Etoposide and cisplatin versus paclitaxel and carboplatin with concurrent thoracic radiotherapy in unresectable stage III non-small cell lung cancer: a multicenter randomized phase III trial

Background

The optimal chemotherapy regimen administered currently with radiation in patients with stage III non-small cell lung cancer (NSCLC) remains unclear. A multicenter phase III trial was conducted to compare the efficacy of concurrent thoracic radiation therapy with either etoposide/cisplatin (EP) or carboplatin/paclitaxel (PC) in patients with stage III NSCLC.

Patients and methods

Patients were randomly received 60-66 Gy of thoracic radiation therapy concurrent with either etoposide 50 mg/m2 on days 1-5 and cisplatin 50 mg/m2 on days 1 and 8 every 4 weeks for two cycles (EP arm), or paclitaxel 45 mg/m2 and carboplatin (AUC 2) on day 1 weekly (PC arm). The primary end point was overall survival (OS). The study was designed with 80% power to detect a 17% superiority in 3-year OS with a type I error rate of 0.05.

Results

A total of 200 patients were randomized and 191 patients were treated (95 in the EP arm and 96 in the PC arm). With a median follow-up time of 73 months, the 3-year OS was significantly higher in the EP arm than that of the PC arm. The estimated difference was 15.0% (95% CI 2.0%-28.0%) and P value of 0.024. Median survival times were 23.3 months in the EP arm and 20.7 months in the PC arm (log-rank test P = 0.095, HR 0.76, 95%CI 0.55-1.05). The incidence of Grade ≥2 radiation pneumonitis was higher in the PC arm (33.3% versus 18.9%, P = 0.036), while the incidence of Grade ≥3 esophagitis was higher in the EP arm (20.0% versus 6.3%, P = 0.009).

Conclusion

EP might be superior to weekly PC in terms of OS in the setting of concurrent chemoradiation for unresectable stage III NSCLC.

Trial registration ID

NCT01494558.

[Analgesic effect and related mechanism of peripheral acupoints electroacupuncture on superficial partial-thickness burn rats]

Objective: To observe the analgesic effect and related mechanism of peripheral acupoints electroacupuncture on superficial partial-thickness burn rats. Methods: Eighty SD rats were divided into sham injury group (SI), pure burn group (PB), electroacupuncture group (E), and sham electroacupuncture group (SE) according to the random number table, with 20 rats in each group. Right posterior leg of rats in group SI were sham injured, while superficial partial-thickness scald (hereinafter referred to as burn) model was reproduced on the right posterior leg of rats in the latter three groups. Electroacupuncture of peripheral acupoints of right posterior leg of rats (equivalent to Zusanli point and Sanyinjiao point of human) in group E were performed from post injury hour (PIH) 12 on, while rats in group SE were treated with sham electroacupuncture, with 30 min each time, one time a day for 3 days. Before injury and at PIH 12, 24, 36, 48, 60, and 72, the threshold of mechanical pain of 5 rats in each group was tested, and the threshold of heat pain of another 5 rats in each group was tested. At PIH 48, brain tissue of 5 rats in each group was obtained to observe the morphology and distribution of astrocytes with positive expression of glia fibrillary acidic protein (GFAP) in periaqueductal gray (PAG) area by immunohistochemical staining, and the number of astrocytes was calculated. At the same time, brain tissue of the rest 5 rats in each group was obtained to determine the expression of GFAP of astrocytes in PAG area with Western blotting. Data were possessed with analysis of variance of repeated measurement, one-way analysis of variance, and SNK test. Results: (1) Compared with that in group SI, the threshold of mechanical pain of rats in groups PB and SE had no significant change before injury and at PIH 12 (with P values above 0.05), but was significantly decreased from PIH 24 to 72 (with P values below 0.05); while the threshold of mechanical pain of rats in group E was significantly decreased from PIH 36 to 72 (with P values below 0.05). The threshold of mechanical pain of rats in group E was significantly higher than that in groups PB and SE at PIH 24 (with P values below 0.05). (2) Compared with that in group SI, the threshold of heat pain of rats in groups PB and SE had no significant change before injury (with P values above 0.05), but was significantly decreased from PIH 12 to 72 (with P values below 0.05); while the threshold of heat pain of rats in group E was significantly decreased from PIH 12 to 60 (with P values below 0.05). The threshold of heat pain of rats in group E was significantly higher than that in groups PB and SE from PIH 24 to 48 (with P values below 0.05). (3) The distribution of astrocytes with positive expression of GFAP in PAG area of rats in group SI was diffuse. The cell volume was small with cell body unobvious, and the projections were sparse, fine and short. The distribution of astrocytes with positive expression of GFAP in PAG area of rats in group PB was relatively concentrated. The cell body was hypertrophy and swelling, and the projections were increased and extended. The morphology and distribution of astrocytes with positive expression of GFAP in PAG area of rats in groups SE and E was similar to that in group PB. The numbers of astrocytes with positive expression of GFAP in PAG area of rats in groups SI, PB, E, and SE were 44±4, 39±4, 27±4, and 36±5, respectively. The number of astrocytes with positive expression of GFAP in PAG area of rats in group PB was significantly less than that in group SI (P<0.05), but similar to that in group SE (P>0.05). The number of astrocytes with positive expression of GFAP in PAG area of rats in group E was significantly less than that in groups PB and SE (with P values below 0.05). (4) The expressions of GFAP of astrocytes in PAG area of rats in groups SI, PB, E, and SE were 1.11±0.16, 0.66±0.15, 0.34±0.06, and 0.56±0.09, respectively. The expression of GFAP of astrocytes in PAG area of rats in group PB was significantly lower than that in group SI (P<0.05), but similar to that in group SE (P>0.05). The expression of GFAP of astrocytes in PAG area of rats in group E was significantly lower than that in groups PB and SE (with P values below 0.05). Conclusions: Electroacupuncture of peripheral acupoints can release the pain followed superficial partial-thickness burn in rats at early stage, and the possible mechanism is that it reduces the activation of astrocytes in PAG area.

