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To evaluate the changes in testicular stiffness and microcirculation caused by spermatic vein ligation in patients with varicocele, we conducted a case-controlled study. A total of 27 grade III left varicocele cases were enrolled. Testicular stiffness and perfusion were evaluated by shear wave elastography and contrast-enhanced ultrasound during subinguinal microscopic varicocelectomy. The external and the internal parenchyma of bilateral testes were selected to compare the shear wave velocity of bilateral testes during the spermatic vein ligation. We mapped and compared the intensity-time curves following bolus contrast injection three times in the same region of interest. Initially, the shear wave velocity of the left internal parenchyma was higher than the right side (1.10 ± 0.06 m/s vs. 1.00 ± 0.03 m/s). It decreased (1.09 ± 0.06 m/s) (p 0.05) after ligation. Meanwhile, the left epididymis had the higher agent peak intensity (0.90 × 10E-5 AU), the largest area under the curve (80.20 × 10E-5 AU s), and the longest washout area (54.35 × 10E-5 AU s). In addition, the left internal parenchyma presented a sharper slope (0.18 × 10E-5 AU/s) (p 0.05). In conclusion, the spermatic vein ligation improved the perfusion of the internal testicular parenchyma, but it could temporally deteriorate the stasis of the epididymis. These changes caused softer testicular parenchyma.

As the staple food for Asian countries and with its ability in arsenic accumulation, rice consumption becomes a dominant pathway for As exposure to humans. Here, we collected 108 rice samples from local markets and online sources in 13 major rice-producing regions in China, and determined As contents, speciation and bioaccessibility in the samples. Total As contents were 25-327 μg kg

Hematopoietic stem cell transplantation (HSCT) has become the standard treatment for many diseases, but it is an intense and distinctive experience for patients. HSCT-related mortality is present throughout the whole process of transplantation, from pretransplantation to recovery. Long-term rehabilitation and the uncertain risk of death evoke feelings of vulnerability, helplessness, and intense fear. Zimmermann et al. proposed that spiritual well-being is an important dimension of quality of life and that patients at the end stage of life require spiritual support in addition to physical care, psychological care, and social support. Therefore, the purpose of this review is to examine the role of spirituality in the process of HSCT. A systematic mixed studies review (SMSR) was based on Pluye and Hong’s framework to understand the role of spirituality in patients’ experiences while undergoing HSCT. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement to report the results of integration. Fifteen original qualitative studies, 19 quantitative studies, and one mixed method study were included in the systematic mixed studies review. The evidence from the review revealed the following three themes: the spiritual experiences of HSCT patients, the spiritual coping styles of HSCT patients, and the spiritual need changes brought about by HSCT. Few medical institutions currently offer spiritual healing, although HSCT patients with different cultural backgrounds may have different spiritual experiences and spiritual coping styles. Psychotherapists or nurses should be considered to provide spiritual care for patients undergoing HSCT, to help patients cope with disease pressures, promote HSCT patients’ comfort, and improve their quality of life.

Selenium (Se) is a necessary micronutrient for humans, and its supplementation from crop grains is important to address the ubiquitous Se deficiency in people worldwide. Se uptake by crops largely depend on soil bioavailable Se rather than soil total Se content, which provides possibilities to explore the Se-rich crops in Se-poor area. Here, the possibility of cultivating Se-rich maize grains in Se-poor farmland was tested based on intensive field sampling and mathematical modelling. Sampling was conducted at county scale, and a total of 7779 topsoil samples and 109 maize samples with paired rhizosphere soils samples were collected. Results showed that although the soil Se content in the study county from southwestern China was at a low level (0.01-2.75 mg kg

Bioaccessibility of hydrophobic organic contaminants (HOCs) from unintentional ingestion of soil is increasingly assessed with in vitro gastrointestinal models incorporating a sorption sink. In this study, the bioaccessibility of DDTs in contaminated soils (n = 11) was determined using "unfed" unified bioaccessibility method (UBM) and fed organic estimation human simulation test (FOREhST) with/without Tenax as an absorbent. By adding Tenax, the bioaccessibility of DDTs determined using UBM was significantly increased from 4.9-30.6% to 31.6-86.0%. In contrast, the bioaccessibility of DDTs determined using FOREhST without/with Tenax were similar with values of 20.0-60.9% vs 31.5-47.6%, implying that the influence of food components on the absorption efficiency of the sink should not be overlooked. Much high fraction of DDTs (bioaccessibility: 11.7-24.8%) remained in FOREhST supernatant after Tenax collection, suggesting that prediction of bioavailability through bioaccessibility obtained by absorbent needs to be treated with caution when bioaccessibility is determined using a "fed state" in vitro method.

