Analysis of Radiation Dose to the Shoulder by Treatment Technique and Correlation With Patient Reported Outcomes in Patients Receiving Regional Nodal Irradiation

Background/Purpose

Shoulder/arm morbidity is a late complication of breast cancer treatment with surgery and regional nodal irradiation (RNI). We set to analyze the impact of radiation technique [intensity modulated radiation therapy (IMRT) or 3D conformal radiation therapy (3DCRT)] on radiation dose to the shoulder with a hypothesis that IMRT use results in smaller volume of shoulder receiving radiation. We explored the relationship of treatment technique on long-term patient-reported outcomes using the quick disabilities of the arm, shoulder, and hand (q-DASH) questionnaire.

Materials/Methods

We identified patients treated with adjuvant RNI (50 Gy/25 fractions) from 2013 to 2018. We retrospectively contoured the shoulder organ-at-risk (OAR) from 2 cm above the ipsilateral supraclavicular (SCL) planning target volume (PTV) to the inferior SCL PTV slice and calculated the absolute volume of shoulder OAR receiving 5–50 Gy (V5–V50). We identified patients that completed a q-DASH questionnaire ≥6 months from the end of RNI.

Results

We included 410 RNI patients: 54% stage III, 72% mastectomy, 35% treated with IMRT. IMRT resulted in significant reductions in the shoulder OAR volume receiving 20–50 Gy vs. 3DCRT. In total, 82 patients completed the q-DASH. The mean (SD) q-DASH=25.4 (19.1) and tended to be lower with IMRT vs. 3DCRT: 19.6 (16.4) vs. 27.8 (19.8), p=0.078.

Conclusion

We found that IMRT reduces radiation dose to the shoulder and is associated with a trend toward reduced q-DASH scores ≥6 months post-RNI in a subset of our cohort. These results support prospective evaluation of IMRT as a technique to reduce shoulder morbidity in breast cancer patients receiving RNI.

Dosimetric parameters associated with radiation-induced esophagitis in breast cancer patients undergoing regional nodal irradiation

BACKGROUND/PURPOSE

Rates of acute esophagitis in breast cancer patients undergoing regional nodal irradiation (RNI) are under-reported. We set to identify esophageal dose-volume constraints associated with grade 2 esophagitis (G2E). We hypothesized that the G2E rate was higher with intensity modulated radiation therapy (IMRT) vs. 3D conformal radiation therapy (3DCRT).

MATERIALS/METHODS

We identified patients that received RNI (50 Gy/25 fractions) from 1/2013 to 6/2019. We retrospectively contoured the esophagus in a consistent manner and recorded esophageal mean dose, max dose, and V10-V50. Our primary endpoint was the G2E rate. Receiver operating characteristics curves analysis (e.g., Youden's J statistic) were used to determine the cutpoints for the dosimetric parameters which were then tested in logistic regression models.

RESULTS

We identified 531 patients (50% left-sided; 41% IMRT; 16.2% G2E). G2E was significantly higher in IMRT vs. 3DCRT patients (23.6% vs. 10.9%, p < 0.0001). All esophageal dosimetric parameters were significantly associated with G2E after adjusting for age and laterality. The cutpoints for esophageal mean dose, V10 and V20 were 11 Gy, 30%, and 15%, respectively. The associations between the dichotomized dose-volume parameters and G2E were OR = 3.82 (95% CI 2.28-6.40, p < 0.0001) for esophageal mean dose, OR = 5.37 (95% CI 3.01-9.58, p < 0.0001) for esophageal V10, and OR = 3.23 (95% CI 1.93-5.41, p < 0.0001) for esophageal V20.

CONCLUSION

In patients receiving RNI with modern techniques, we found that G2E occurs in >15%, and more frequently with IMRT. These data strongly support the routine contouring of the esophagus in RNI planning, and our constraints should be incorporated in future prospective protocols of RNI.