CAMK2γ in intestinal epithelial cells modulates colitis-associated colorectal carcinogenesis via enhancing STAT3 activation

Inflammation is one of the major risk factors for cancer. Here, we show that calcium/calmodulin-dependent protein kinase II gamma (CAMK2γ) in intestinal epithelial cells (IECs) modulates inflammatory signals and promotes colitis-associated cancer (CAC) in mice. We have identified CAMK2γ as a downstream target of colitis-induced WNT5a signaling. Furthermore, we have shown that CAMK2γ protects against intestine tissue injury by increasing IEC survival and proliferation. CAMK2γ knockout mice displayed reduced CAC. Furthermore, we used bone marrow transplantation to reveal that CAMK2γ in IECs, but not immune cells, was crucial for its effect on CAC. Consistently, transgenic over-expression of CAMK2γ in IECs accelerated CAC development. Mechanistically, CAMK2γ in IECs enhanced epithelial STAT3 activation to promote survival and proliferation of colonic epithelial cells during CAC development. These results thus identify a new molecular mechanism mediated by CAMK2γ in IECs during CAC development, thereby providing a potential new therapeutic target for CAC.

Microstructural study of the lunate in stage III Kienböck's disease with micro-computed tomography imaging

Seventeen fresh lunates with stage III Kienböck's disease were scanned with micro-computed tomography. Four regions of interest were selected to measure trabecular parameters, which were compared with those from normal lunates. Within the three regions in the distal surface, there was more compact trabecular bone in the middle region when compared with the palmar and dorsal regions. In the central part, the trabeculae of the Kienböck's lunates were much thicker than those in normal lunates. The diameters of the palmar nutrient foramina of the Kienböck's lunates were significantly smaller than those in normal lunates. In affected lunates, the bony disruptions were mostly located in the palmar or dorsal areas, which were shown from trabecular bone structure analysis to be structurally weaker. This leads to separation of the distal part of the fractured bone, disruption of the blood supply, poor bone remodelling and proneness to secondary fracture and eventual collapse.

