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There are no quantitative selection criteria for identifying high-grade glioma (HGG) patients who are suited for volumetric-modulated arc therapy (VMAT). This study aimed to develop selection criteria that can be used for the selection of the optimal treatment modality in HGG. We analyzed 20 patients with HGG treated by 3D conformal radiotherapy (3DCRT). First, VMAT plans were created for each patient retrospectively. For each plan, the normal tissue complication probability (NTCP) for normal brain was calculated. We then divided the patients based on the NTCPs of the 3DCRT plans for normal brain, using the threshold of 5%. We compared the NTCPs of the two plans and the gross tumor volumes (GTVs) of the two groups. For the GTVs, we used receiver operating characteristic curves to identify the cut-off value for predicting NTCP < 5%. We determined the respective correlations between the GTV and the GTV's largest cross-sectional diameter and largest cross-sectional area. In the NTCP ≥ 5% group, the NTCPs for the VMAT plans were significantly lower than those for the 3DCRT plans (P = 0.0011). The NTCP ≥ 5% group's GTV was significantly larger than that of the NTCP < 5% group (P = 0.0016), and the cut-off value of the GTV was 130.5 cm3. The GTV was strongly correlated with the GTV's largest cross-sectional diameter (R2 = 0.82) and largest cross-sectional area (R2 = 0.94), which produced the cut-off values of 7.5 cm and 41 cm2, respectively. It was concluded that VMAT is more appropriate than 3DCRT in cases in which the GTV is ≥130.5 cm3., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.)

Background and Purpose: To compare chemoradiotherapy (CRT) with low-dose continuous 5-fluorouracil (5FU) to CRT with 5FU+cisplatin (CDDP) for esophageal squamous cell carcinoma (ESCC) in a retrospective cohort study., Methods and Materials: We reviewed the cases of Stage I-IV ESCC patients who underwent definitive CRT in 2000-2014. Concomitant chemotherapy was one of the three regimens: (1) high-dose intermittent 5FU and CDDP (standard-dose FP: SDFP), (2) low-dose continuous 5FU and CDDP (LDFP), or (3) low-dose continuous 5FU (LD5FU). The general selection criteria for chemotherapy were: SDFP for patients aged <70 yrs; LDFP for those aged 70-74 yrs; LD5FU for those aged ≥75 yrs or with performance status (PS) ≥3. Propensity scores were derived with chemotherapy (LD5FU vs. 5FU+CDDP) as the dependent variable., Results: In a multivariate analysis, chemotherapy (LD5FU vs. SDFP, p  = .24; LDFP vs. SDFP, p  = .52) did not affect the overall survival (OS). LD5FU caused significantly less grade 3-4 leukopenia (9%) compared to SDFP (47%) and LDFP (44%) ( p  < .001). In a propensity-matched analysis, LD5FU affected neither OS (HR 1.06; 95%CI 0.55-2.05; p  = .87) nor progression-free survival (HR 0.95, 95%CI 0.50-1.81; p  = .87)., Conclusion: CRT with low-dose continuous 5FU may be a less toxic option for elderly ESCC patients.

Purpose: To investigate the effects of a respiratory gating and multifield technique on the dose-volume histogram (DVH) in radiotherapy for esophageal cancer., Methods and Materials: Twenty patients who underwent four-dimensional computed tomography for esophageal cancer were included. We retrospectively created the four treatment plans for each patient, with or without the respiratory gating and multifield technique: No gating-2-field, No gating-4-field, Gating-2-field, and Gating-4-field plans. We compared the DVH parameters of the lung and heart in the No gating-2-field plan with the other three plans., Result: In the comparison of the parameters in the No gating-2-field plan, there are significant differences in the Lung V 5Gy , V 20Gy , mean dose with all three plans and the Heart V 25Gy -V 40Gy with Gating-2-field plan, V 35Gy , V 40Gy , mean dose with No Gating-4-field plan and V 30Gy -V 40Gy , and mean dose with Gating-4-field plan. The lung parameters were smaller in the Gating-2-field plan and larger in the No gating-4-field and Gating-4-field plans. The heart parameters were all larger in the No gating-2-field plan., Conclusion: The lung parameters were reduced by the respiratory gating technique and increased by the multifield technique. The heart parameters were reduced by both techniques. It is important to select the optimal technique according to the risk of complications.

