Search

Introduction: Although positron‐emission tomography (PET) plays an integral role in cervix cancer diagnosis, there are limited data on PET‐based image‐guided brachytherapy (IGBT). We aimed to report the long‐term outcomes of PET‐based IGBT. Methods: We reviewed 151 patients treated with definitive radiotherapy (RT), including PET‐based IGBT between 2009 and 2018. After median 45 Gy of external beam RT with the four‐field technique, a median 24 Gy of high‐dose‐rate iridium‐192 IGBT was delivered in six fractions with Fletcher‐Suit tandem and ovoids. All patients underwent 18F‐fluorodeoxyglucose‐PET/computed tomography planning with a brachytherapy applicator. Multivariable analysis of local control (LC) was performed using Cox regression analysis. Results: The median high‐risk clinical target volume (HRCTV) and HRCTV D90% were 51.8 (interquartile range [IQR] 35.9–79.4) cm3 and 77.7 (IQR 74.7–81.2) Gy, respectively. With a median follow‐up of 57 (IQR 24.3–81.4) months, the 5‐year LC rate was 89.2%. HRCTV ≥72 cm3 was associated with inferior LC (hazard ratio, 3.72, p =.017) after multivariable analysis: the 5‐year LC rates were 94.0% and 77.9% for HRCTVs ≥72 and < 72 cm3, respectively (p =.002). The impact of HRCTV D90% ≥70 Gy on LC was significant in patients with an HRCTV ≥72 cm3 compared to that in those with HRCTV < 72 cm3. Patients with adeno/adenosquamous carcinoma demonstrated inferior LC in both groups. There were 13 (8.6%) and 11 (7.3%) patients with acute and late severe toxicities after RT. Conclusion: PET‐based IGBT leads to favorable LC, and HRCTV ≥72 cm3 requires further dose escalation to improve outcomes. [ABSTRACT FROM AUTHOR]

Aim: This study was performed to evaluate patterns of breast cancer subtypes in Korean patients with synchronous (SBC) or metachronous bilateral breast cancer (MBC). Methods: We retrospectively reviewed records of 302 patients with SBC (n = 161) or MBC (n = 141) who received curative surgery at our hospital between 1995 and 2013. Expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) was determined by immunohistochemistry (IHC) staining. We categorized breast cancers into the following subtypes: ER+ or PR+, HER2− (i.e., luminalA); ER+ or PR+, HER2+ (i.e., luminalB HER2+); ER−, PR− and HER2+ (i.e., HER2‐enriched); ER−, PR− and HER2− (i.e., triple negative, TN). Results: More patients with MBC were ≤40 years at the time of breast cancer diagnosis than patients with SBC (34.6% vs. 19.3%, P < 0.01). The proportion of subtypes in SBC and MBC were as follows: luminalA, 65.8% vs. 45.0%; luminalB, HER2+, 9.0% vs. 8.5%; HER2‐enriched, 4.1% vs. 12.1%; and TN, 11.2% vs. 31.2%, respectively (P < 0.01). The 10‐year overall survival rate in patients with SBC and MBC was 89.0% and 93.6%, respectively. The 10‐year disease‐free survival rate in patients with SBC and MBC was 79.6% and 80.9%, respectively. Locoregional recurrence was found in 2.5% of patients with SBC and 9.9% of patients with MBC. Distant metastasis occurred in 8.7% of patients with SBC and 4.9% of patients with MBC. Conclusion: The distribution of breast cancer subtypes was different between SBC and MBC. TN‐subtype was profoundly more frequent in MBC whereas luminal‐subtype was most frequently found among SBC. [ABSTRACT FROM AUTHOR]