This study estimated the prevalence, correlates, severity and functional impairment of disabilities attributed to neurotic disorders in the Chinese population. Data from a representative national sample of 2,526,145 non-institutionalized residents were obtained from the Second China National Sample Survey on Disabilities (CNSSD) in 2006. The data were analyzed to estimate prevalence, correlates, severity and functional impairment of disability attributable to neurotic disorders by gender, age, region, and other key socio-demographic and economic factors. The disability prevalence attributed to neurotic disorders was 0.032% (805/2,526,145) in China. Women, rural residents, unemployed job status, low education level and those who were divorced or widowed showed higher prevalence rates than their counterparts. Proportions of mild, moderate, severe and extremely severe of neurotic attributed disability only accounted for 78.48%, 9.14%, 6.5% and 5.9%, respectively. Finally, these findings provide evidence that, prevalence rates of disability attributable to neurotic disorders vary greatly among different population groups and regions. Multiple disabilities including disability attributable to neurotic disorders can bring much more impairment to individuals than disability attributable to neurotic disorder only.

To investigate the anticancer properties of a well-known naturally occurring sesquiterpene lactone - artemisinin - against cisplatin resistant human breast carcinoma cells along with examining its effects on apoptosis, autophagy as well as cell cycle phase distribution.MTT assay was used to study cytotoxic effects of artemisinin while clonogenic assay analysed its effects on cancer cell colony formation. Fluorescence microscopy using DAPI staining was employed to study apoptotic effects of artemisinin which was followed by annexin V/propidium iodide (PI) assay which quantified the apoptotic effects of artemisinin in cancer cells. Apoptotic effects of artemisinin were finally confirmed by western blot assay by analysing its effects on Bcl-2 and Bax protein expressions. Effects of artemisinin on autophagy were determined by transmission electron microscopy (TEM). Effects on cell cycle were analysed by flow cytometry and western blot.The results indicated that artemisinin led to considerable and dose-dependent antiproliferative effects on MDA-MB-231 cisplatin-resistant breast cancer cells with less toxicity in normal cell line, thus exhibiting selectivity. The colony formation decreased significantly as artemisinin dose increased. DAPI and comet assays revealed that artemisinin induced powerful apoptotic effects, triggering significant dose-dependent DNA damage. TEM indicated that artemisinin induced autophagy in MDA-MB-231 cisplatin-resistant human breast cancer cells by creating autophagosomes and autophagic vacuoles. The molecule also targeted G2/M phase cell cycle along with targeting some key cell cycle related proteins including cyclin-B1, cyclin D1 and cyclin E.The results show that artemisinin showed strong anticancer effects in MDA-MB-231 cisplatin-resistant cancer cells by triggering apoptosis and autophagy and G2/M phase arrest.

To explore the application value of elastic ultrasound (EUS) and contrast-enhanced ultrasonography (CEUS) in detecting the changes of testicular blood supply after blockage of the vas deferens artery.This study included 11 cases of microscopic varicocele ligation. We obtained the EUS and CEUS values of the patients before and after blocking the vas deferens artery and analyzed the data by paired comparison.After the blockage of the vas deferens artery, the testicular hardness was reduced across the tunica albuginea and within the testis, with Ave decreased from 11.44 ± 2.52 before to 6.21 ± 1.16 after the blockage of the vas deferens artery across the tunica albuginea (P0.01) and from 3.99 ± 1.03 before to 3.27 ± 0.70 after the blockage within the testis (P = 0.012). The AUC in the epididymis was reduced from 80.98 ± 60.74 before to 42.82 ± 16.01 after the blockage (P = 0.021), and the AWi in the central testis from 17.19 ± 11.09 before to 11.03 ± 8.58 after the blockage (P = 0.034). No statistically significant differences, however, were observed in the values obtained close to the tunica albuginea or in the Awi and Awo in the testis after the blockage (P0.05).Elastic ultrasound and contrast-enhanced ultrasonography play important roles in evaluating the changes of testicular blood supply in different states.

Objective: To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients. Patients and Methods: We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization. Results: There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stone-free and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases. Conclusion: With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi.

Evaluating the bioavailability of Cd to rice (Oryza sativa L.) was essential in the karst region, Southwestern China, where the soils have previously been shown to be anomalously enriched in Cd through geogenic processes. In this research, we examined the bioavailability of Cd to rice samples collected from 278 sites in Guangxi province, where rice is the most widely cultivated cereal crop that is responsible for the largest human dietary exposure to Cd. Both soil chemical extraction and soil-plant transfer modelling approaches were used to predict the bioavailability to rice. Some of the soil types were highly enriched in Cd, but their bioavailability was low, since the soil carbonates raised soil pH and remarkably reduced Cd bioavailability. In contrast, acidic soils (Ca was largely leached) with relatively low total Cd, the grown rice plants accumulated higher Cd in their grains. Results from CaCl2 extraction experiments provided good predictions for Cd in rice grain grown in soils of different types. Stepwise multiple regressions revealed soil pH and soil Ca content were the dominant factors that control the transfer of Cd from soil to rice. An extended Freundlich-type model and a polynomial surface model provided good prediction for Cd in rice grains. The diffusive gradients in thin films (DGT) technique gave the best estimation of soil Cd bioavailability, whereas water-extracted soil solution Cd provided relatively poor fits. Regional soil threshold that derived using the models, can avoid exceedance of Cd in rice and thereby enable local agricultural practitioners or authorities to develop appropriate management for croplands with high Cd background.

