A Method to Evaluate Critical Factors for Successful Implementation of Clinical Pathways

OBJECTIVE

Clinical pathways (CPs) have been viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Despite widespread enthusiasm for CPs, research has shown that many CP initiatives are unsuccessful. To this end, this study provides a methodology to evaluate critical success factors (CSFs) that can aid healthcare organizations to achieve successful CP implementation.

DESIGN

This study presents a new approach to evaluate CP implementation CSFs, with the aims being: (1) to identify CSFs for implementation of CPs through a comprehensive literature review and interviews with collaborative experts; (2) to use a filed study data with a robust fuzzy DEMATEL (the decision making trial and evaluation laboratory) approach to visualize the structure of complicated causal relationships between CSFs and obtain the influence level of these factors.

PARTICIPANTS

The filed study data is provided by ten clinical experts of a Chinese hospital.

RESULTS

23 identified CSF factors which are initially identified through a review of the literature and interviews with collaborative experts. Then, a number of direct and indirect relationships are derived from the data such that different perceptions can be integrated into a compromised cause and effect model of CP implementation.

CONCLUSIONS

The results indicate that the proposed approach can systematically evaluate CSFs and realize the importance of each factor such that the most common causes of failure of CP implementation could be eliminated or avoided. Therefore, the tool proposed would help healthcare organizations to manage CP implementation in a more effective and proactive way.

Growth kinetics of Cu6Sn5 intermetallic compound at liquid-solid interfaces in Cu/Sn/Cu interconnects under temperature gradient

The growth behavior of intermetallic compounds (IMCs) at the liquid-solid interfaces in Cu/Sn/Cu interconnects during reflow at 250 °C and 280 °C on a hot plate was investigated. Being different from the symmetrical growth during isothermal aging, the interfacial IMCs showed clearly asymmetrical growth during reflow, i.e., the growth of Cu₆Sn₅ IMC at the cold end was significantly enhanced while that of Cu₃Sn IMC was hindered especially at the hot end. It was found that the temperature gradient had caused the mass migration of Cu atoms from the hot end toward the cold end, resulting in sufficient Cu atomic flux for interfacial reaction at the cold end while inadequate Cu atomic flux at the hot end. The growth mechanism was considered as reaction/thermomigration-controlled at the cold end and grain boundary diffusion/thermomigration-controlled at the hot end. A growth model was established to explain the growth kinetics of the Cu₆Sn₅ IMC at both cold and hot ends. The molar heat of transport of Cu atoms in molten Sn was calculated as + 11.12 kJ/mol at 250 °C and + 14.65 kJ/mol at 280 °C. The corresponding driving force of thermomigration in molten Sn was estimated as 4.82 × 10⁻¹⁹ N and 6.80 × 10⁻¹⁹ N.

The expression of PD-L1 APE1 and P53 in hepatocellular carcinoma and its relationship to clinical pathology

OBJECTIVE

To study the expression of programmed death-ligand1 (PD-L1) in hepatocellular carcinoma and its relationship with clinicopathological characteristics and, prognosis of hepatocellular carcinoma and APE1, P53 protein expression levels.

PATIENTS AND METHODS

A total of 128 patients with hepatocellular carcinoma were enrolled in this study. The expression of PD-L1, APE1 and P53 were detected by immunohistochemistry.Use immunohistochemical ABC staining method to detect the expression levels of PD-L1, APE1 and P53 protein in the hepatocellular carcinoma of 128 cases.

RESULTS

Positive The positive expression rates levels of PD-L1, APE1, and P53 protein in hepatocellular carcinoma tissues are were 82.03%, 92.19%, and 60.94%. PD-L1 positive expression were significantly associated with clinical stage, The PD-L1 protein has a high expression in patients with I ~ II stage liver cancerHBV infection positive and nonportal vein thrombosis (p=0.041; p=0.030; p=0.014). It is inversely correlated with P53 and PD-L1 expression (correlation coefficient -0.227, p=0.010), and positively correlated with APE1 expression (correlation coefficient 0.189, p=0.032). The expression of PD-L1 is associated with the survival time of patients with hepatocellular carcinoma, and the median survival time of patients with high expression of PD-L1 is ten months. The median survival time of patients with low expression is five months (p=0.001). The relationship between the expression of APE1 and P53 protein and overall survival time of patients with hepatocellular carcinoma has not been found.

