Safe Handling of Patient Gowns During the COVID-19 Pandemic: An Intelligent System for Patients With Cancer Undergoing Daily Radiotherapy

BACKGROUND/AIM

Nosocomial infection is a substantial clinical, societal and economic burden, especially during the COVID-19 pandemic. Patients with cancer are required to change into patient gowns before receiving radiotherapy. To improve efficiency and infection control, we designed novel intelligent devices for both gown distribution and recycling. We conducted a pilot study to provide evidence for the device in healthcare quality improvement.

MATERIALS AND METHODS

We designed and set up intelligent machines with an infrared sensor for patient gown distribution and recycling. The performance of these machines was assessed by questionnaire survey of patients' perceptions and handling by laundry personnel.

RESULTS

We composed a questionnaire to measure patient/personnel satisfaction upon gown handling based on the existing data of our hospital. Two generations of patient gown distribution machines were introduced. One was the novel automated device for both gown distribution and recycling. The other one was the conventional wooden cabinets and/or hamper stands with foot pedals. Survey results showed that approximately 90% satisfaction was achieved with the automated machines. Overall satisfaction with the new soiled gown recycling machines was significantly higher than that with the conventional receptacles (p<0.01).

CONCLUSION

The automated patient gown distribution machines safely and efficiently provide patients with suitable gowns. The automated patient gown recycling machine reduces contamination of the gown recycling area. Using these machines improves infection control in the hospital environment and effectively reduces the risk of nosocomial infection.

Topoisomerase I Inhibition Radiosensitizing Hepatocellular Carcinoma by RNF144A-mediated DNA-PKcs Ubiquitination and Natural Killer Cell Cytotoxicity

Background and Aims

Topoisomerase I (TOP1) participates the repair of DNA double-strand breaks (DSBs) upon radiation therapy (RT). RNF144A mediates ubiquitination of catalytic subunit of DNA protein kinase (DNA-PKcs), a critical factor in DSB repair. This study aimed to investigate the natural killer (NK) cell-mediated radiosensitization with TOP1 inhibition and the mechanism by DNA-PKcs/RNF144A.

Methods

In vitro synergism with TOP1i or cocultured NK cells and RT were evaluated in human hepatocellular carcinoma (HCC) cell lines (Huh7/PLC5) by clonogenic survivals. Orthotopic xenografts were treated with Lipotecan and/or RT. Protein expression was analyzed by western blotting, immunoprecipitation, subcellular fractionation, and confocal microscopy.

Results

Lipotecan/RT had a superior synergistic effect to RT on HCC cells. Combined RT/Lipotecan reduced the xenograft size by 7-fold than RT (p<0.05). Lipotecan caused more radiation-induced DNA damage and DNA-PKcs signaling. The expression of major histocompatibility complex class I-related chain A and B (MICA/B) on tumor cells is associated with the sensitivity to NK cell-mediated lysis. Cocultured NK and HCC cells with Lipotecan radiosensitized HCC cells/tissues with the expression of MICA/B. RNF144A increased more in Huh7 cells with combined RT/TOP1i, and reduced the prosurvival function of DNA-PKcs. The effect was reversed by inhibiting the ubiquitin/proteasome system. In comparison, RNF144A decreased through nuclear translocation with the cumulated DNA-PKcs and radio-resistance of PLC5 cells.

Conclusions

TOP1i reinforces NK cell-activated anti-HCC effect of RT through RNF144A mediated DNA-PKcs ubiquitination. RNF144A provides a reason for differentiating radiosensitization effect between HCC cells.

Moving from tangibility toward digitalization: investigating team dynamics and facilitator support among medical students in conventional and digital small-group tutorials

BACKGROUND

Small group tutorials (SGT) promotes self-directed learning and is widely used in medical education. The coronavirus pandemic (COVID-19) has accelerated the trend toward SGT digitalization, with unclear effect. We hypothesize that team dynamics and facilitator support influence SGT satisfaction in digital versus conventional SGT.

METHODS

During the spring semester of year 2021, medical students (the second, third, and fourth year; n = 433) participating in conventional face-to-face and digital SGT curricula were enrolled. Participating students completed the collaborative learning attitude scale (including team dynamics, team acquaintance, and facilitator support dimensions) and teamwork satisfaction scale, previously validated for small-group collaborative learning, and chose preference between conventional or digital SGT in future curricula. Exploratory factor analysis (EFA) was performed to extract the essential structural factors of these scales. Paired t-tests were conducted to compare differences in different dimensions and satisfaction between the conventional and digital SGT settings. Two sets of multiple regression analyses were done; one with team satisfaction scale results and the other with preference for digital SGT as the dependent variable were used to evaluate determinants of these two variables.

RESULTS

The EFA results revealed that the original collaborative learning attitude scale was concentrated on two dimensions: team dynamics and facilitator support. No significant differences were noted between the SGT settings for the two dimensions and teamwork satisfaction. Regression analyses showed that teamwork dynamics was independently correlated with teamwork satisfaction in both conventional and digital SGT. Facilitator support was positively correlated with teamwork satisfaction in conventional, but not digital SGT. Higher teamwork satisfaction was an important determinant of preference for digital SGT among medical students.

CONCLUSIONS

Team dynamics were closely linked to teamwork satisfaction among medical students in both conventional and digital SGT, while the role of facilitator support became less obvious during digital SGT.

Efficacy and safety of combined targeted therapy and immunotherapy versus targeted monotherapy in unresectable hepatocellular carcinoma: a systematic review and meta-analysis

BACKGROUND

Cancer therapy has evolved from non-specific cytotoxic agents to a selective, mechanism-based approach that includes targeted agents and immunotherapy. Although the response to targeted therapies for unresectable hepatocellular carcinoma (HCC) is acceptable with the improved survival, the high tumor recurrence rate and drug-related side effects continue to be problematic. Given that immune checkpoint inhibitor alone are not robust enough to improve survival in unresectable HCC, growing evidence supports the combination of targeted therapy and immunotherapy with synergistic effect.

METHODS

Online databases including PubMed, EMBASE, Cochrane Library, and Web of Science were searched for the studies that compared targeted monotherapy with the combination therapy of targeted drug and checkpoint inhibitors in unresectable HCC patients. Eligibility criteria were the presence of at least one measurable lesion as defined by the Response Evaluation Criteria in Solid Tumors (version 1.1) for unresectable HCC patients, an Eastern Cooperative Oncology Group performance status of 0-2, and a Child-Pugh score ≤ 7. Outcome measurements include overall survival (OS), progression-free survival (PFS), and treatment-related adverse event (TRAE).

RESULTS

Three phase II/III randomized controlled trials were included in this study. The pooled results showed that combination therapy significantly improved survival than targeted monotherapy, in terms of OS (hazard ratio (HR) = 0.67; 95% confidence interval [CI]: 0.50-0.91) and PFS (HR = 0.58; 95% CI: 0.51-0.67), respectively. In the incidence of grade 3-5 TRAEs, the combination therapy was significantly higher than targeted monotherapy (odds ratio = 1.98; 95% CI: 1.13-3.48).

CONCLUSION

For unresectable HCC, combined targeted drug and immunotherapy significantly improved survival compared with targeted monotherapy. However, the incidences of AEs of combinational therapy were higher than targeted monotherapy.

Radiosensitization effect by HDAC inhibition improves NKG2D-dependent natural killer cytotoxicity in hepatocellular carcinoma

Background

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. Radiotherapy (RT) controls HCC unsatisfactorily and temporarily. Histone deacetylase inhibitor (HDACi) is a heterogeneous group of epigenetic therapeutics with promising anticancer effects and synergism in combination with RT. HDACi modulates natural killer (NK) cell ligand expression on tumor cells, and leads to immune evasion of cancer cells. Expressions of NK group 2D (NKG2D) ligands on cancer cells determine the cytotoxic effect by interacting with NKG2D receptor on NK cells. However, the role of NKG2D signaling in HCC upon combined RT and HDACi remains unclear.