Nuclear receptors (NRs) are a superfamily of ligand-dependent transcription factors that are closely related to cell development, differentiation, reproduction, homeostasis, and metabolism. According to the alignments of the conserved domains, NRs are classified and assigned the following seven subfamilies or eight subfamilies: (1) NR1: thyroid hormone like (thyroid hormone, retinoic acid, RAR-related orphan receptor, peroxisome proliferator activated, vitamin D3- like), (2) NR2: HNF4-like (hepatocyte nuclear factor 4, retinoic acid X, tailless-like, COUP-TFlike, USP), (3) NR3: estrogen-like (estrogen, estrogen-related, glucocorticoid-like), (4) NR4: nerve growth factor IB-like (NGFI-B-like), (5) NR5: fushi tarazu-F1 like (fushi tarazu-F1 like), (6) NR6: germ cell nuclear factor like (germ cell nuclear factor), and (7) NR0: knirps like (knirps, knirpsrelated, embryonic gonad protein, ODR7, trithorax) and DAX like (DAX, SHP), or dividing NR0 into (7) NR7: knirps like and (8) NR8: DAX like. Different NRs families have different structural features and functions. Since the function of a NR is closely correlated with which subfamily it belongs to, it is highly desirable to identify NRs and their subfamilies rapidly and effectively. The knowledge acquired is essential for a proper understanding of normal and abnormal cellular mechanisms. With the advent of the post-genomics era, huge amounts of sequence-known proteins have increased explosively. Conventional methods for accurately classifying the family of NRs are experimental means with high cost and low efficiency. Therefore, it has created a greater need for bioinformatics tools to effectively recognize NRs and their subfamilies for the purpose of understanding their biological function. In this review, we summarized the application of machine learning methods in the prediction of NRs from different aspects. We hope that this review will provide a reference for further research on the classification of NRs and their families.

Background/Aims: The function of BRAF V600E as a prognostic biomarker continues controversial by reason of conflicting results in the published articles. Methods: A systematical literature search for relevant articles was performed in PubMed, Cochrane Library, Google Scholar, Medline and Embase updated to August 5, 2015. The Chi-square test and I2 were employed to examine statistical heterogeneity. Pooled ORs with their corresponding 95% confidence intervals (95%CIs) were calculated to assess the relationship between clinicopathological features and BRAFV600E mutation. Subgroup analyses by ethnicity were also performed to explore the potential sources of heterogeneity. Furthermore, publication bias was detected using the funnel plot and all statistical analyses were conducted by the software of R 3.12. Results: Of 25,241 cases with PTC, 15,290 (60.6%) were positive for BRAF mutation and 9,951 (39.4%) were tested negative for BRAF mutation. Negative status of BRAFV600E mutation negative was significantly associated with gender (OR = 0.90, 95%CI = 0.83-0.97) and concomitant hashimoto thyroiditis (OR = 0.53, 95%CI = 0.43-0.64). By contrast, positive status of BRAFV600E mutation was a significant predictor of multifocality (OR = 1.23; 95%CI = 1.14-1.32), extrathyroidal extension (OR = 2.23; 95%CI = 1.90-2.63), TNM stage (OR = 1.67; 95%CI = 1.53-1.81), lymph node metastasis (OR = 1.67; 95%CI = 1.45-1.93), vascular invasion (OR = 1.47; 95%CI = 1.22-1.79) and recurrence/persistence (OR = 2.33; 95%CI = 1.71-3.18). However, there was no significant association between BRAFV600E mutation and factors including age > 45 (OR = 0.98; 95%CI = 0.89-1.07), tumor size (OR = 0.84; 95%CI = 0.64-1.09) and distant metastasis (OR = 1.23; 95%CI = 0.67-2.27). Conclusion: This meta-analysis confirmed significant associations between BRAFV600E mutation and female gender, multifocality, ETE, LNM, TNM stage, concomitant hashimoto thyroiditis, vascular invasion and recurrence/persistence, suggesting the predictive value of BRAFV600Emutation for PTC prognosis.

To investigate the pathogenesis and management of sleep-related painful erections(SRPE).This study included 9 SRPE patients aged 39- 59( mean 47. 8) years and with a mean disease course of 13. 5 ± 1. 2 months. We conducted blood urine routine examinations, collected four blood coagulation indexes, obtained IIEF-5 scores and sexual hormone levels, and recorded the nocturnal penile tumescence( NPT) and results of polysomnographic sleep monitoring of the patients. After 1,4,8,12,and 24 weeks of individualized treatment for each patient, we performed telephone follow-up for therapeutic effects and adverse drug reactions.All the 9 patients were diagnosed with primary SRPE after excluding other diseases,6 of them treated with chlorimipramine or chlorimipramine combined with other medicine and the other 3 by antiandrogen therapy. Complete pain remission was achieved by 77. 78% at 4 weeks and 66. 67% at 24 weeks. The 3 patients treated by antiandrogen therapy experienced recurrence at 24 weeks but relieved after 1 week of adjusted treatment.Chlorimipramine, combination of chlorimipramine with medicine, and antiandrogen therapy are all evidently effective for the treatment of primary SRPE.