CONCLUSIONS

The PD-L1 and APE1 expression in hepatocellular carcinoma are related to the level of the expression of P53 protein. The expression state of PD-L1 may be a prognostic factor in hepatocellular carcinoma.

Postoperative chemoradiotherapy improves survival in esophageal squamous cell cancer with extracapsular lymph node extension

In esophageal squamous cell carcinoma (ESCC), extracapsular extention (ECE) in metastatic lymph nodes portends high rate of recurrence and poor prognosis. To our knowledge, the effectiveness of postoperative chemoradiotherapy (CRT) in these patients has never been investigated. In this retrospective study, we compared the outcomes of surgery with or without postoperative chemoradiotherapy in ESCC patients with ECE. From 2008 to 2009, 90 ECSS patients with ECE were included. Among those patients, 47 only received curative surgery alone, and 43 received additional postoperative concurrent CRT which consisted of radiotherapy (median dose 50 Gy) and chemotherapy (5-fluorouracil 1000 mg/m(2), days 1-4 and 29-32; cisplatinum 25 mg/m(2), days 1-3 and 29-31). Patients treated with postoperative CRT had significantly more T3/4 tumors (p=0.023). Based on log-rank stratified by T stage, postoperative adjuvant CRT significantly improved the overall survival (p=0.017) and progression free survival (p=0.002). In multivariate analysis, adjuvant CRT was identified as an independent prognostic factor (HR=0.494, CI 0.290-0.844, p=0.010). Compared with surgery alone, the CRT group had significantly fewer cases of regional recurrence (P=0.048) and overall recurrence (P=0.024). However, there was no significant difference in distant metastasis between two groups (P=0.755). In conclusion, our data suggest that the postoperative adjuvant CRT might be beneficial in selected subgroups of ESCC patients with ECE. To further verify these results, a prospective trial with a large sample size is needed.

Chaperone-like protein p32 regulates ULK1 stability and autophagy

Mitophagy mediates clearance of dysfunctional mitochondria, and represents one type of mitochondrial quality control, which is essential for optimal mitochondrial bioenergetics. p32, a chaperone-like protein, is crucial for maintaining mitochondrial membrane potential and oxidative phosphorylation. However, the relationship between p32 and mitochondrial homeostasis has not been addressed. Here, we identified p32 as a key regulator of ULK1 stability by forming complex with ULK1. p32 depletion potentiated K48-linked but impaired K63-linked polyubiquitination of ULK1, leading to proteasome-mediated degradation of ULK1. As a result, silencing p32 profoundly impaired starvation-induced autophagic flux and the clearance of damaged mitochondria caused by mitochondrial uncoupler. Importantly, restoring ULK1 expression in p32-depleted cells rescued autophagy and mitophagy defects. Our findings highlight a cytoprotective role of p32 under starvation conditions by regulating ULK1 stability, and uncover a crucial role of the p32-ULK1-autophagy axis in coordinating stress response, cell survival and mitochondrial homeostasis.Cell Death and Differentiation advance online publication, 24 April 2015; doi:10.1038/cdd.2015.34.