Method

In vitro co-culture system with NK cells was tested for human and murine HCC cell lines. Pan-HDACi (panobinostat) and specific HDAC4 knockdown (HDAC4-KD) were used for HDAC inhibition. Clonogenic assay and flow cytometry examined HCC cell survival and NKG2D ligand expression, respectively. Syngeneic mouse model was used to validate the radiosensitizing effect in vivo.

Results

Combined RT and HDACi/HDAC4-KD significantly enhanced NK cell-related cytotoxicity and increased NKG2D ligands, MICA/MICB expressions in human and RAE-1/H60 expressions in murine HCC cells. Delayed tumor growth in vivo by the combinational treatment of RT and HDACi/HDAC4-KD was shown with the associated NKG2D ligand expressions. However, NKG2D receptor did not significantly change among tumors.

Conclusion

Radiosensitizing effect with combined RT and HDAC inhibition increased the expression of NKG2D ligands in HCC cells and enhanced their susceptibility to NK cell-mediated cytotoxicity. These findings imply the potential use of combined RT/HDACi and NK cell-directed immunotherapy.

Effectiveness of tutor shadowing on faculty development in problem-based learning

BACKGROUND

To enhance tutors' teaching skills, tutor shadowing for novice tutors of problem-based learning (PBL) in addition to conventional faculty development (FD) was applied. This study aimed to develop a tutoring-skill scale (TS-scale) and evaluate the effect of shadowing on PBL tutors.

METHODS

This study employed a before-and-after study design with three phases. In phase 1, a TS-scale was elaborated. A validity examination was performed in phase 2. Phase 3 was a study of the effectiveness using a TS-scale survey of novice PBL tutors before and after the FD course. The FD course for novice PBL tutors included an FD workshop and PBL shadowing activities.

RESULTS

A TS-scale with a 32-item questionnaire of self-rated confidence for PBL tutors was identified in phase 1. In phase 2, 7 experienced specialists in medical education were invited to evaluate the content validity of the scale. The item content validity index (I-CVI) ranged from 0.86 to 1, and the scale-CVI (S-CVI) was 0.95. A total of 85 novice PBL tutors completed the TS-scale before the FD course, yielding a Cronbach's alpha of 0.98. An exploratory factor analysis with varimax rotation was performed. The twenty-four items with significant loadings greater than 0.5 were incorporated into a new TS-scale and were grouped into three factors: student contact, medical expertise, and teaching expertise. In phase 3, 76 novice PBL tutors completed the 24-item TS-scale before (pretest) and after (posttest) the FD course. Their self-rated confidence improved significantly across the three factors after the FD course. The pretest and posttest scores did not differ according to the tutors' gender, the grades they taught, or their specialty background.

CONCLUSIONS

Novice PBL tutors benefit from FD that incorporates tutor shadowing in the 3 key domains of tutoring competencies. The TS-scale developed in this study can be applied in future research on FD design.

Competing Risk Analysis of Outcomes of Unresectable Pancreatic Cancer Patients Undergoing Definitive Radiotherapy

PURPOSE

We investigated potential factors, including clinicopathological features, treatment modalities, neutrophil-to-lymphocyte ratio (NLR), carbohydrate antigen (CA) 19-9 level, tumor responses correlating with overall survival (OS), local progression (LP), and distant metastases (DMs), in patients with locally advanced pancreatic cancer (LAPC) who received definitive radiotherapy (RT).

METHODS

We retrospectively analyzed demographic characteristics; biologically effective doses (BED10, calculated with an α/β of 10) of RT; and clinical outcomes of 57 unresectable LAPC (all pancreatic adenocarcinoma) patients receiving definitive RT using modern techniques with and without systemic therapy between January 2009 and March 2019 at our institution. We used Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 to evaluate the radiographic tumor response after RT. The association between prognostic factors and OS was assessed using the Kaplan-Meier analysis and a Cox regression model, whereas baseline characteristics and treatment details were collected for competing-risk regression of the association with LP and DM using the Fine-Gray model.

RESULTS

A median BED10 of 67.1 Gy resulted in a disease control rate of 87.7%, and the median OS was 11.8 months after a median follow-up of 32.1 months. The 1-year OS rate, cumulative incidences of LP, and DM were 49.2%, 38.5%, and 62.9%, respectively. Multivariate analyses showed that pre-RT NLR ≥3.5 (adjusted hazard ratio [HR] = 8.245, p < 0.001), CA19-9 reduction rate ≥50% (adjusted HR = 0.261, p = 0.005), RT without concurrent chemoradiotherapy (adjusted HR = 5.903, p = 0.004), and administration of chemotherapy after RT (adjusted HR = 0.207, p = 0.03) were independent prognostic factors for OS. Positive lymph nodal metastases (adjusted subdistribution HR [sHR] = 3.712, p = 0.003) and higher tumor reduction after RT (adjusted sHR = 0.922, p < 0.001) were significant prognostic factors for LP, whereas BED10 ≥ 67.1 Gy (adjusted sHR = 0.297, p = 0.002), CA19-9 reduction rate ≥50% (adjusted sHR = 0.334, p = 0.023), and RT alone (adjusted sHR = 2.633, p = 0.047) were significant prognostic factors for DM.

CONCLUSION

Our results indicate that pre-RT NLR and post-RT monitoring of CA19-9 and tumor size reduction can help identify whether patients belong to the good or poor prognostic group of LAPC. The incorporation of new systemic treatments during and after a higher BED10 RT dose for LAPC patients is warranted.

Multi-Institutional Retrospective Study of Radiotherapy for Hepatocellular Carcinoma in the Caudate Lobe

Background: No studies evaluating the clinical outcomes of radiotherapy (RT) for hepatocellular carcinoma (HCC) in the caudate lobe have been available to date. The purpose of this study was to evaluate the effectiveness and safety of RT for HCC in the caudate lobe.

Material and Methods: Seventy patients with HCC in the caudate lobe treated with RT from a multi-institutional database were included in this study. The median equivalent dose in 2 Gy (EQD2) was 80.0 Gy₁₀ (range, 31.3–99.3), and freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) rates were evaluated.

Results: The median time of follow-up was 47.9 months (range, 3.4–127), and the 5-year FFLP, PFS, and OS rates were 80.6% [95% confidence interval (CI), 70.8–91.8], 13.8% (95% CI, 7.5–25.4), and 51.3% (95% CI, 39.9–66.1), respectively. In the multivariate analysis, the radiation dose was significantly associated with the FFLP rate [hazard ratio (HR), 0.57 per 10 Gy₁₀ increase, p = 0.001], and the status of FFLP was significantly associated with OS (HR, 2.694, p = 0.014). The overall rate of ≥grade 3 adverse events was 5.7% (4 of 70), and RT-related mortality was not observed.

Conclusion: RT for HCC in the caudate lobe showed promising FFLP and OS rates with safe toxicity profiles. These findings suggest that RT may be a promising treatment option for HCC in the caudate lobe.

Development and Validation of a Nomogram for Patients with Nonmetastatic BCLC Stage C Hepatocellular Carcinoma after Stereotactic Body Radiotherapy

BACKGROUND

Stereotactic body radiotherapy (SBRT) is an emerging treatment modality for hepatocellular carcinoma (HCC) with promising outcome. However, appropriate survival prediction models are scarce. This study aimed to develop a simple and clinically useful prognostic nomogram for patients with nondistant metastatic Barcelona Clinic Liver Cancer (BCLC) stage C HCC undergoing SBRT.

METHODS

The data were based on a prospective multi-institutional registry enrolling 246 patients with nondistant metastatic BCLC stage C HCC treated with SBRT between January 1, 2008 and December 31, 2016. They were randomly divided into two subsets: 164 into the development cohort and 82 into the validation cohort. We identified and included prognostic factors for survival to derive a nomogram in the development cohort. The predictability of the nomogram was evaluated in the validation cohort. The area under the receiver operating characteristic curve (AUROC) and the calibration plot were used to evaluate the performance of the nomogram.