In this study, the clinical effects were compared between a thromboxane synthetase inhibitor (sodium ozagrel) and a thrombolytic agent (urokinase) in patients with acute cerebral infarction. The subjects consisted of 598 patients admitted on the day of the onset of the cerebral infarction in the territory of the internal carotid artery who showed a low density area on CT images within 5 days. Of these patients, 300 were treated with sodium ozagrel and classified as Group Oz, while the remaining 298 were treated with urokinase and classified as Group Ur. The results were as follows: 1. In group Oz, complete recovery of motor impairment was seen in 209 (69.7%) patients. Complete recovery within 3 weeks after onset was seen in 186 (62.0%) patients. In group Ur, complete recovery of motor impairment was seen in 175 (58.7%) patients. Complete recovery within 3 weeks after onset was seen in 120 (40.3%) patients. Therefore, a higher incidence of complete recovery of the motor impairment was noted in group Oz [p < 0.001: chi 2 test]. Similarly, complete recovery within 3 weeks after onset was more frequent in group Oz [p < 0.001: chi 2 test]. 2. In group Oz, complete recovery was made contribution statistically by Anosognosia (Ag) and unilateral neglect (UN) on admission [multivariate analysis: p < 0.01]. In group Ur, complete recovery was made contribution statistically by Ag (p < 0.01), UN (p < 0.01) and aphasia (p < 0.05). 3. Progressive stroke was observed in 29 (9.5%) patients in the group Oz and in 71 (23.0%) patients in group Ur. There was a higher incidence of progressive stroke in group Ur [p < 0.001: chi 2 test] 4. All patients with progressive stroke had initial evidence of deterioration of neurological deficits within 6 days after the onset in group Oz, and within 5 days after the onset in group Ur. The maximal period from the beginning to the end of the deterioration of neurological deficit was 7 days. 5. In group Oz, progressive stroke was only seen in 29 (29.9%) of the patients who were admitted with motor disturbances and unilateral neglect. In group Ur, progressive stroke was seen in 8 (4.3%) of the 187 patients with motor disturbances without higher cortical dysfunction, in 17 (47.2%) of the 36 patients with motor disturbances and higher cortical dysfunction without unilateral neglect and was seen in 46 (61.3%) of the patients with motor disturbances and unilateral neglect. 6. Hemorrhagic infarction was observed in 14 (4.6%) patients in group Oz and in 31 (10.0%) patients in group Ur. There was a higher incidence of hemorrhagic infarction in group Ur [p < 0.001: chi 2 test]. 7. In group Oz, there was a higher incidence of hemorrhagic infarction among patients with atrial fibrillation (Af) on the ECG [p < 0.001: chi 2 test]. Similarly, in group Ur, hemorrhagic infarction was more frequent among patients with atrial fibrillation (Af) on the ECG [p < 0.001: chi 2 test]. Therefore, sodium ozagrel was clinically more efficient and safer than urokinase in patients with acute cerebral infarction.

Early diagnosis of motor function status and changes in motor impairment level of the upper limbs and fingers in patients with acute cerebral infarction is important in establishing a treatment plan. This study investigated a method of predicting motor function outcome and changes in motor impairment based on the characteristics of symptoms on admission and severity according to the CT classification. The subjects were 309 patients with carotid-system cerebral infarction admitted on the day of onset of symptoms and who exhibited a low density area in the territory of the middle cerebral artery on CT images within 5 day of the onset of symptoms. The motor function level was evaluated according to Brunnstrom's stage. The findings were as follows: 1) The motor function level of the upper limbs and fingers improved to stage 3 or more in patients without unilateral neglect. 2) Complete recovery of motor impairment of the upper limbs and fingers was observed in 163 patients (54.7%). Motor impairment of the upper limbs recovered within 3 weeks after the onset in 121 patients, and from 22 days to 3 months after the onset in the remaining 42 patients. Similarly, motor impairment of the fingers recovered within 3 weeks after the onset in 113 patients, and between 22 days and 3 months after the onset in the remaining 50 patients. 3) Stage 4 or higher motor impairment grade on admission was seen in 107 (88.4%) of the patients with recovery of impaired motor function in the upper limbs within 3 weeks after the onset. Similarly, stage 4 or higher was seen in 101 (89.4%) patients with recovery of impaired motor function of the fingers within 3 weeks after the onset. 4) Of the 44 patients with recovery of impaired motor function of the upper limbs between 22 days and 3 months after the onset, 30 improved to stage 4 by 2 weeks after the onset and to stage 6 by one month. The remaining 12 patients improved to stage 5 by one month after the onset and to stage 6 by 3 months. Of the 50 patients with recovery of impaired motor function of the fingers between 22 days and 3 months after the onset, 44 improved to stage 4 by 2 weeks after the onset and to stage 6 by one month. The remaining 6 patients improved to stage 5 by one month after the onset and to stage 6 by 3 months. 5) Progressive stroke was observed in 60 patients (20.1%). All patients with progressive stroke showed unilateral neglect on admission. 6) Completed stroke, excludise of progressive stroke, was seen in 75 patients (24.3%). In the patients with completed stroke, there was clearly no improvement in the motor impairment of the limbs and fingers over 3 months after onset. 7) It was difficult to predict motor function level at the time of discharge based on the evaluation of stage on admission and the location of the low density area on CT. 8) Our CT classification was closely correlated with the motor function outcome of the upper limbs and fingers. Therefore, this classification and assessment of whether unilateral neglect is present on admission may be useful in predicting motor function outcome and changes in motor impairment of the upper limbs and fingers early after the onset of acute cerebral infarction.