This study determined the dosimetric comparison of moderate deep inspiration breath-hold using active breathing control and free-breathing intensity-modulated radiotherapy (IMRT) after breast-conserving surgery for left-sided breast cancer.Thirty-one patients were enrolled. One free breathe and two moderate deep inspiration breath-hold images were obtained. A field-in-field-IMRT free-breathing plan and two field-in-field-IMRT moderate deep inspiration breath-holding plans were compared in the dosimetry to target volume coverage of the glandular breast tissue and organs at risks for each patient.The breath-holding time under moderate deep inspiration extended significantly after breathing training (P0.05). There was no significant difference between the free-breathing and moderate deep inspiration breath-holding in the target volume coverage. The volume of the ipsilateral lung in the free-breathing technique were significantly smaller than the moderate deep inspiration breath-holding techniques (P0.05); however, there was no significant difference between the two moderate deep inspiration breath-holding plans. There were no significant differences in target volume coverage between the three plans for the field-in-field-IMRT (all P0.05). The dose to ipsilateral lung, coronary artery and heart in the field-in-field-IMRT were significantly lower for the free-breathing plan than for the two moderate deep inspiration breath-holding plans (all P0.05); however, there was no significant difference between the two moderate deep inspiration breath-holding plans.The whole-breast field-in-field-IMRT under moderate deep inspiration breath-hold with active breathing control after breast-conserving surgery in left-sided breast cancer can reduce the irradiation volume and dose to organs at risks. There are no significant differences between various moderate deep inspiration breath-holding states in the dosimetry of irradiation to the field-in-field-IMRT target volume coverage and organs at risks.

In genetic case-control association studies, a standard practice is to perform the Cochran-Armitage (CA) trend test with 1 degree-of-freedom (df) under the assumption of an additive model. However, when the true genetic model is recessive or near recessive, it is outperformed by Pearson’s χ2 test with 2 df. In this paper we analytically reveal the statistical basis that leads to the phenomenon. First, we show that the CA trend test examines the location shift between the case and control groups, whereas Pearson’s χ2 test examines both the location and dispersion shifts between the two groups. Second, we show that under the additive model the effect of location deviation outweighs that of the dispersion deviation, and vice versa under a near recessive model. Therefore Pearson’s χ2 test is a more robust test than the CA trend test and it outperforms the latter when the mode of inheritance evolves to the recessive end.

The China Mental Health Survey (CMHS) is the first nationally representative community survey on mental disorders and mental health services in China. One-step diagnoses for mood disorders, anxiety disorders and substance use disorders were obtained using the Composite International Diagnostic Interview-3.0 (CIDI-3.0), according to the criteria and definition of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A two-step procedure was applied for schizophrenia and other psychotic disorders, using psychosis screening section in CIDI-3.0 as a screening instrument and the Structured Clinical Interview for DSM-IV Axis I disorders (SCID) as a diagnostic tool. Dementia was diagnosed by the 10/66 dementia diagnosis package in a two-step design. The main aims of the CMHS were: (1) to investigate the prevalence of mood disorders, anxiety disorders, substance use disorders, schizophrenia and other psychotic disorders, and dementia; (2) to obtain data of service use of individuals with mental disorders in China; and (3) to analyse the social and psychological risk factors or correlates of mental disorders and mental health services. This paper presents a brief review of the background of the CMHS, its aims and measures.

The molecular subtypes of breast cancer based on status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2) expression are associated with markedly different clinical outcomes. We retrospectively analyzed 774 breast cancer patients with four or more positive nodes, who underwent mastectomy between March 1999 and December 2007. Treatment with postmastectomy radiotherapy (PMRT) reduced the rates of locoregional recurrence-free survival (LRFS; 6.7% vs. 26.6%), distant metastasis-free survival (DMFS; 26.9% vs. 50.0%), and mortality (24.4% vs. 45.3%) for luminal-A subtypes (ER+ or PR+, Her2-) and reduced LRFS (12.1% vs. 27.5%) for the luminal-B subtype (ER+ or PR+, Her2+) compared with patients not receiving PMRT. However, PMRT did not affect the endpoints for the Her2-enriched or basal subtypes. Thus, understanding the differences in patterns of relapse between the different subtypes of breast cancer may enable targeted adjuvant therapy and improved surveillance decisions.