RESULTS

The median survival was 13.5 months, with 1- and 2-year overall survival (OS) rates of 55.0 and 32.9%, respectively. Number of tumors, largest tumor size, macrovascular invasion, Child-Turcotte-Pugh class, and biologically effective dose were significantly associated with OS (p < 0.05). These predictors were included to develop a nomogram with an AUROC of 0.77 (0.73-0.87). The prediction model was well calibrated in the validation cohort. The OS for patients who were divided by their risk scores differed significantly (p < 0.001).

CONCLUSIONS

The nomogram we generated had discriminatory and satisfactory predictability for OS among nonmetastatic BCLC stage C HCC patients treated with SBRT. It demands further validations with cross-country data to confirm its worldwide usefulness.

Targeting human epidermal growth factor receptor 2 enhances radiosensitivity and reduces the metastatic potential of Lewis lung carcinoma cells

BACKGROUND

Sublethal radiation induces matrix metalloproteinase 9 (MMP-9)-mediated radioresistance in Lewis lung carcinoma (LLC) cells and their metastatic dissemination. We aim to determine if EGFR/HER2 activation associates with MMP-9-mediated radioresistance and invasiveness in irradiated LLC cells.

METHODS

LLC cells were treated with erlotinib or afatinib followed by sublethal radiation. After irradiation, we examined the phosphorylation of EGFR/HER2 and MMP-9 expression. Colony formation assay determined if the kinase inhibitors sensitize LLC cells to radiation. Matrigel-coated Boyden chamber assay assessed cellular invasiveness. Resulting tumors of wild-type LLC cells or HER2 knock-down mutant cells were irradiated to induce pulmonary metastases.

RESULTS

Afatinib more effectively sensitized LLC cells to radiation and decreased invasiveness by inhibiting phosphorylation of EGFR, HER2, Akt, ERK, and p38, and down-regulating MMP-9 when compared to erlotinib. Afatinib abolished radiation-induced lung metastases in vivo. Furthermore, LLC HER2 knock-down cells treated with radiation had growth inhibition.

CONCLUSION

Dual inhibition of radiation-activated EGFR and HER2 signaling by afatinib suppressed the proliferation and invasion of irradiated LLC cells. Increased radiosensitivity and decreased metastatic dissemination were observed by pharmacological or genetic HER2 inhibition in vivo. These findings indicate that HER2 plays a pivotal role in enhancing radioresistance and reducing metastatic potential of LLC cells.

Improved prognosis with induction chemotherapy in pathological complete responders after trimodality treatment for esophageal squamous cell carcinoma: Hypothesis generating for adjuvant treatment

PURPOSE

To compare the locations of recurrences and survival outcomes in esophageal squamous cell carcinoma (ESCC) patients with pathological complete response (pCR) after neoadjuvant concurrent chemoradiotherapy (CCRT) with or without preceding induction chemotherapy (IC) followed by esophagectomy.

METHODS

Among 276 patients with locally advanced ESCC undergoing trimodality treatment during 2004-2014, 94 (34.1%) with pCR were eligible. The cohort included 26 patients undergoing IC before CCRT (IC group), and 68 patients who did not receive IC (non-IC group).

RESULTS

At a median follow-up of 51.4 months (95% confidence interval; 42.9-62.1), 19 patients experienced recurrences. There was a trend toward fewer distant failures in the IC group (0% vs.14.7%, p = 0.057), while locoregional recurrence was similar (7.7% vs. 7.4%). IC was associated with significantly improved survivals with the 5-year RFS and OS rates for the IC group of 85.1% and 90.5%, respectively, compared to of 46.2% and 48.1% for the non-IC group (p = 0.008 for RFS, and p = 0.015 for OS). By multivariable analyses, IC remained the only significant factor associated with survivals (HR:0.18 for RFS, p = 0.020 and HR:0.18 for OS, p = 0.025). The effect of IC in the whole cohort, irrespective of pathological response, was also assessed. Patients with non-pCR in the IC group had a trend toward worse survivals compared to the non-IC group CONCLUSIONS: In ESCC patients with pCR after trimodality treatment, IC was associated with favorable survivals. The benefits of IC might be a hypothesis generation for adjuvant treatment for patients with pCR.

A multi-institutional predicting nomogram for BCLC stage C hepatocellular carcinoma after stereotactic body radiotherapy

353

Background: The study aimed to develop a nomogram to predict overall survival (OS) among hepatocellular carcinoma (HCC) patients with BCLC stage C after stereotactic body radiotherapy (SBRT). Methods: Clinical data from the multicenter study consisted of 270 HCC patients with BCLC stage C. The patients underwent SBRT with a median dose of 40 Gy (range: 25-60 Gy) in 2-6 fractions. The model included age, gender, ECOG performance status, etiology (HBV, HCV, and non-B, non-C), number of tumor, tumor size, AFP level, presence of macrovascular invasion, Child-Pugh class, N stage, M stage, sorafinib use, and biologically effective dose. Cox’s proportional hazards models were utilized to estimate regression coefficients of death risk predictors and derive risk scores. The area under receiver operating curve (AUROC) was used to evaluate the performance of the risk models. Results: The median survival was 12.6 months, with 1-year and 2-year OS rates of 51.6% and 30.8%, respectively. Multiple regression showed age (with 5-year increase, HR = 0.89, p = 0.002), ECOG (1 vs. 0, HR = 1.72, p = 0.016; 2 vs. 0, HR = 2.64, p = 0.002), number and size of tumors ( > 5 tumors or > 8 cm vs. ≤5 tumors and ≤ 8 cm, HR = 1.83, p = 0.003; > 5 tumors and > 8cm vs. ≤5 tumors and ≤ 8 cm, HR = 2.04, p = 0.013), macrovascular invasion (yes vs. no, HR = 2.22, p < 0.001), Child-Pugh class (B vs. A, HR = 2.83, p < 0.001), and M stage (1 vs. 0, HR = 2.30, p = 0.001) are statistically significant predictors for OS. All of these significant predictors were included in the risk prediction model. The total risk score of the prediction model ranged from 0 to 48. Each score had its corresponding risk of OS. The AUROC for predicting 1-year OS was 0.820. Conclusions: The nomogram we generated among HCC patients undergoing SBRT had discrimination satisfactory predictability for OS. It can be used to stratify high-risk patients and select appropriate patients for future clinical trials.

Targeting histone deacetylase 4/ubiquitin-conjugating enzyme 9 impairs DNA repair for radiosensitization of hepatocellular carcinoma cells in mice

Several strategies to improve the efficacy of radiation therapy against hepatocellular carcinoma (HCC) have been investigated. One approach is to develop radiosensitizing compounds. Because histone deacetylase 4 (HDAC4) is highly expressed in liver cancer and known to regulate oncogenesis through chromatin structure remodeling and controlling protein access to DNA, we postulated that HDAC4 inhibition might enhance radiation's effect on HCC cells. HCC cell lines (Huh7 and PLC5) and an ectopic xenograft were pretreated with HDAC inhibitor or short hairpin RNA to knock down expression of HDAC4 and then irradiated (2.5-10.0 Gy). We evaluated cell survival by a clonogenic assay; apoptosis by Annexin V immunofluorescence; γH2AX, Rad51, and HDAC4 by immunofluorescence staining; HDAC4, Rad51, and ubiquitin-conjugating enzyme 9 (Ubc9) in HCC cell nuclei by cell fractionation and confocal microscopy; physical interaction between HDAC4/Rad51/Ubc9 by immunoprecipitation; and the downstream targets of HDAC4 knockdown by immunoblotting. Both HDAC4 knockdown and HDAC inhibitor enhanced radiation-induced cell death and reduced homologous recombination repair of DNA double-strand breaks and protein kinase B activation, leading to increased apoptosis. HDAC4 knockdown with or without an HDAC inhibitor significantly delayed tumor growth in a radiation-treated xenograft model. Radiation stimulated nuclear translocation of Rad51 in an HDAC4-dependent manner and the binding of Ubc9 directly to HDAC4, which led to Ubc9 acetylation. Moreover, these effects were accompanied by HDAC4/Ubc9/Rad51 complex dissociation through inhibiting nuclear translocation. Conclusion: HDAC4 signaling blockade enhances radiation-induced lethality in HCC cells and xenografts. These findings raise the possibility that HDAC4/Ubc9/Rad51 complex in DNA repair may be a target for radiosensitization of HCC. (Hepatology 2018;67:586-599).