Microstructural study of the lunate in stage III Kienböck's disease with micro-computed tomography imaging

Seventeen fresh lunates with stage III Kienböck's disease were scanned with micro-computed tomography. Four regions of interest were selected to measure trabecular parameters, which were compared with those from normal lunates. Within the three regions in the distal surface, there was more compact trabecular bone in the middle region when compared with the palmar and dorsal regions. In the central part, the trabeculae of the Kienböck's lunates were much thicker than those in normal lunates. The diameters of the palmar nutrient foramina of the Kienböck's lunates were significantly smaller than those in normal lunates. In affected lunates, the bony disruptions were mostly located in the palmar or dorsal areas, which were shown from trabecular bone structure analysis to be structurally weaker. This leads to separation of the distal part of the fractured bone, disruption of the blood supply, poor bone remodelling and proneness to secondary fracture and eventual collapse.

Oscillation in tissue oxygen index during recovery from exercise

It was hypothesized that an oscillation of tissue oxygen index (TOI) determined by near-infrared spectroscopy during recovery from exercise occurs due to feedback control of adenosine triphosphate and that frequency of the oscillation is affected by blood pH. In order to examine these hypotheses, we aimed 1) to determine whether there is an oscillation of TOI during recovery from exercise and 2) to determine the effect of blood pH on frequency of the oscillation of TOI. Three exercises were performed with exercise intensities of 30 % and 70 % peak oxygen uptake (V(.)o(2)peak) for 12 min and with exercise intensity of 70 % V(.)o(2)peak for 30 s. TOI during recovery from the exercise was analyzed by fast Fourier transform in order to obtain power spectra density (PSD). There was a significant difference in the frequency at which maximal PSD of TOI appeared (Fmax) between the exercises with 70 % V(.)o(2)peak for 12 min (0.0039+/-0 Hz) and for 30 s (0.0061+/-0.0028 Hz). However, there was no significant difference in Fmax between the exercises with 30 % (0.0043+/-0.0013 Hz) and with 70 % V(.)o(2)peak for 12 min despite differences in blood pH and blood lactate from the warmed fingertips. It is concluded that there was an oscillation in TOI during recovery from the three exercises. It was not clearly shown that there was an effect of blood pH on Fmax.

Azimuthal Anisotropy in U+U and Au+Au Collisions at RHIC

Collisions between prolate uranium nuclei are used to study how particle production and azimuthal anisotropies depend on initial geometry in heavy-ion collisions. We report the two- and four-particle cumulants, v_{2}{2} and v_{2}{4}, for charged hadrons from U+U collisions at sqrt[s_{NN}]=193  GeV and Au+Au collisions at sqrt[s_{NN}]=200  GeV. Nearly fully overlapping collisions are selected based on the energy deposited by spectators in zero degree calorimeters (ZDCs). Within this sample, the observed dependence of v_{2}{2} on multiplicity demonstrates that ZDC information combined with multiplicity can preferentially select different overlap configurations in U+U collisions. We also show that v_{2} vs multiplicity can be better described by models, such as gluon saturation or quark participant models, that eliminate the dependence of the multiplicity on the number of binary nucleon-nucleon collisions.

Oscillation of tissue oxygen index in non-exercising muscle during exercise

The purpose of the present study was to examine how oscillation of tissue oxygen index (TOI) in non-exercising exercise is affected during high-intensity and low-intensity exercises. Three exercises were performed with exercise intensities of 30% and 70% peak oxygen uptake (Vo(2)peak) for 12 min and with exercise intensity of 70% Vo(2)peak for 30 s. TOI in non-exercising muscle (biceps brachii) during the exercises for 12 min was determined by nearinfrared spectroscopy. TOI in the non-exercising muscle during the exercises was analyzed by fast Fourier transform (FFT) to obtain power spectra density (PSD). The frequency at which maximal PSD appeared (Fmax) during the exercise with 70% Vo(2)peak for 12 min (0.00477 ± 0.00172 Hz) was significantly lower than that during the exercise with 30% Vo2peak for 12 min (0.00781 ± 0.00338 Hz). There were significant differences in blood pH and blood lactate between the exercise with 70% Vo(2)peak and the exercise with 30% Vo(2)peak. It is concluded that TOI in nonexercising muscle oscillates during low-intensity exercise as well as during high-intensity exercise and that the difference in Fmax between the two exercises is associated with the difference in increase in blood lactate derived from the exercise.