Potential of oxygen and nitrogen reactive intermediates to disperse Listeria monocytogenes from biofilms

Studying biofilm dispersal is important to prevent Listeria monocytogenes persistence in food processing plants and to avoid finished product contamination. Reactive oxygen and nitrogen intermediates (ROI and RNI, respectively) may trigger cell detachment from many bacterial species biofilms, but their roles in L. monocytogenes biofilms have not been fully investigated. This study reports on ROI and RNI quantification in Listeria monocytogenes biofilms formed on stainless steel and glass surfaces; bacterial culture and microscopy combined with fluorescent staining were employed. Nitric oxide (NO) donor and inhibitor putative effects on L. monocytogenes dispersal from biofilms were evaluated, and transcription of genes (prfA, lmo 0990, lmo 0807, and lmo1485) involved in ROI and RNI stress responses were quantified by real-time PCR (qPCR). Microscopy detected the reactive intermediates NO, peroxynitrite, H₂O₂, and superoxide in L. monocytogenes biofilms. Neither NO donor nor inhibitors interfered in L. monocytogenes growth and gene expression, except for lmo0990, which was downregulated. In conclusion, ROI and RNI did not exert dispersive effects on L. monocytogenes biofilms, indicating that this pathogen has a tight control for protection against oxidative and nitrosative stresses.

Size-dependent cellular uptake and TLR4 attenuation by gold nanoparticles in lung adenocarcinoma cells

AIM

To elucidate uptake mechanisms and immunomodulatory potential of differently sized gold nanoparticles (GNPs) in lung adenocarcinoma cells (A549) to enable their use as an adjunct therapy for treating inflammation-linked lung cancer.

METHODS

Internalization of the synthesized (5, 15 and 30 nm) GNPs by various endocytosis pathways was determined. Immunomodulatory mechanisms induced by differently sized GNPs in A549 cells in the presence of TLR4 and TLR9 ligands were evaluated.

RESULTS

GNPs were size-dependently internalized efficiently by A549 cells. Various sized GNPs downregulated the expression of proinflammatory signaling molecules (5 nm most potent). Mechanistically, 5-nm GNPs attenuated TLR4 signaling by downregulating TLR4 expression in A549 cells.

CONCLUSION

Our study suggests the use of immunomodulatory GNPs as an adjunct therapy against inflammation-linked lung cancer.

Nutritional value of school meals and their contributions to energy and nutrient intakes of rural school children in Enugu and Anambra States, Nigeria

Background

Nutritional deficiencies among school children may hinge on inadequate nutrient intake. School meals should improve nutrient intakes by providing a third of recommended daily energy and nutrient intakes (RNI). The study aimed at evaluating school meals served in three rural schools to determine if they met one third of the RNI of the children. This will enhance meal planning.

Methods

Food samples (20 g) that constituted the school meals were collected for five consecutive days from three schools where school lunch programme was implemented. These were put in labelled small air tight plastic containers and stored in deep freezers in the Department of Home Science, Nutrition and Dietetics, University of Nigeria, Nsukka. The samples were analysed chemically using standard methods. Portion sizes of foods were obtained and the contributions made by these meals to the children's RNI were calculated. Results were presented in percentages and means ± standard deviations.

Results

The results showed that energy value of the meals ranged from 32.27 - 243.4 Kcal/100 g. The school meals contained carbohydrate (0.7 - 48.4 g), protein (0.69 - 12.6 g), vitamin C (0.7 - 8.22 mg), vitamin A (3.0 - 255.5 RE), iron (0.05 - 1.7 mg), calcium (3.0 -120 mg) and zinc (0.14 - 3.0 mg) per 100 g of food consumed. They contributed 16.4 - 25.5% energy, 53.4 - 116.9% protein, 66.0 - 159.5% vitamin A, 37.3 - 45.7% vitamin C, 13.2 - 28.5% calcium, 5.9 - 20.6% iron and 35.1 - 92.9% zinc to the children's daily requirements.