Treatment outcomes of and prognostic factors for definitive radiotherapy with and without chemotherapy for Stage I/II nasal extranodal NK/T-cell lymphoma

Treatment strategies for nasal extranodal NK/T-cell lymphoma (ENKTL), including sequential chemotherapy followed by radiotherapy (SCRT), concurrent chemoradiotherapy (CCRT), or radiotherapy alone (RT), remain varied. The purpose of this study was to assess the treatment outcome, the toxicity, and the potential prognostic factors for patients with early-stage nasal ENKTL treated using definitive RT (minimum of 50 Gy) with or without chemotherapy. From 1998 to 2014, 37 patients were included in the study. Eight patients were treated with RT alone, 1 with CCRT, and 28 with SCRT. Local regional control (LRC), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. RT resulted in an overall response rate of 91.2%, with a complete response rate of 78.4%. After a median follow-up time of 36.8 months, the 3-year LRC, PFS and OS were 87.4%, 64.0% and 76.3%, respectively. Acute severe toxicity (Grade 3) of mucositis was observed in 6 (16.2%) of the 37 patients. In univariate analyses, extensive disease (Stage I/II with local invasiveness) and the presence of B symptoms were significantly associated with a poor PFS, whereas extensive disease was significantly associated with a poor OS. Multivariate analysis identified the presence of extensive disease as an independent predictor of PFS (P < 0.001) and OS (P = 0.015). High-dose RT with or without chemotherapy reported promising locoregional control and a favorable outcome for patients with early-stage nasal ENKTL without local invasiveness. Further investigation of new treatment strategies for patients with local invasiveness is warranted.

The ratio of weight loss to planning target volume significantly impacts setup errors in nasopharyngeal cancer patients undergoing helical tomotherapy with daily megavoltage computed tomography

Background

Changes in head and neck anatomy during radiation therapy (RT) produce setup uncertainties of nasopharyngeal cancer (NPC) irradiation. We retrospectively analyzed image guidance data to identify clinical predictors of setup errors.

Patients and methods

The data of 217 NPC patients undergoing definitive RT on a helical tomotherapy (HT) unit were analyzed. Factors including tumor stage, body mass index, weight loss, and planning target volume (PTV) were assessed as predictors of daily megavoltage computed tomography (MVCT) setup displacements, which were automatically registered using software.

Results

Mean daily setup displacements (in mm) were 1.2 ± 0.6, 1.8 ± 0.8, 3.4 ± 1.4 in the medial-lateral (ML), superior-inferior (SI), and anterior-posterior (AP) directions, respectively. Mean weight loss was 4.6 ± 3.3 kg (6.8 ± 4.9%). Patients with weight loss > 5% had significantly larger setup displacements in the AP (3.6 ± 1.5 vs. 2.9 ± 1.1 mm, p < 0.001) and SI (1.6 ± 0.7 vs. 1.9 ± 0.9 mm, p = 0.01) direction, but not in the ML direction (p = 0.279). The AP setup error increased 0.06 mm (y = 0.055x + 2.927, x: percentage of weight loss/PTV, y: AP displacement) per one percent increase in weight loss normalized to PTV.

Conclusions

Patients with weight loss > 5% and smaller PTVs, possibly because of small body frame or neck girth, were more likely to have increased setup errors in the AP direction.

How to Improve Therapeutic Ratio in Radiotherapy of HCC

BACKGROUND

During the past two decades, external-beam radiation technology has substantially changed from traditional two-dimensional to conformal three-dimensional to intensity-modulated planning and stereotactic body radiotherapy (SBRT).

SUMMARY

Modern techniques of radiotherapy (RT) are highly focused and capable of delivering an ablative dose to targeted hepatocellular carcinoma (HCC) tumors. SBRT is an option for selected patients with limited tumor volume and non-eligibility for other invasive treatments. Moreover, RT combined with a radiation sensitizer (RS) to increase the therapeutic ratio has shown promising results in select studies, prompting further investigation of this combination. With the undetermined role of RT in treatment guidelines and variation in patterns of treatment failure after RT in patient with HCC, useful biomarkers to guide RT decision-making and selection of patients are needed and emerging.

KEY MESSAGE

The objective of this review is to summarize the current RS with SBRT schemes and biomarkers for patient selection used to maximize the effect of RT on HCC.

Differences in toxicity and outcome associated with circadian variations between patients undergoing daytime and evening radiotherapy for prostate adenocarcinoma

This retrospective study tested the hypothesis that disease control and treatment-related toxicity in patients undergoing high-dose radiotherapy (HDRT) for prostate cancer varies in a circadian manner. Patients with localized prostate adenocarcinoma receiving HDRT (median 78 Gy) to the prostate and involved seminal vesicle(s) without elective pelvic irradiation were divided into a daytime treatment (before 5 PM) group (n = 267) and evening treatment (after 5 PM) group (n = 142). Biochemical failure (Phoenix definition), acute and late gastrointestinal (GI) and genitourinary toxicities (Common Terminology Criteria for Adverse Events version 4), biochemical failure-free survival (BFFS) and freedom from late toxicity were assessed. Analyses were performed by binary logistic regression and Cox proportional hazard regression. The median follow-up was 68 months, and 75% of patients were ≥70 years old. Evening HDRT was significantly associated with worse freedom from ≥grade 2 late GI complications (hazard ratio = 2.96; p < 0.001). The detrimental effect of evening HDRT was significant in patients older than 70 years old (p < 0.001) but not in younger patients (p = 0.63). In a subgroup of propensity score-matched cohort with T2b-T3 disease (n = 154), the 5-year BFFS was worse in the evening group than the daytime group (72% vs. 85%, hazard ratio = 1.95, p = 0.05). Our study indicates that evening HDRT may lead to more GI complications, especially in older patients, and worse BFFS in patients with T2b-T3 disease.

Abstract A002: Serum biomarkers of VEGF-A and TGF-β1 predict pathological response and survival of esophageal cancer patients treated with neoadjuvant chemoradiotherapy and esophagectomy

This study is aimed to identify serum biomarkers that predict treatment response and survival by screening proximity ligation assay (PLA) and verified enzyme-linked immunosorbent assay (ELISA) for patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant concurrent chemoradiotherapy (CCRT) followed by esophagectomy. One hundred and three patients with ESCC receiving CCRT consisting of taxane-/5-fluorouracil-based chemotherapy and 40Gy radiotherapy followed by surgery were prospectively enrolled. Serum samples were collected before and within 1 month after completion of CCRT. With the use of PLA, 15 biomarkers were simultaneously analyzed in the initial 79 patients. The biomarkers significantly associated with pathological response (PathR)/survival were verified by ELISA in an expanded group of 103 patients. Associations between serum levels of biomarkers and clinical factors correlating with PathR, disease-free survival (DFS), and overall survival (OS) were evaluated by ANOVA and log-rank tests. Following CCRT, 38 patients had pathologically complete response (37%), 44 microscopic (43%), and 21 macroscopic residual disease (20%). With a median follow-up of 66 months, the median DFS and OS were 23.7 months and 43.5 months, respectively. Among the 15 biomarkers screened by PLA, vascular endothelial growth factor-A (VEGF-A) and transforming growth factor-β1 (TGF-β1) were significantly associated with PathR and/or DFS. These biomarkers were further analyzed by ELISA to confirm initial biomarker findings by PLA. On ELISA, both pre- and post-CCRT VEGF-A levels were significantly correlated with PathR (p=0.042 and 0.019, respectively). Patients with high pre-CCRT VEGF-A/TGF-β1 levels (≥median) had significantly worse median DFS (9.3 months vs. 34.6 months, p=0.007) and worse median OS (26.7 months vs. 51.5 months, p=0.05). On multivariate analysis, PathR (p=0.001) and pre-CCRT high levels (≥median) of both VEGF-A and TGF-β1 (p=0.005) were independent factors for DFS. PathR (p=0.002) was the only significant factor for OS, while pre-CCRT high levels of both VEGF-A and TGF-β1 were borderline significant (p=0.065). In conclusion, serum VEGF-A may be used to predict post-CCRT pathological response. High serum levels of VEGF-A and TGF-β1 before CCRT associate with significantly worse DFS and a trend toward worse OS.