The early diagnosis of the motor functional outcome of the upper and lower limbs in patient with cerebrovascular disease is important in establishing a treatment plan. The purpose of this study was to establish a method to evaluate the severity of low density areas on CT scans in patients with hemiparesis caused by cerebral infarction. The subjects were 186 patients who were admitted on the day of onset, showed a low density area on CT images within 5 days of onset. Of these patients, 111 had cerebral infarction, and the other 75 had reversible ischemic neurological deficit (RIND). On CT images, the low density area in the slice of corpus calosum splenium (S-1) and that of ventricular body (S-2) was measured, and its relationship with motor functional results at the time of discharge was evaluated. The motor functional level was evaluated using Brunnstrom's stage. The findings are as follows: 1) Discriminant analysis was performed using an explanatory variable of 1 and an error rates of 5% or less. The severity of the low density area could be classified into 4 major types in S-1: I-IV; and into 3 subtypes in S-2: a, b, c. The 186 patients were topographically classified using the major types and subtypes. 2) The 75 patients with type I a, b, c and II a motor function recovered within 3 weeks (RIND). Of 16 patients with type II b, 10 recovered after rehabilitation for 3 weeks or more, but the other 6 showed remaining of motor impairment in the upper limbs. Of 29 patients with type II c, 5 recovered, but the other 15 showed remaining of motor impairment in the upper limbs. 3) Of patients with type III, none recovered completely. All patients with III c had hemiparesis. 4) In 3 patients with type IV b, Stage 1.2 paresis remained in the upper limbs and Stage 4.3 in the lower limbs. Of 38 patients with type IV c, 23 showed remaining of Stage 1.2 paresis in both upper and lower limbs, and the other 10 showed Stage 1.2 paresis in the upper limbs. 5) The severity classification of the low density area on CT images was closely related to the motor functional outcome of the upper and lower limbs. Therefore, this classification is useful for determining the treatment method early after onset.

Diagnosis of deterioration of neurological deficits in the early stage after hospital admission immediately after the onset of cerebral infarction is important in establishing a treatment plan. This study investigated the clinical characteristics of progressive stroke on admission. The subjects were 309 patients admitted on the day of the onset of symptoms and showed a low density area on CT images within 5 days. There were 202 with cerebral infarction in the territory of the deep perforate arteries, 77 with cerebral infarction in the territory of the cortical branch of the middle cerebral artery (MCA), and the remaining 36 had cerebral infarction in the territory of MCA. The results were as follows: 1) Progressive stroke was observed in 71 patients (23.0%): 60 with completed stroke and 11 with reversible ischemic neurological deficits (RIND). 2) The patients with progressive stroke were clearly older than those with non progressive stroke (p < 0.05: Cochran Cox's test). 3) Progressive stroke was seen more frequently in patients with cerebral infarction of the cortical branch of the MCA and patients with occlusion of the internal carotid artery and MCA trunk than patients with cerebral infarction of the deep perforate arteries (p < 0.001: chi 2 test). 4) All patients with progressive stroke had initial evidence of deterioration of neurological deficits within 5 days after the onset, with 39 patients showing deterioration on day 2 and 13 patients showing deterioration on day 3. 5) Deterioration of neurological deficits usually stopped the day after the start of progression. The maximum period from the beginning to the end of the deterioration of neurological deficits was 7 days. 6) Progressive stroke was not seen in 11 patients who were admitted with higher cortical dysfunction and without sensory or motor disturbances, and was seen in only 8 (4%) of the 187 patients with sensory or motor disturbances without higher cortical dysfunction. 7) Progressive stroke was seen in 63 (57%) patients with sensory or motor disturbances and higher cortical dysfunction. 8) Progressive stroke was seen frequently in patients with atrial fibrillation (Af) on the ECG [P < 0.001). 9) Fifty-six of 71 patients with progressive stroke showed persistent severe motor impairment in the upper limbs. Therefore, to diagnose progressive stroke, it is useful to assess the higher cortical dysfunction and examine for Af on admission.

Crossing experiments and food-choice tests show that two sympatric species of phytophagous ladybird beetles, Epilachna niponica and E. yasutomii, are reproductively isolated by host-plant specificity. Adult beetles selected their natural hosts when given choices, though some accepted the host of the other species when no choice was offered. In each species, survival of larvae to the second instar was significantly higher on their own host plant. No evidence for sexual isolation, gametic isolation, hybrid inviability, or reduced hybrid fertility was detected. Reproductive isolation by host specificity is an important prerequisite for certain models of sympatric speciation. Although the present example supports the plausibility of such models, an allopatric origin of host-plant specificity cannot be discounted., (© 1989 The Society for the Study of Evolution.)