Conclusion

The school meals provided over one third of the RNI for protein, vitamins A and C, and zinc but did not meet a third of the RNI for energy, calcium and iron.

The protective effect of a novel antioxidant gene from Mycobacterium avium against nitrosative and oxidative stress in E. coli

The production of reactive oxygen intermediates (ROI) and reactive nitrogen intermediates (RNI) is an important host defense mechanism in response to infection by Mycobacterium tuberculosis. A variety of genes have been implicated in resistance to ROI and RNI, including noxR1. However, studies in Mycobacterium avium, an important pathogen among nontuberculous mycobacteria, are limited. We aim to investigate the role of a novel gene cloned from M. avium with high similarity to noxR1, noA, in resistance against RNI and ROI in M. tuberculosis. After subcloning noA into vector for expression in E. coli, we performed survival rate analysis in the bacteria transformed with noA (pET-noA) and without noA (pET-his) after exposure to nitrosative stresses by S-nitrosoglutathione (GSNO) and sodium nitrite, and oxidative stresses by H₂O₂. Compared with pET-his, the survival rate of pET-noA was 1 log₁₀-fold higher after exposure to GSNO and sodium nitrite. We observed 1 log₁₀-fold, 2 log₁₀-fold and 3 log₁₀-fold higher survival rate in pET-noA than pET-his after exposure to H₂O₂ for 3, 6 and 9 h, respectively. With the combined treatment of H₂O₂ and GSNO, we found more than 2 log₁₀-fold increase in survival rate in pET-noA comparing with pET-his, suggesting a possible synergistic effect. In summary, noA gene cloned from M. avium has been shown to protect E. coli from both RNI and ROI.

Antimicrobial responses of teleost phagocytes and innate immune evasion strategies of intracellular bacteria

During infection, macrophage lineage cells eliminate infiltrating pathogens through a battery of antimicrobial responses, where the efficacy of these innate immune responses is pivotal to immunological outcomes. Not surprisingly, many intracellular pathogens have evolved mechanisms to overcome macrophage defenses, using these immune cells as residences and dissemination strategies. With pathogenic infections causing increasing detriments to both aquacultural and wild fish populations, it is imperative to garner greater understanding of fish phagocyte antimicrobial responses and the mechanisms by which aquatic pathogens are able to overcome these teleost macrophage barriers. Insights into the regulation of macrophage immunity of bony fish species will lend to the development of more effective aquacultural prophylaxis as well as broadening our understanding of the evolution of these immune processes. Accordingly, this review focuses on recent advances in the understanding of teleost macrophage antimicrobial responses and the strategies by which intracellular fish pathogens are able to avoid being killed by phagocytes, with a focus on Mycobacterium marinum.

The consumption of more vegetables and less meat is associated with higher levels of acculturation among Mongolians in South Korea

Although Mongolian immigrants are a rapidly growing population in South Korea, the 2 countries have distinct diets because of climatic and geographical differences. The Mongolian diet is mostly animal-based with few vegetables and fruits, whereas the Korean diet is largely plant based. The purpose of this study was to examine the association between acculturation and dietary intakes among Mongolians living in South Korea. We hypothesized that higher levels of acculturation would be associated with higher vegetable, fruit, and plant-based food intakes among Mongolian immigrants. A total of 500 Mongolian immigrants participated in this study conducted between December 2010 and May 2011. To measure the acculturation level, we developed an acculturation scale based on the Suinn-Lew Asian self-identity acculturation scale. Dietary intakes were assessed using the 24-hour dietary recall method. Associations between acculturation and dietary intakes were investigated using a general linear model adjusted for demographic characteristics. The participants were grouped into either a low-acculturation group or a high-acculturation group. The high-acculturation group reported significantly higher consumption of vegetables and rice and significantly lower consumption of meat, potatoes, and flour products compared with their low-acculturation counterparts. However, a higher level of acculturation was also significantly related to a higher intake of sodium. These findings could be used to tailor nutrition programs to different acculturation levels.