Citation Format: Jason Chia-Hsien Cheng, Yun Chiang, Feng-Ming Hsu, Chiao-Ling Tsai, Chih-Hung Hsu, Jang-Ming Lee. Serum biomarkers of VEGF-A and TGF-β1 predict pathological response and survival of esophageal cancer patients treated with neoadjuvant chemoradiotherapy and esophagectomy. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr A002.

Sonic Hedgehog inhibition as a strategy to augment radiosensitivity of hepatocellular carcinoma

BACKGROUND AND AIM

Sonic Hedgehog (SHH) is a regulator in tumorigenesis of hepatocellular carcinoma (HCC). This study aimed to determine whether radiation-induced SHH signaling occurs in HCC and whether SHH inhibitor acts as a radiosensitizer.

METHODS

The in vitro effects of combining SHH ligand (recombinant human SHH) or inhibitor (cyclopamine) with irradiation were evaluated in the human HCC cell lines, Huh-7 and PLC/PRF/5, and murine cell line BNL. Cell survival and apoptosis were measured using a colony formation assay, annexin-V staining, and poly (ADP-ribose) polymerase activation. Western blotting and immunofluorescence staining were used to detect protein expression. The in vivo response to radiotherapy and/or cyclopamine was tested in BALB/c mice bearing an orthotopic allogeneic tumor.

RESULTS

Treatment of HCC cells with irradiation and SHH ligand had a protective effect on clonogenic cell survival. Treatment with irradiation and cyclopamine was a more potent inhibitor of cell proliferation than either modality alone. The antiproliferative activity of cyclopamine was attributable to apoptosis induction. Radiation dose-dependently upregulated the expression of Gli-1 (a transcription factor induced by SHH), and this effect was observed mainly in the nucleus. When combined with cyclopamine, irradiation inhibited Gli-1 and increased DNA double-strand breakage. Radiotherapy increased SHH and Gli-1 expression in allogeneic tumor. When compared with radiotherapy alone, cyclopamine with radiotherapy reduced the mean tumor size of orthotopic tumors by 67% (P < 0.05).

CONCLUSION

Combining an SHH inhibitor with radiotherapy may enhance HCC cell and orthotopic tumor radiosensitivity.

Targeting Phosphatidylinositide3-Kinase/Akt pathway by BKM120 for radiosensitization in hepatocellular carcinoma

Tumor control of hepatocellular carcinoma by radiotherapy remains unsatisfactory. The phosphatidylinositol 3-kinase (PI3K)/Akt pathway plays a critical role in inhibiting cancer cell death. Elevated PI3K/Akt activity is associated with increased cellular resistance to irradiation. Our aim was to determine whether the inhibition of PI3K/Akt activity by a PI3K inhibitor, BKM120, contributes to the increased sensitivity of liver cancer cells to irradiation. The hepatocellular carcinoma cell lines (Huh7 and BNL) were used to evaluate the in vitro synergism between BKM120 and irradiation. Balb/c mice bearing ectopic BNL xenografts were treated with BKM120 and/or radiotherapy to assess the in vivo response. BKM120 increased cell killing by radiation, increased the expression of apoptotic markers, and suppressed the repair of radiation-induced DNA double-strand breaks. BKM120 pretreatment inhibited radiation-induced Akt phosphorylation and enhanced the tumor-suppressive effect and radiation-induced tumor cell apoptosis in ectopic xenografts. Inhibition of mTOR phosphorylation by rapamycin enhanced the radiosensitivity of BKM120-treated hepatocellular carcinoma cells. The synergism between BKM120 and irradiation likely inhibits the activation of Akt by radiation, leading to increased cell apoptosis and suppression of DNA-double-strand breaks repair in hepatocellular carcinoma cells. These data suggest that the BKM120/radiation combination may be a strategy worthy of clinical trials.

Variations in cognitive demand affect heart rate in typically developing children and children at risk for developmental coordination disorder

BACKGROUND

Developmental coordination disorder (DCD) is a diagnosis for children who present with movement difficulties, but are of normal intelligence without neurological deficits. Previous studies have demonstrated that children with DCD exhibit perceptual deficits and lower cognition performance. To date, their autonomic nervous system (ANS) responses during tasks requiring cognitive and perceptual effort have not been compared to typically developing children (TDC).

OBJECTIVE

The present study investigated heart rate variability (HRV) as a marker for ANS response differences between DCD and TDC, and the impact of different levels of task difficulty.

METHODS

Participants were 60 individuals (9-10 years); 30 children at risk for DCD, and 30 TDC. Each participant performed two tasks each of which demanded enhanced cognitive effort: a visual signal detection task and a digit memory task-each task had two levels of difficulty, low (LD) and high (HD). Heart rate responses were continuously recorded during performance of each task. Frequency domain analysis and heart rate sample entropy (SampEn) were computed to determine ANS responses in each of the tasks.

RESULTS

HRV differences were detected between the two levels of task difficulty, LD and HD, for the visual signal detection task, but not for the digit memory task. HRV differences between LD and HD conditions were greater for TDC children than DCD when engaged in visual signal detection task, compare to the memory task.

INTERPRETATION

The results suggest that children at risk for DCD may show decreased HRV as a marker for altered ANS responses and potential deficits in the linkage between their perceptions and actions.

Newly diagnosed gastroesophageal reflux disease increased the risk of acute exacerbation of chronic obstructive pulmonary disease during the first year following diagnosis--a nationwide population-based cohort study

BACKGROUND

While prior studies have demonstrated that chronic obstructive pulmonary disease (COPD) is associated with gastroesophageal reflux disease (GERD), and that GERD is associated with acute exacerbations of COPD (AECOPD), no study to date has been able to establish temporality in this relationship. The purpose of this cohort study was to explore the impact of a new diagnosis of GERD on the risk of subsequent AECOPD.

METHODS

We used a retrospective population-based cohort design to analyse the data of 1976 COPD subjects with GERD as an exposure cohort and 3936 COPD subjects without GERD as a comparison group. We individually tracked each subject in this study for 12 months and identified those subjects who experienced an episode of AECOPD. Hazard ratios (HR) were calculated using Cox proportional hazards regression analysis.

RESULTS

The incidence of AECOPD was 4.08 and 2.79 per 100 person-year in individuals with and without GERD, respectively (p = 0.012). Following adjustment for sex, age, ischaemic heart disease, heart failure, atrial fibrillation, hypertension, osteoporosis, anxiety, diabetes mellitus, angina, stroke, anaemia, dementia, occupational category, monthly insurance premium, number of OPD visits and COPD severity. The stepwise Cox regression analysis revealed that GERD was independently associated with an increased risk of AECOPD (HR = 1.48, 95% CI = 1.10-1.99).

CONCLUSION

This study demonstrated that GERD is an independent risk factor for AECOPD. Caution should be exercised when assessing GERD symptoms in patients with COPD.