BACKGROUND AND OBJECTIVE The role of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-T2 tumors and 1-3 positive axillary nodes is still uncertain. This study investigated the value of PMRT for these patients. METHODS In the retrospective data of 488 eligible patients, survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using a log-rank test and the Cox proportional hazards model, respectively. RESULTS The median observation time was 54 months. The 5- and 10-year locoregional recurrence-free survival (LRFS) rates were 90.8% and 86.9%, respectively. The 5- and 10-year disease-free survival (DFS) rates were 82.0% and 74.3%, respectively. The 5- and 10-year overall survival (OS) rates were 90.7% and 82.7%, respectively. For the 412 patients without PMRT, T2 classification, 2-3 positive nodes, and hormone (estrogen and progesterone) receptor-negative were risk factors for locoregional recurrence in the multivariate analysis. On the basis of these 3 risk factors, the group with 2-3 factors had a 10-year LRFS rate of 63.1% compared with 96.1% for the group with 0-1 factors (P < 0.001). For the group with 2-3 risk factors, LRFS and DFS were significantly improved by PMRT, with the 5- and 10-year LRFS rates without PMRT of 82.4% and 63.1%, respectively, and, with PMRT, of 98.1% at both 5 years and 10 years (P = 0.002). The 5- and 10-year DFS rates without PMRT were 72.0% and 57.6%, respectively, and, with PMRT, the 5- and 10-year DFS rates were 89.4% and 81.7%, respectively (P = 0.007). There was no significant difference in the 10-year OS rates between patients with and without PMRT. However, there is the potential benefit of 15.3% (87.1% vs. 71.8%, P = 0.072). Conversely, the group with 0-1 factors of PMRT had no effect on prognosis. CONCLUSIONS In patients receiving mastectomy with T1-T2 breast cancer with 1-3 positive nodes, for the group with 2-3 risk factors, PMRT significantly improved LRFS and DFS and has potential benefit in OS.

Purpose: Triple-negative breast cancer (TNBC) is a high risk form of this disease, even after surgery, due to the absence of targets for hormone treatment and anti–Her-2 therapy. Chemotherapy is the main therapeutic strategy for such patients with breast cancer, although the outcome is often unsatisfactory. Thus, the development of combination adjuvant therapies is essential for improved prognosis in patients with TNBC. In this study, we investigated the efficacy of a sequential combination of cytokine-induced killer cell (CIK) infusion and chemotherapy for patients with post-mastectomy TNBC. Experimental Design: From 2008 to 2012, 90 patients with post-mastectomy TNBC were included in this retrospective study: 45 cases received chemotherapy alone or with sequential radiotherapy; a further 45 cases received chemotherapy with/without radiotherapy and sequential CIK infusion. Results: Survival analysis showed significantly higher disease-free survival (DFS) and overall survival (OS) rates in the CIK treatment group compared with the control group (P = 0.0382, P = 0.0046, respectively; log-rank test). Multivariate survival analysis showed that CIK adjuvant treatment was an independent prognostic factor for OS of patients with TNBC. In subgroup analyses, CIK adjuvant treatment significantly increased the DFS rate of patients with pathologic grade 3, and significantly increased the OS rate of patients in N1, N2, N3, IIB, III TNM (tumor–node–metastasis) stages, and with pathologic grade 3. Conclusions: These data indicate that adjuvant CIK treatment combined with chemotherapy is an effective therapeutic strategy to prevent disease recurrence and prolong survival of patients with TNBC, particularly those with lymph node metastasis, advanced TNM stage, and poor pathologic grade. Clin Cancer Res; 20(11); 3003–11. ©2014 AACR.

The purpose of this study was to compare the quality of life (QoL) and overall satisfaction with treatment of women with stage T1-2N0M0 breast cancer treated with breast conserving therapy (BCT) or mastectomy (MAS) in southern China. Functional assessment of cancer therapy—breast, traditional Chinese version 4 (FACT-B), was administered to 180 patients with stage T1-2N0M0 breast cancer (82 BCT and 98 MAS) treated between July 2000 and July 2008. The two groups differed in tumor pathology and how axillary lymph nodes were treated (sentinel node biopsy vs. dissection), while other disease and socioeconomic characteristics were similar. The median follow-up after completion of radiotherapy was 60 months in the BCT group, and 65 months in the MAS group. The scores of the physical, functional, and emotional domains and breast-specific concerns of FACT-B were not significantly different between the groups. The social domain score of the BCT group was significantly greater than those of the MAS group. Patients who underwent BCT did not report better QoL than those who received MAS, but BCT patients experienced easier social adjustment.