Chaperone-like protein p32 regulates ULK1 stability and autophagy

Mitophagy mediates clearance of dysfunctional mitochondria, and represents one type of mitochondrial quality control, which is essential for optimal mitochondrial bioenergetics. p32, a chaperone-like protein, is crucial for maintaining mitochondrial membrane potential and oxidative phosphorylation. However, the relationship between p32 and mitochondrial homeostasis has not been addressed. Here, we identified p32 as a key regulator of ULK1 stability by forming complex with ULK1. p32 depletion potentiated K48-linked but impaired K63-linked polyubiquitination of ULK1, leading to proteasome-mediated degradation of ULK1. As a result, silencing p32 profoundly impaired starvation-induced autophagic flux and the clearance of damaged mitochondria caused by mitochondrial uncoupler. Importantly, restoring ULK1 expression in p32-depleted cells rescued autophagy and mitophagy defects. Our findings highlight a cytoprotective role of p32 under starvation conditions by regulating ULK1 stability, and uncover a crucial role of the p32-ULK1-autophagy axis in coordinating stress response, cell survival and mitochondrial homeostasis.

Isolation of lactic acid bacteria from pao cai, a Chinese traditional fermented vegetable, with inhibitory activity against Salmonella associated with fresh-cut apple, using a modelling study

AIMS

To isolate lactic acid bacteria (LAB) from pao cai, a Chinese traditional fermented vegetable, with outstanding inhibitory activity against Salmonella inoculated on fresh-cut apple, using a modelling method.

METHODS AND RESULTS

Four kinds of pao cai were selected. A total of 122 isolates exhibited typical LAB characteristics: Gram-positive and catalase negative, among which 104 (85·24%) colonies showed antibacterial activity against Salmonella by the well diffusion assay. Four colonies showing maximum antibacterial radius against Salmonella were selected to co-inoculate with Salmonella on fresh-cut apple and stored at 10°C, further identified as three strains of Lactobacillus plantarum and one strain of Lactobacillus brevis by 16s rRNA gene sequence analysis. The modified Gompertz model was employed to analyse the growth of the micro-organisms on apple wedges. Two of the four selected strains showed antagonistic activity against Salmonella on fresh-cut apple, one of which, RD1, exhibited best inhibitory activity (Salmonella were greatly inhibited when co-inoculated with RD1 at 10°C at 168 h). No deterioration in odour or appearance of the apple piece was observed by the triangle test when fresh-cut apple was inoculated with RD1.

CONCLUSIONS

The mathematical modelling method is essential to select LAB with outstanding inhibitory activity against Salmonella associated with fresh-cut apple. LAB RD1 holds promise for the preservation of fresh-cut apple.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provided a new method on fresh-cut product preservation. Besides, to make the LAB isolating procedure a more correct one, this study first added the mathematical modelling method to the isolating procedure.

Clinical significance of microRNA-24 expression in esophageal squamous cell carcinoma

microRNA-24 has been reported to participate in tumorgenesis and progression by several signaling pathways in various tumors. However, its potential as a serum diagnostic factor and predictive biomarker for esophageal squamous cell carcinoma (ESCC) has not been studied. In the present study, serum samples were collected from 105 pathologically proven ESCC patients and 30 healthy volunteers. All patients were treated with concurrent chemotherapy and radiotherapy. Real-time polymerase chain reaction was carried out to measure the serum miR-24 expression level in all patients and volunteers. The data were compared among radio-sensitive group (CR+PR, 62 patients), radio-resistant group (SD+PD, 43 patients) and healthy volunteers to elucidate the diagnostic value of serum miR-24 testing for ESCC and the predictive value of miR-24 expression of treatment response. In the result, of the 105 ESCC patients enrolled in the study, 62 patients achieved partial or complete response. The serum miR-24 level in ESCC patients is 4.82 times as high as that in healthy subjects(P<0.01), indicating that serum miR-24 expression could be an excellent diagnostic factor. The mean miR-24 serum levels differ by 2.05 folds between radiosensitive group and radioresistant group, indicating that it may serve as a biomarker for predicting the response of ESCC patient to CRT. Furthermore, the responsiveness of therapy is significantly correlated with Cyfra21-1(P<0.05), serum miR-24 level (P<0.05) and the myelosuppression (P<0.01). In the prsent study, we come to the conclusion that serum miR-24 has the potential to serve as a noninvasive biomarker for both ESCC diagnosis and predicting treatment responses to concurrent chemo-radiation therapy. ESCC patients with lower Cyfra21-1, higher miR-24, and severer myelosupression were much more sensitive to CRT.

