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Casein serves as a protein extract from cow milk and its products; it is an available and cheap natural polymer material. Casein-based hydrogels have been extensively used in drug delivery systems due to their good biocompatibility and fast degradation. Although chemical crosslinking agents have been used for crosslinking of casein hydrogels, it is also associated with adverse effects and potential biotoxicity. In this work, casein was modified with methacrylic anhydride (MA). The functionalized casein (CaseinMA) possessed the ability to form hydrogels under 365 nm UV light in water solution without using toxic agents. Alginate was (0.4%, 0.8%, and 1.2%) found to successfully adjust the mechanical performance of CaseinMA hydrogels. The swelling property and degradation behavior indicated that the composite hydrogels had excellent water holding ability and degradability. MTT assay and hemolytic test demonstrated that CaseinMA/Alg hydrogels containing photoinitiator (Irgacure 2959) had good biocompatibility. At last, CaseinMA/Alg microspheres loaded with metformin hydrochloride (MET) were fabricated by using electrostatic droplet technology. The CaseinMA/Alg microspheres had a pH-sensitive property and slow sustained release as compared to mono-component microspheres in drug releasing test. CaseinMA/Alg hydrogels were confirmed that had good biocompatibility and mechanical properties; it is expected to be applied in many fields such as drug delivery system and wound management. [ABSTRACT FROM AUTHOR]

Management of brainstem metastatic tumor is challenging. This study aimed to evaluate overall survival and quality-of-life in patients with non-small cell lung cancer (NSCLC) brainstem metastases who were treated with the Cyberknife stereotactic radiosurgery. From August 2007 through August 2016, a total of 32 patients with 34 brainstem metastases of NSCLC were consecutively enrolled and treated with the Cyberknife radiosurgery (CKRS) at The Huashan Hospital. The study was limited to patients with NSCLC, which was confirmed by postoperative pathological examination. Patients were treated by CKRS as an initial treatment or a second treatment after whole-brain radiation therapy (WBRT). Quality of life was assessed by the SF-12 score and neurological examination. Four out of the 32 (12.5%) patients received WBRT before or concurrent with CKRS treatment. The mean survival time after CKRS was 10.0 (95%CI: 6.0–14.0) months. Karnofsky performance score was not the independent predictor of survival after radiosurgery as analyzed by log-rank test (p = 0.392). Age, however, was a significant predictor of improved survival as analyzed by multivariate analysis (p = 0.024). SF-12 physical component scores demonstrated no significant change after treatment. The CKSR is a non-invasive, safe, and effective modality in the treatment of patients with brainstem metastases of NSCLC. Better therapeutic outcomes of CKSR for brainstem metastasis might be achieved in the patients older than 65 years old. [ABSTRACT FROM AUTHOR]

Abstract Background Bevacizumab has been suggested as a new treatment modality for cerebral radiation necrosis due to its ability to block the effects of vascular endothelial growth factor (VEGF) in leakage-prone capillaries, though its use still remains controversial in clinical practice. Methods The use of bevacizumab in 17 patients with symptomatic cerebral radiation necrosis poorly controlled with dexamethasone steroid treatments was examined between March 2010 and January 2012. Bevacizumab therapy was administered for a minimum of two cycles (7.5 mg/kg, at two-week interval) with a median of four bevacizumab injections. Changes in bi-dimensional measurements of the largest radiation necrosis lesions were observed by gadolinium-enhanced and T2-weighted magnetic resonance imaging (MRI). Additionally, dexamethasone dosage, Karnofsky performance status (KPS), adverse event occurrence and associated clinical outcomes were recorded for each patient. Results MRI analysis revealed that the average reduction was 54.9% and 48.4% in post-gadolinium and T2-weighted sequence analysis, respectively. Significant clinical neurological improvements were expressed in 10 patients according to KPS values. Dexamethasone reduction was achieved four weeks after initiation of bevacizumab in all patients, with four patients successfully discontinuing dexamethasone treatment. Mild to moderate bevacizumab-related adverse events, such as fatigue, proteinuria and hypertension were observed in three patients. Upon follow-up at 4 to 12 months, 10 patients showed clinical improvement, and 7 patient deaths occurred from tumor progression (5 patients), recurrent necrosis (1 patient), and uncontrolled necrosis-induced edema (1 patient). Conclusions These findings suggest bevacizumab as a promising treatment for cerebral radiation necrosis induced by common radiation therapies, including external beam radiotherapy (EBRT), stereotactic radiosurgery (SRS), and fractionated stereotactic radiotherapy (FSRT).