A growing number of studies worldwide have advocated the replacement of whole-breast irradiation with accelerated partial breast irradiation using three-dimensional conformal external-beam radiation (APBI-3DCRT) for early-stage breast cancer. But APBI can be only used in selected population of patients with early-staged breast cancer. It is not replacing the whole breast radiotherapy. This study aimed to examine the feasibility and acute normal tissue toxicity of the APBI-3DCRT technique in Chinese female patients who generally have smaller breasts compared to their Western counterparts.From May 2006 to December 2009, a total of 48 Chinese female patients (with early-stage breast cancer who met the inclusion criteria) received APBI-3DCRT after breast-conserving surgery at Sun Yat-sen University Cancer Center. The total dosage from APBI-3DCRT was 34 Gy, delivered in 3.4 Gy per fractions, twice per day at intervals of at least six hours. The radiation dose, volume of the target area and volume of irradiated normal tissues were calculated. Acute toxicity was evaluated according to the Common Toxicity Criteria (CTC) 3.0.Among the 48 patients, the planning target volume for evaluation (PTVE) was (90.42 ± 9.26) cm³, the ipsilateral breast volume (IBV) was (421.74 ± 28.53) cm³, and the ratio between the two was (20.74 ± 5.86)%. Evaluation of the dosimetric characteristics of the PTVE revealed excellent dosimetric results in 14 patients and acceptable results in 34 patients. The dose delivered to the PTVE ranged from 93% to 110% of the prescribed dose. The average ratio of the volume of PTVE receiving 95% of the prescription dose (V95) was (99.26 ± 0.37)%. The habituation index (HI) and the conformity index (CI) were 1.08 ± 0.01 and 0.72 ± 0.02, respectively, suggesting good homogeneity and conformity of the dose delivered to the target field. The radiation dose to normal tissues and organs was within the dose limitation. Subjects experienced mild acute toxicity. The main manifestations were breast edema in 22 patients, breast pain in 7, skin erythema in 25, general malaise in 22 and cytopenia in 8. No acute radiological cardiac or pulmonary injury was found.The results of our short-term follow-up showed that it is feasible to perform APBI-3DCRT for early-stage breast cancer after breast-conserving surgery in Chinese female patients with smaller breasts. However, further studies are required to elucidate its efficacy and long-term side effects.

To compare quality of life (QoL) of early breast cancer patients treated with either accelerated partial breast irradiation (APBI) or whole breast irradiation (WBI) after breast-conserving therapy in China. The functional assessment of chronic illness therapy—Breast, traditional Chinese version 4 (FACT-B) instruments were given to 84 women (31 APBI and 53 WBI) who attended the radiotherapy clinic between July 2006 and May 2009 at Cancer Center of Sun Yat-sen University. Baseline characteristics and Karnofsky performance status scores were not different between the two groups. The median follow-up period in the APBI group was 29 versus 34 months in the WBI group. The APBI group scores in the physical domain, functional domain, social domain, and breast-specific concerns of FACT-B were 23.01 ± 3.91, 17.97 ± 4.99, 20.87 ± 4.80, and 22.55 ± 5.45, respectively, and were not significantly different from those of the WBI group (22.80 ± 3.50, 17.50 ± 4.40, 20.13 ± 5.31, 23.81 ± 4.65, respectively, P = 0.987, P = 0.476, P = 0.442, P = 0.330, respectively). However, the scores of the APBI group with respect to the emotional domains were lower compared to those of the WBI group (16.84 ± 3.86 vs. 19.47 ± 3.45, respectively, P = 0.002). Compared with women who underwent WBI, women treated with APBI were shown to have no significantly better QoL outcome, and yet had worse emotional response to their treatment.

To evaluate the dosimetric advantages of postmastectomy electron-beam chest-wall irradiation after left mastectomy in patients with breast cancer.Electron-beam chest-wall irradiation and tangential field irradiation were planned using Pinnacle7.4f planning systems for 42 patients with left breast cancer after mastectomy. The total prescribed dose for both plans was 5000 cGy/25 fractions. The dose volume histogram was used to compare the dosimetry of the clinical target volume (CTV) and the organs at risk such as the heart and ipsilateral lung.The maximum dose (Dmax) of the CTV of electron beam chest-wall irradiation plans was significantly higher than that of tangential field irradiation plans (5562±61 vs 5402±82 cGy, t=6.10, P0.05). The CTV of the electron beam chest-wall irradiation plans showed better heterogeneity than that of the tangential field irradiation plans, with heterogeneity index of 1.18±0.03 and 1.13±0.18, respectively (t=6.50, P0.05). Electron beam chest-wall irradiation plans had also a better conformal index of the CTV than tangential field irradiation plans (0.77±0.17 vs 0.57±0.17, t=3.49, P0.05). The V40 of the ipsilateral lung, the maximum dose of the heart, V30 and V40 of the heart in the electron beam chest-wall irradiation plans were smaller than those of the tangential field irradiation plans [(5.86±3.68)% vs (8.73±3.26)%, t=-2.27, P0.05; 4839±388 cGy vs 5095±176 cGy, t=-2.32, P0.05; (2.58±1.50)% vs (7.20±2.62)%, t=-4.70, P0.05; (1.74±1.23)% vs (4.20±2.51)%, t=-3.50, P0.05].Compared with the tangential field irradiation plans, electron-beam chest-wall irradiation has better coverage index of the CTV and can decrease the high-dose volume of the normal tissue, but shows a poorer habituation index of the CTV.