KEYWORDS

miR-24 expression, esophageal squamous cell carcinoma, chemo-radiation therapy, radiosensitivity.

Cost-effectiveness of alternative strategies for integrating MRI into breast cancer screening for women at high risk

BACKGROUND

Magnetic resonance imaging (MRI) is recommended for women at high risk for breast cancer. We evaluated the cost-effectiveness of alternative screening strategies involving MRI.

METHODS

Using a microsimulation model, we generated life histories under different risk profiles, and assessed the impact of screening on quality-adjusted life-years, and lifetime costs, both discounted at 3%. We compared 12 screening strategies combining annual or biennial MRI with mammography and clinical breast examination (CBE) in intervals of 0.5, 1, or 2 years vs without, and reported incremental cost-effectiveness ratios (ICERs).

RESULTS

Based on an ICER threshold of $100,000/QALY, the most cost-effective strategy for women at 25% lifetime risk was to stagger MRI and mammography plus CBE every year from age 30 to 74, yielding ICER $58,400 (compared to biennial MRI alone). At 50% lifetime risk and with 70% reduction in MRI cost, the recommended strategy was to stagger MRI and mammography plus CBE every 6 months (ICER=$84,400). At 75% lifetime risk, the recommended strategy is biennial MRI combined with mammography plus CBE every 6 months (ICER=$62,800).

CONCLUSIONS

The high costs of MRI and its lower specificity are limiting factors for annual screening schedule of MRI, except for women at sufficiently high risk.

Pathological analysis of extracapsular extension of metastatic lymph node and its potential impact on nodal clinical target volume in the radiotherapy of esophageal squamous cell carcinoma

There is no consensus regarding the clinical target volume (CTV) margins which surround the gross tumor volume of metastatic lymph nodes (LN) in radiotherapy of esophageal squamous cell carcinoma (ESCC). This study retrospectively assessed the distance of extracapsular extension (ECE) of metastatic LN in thoracic ESCC and defined nodal CTV margins. Histological sections of metastatic LNs from 217 patients with thoracic ESCC were re-examined. The incidence and maximal distance of ECE of metastatic LNs were assessed. The relationships between ECE and clinicopathologic features were also investigated. The ECE was found in 37.3% of patients (81/217) and 23.1% of metastatic LN (159/689), and the incidences had a significant relationship with N stage and LN size. The median distance of ECE was 1.0 mm (range, 0.2-9.7 mm). The distance of ECE showed a positive correlation with LN size (Spearman's correlation coefficient = 0.419; p<0.001). The ECE distances of LN with <10 mm diameter were significantly smaller than LN with 10-30 mm diameter (p<0.001). The 95th percentiles of ECE distances for these two groups were 3 mm and 5 mm, respectively. For pathologic LN <10 mm in diameter, a 3-mm CTV margin appears to be adequate to encompass 95% of the microscopic ECE, and for LN 10-30 mm, a 5-mm CTV margin is recommended.

Coverage effect on reactivity can be more complicated than what you believe: H2 dissociation on H-precovered Pd(111)

A systematic investigation based on density-functional-theory calculations is presented for elucidating the effect of adatoms on the energetics of H2 dissociation on H-precovered Pd(111) surfaces. Surprisingly, we found that the H-adatoms do not only have a poisoning effect but can also promote H2 dissociation when they are adsorbed on sites which are sufficiently far from the dissociating H2 molecule. The presence of these antagonistic effects produces many crossovers of the minimum energy profiles for H2 dissociation when coverage is varied and thus leads to a quite perplexing picture for the adatom effects. We devised a sorting procedure which allows for rationalizing nicely the influence of H-adatoms on the energetics of H2 dissociation on H-precovered Pd(111) surfaces.