Neoadjuvant bevacizumab and chemoradiotherapy in locally advanced rectal cancer: early outcome and technical impact on toxicity

Background

We aimed to evaluate early clinical and pathological results for treating locally advanced rectal cancer with bevacizumab and neoadjuvant concurrent chemoradiotherapy using the technique of prone-position volumetric modulated arc therapy and to compare the toxicity of volumetric modulated arc therapy with that of supine-position four-field box radiotherapy.

Methods

Twelve patients with stage IIA to IVA rectal adenocarcinoma, treated with neoadjuvant concurrent chemoradiotherapy (45 Gy in 25 fractions to the rectal tumor and pelvic lymphatics) and bevacizumab, were prospectively enrolled. Chemotherapy included FOLFOX (leucovorin, fluorouracil, and oxaliplatin) (n =11) and 5-fluorouracil (n =1). All patients received prone-position volumetric modulated arc therapy. A historical cohort treated with supine-position box radiotherapy, including six other patients treated with bevacizumab-based concurrent chemoradiotherapy in our hospital, was used for comparison. Setup errors, toxicities, and potential biomarkers were evaluated.

Results

All patients completed neoadjuvant concurrent chemoradiotherapy and underwent total mesorectal excision. Four (33.3%) patients had pathological complete response. Significantly more grade 2 or 3 diarrhea was associated with the supine-box technique (5/6 versus 2/12, P =0.01). The magnitude of setup errors was similar between the supine-box and prone volumetric modulated arc therapy techniques. The estimated 2-year survival and 2-year failure-free survival rates were 100% and 72.9% in the prone volumetric modulated arc therapy group and 66.7% and 66.7% in the supine box group, respectively.

Conclusions

The early clinical outcome has been encouraging. Volumetric modulated arc therapy in prone-positioned patients was technically advantageous and reduced bowel toxicity.

Superior liver sparing by combined coplanar/noncoplanar volumetric-modulated arc therapy for hepatocellular carcinoma: a planning and feasibility study

Compared with step-and-shoot intensity-modulated radiotherapy (sIMRT) and tomotherapy, volumetric-modulated arc therapy (VMAT) allows additional arc configurations in treatment planning and noncoplanar (NC) delivery. This study was first to compare VMAT planning with sIMRT planning, and the second to evaluate the toxicity of coplanar (C)/NC-VMAT treatment in patients with hepatocellular carcinoma (HCC). Fifteen patients with HCC (7 with left-lobe and 8 with right-lobe tumors) were planned with C-VMAT, C/NC-VMAT, and sIMRT. The median total dose was 49Gy (range: 40 to 56Gy), whereas the median fractional dose was 3.5Gy (range: 3 to 8Gy). Different doses/fractionations were converted to normalized doses of 2Gy per fraction using an α/β ratio of 2.5. The mean liver dose, volume fraction receiving more than 10Gy (V10), 20Gy (V20), 30Gy (V30), effective volume (Veff), and equivalent uniform dose (EUD) were compared. C/NC-VMAT in 6 patients was evaluated for delivery accuracy and treatment-related toxicity. Compared with sIMRT, both C-VMAT (p = 0.001) and C/NC-VMAT (p = 0.03) had significantly improved target conformity index. Compared with C-VMAT and sIMRT, C/NC-VMAT for treating left-lobe tumors provided significantly better liver sparing as evidenced by differences in mean liver dose (p = 0.03 and p = 0.007), V10 (p = 0.003 and p = 0.009), V20 (p = 0.006 and p = 0.01), V30 (p = 0.02 and p = 0.002), Veff (p = 0.006 and p = 0.001), and EUD (p = 0.04 and p = 0.003), respectively. For right-lobe tumors, there was no difference in liver sparing between C/NC-VMAT, C-VMAT, and sIMRT. In all patients, dose to more than 95% of target points met the 3%/3mm criteria. All 6 patients tolerated C/NC-VMAT and none of them had treatment-related ≥ grade 2 toxicity. The C/NC-VMAT can be used clinically for HCC and provides significantly better liver sparing in patients with left-lobe tumors.

Biomarker studies on radiotherapy to hepatocellular carcinoma

Radiotherapy (RT) has been gradually integrated into the multimodality treatment for hepatocellular carcinoma (HCC). The various patterns of failure in HCC patients undergoing RT drive the need of effective biomarkers to guide treatment decisions. Limited numbers of biomarkers have been investigated in HCC, with even fewer of them for patients treated by RT. Serum or plasma biomarkers measured by enzyme-linked immunosorbent assay were the most common practice. Of particular interest are those biomarkers that are detectable early in the course of radiotherapy which correlated with ultimate clinical outcome. Functional magnetic resonance imaging (MRI) is increasingly used to evaluate the imaging pattern indicative of disease control following RT. Positron emission tomography shows that pre-RT standard uptake values associate with various types of recurrence after treatment. Proximity ligation assay (PLA) is evolving with the unique features of dual-probe identification, ligation and amplification to allow the small volume of serum/plasma samples for evaluating multiple biomarkers. We demonstrate the screening work of biomarkers by PLA with pre- and post-RT serum samples from HCC patients undergoing RT. Efforts are being made to search for the potential biomarkers for HCC patients treated by RT.

Practically acquired and modified cone-beam computed tomography images for accurate dose calculation in head and neck cancer

BACKGROUND

On-line cone-beam computed tomography (CBCT) may be used to reconstruct the dose for geometric changes of patients and tumors during radiotherapy course. This study is to establish a practical method to modify the CBCT for accurate dose calculation in head and neck cancer.

PATIENTS AND METHODS

Fan-beam CT (FBCT) and Elekta's CBCT were used to acquire images. The CT numbers for different materials on CBCT were mathematically modified to match them with FBCT. Three phantoms were scanned by FBCT and CBCT for image uniformity, spatial resolution, and CT numbers, and to compare the dose distribution from orthogonal beams. A Rando phantom was scanned and planned with intensity-modulated radiation therapy (IMRT). Finally, two nasopharyngeal cancer patients treated with IMRT had their CBCT image sets calculated for dose comparison.

RESULTS

With 360° acquisition of CBCT and high-resolution reconstruction, the uniformity of CT number distribution was improved and the otherwise large variations for background and high-density materials were reduced significantly. The dose difference between FBCT and CBCT was < 2% in phantoms. In the Rando phantom and the patients, the dose-volume histograms were similar. The corresponding isodose curves covering ≥ 90% of prescribed dose on FBCT and CBCT were close to each other (within 2 mm). Most dosimetric differences were from the setup errors related to the interval changes in body shape and tumor response.

CONCLUSION

The specific CBCT acquisition, reconstruction, and CT number modification can generate accurate dose calculation for the potential use in adaptive radiotherapy.

Postural responses to a suprapostural visual task among children with and without developmental coordination disorder

We sought to determine the effects of varying the perceptual demands of a suprapostural visual task on the postural activity of children with developmental coordination disorder (DCD), and typically developing children (TDC). Sixty-four (32 per group) children aged between 9 and 10 years participated. In a within-participants design, each child performed a signal detection task at two levels of difficulty, low (LD) and high difficulty (HD). During performance of the signal detection tasks we recorded positional variability of the head and torso using a magnetic tracking system. We found that task difficulty had a greater effect on task performance among the TDC group than among children with DCD. Overall positional variability was greater the DCD group than in the TDC group. In the TDC group, positional variability was reduced during performance of the HD task, relative to sway during performance of the LD task. In the DCD group, positional variability was greater during performance of the HD task than during performance of the LD task. In children, DCD may reduce the strength of functional integration of postural activity with the demands of suprapostural visual tasks.