Background: Excessive skeletal muscle loss during neoadjuvant concurrent chemoradiotherapy (NACRT) is significantly related to survival outcomes of oesophageal cancer. However, the conventional method for measuring skeletal muscle mass requires computed tomography (CT) images, and the calculation process is labour‐intensive. In this study, we built machine‐learning models to predict excessive skeletal muscle loss, using only body mass index data and blood laboratory test results. Methods: We randomly split the data of 232 male patients treated with NACRT for oesophageal cancer into the training (70%) and test (30%) sets for 1000 iterations. The naive random over sampling method was applied to each training set to adjust for class imbalance, and we used seven different machine‐learning algorithms to predict excessive skeletal muscle loss. We used five input variables, namely, relative change percentage in body mass index, albumin, prognostic nutritional index, neutrophil‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio over 50 days. According to our previous study results, which used the maximal χ2 method, 10.0% decrease of skeletal muscle index over 50 days was determined as the cut‐off value to define the excessive skeletal muscle loss. Results: The five input variables were significantly different between the excessive and the non‐excessive muscle loss group (all P < 0.001). None of the clinicopathologic variables differed significantly between the two groups. The ensemble model of logistic regression and support vector classifier showed the highest area under the curve value among all the other models [area under the curve = 0.808, 95% confidence interval (CI): 0.708–0.894]. The sensitivity and specificity of the ensemble model were 73.7% (95% CI: 52.6%–89.5%) and 74.5% (95% CI: 62.7%–86.3%), respectively. Conclusions: Machine learning model using the ensemble of logistic regression and support vector classifier most effectively predicted the excessive muscle loss following NACRT in patients with oesophageal cancer. This model can easily screen the patients with excessive muscle loss who need an active intervention or timely care following NACRT. [ABSTRACT FROM AUTHOR]

Background The effect of ALS-L1023, an extract of Melissa officinalis L. (Labiatae; lemon balm) leaves, on experimental choroidal neovascularization (CNV) in mice was evaluated. Methods C57BL/6 mice were given either vehicle or ALS-L1023 daily via oral gavage for 3 weeks (days 0-21). CNV was induced by rupturing Bruch's membrane using laser photocoagulation (day 7). Two weeks after laser injury (day 21), the CNV lesions were evaluated by an examination of choroidal flat mounts using fluorescein-labelled dextran, immunofluorescence staining with isolectin B4 and fluorescence angiography. The effects of ALS-L1023 on endothelial cell tube formation and the expression of phosphorylated extracellular signal-regulated kinase 1/2 were evaluated using human umbilical vein endothelial cells. Results The extent of CNV was reduced by ALS-L1023. Mice treated with 100 and 200 mg/kg/day of the material exhibited 44.3 and 68.1% reductions in the extent of CNV lesions, respectively, compared to the vehicle group ( P < 0.001). The size of the isolectin B4-labelled area was also significantly decreased in the ALS-L1023-treated groups ( P < 0.001). On fluorescein angiography, ALS-L1023-treated mice exhibited significantly less leakage of fluorescent material than did vehicle-treated mice. ALS-L1023 decreased vascular endothelial growth factor-induced human umbilical vein endothelial cell tube formation in a dose-dependent manner. The expression of phosphorylated extracellular signal-regulated kinase 1/2 was suppressed by ALS-L1023. Conclusions The laser-induced CNV in mice can be inhibited by ALS-L1023. Therefore, it may have therapeutic potential for the treatment of diseases involving CNV. [ABSTRACT FROM AUTHOR]

A bstract Backgound: To compare differences in endoscopic revision after previously failed lacrimal surgery that involved either external or endoscopic dacryocystorhinostomy. Design: Retrospective, comparative, nonrandomized clinical study. Participants: We assessed 77 patients (82 surgeries) treated for recurrent nasolacrimal duct obstruction. Methods: Electronic medical records for patients with recurrent epiphora who underwent endoscopic revisional dacryocystorhinostomy, after previous external or endoscopic dacryocystorhinostomy at Seoul St. Mary's Hospital from 2004 to 2010, were reviewed. Main Outcome Measures: Data regarding the lacrimal drainage system, comprehensive eye examination, surgical outcome and preoperative/perioperative transnasal endoscopy were analysed. Results: In total, 77 patients underwent 82 endoscopic revisional dacryocystorhinostomy procedures. A success rate of 84% was achieved for cases of previous external dacryocystorhinostomy and 80.7% for previous endoscopic dacryocystorhinostomy ( P = 0.722). For preoperative nasal endoscopy, more of the patients who underwent previous external dacryocystorhinostomy exhibited a hypertrophic middle turbinate and severe septal deviation when compared with patients who underwent previous endoscopic dacryocystorhinostomy ( P = 0.031, P = 0.001, respectively). For perioperative nasal endoscopy, more of the patients who underwent previous endoscopic DCR exhibited a smaller ostium when compared with patients who underwent previous external dacryocystorhinostomy ( P = 0.031). Conclusions: The success rate of revisional dacryocystorhinostomy in the previous external dacryocystorhinostomy group was slightly higher than that in the previous endoscopic dacryocystorhinostomy group. Differences in preoperative and perioperative endoscopic findings were detected between the groups. Clarifying these differences in endoscopic revision will help improve the surgical outcomes of primary surgery involving either external or endoscopic dacryocystorhinostomy. [ABSTRACT FROM AUTHOR]