The aim of this study was to use four-dimensional CT (4DCT) in the planning of 3D conformational external beam radiation therapy (3DCRT) for patients with early stage breast cancer. A total of nine Chinese women who received breast conservation treatment were included in this study. Target localization and movement (range of motion) during normal respiration were assessed using ultrasound and 4DCT. Plans based on 3DCT and 4DCT scans were developed in accordance to RTOG0319 guidelines and dose delivery comparisons were made between these plans. The mean ranges of motion of the excision cavity volume as determined using 4DCT were 1.03 +/- 0.51, 2.08 +/- 0.92, and 1.27 +/- 0.58 mm in the right-left, anterior-posterior, and superior-interior directions, respectively. There were no significant differences between the mean and maximum PTV-E doses or the volume receiving 95% of the prescribed dose (V95). 4D plan prescribed dose levels were significantly lower (p < 0.05) than 3D plan levels for all of the following: ipsilateral breast V100, ipsilateral lung V30, and contralateral lung V5. Maximum contralateral breast and thyroid doses were also significantly lower with the 4D plan (p < 0.05). This study highlights the usefulness of 4DCT for the planning of 3DCRT in breast cancer patients. Our findings suggest that the use of 4DCT can lead to improvements in target definition and decreases in normal tissues irradiation.

To investigate the correlation of prolactin receptor (PRL-R) expression to estrogen receptor (ER) and progesterone receptor (PR) expressions in primary breast cancer.For 130 female patients with breast cancer (median age 46 years), PRL-R expression in the primary tumor was detected by immunohistochemistry, and the correlation between PRL-R and ER/PR expressions was analyzed statistically.PRL-R positivity in the primary tumor was found in 89 of the patients (68.5%), and the positivity rate for PRL-R was positively correlated to ER expression (P0.05). Further stratification of the patients according to the CerbB-2 status revealed such a correlation only in CerbB-2-positive patients (P0.05). In the patient cohort, no significant correlation was found in the positivity rate between PRL-R and PR expressions (P0.05), but in CerbB-2-positive patients, the positivity rate of PRL-R showed a positive correlation to PR expression (P0.05).The positive correlations in positivity rate between the PRL-R and ER/PR expressions are found only in CerbB-2 positive patients with breast cancer, and the expressional status of CerbB-2 affects the correlation between PRL-R and ER/PR expression in breast cancer.

Objective: This phase II study was designed to evaluate the effects of vinorelbine (VRL) and capecitabine (CAP) as second-line combination chemotherapy in patients with advanced breast cancer (ABC) previously treated with anthracyclines and/or taxanes. Methods: Treatment consisted of VRL 25 mg/m2 administered on days 1 and 8 of a 21-day treatment cycle, along with oral CAP 825 mg/m2 twice daily for 14 days, followed by 7 days of rest. Results: 50 patients were enrolled and 48/50 (96.0%) patients were assessable for response. The median time to progression (TTP) and overall survival (OS) of the patients were 5.0 (95% confidence interval, CI, 2.1–7.9 months) and 12.0 months (95% CI, 8.0–16.0 months), respectively. The objective response rate was 26.0% (95% CI, 13.8–38.2%) with 1 confirmed complete response and 12 partial responses. The most frequent hematological adverse event was neutropenia of grade 3 and 4 in 5 (10.4%) and 2 patients (4.2%), respectively. Grade 3 stomatitis, asthenia, and diarrhea were observed in 1 (2.1%), 2 (4.2%) and 3 (6.3%) patients, respectively. Conclusion: The combination of VRL and CAP is feasible as second-line chemotherapy in patients with ABC previously treated with anthracyclines and/or taxanes, with efficacy being comparable to other available combination regimens.

For early stage breast cancer with less than four metastatic axillary lymph nodes (ALN), indications for adjuvant radiotherapy are not well defined. This study was to investigate the risk factors for postmastectomy locoregional recurrence and survival in those patients.In total 217 patients undergoing mastectomy in Sun Yat-sen University Cancer Center between March 1998 and March 2002 were retrospectively reviewed. Seventy-one patients were at pT1 stage, and 146 cases at pT2 stage. Two hundred and two patients received adjuvant chemotherapy, 51 received radiotherapy (RT), and 116 received endocrine therapy whose estrogen receptors (ER) or progesterone receptors (PR) were positive.The median follow-up time for these patients was 69 months. The 5-year actuarial locoregional recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were 85.2%, 81.8%, and 90.2%, respectively. Treatment failure was found in 44 patients, among whom 21 cases were diagnosed as locoregional recurrence. The 5-year actuarial OS was significantly lowered in patients with locoregional recurrence than in those without (61.9% vs. 93.6%, P0.0001). Age younger than 35 years, pT2 tumor, and the rate of metastatic ALNor=30% were risk factors for poor LRFS, DFS, and OS. When a scoring system was established consisting of these three prognostic factors, the 5-year actuarial LRFS in patients with varied scores were significantly different (P=0.0072). In the subgroup of 159 patients who received adjuvant chemotherapy of not less than five cycles, 35 patients who received adjuvant RT achieved significantly better survival rates than those who did not.Age younger than 35 years, pT2 tumor, and the rate of metastatic ALNor=30% are risk factors for locoregional recurrence and survival in patients with early stage breast cancer who have one to three positive ALN. Adjuvant RT is recommended for those patients.