Handling leachate from glass cullet stockpiles

Mixed glass cullet (crushed recycled glass containers) is stockpiled uncovered before use as roadway construction aggregate or daily cover in landfills. Rainwater that leaches through the stockpiles dissolves and suspends contaminants such as those from food residuals and paper labels. The objective of this study was to determine leachate quantity and quality from cullet stockpiles as a basis for development of Best Management Practices (BMPs). Four 35-tonne field stockpiles were set up for leachate analysis and to determine the effects of mechanical turning treatment on the leachate. Field-collected leachate and laboratory-generated washwater of cullet (water:cullet=3:1 by weight) were both analyzed for basic wastewater parameters, which showed pollutant levels comparable to or higher than those of untreated domestic wastewater or urban stormwater. While organic contamination decreased substantially (e.g., washwater BOD>95% reduction), TKN and total-phosphorus levels in leachate ranged between 11.6-154mgL(-1) and 1.6-12.0mgL(-1), respectively, and remained comparable to levels found in untreated domestic wastewater after four months. Turning enhanced the degradation of the organic constituents inside the stockpiles, which was confirmed by elevated temperatures. Based on this study, leachate from glass cullet stockpiles should not be released to surface water. For leachate from long-term cullet stockpiles, release to groundwater should be only done after treatment to reduce nitrogen levels.

Exclusive breastfeeding and incident atopic dermatitis in childhood: a systematic review and meta-analysis of prospective cohort studies

BACKGROUND

Breastfeeding is undisputedly preferable to formula feeding for infant nutrition because of its nutritional, immunological and psychological benefits. However, studies on the association between breastfeeding and development of atopic dermatitis (AD) have shown inconsistent results.

OBJECTIVES

To examine the association between exclusive breastfeeding for at least 3 months after birth and the development of AD in childhood.

METHODS

An electronic literature search of MEDLINE (January 1966-May 2008) and EMBASE (1980-May 2008) was conducted. Prospective cohort studies that met the predetermined criteria were independently assessed by three reviewers. The pooled effect estimate was calculated by random effects model. Heterogeneity across the studies was investigated by meta-regression analysis.

RESULTS

Twenty-one studies with 27 study populations were included for meta-analysis. The summary odds ratio (OR) for the effect of exclusive breastfeeding on the risk of AD was 0.89 (95% confidence interval, CI 0.76-1.04). Heterogeneity was found across the studies (chi(2) = 83.6, d.f. = 26; P < 0.001). Breastfeeding was associated with a decreased risk of AD (OR 0.70; 95% CI 0.50-0.99) when analysis was restricted to the studies comparing breastfeeding with conventional formula feeding. The pooled OR for study populations with atopic heredity was 0.78 (95% CI 0.58-1.05).

CONCLUSIONS

There is no strong evidence of a protective effect of exclusive breastfeeding for at least 3 months against AD, even among children with a positive family history.

Influence of temperature on the ontogenetic expression of neural development-related genes from developing tilapia brain expressed sequence tags

The developing central neural circuits in teleosts are genetically controlled and temperature-initiated. We compiled a list of transcripts expressed in the developing tilapia (Oreochromis mossambicus) brain using expressed sequence tags derived from the developing brain, and investigated genes with thermosensitive ontogenetic expression. Of 1084 clones, 893 were unique genes, 445 of which were known. Fourteen of the latter were neural development-related, and the ontogenetic expression of nine was temperature-influenced. Discs large homolog 5, myelin expression factor 2, plasticity-related protein-2, tsc2 gene product-related genes, and an inhibitor of differentiation protein 2 (Id2) were differentially temperature-influenced according to their developmental stages. Endothelial differentiation-related factor 1, midkine-related growth factor b, and mitogen-activated protein kinase 14b were specifically influenced by elevated temperature, and beta-catenin-like isoform 1 by lower temperature. Neural development-related genes, particularly those with thermosensitive ontogenetic expression, might be important for developing central neural circuits in teleosts.

Estradiol and para-chlorophenylalanine downregulate the expression of brain aromatase and estrogen receptor-alpha mRNA during the critical period of feminization in tilapia (Oreochromis mossambicus)

The period of maximal feminizing action of 17beta-estradiol (E(2)) upon sex ratio is before 10 days posthatching in tilapia (Oreochromis mossambicus). The effect of E(2) at this time is mimicked by para-chlorophenylalanine (p-CPA), a serotonin (5-hydroxytryptamine; 5-HT) synthesis inhibitor. The effect of E(2) on sexual differentiation may be mediated by the 5-HT system, which is consistent with the suggestion in mammals. The masculinizing actions of 17alpha-methyltestosterone (MT) are most potent later at up to day 20 of age, and may depend on MT induction of aromatase activity. In the present study, the effects of gonadal steroids and p-CPA on brain aromatase and estrogen receptor (ER) mRNA expression during the critical period of sexual differentiation were investigated. Treatment of tilapia with E(2) resulted in a significant decrease in the expression of brain aromatase and ERalpha between days 0 and 10, but not subsequently. The effect of E(2) at this time can be mimicked by p-CPA. Treatment of tilapia with MT, by contrast, resulted in a significant increase in brain aromatase, ERalpha and ERbeta mRNA expression when given between days 10 and 20. The downregulation of brain aromatase and ERalpha mRNA expression by E(2) before 10 days of age and, in turn, the upregulation of brain aromatase and ERalpha and ERbeta mRNA expression by MT at up to day 20 of age coincide with the period in which E(2) and MT have the maximal effect on gonadal feminization and masculinization, respectively.

Measurement and simulation of light distribution in biological tissues

Lateral light-distribution images of biologic tissues were used to study the tissues' optical characteristics. Monte Carlo simulation with the same conditions was performed to simulate the light distribution for comparison. Simulation results showed that the lateral light distribution was similar to the internal light distribution in biologic tissue. The direction of muscle fibers and the temperature both affect the near-field light distribution in tissue. The lateral view distribution can be both measured and simulated to study photon migration in tissue. It can also be used to estimate or verify the optical coefficients of tissue.

Comparative anti-caries effects of tablet and liquid fluorides in cleft children

Children with cleft lip and/or palate are at a higher risk for developing caries of the primary incisors compared with non-cleft children. To determine whether fluoride in tablet or liquid form would be more efficacious with children with cleft lip and/or palate, a two-year clinical investigation was conducted to test the anti-caries effects. One-hundred and fifteen cleft children (59 boys and 56 girls) between 22 and 26 months old were randomly selected into control, tablet and liquid fluoride groups. The amount of administered fluoride was 0.25 mg F daily in non-fluoridated Taiwan. Dental examinations were conducted using mirrors and #23 explorers. Caries were assessed using the DMF index in the baseline, first year and second year. The results showed that children in the tablet and liquid groups had a significantly lower DMFT increment than in the control group (p < 0.05). In the DMFS index, children in the liquid group showed a significantly lower caries increment than in the control group (p < 0.01), and children in the tablet group presented a borderline, but non-significant statistical difference when compared with the control group (p = 0.065). No significant statistical difference was found in either DMFT or DMFS between tablet and liquid fluoride administrations (p = 0.521 and p = 0.383, respectively). It is concluded that dietary fluoride supplements in liquid form show efficacy in reducing early childhood caries in the cleft children. Liquid fluoride showed slightly better numerical anti-caries effect than tablet fluoride, which is possibly due to its ease of administration with small children.

Lateral approach without ligament release in total knee arthroplasty: new concepts in the surgical technique

A lateral approach without ligament release was performed in 475 primary total knee arthroplasties (TKAs) in 344 patients and 50 revision TKAs in 39 patients. Deformities of the genu varum or valgum were corrected by accurate bone cut; no ligament releases were required other than to achieve adequate exposure. A lateral approach allowed both self-centering of the extensor mechanism and knee closure in complete flexion. Better range of motion was achieved. More than 90 degree active flexion usually occurred 3 days postoperatively. Postoperative roentgenograms showed all knees had good varus and valgus stability, which was sustained with time, except 1 with late genu recurvatum due to inadequate polyethylene thickness and the other with a broken tibial base plate. Complications such as disruption of patellar blood supply and knee instability, more frequently observed in the medial approach with ligament release, did not occur. The results suggest that this new technique is safe and may give better outcomes.