The lung is one of the commonest sites of exposure to environmental allergen or pathogen, so the expression of a variety of cytokines in the lung is dynamically regulated by inflammatory or structural cells in the lung. In the last decades, characterization of the local lung cytokine milieu in allergic or injury models has identified a collective role of certain cytokines, such as type 1 or type 2 cytokines, driving polarized inflammatory and tissue phenotypes. With the development of transgenic mouse modelling systems, the effector function of individual cytokine and the pathophysiological consequences of cytokine polarization in the lung have been effectively evaluated. Here, we present an overview of the transgenic systems currently used to assess the biological function of cytokine or other mediators in the lung. We discuss the inflammatory and tissue phenotypes detected in the lungs of transgenic mice over-expressing representative T helper type 1 (interferon-γ, interleukin-12), T helper type 2 (interleukins -4, -5, -9, -10 and -13), and T helper type 17 cytokines. The effects of genetic modification of cytokine receptors or transcriptional factors such as GATA-3 and T-bet in pulmonary inflammation and remodelling tissue responses are also discussed because these transcription factors are regarded as essential regulators of cytokine polarization. Finally, we discuss the limitations and future application of transgenic approaches in the studies of human lung diseases characterized by cytokine polarization. [ABSTRACT FROM AUTHOR]

Background Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) induces cell death in various tumor cells, but relatively spares normal cells. Recombinant adeno-associated virus (rAAV) vectors have a number of advantages including in vivo long-term gene expression. Here, we assessed the biological activity of a novel, secreted form of TRAIL (sTRAIL) for cancer gene therapy using a rAAV2 vector. Methods A plasmid and rAAV2 vectors were constructed encoding sTRAIL composed of a leader sequence, the isoleucine zipper, and the active domain of TRAIL (aa 95-281). The functionality of sTRAIL was validated by cell viability, FACS analysis, caspase-3 activity, and TUNEL staining. rAAV-sTRAIL was injected intratumorally to nude mice bearing human A549 lung tumor cells. Nude mice received A549 tumor cells after intravenous delivery of rAAV-sTRAIL. The antitumor effect was then evaluated by measuring tumor regression and occurrence in the experimental animal. Results sTRAIL was released from cells transfected with the sTRAIL expression construct or transduced with rAAV-sTRAIL, and induced apoptosis in cancer cells, but spared normal fibroblast cells. Secreted sTRAIL formed oligomers including trimers with intersubunit disulfide. Purified sTRAIL exerted much lower cytotoxicity on primary human hepatocytes compared to recombinant TRAIL. Intratumoral delivery of rAAV-sTRAIL significantly inhibited growth of A549 tumors established in nude mice. A number of apoptotic tumor cells were detected by TUNEL staining in mice treated with rAAV-sTRAIL. Systemic pretreatment with rAAV-sTRAIL significantly inhibited tumor formation in nude mice. Conclusion The results suggest that rAAV-sTRAIL may be useful for local or systemic cancer gene therapy for treating TRAIL-sensitive tumors. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented on a clinical case of a 54-year-old woman with tight orbit syndrome treated with orbital decompression.

The article presents a case study of a 22-year-old man with massive hemoptysis who undergo mechanical ventilation and intubation. It states that using emergency bronchoscopy, he was diagnosed of widespread blood clots. It says that several of his cylindrical clots were taken out through suctioning, which caused his tidal volume to rise to 400 milliliter (ml) and oxygen saturation to the upper 80s. It explains that endobronchial obstruction by blood clots causes airway obstruction.