To evaluate the radiosensitivity and toxicity of sodium glycididazole and cisplatin in concurrent chemoradiotherapy for local advanced nasopharyngeal carcinoma (NPC).Sixty patients with local advanced NPC (T3-4N2-3M0) were randomly divided into chemoradiotherapy group (n=30) and chemoradiotherapy plus sodium glycididazole group (n=30). All the patients received radiotherapy with (60)Co or 6-8 MV linear accelerator and concurrent injection of cisplatin at a weekly dose of 20 mg/m square. In sodium glycididazole group, the patients received injections of sodium glycididazole at 800 mg/m square prior to the radiotherapy 3 times a week.At the end of the therapy and 3 month after the radiotherapy, a response rate of 100% was achieved in both of the groups. But at the end of the therapy, the chemoradiotherapy plus sodium glycididazole group showed a significantly higher rate of complete tumor remission than the chemoradiotherapy group (93.3% vs 73.33%, chi(2)=4.32, P=0.038). The patients in the two groups showed similar tolerance of the therapy during the observation.Sodium glycididazole plus cisplatin can accelerate the tumor remission and improve the complete remission rate in patients with local advanced NPC without causing severe toxicity.

The conditioning regimens are the critical factors in the allogeneic hematopoietic stem cell transplantation. This study was conducted to compare the effectiveness and side-effects of two conditioning regimens in allogeneic hematopoietic stem cell transplantation (allo-HSCT).Twenty-one cases received busulfan(BU) 16 mg/kg plus cyclophosphamide(CY) 120 mg/kg,the other 23 cases received total body irradiation(TBI) 7.5-8.5 Gy plus CY 120 mg/kg regimen.The 3-year disease-free survivals (DFS) were 61.5% in BU/CY group and 64.7% in TBI/CY group, respectively (P0.05). The relapse rates were 23.8% and 26%, respectively, without significant difference (P0.05). The incidence of liver damage in the BU/CY group was higher (80.9%) than that in the TBI/CY group (54.3%) (P0.05), while no case developed hepatic veno-occlusive disease. Stomatitis and gastrointestinal toxicity were significantly lower in the BU/CY group (33.3% and 42.9%) compared with TBI/CY group (78.2% and 78.2%), respectively (P0.05). Bladder toxicity (23.8% and 26%) and pulmonary toxicity(14.3% and 13%) were similar in the two groups(P0.05), while one patient in TBI/CY group developed grade IV pulmonary toxicity, which is lethal. No case was found to have cardiac, renal, or central nervous system grade I toxicity.The two groups have equal effectiveness, BU/CY regimen is relatively easy to administer and well tolerated with low extramedullary toxicity.

INTRODUCTION: Ki-67 expression is a biomarker for proliferation. Its prognostic value is recognized in breast cancer (BC) patients with negative axillary nodes, but is less clear in BC patients with positive axillary lymph nodes. METHODS: We retrospectively reviewed the medical records of 1131 Chinese BC patients treated from January 2002 to June 2007 and 450 patients met the inclusion criteria: positive nodes, adjuvant therapy, and complete biomarker profile (estrogen receptor (ER), progesterone receptor (PR), HER2, p53, Ki-67). Univariate and multivariate regression analysis were used to correlate biomarkers and tumor characteristics with metastasis free survival (MFS) and overall survival (OS). RESULTS: Median follow-up time was 46 months (range 5-76 months). The Ki-67 expression was associated significantly with histological grade, ER, PR, HER2, and P53 status (P

Background The aim of this study was to evaluate the prognostic value of the number of negative lymph nodes (NLNs) in breast cancer patients after mastectomy. Methods 2,455 breast cancer patients who received a mastectomy between January 1998 and December 2007 were retrospectively reviewed. The prognostic impact of the number of NLNs with respect to disease-free survival (DFS) was analyzed. Results The median follow-up time was 62.0 months, and the 5-year and 10-year DFS was 87.1% and 74.3%, respectively. The DFS of patients with >10 NLNs was significantly higher than that of patents with ≤10 NLNs, and the 5-year DFS rates were 87.5% and 69.5%, respectively (P

The advent of novel B-cell receptor pathway targeting agents like ibrutinib dramatically changed management of B-cell malignancies. However, with concomitant anticoagulation (AC) and antiplatelet (AP) therapy, ibrutinib is associated with increased bleeding. This post hoc analysis aimed to determine the role of AC/AP therapy in patients with idelalisib-treated B-cell malignancies and to establish if it contributes to increased bleeding events. Data from two idelalisib trials (rituximab ± idelalisib in chronic lymphocytic leukemia [CLL] and idelalisib monotherapy in indolent non-Hodgkin lymphoma [iNHL]) were analyzed. Antithrombotic therapy was common (36%-63%), with comparable bleeding incidence across treatment groups (14%-19%; p = 0.56). Bleeding events of grade ≥3 occurred in 0.9% and 3.2% of the idelalisib-treated CLL and iNHL cohorts, respectively. Our findings demonstrate no increase in bleeding events with simultaneous AC/AP treatment and idelalisib use. Hemorrhagic risk is prevalent in these patients and an important consideration when evaluating available treatment options. ClinicalTrials.gov identifiers: NCT01539512 and NCT01282424.