Effects of estrogen and neurotransmitters on the primary cultures of tilapia brain from different ages

The effects of estrogen and neurotransmitters on the proliferation of brain cells were investigated in the primary cultures of tilapia brain from different ages. Treatment of brain cells that were cultured on day 1, 3, 5, 7, 10, 30, and 180 posthatching with serotonin (5-HT), resulted in a significant increase of the Brdu(+)-cell number. By contrast, norepinephrine (NE) resulted in a significant decrease and gamma-aminobutyric acid (GABA) had no effect. 17 beta-Estradiol (E(2)) significantly increased the Brdu(+)-cell number when the brain cells were cultured after 5 days of age, but had no effect when cultured on day 1 or 3 of age. These results indicate that the proliferation of brain cell is enhanced by 5-HT at each stage. This effect is mimicked by E(2) when given after 5 days of age. Conversely, NE has an effect to depress the proliferation of brain cells. Whereas, GABA has no effect.

Simplified rat intubation using a new oropharyngeal intubation wedge

Our new oropharyngeal intubation wedge made from a plastic 3-ml syringe has been used successfully for the expansion of the oropharyngeal cavity and visualization of vocal cords for endotracheal intubation in the rat. All the animals we used tolerated the intubation and ventilation procedures in a series of experiments. After the proper setting of the respirator, vital signs were maintained within normal range. The postmortem examination and measurements in the upper airway confirmed that the endotracheal tube was properly sited and also demonstrated the precise size of the device that should be used. The main advantages of this method include low cost, simplicity, and reliability. Furthermore, because no expensive, elaborate, difficult-to-operate, or hard-to-get special equipment is needed, this technique can be used in every laboratory.

Effects of gonadal steroids on brain serotonergic and aromatase activity during the critical period of sexual differentiation in tilapia, Oreochromis mossambicus

The effects of gonadal steroids on brain serotonin (5-HT) and aromatase activity during the critical period of sexual differentiation were investigated in tilapia, Oreochromis mossambicus. Treatment of tilapia with 17beta-oestradiol (E2) between days 7 and 10 posthatching resulted in a significant increase in the female : male ratio as determined at day 90, and a significant reduction in brain 5-HT content. Treatment between days 10 and 20, or between days 20 and 30, had no significant effect. Since the 5-HT system may influence sexual differentiation, we examined the effects of para-chlorophenylalanine (p-CPA), a 5-HT synthesis inhibitor. As with E2, treatment of tilapia with p-CPA between days 7 and 10 posthatching resulted in a significant increase in the female : male ratio. Again, treatment between days 10 and 20, or between days 20 and 30, had no significant effect. Both p-CPA and E2 significantly depressed brain aromatase activity when administrated between days 7 and 10, but not subsequently. In tilapia treated between days 7 and 10, the brain 5-HT content was lowered by E2 to an extent similar to that seen with p-CPA, which is consistent with the suggestion that the effect of E2 on sexual differentiation may be mediated by the 5-HT system. Treatment of tilapia with 17alpha-methyltestosterone (MT), by contrast, resulted in a reduction in the female : male ratio, and treatment was most effective when given between days 10 and 20. The period of maximal effect of MT upon sex ratio appears to coincide with the ability of MT to induce an increase in brain aromatase activity.

Effect of CO2 laser on healing of cultured meniscus

BACKGROUND AND OBJECTIVE

A new method to improve cartilage repair is clinically important. The enhancement of meniscal healing by low power CO2 laser was investigated in an organ culture system.

STUDY DESIGN/MATERIALS AND METHODS

A longitudinal or a radial defect was made in the avascular zone of rabbit menisci. Irradiation by CO2 laser with 1 W (energy density 50 J/cm2) and 2 W (energy density 100 J/cm2) was used.

RESULTS

Histologic and scanning electron microscopic evaluations revealed that both energy densities of laser irradiation and the type of and the site of meniscal defect can influence the course and the outcome of meniscal healing. A marked increase in fibrochondrocytic proliferation and regeneration of collagen fibers were demonstrated in the meniscal defects irradiated by 100 J of CO2 laser energy.

CONCLUSIONS

The healing of meniscal defects could be promoted by low power CO2 laser irradiation.

Temperature affects the development of central neurotransmitter systems of tilapia, Oreochromis mossambicus

The effects of temperature on the development of central neurotransmitter systems were investigated with tilapia, Oreochromis mossambicus. Zero-day-old (the hatching day) tilapia were kept at four different temperatures: 20 (lower), 24 (control), and 28 and 32 degrees C (elevated), respectively. On the 5th day, brain serotonin (5-HT), norepinephrine (NE), gamma-aminobutyric acid (GABA), and glutamate (Glu) contents were quantified by a high-performance liquid chromatograph with electrochemical detection. Similar experiments were performed on the 5-, 10-, 15-, 20-, and 25-day-olds. The results showed that aquatic temperature influenced brain 5-HT, NE, Glu, and GABA contents during its respective restricted period. The influence of both lower and elevated temperatures on the neurotransmitter content, either increasing or suppressing, is dependent on its developing stage. The facts provide an evidence that the development of central neurotransmitter systems is influenced by aquatic temperature during its specific effective period.

Effects of temperature on the deformity and sex differentiation of tilapia, Oreochromis mossambicus

The effects of temperature on the deformity and sex differentiation of tilapia, Oreochromis mossambicus, were investigated. Zero- (the hatching day), 5-, and 10-day-old tilapia were respectively divided into 4 groups that were reared at 20, 24, 28, and 32 degrees C for 5 days. Percentages of deformity were significantly increased when tilapia were kept in the elevated temperatures (28 and 32 degrees C) before 5 days old during this experiment, whereas the lower temperature (20 degrees C) had no effect on the development of morphology. On the other hand, exposure to the lower temperature before 10 days old induced a high proportion of females whereas a high proportion of males was induced by the elevated temperature after 10 days old during this experiment. These results indicate that morphological development is influenced by temperature, particularly by the elevated temperature during a restricted developmental period. Both lower and elevated temperatures induce the gonadal feminization and masculinization, respectively, during its restricted developmental period. J. Exp. Zool. 286:534-537, 2000.

Acoustic inspection of bond strength of steel-reinforced mortar after exposure to elevated temperatures

In order to evaluate the bond strength between the reinforcement and concrete after fire damage, a combination of acoustic through-transmission and pull-out tests were used. Previous studies have shown a 25% decrease in the ultrasonic pulse velocity at 90% of the maximum load at room temperature. The specimens were kept in the oven at an elevated temperature for 1, 2, or 3 h. They were then removed and cooled to room temperature. Inspection was conducted using a high-power ultrasonic pulse velocity system while a pull-out load was applied. The correlation between preheated temperature, acoustic wave velocity, and the applied load was analyzed. Initial results show that bond strength and pulse velocity decreased substantially as the temperature or the heating time increased.

Age-related differences in the secretion of calcitonin in male rats

The mechanism of hypercalcitoninemia associated with aging was investigated in male rats. To mimic some of the hormonal changes with aging, orchidectomized (Orch) and hyperprolactinemic rats were used to mimic the physiological status of aging. Orch and haloperidol-induced hyperprolactinemic rats aged 3, 8, and 17 months were infused with CaCl2 and then bled from a jugular catheter following the CaCl2 challenge. Rat thyroid gland was incubated with Locke's medium at 37 degrees C for 30 minutes. Compared with 8- and 3-month-old rats, 17-month-old rats exhibited the lowest levels of plasma testosterone and the highest levels of plasma prolactin (PRL) and calcitonin (CT). The release of CT in the thyroid glands in vitro was highest in 17-month-old rats. Orchidectomy decreased rat plasma CT and thyroid CT release in vitro. Hyperprolactinemic rats had higher levels of plasma PRL and CT compared with control animals. The release of thyroid CT in vitro was greater in hyperprolactinemic rats. These results suggest that the hypersecretion of CT in 17-month-old rats may be due in part to hyperprolactinemia.