Prevalence of chronic kidney disease and prediabetes and associated risk factors: a community-based screening in Zhuhai, Southern China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prevalence of chronic kidney disease (CKD) and prediabetes has increased in China, and at different rates in different locations. Therefore a community-based screening research was conducted in order to determine the prevalence of CKD and prediabetes, and to analyze associated risk factors of CKD and prediabetes in a city of Southern China.</p><p><b>METHODS</b>A total of 7801 community residents aged 18 year and older from 6 communities were screened by a stratified random cluster sampling method. An estimated glomerular filtration rate (eGFR), albuminuria, fasting plasma glucose (FPG), and homeostatic model assessment of insulin resistance (HOMA-IR) were measured. Age-standardized prevalence was calculated by the direct method with the use of data on the population distribution in China in 2006. Multivariate logistic analysis was used to analyze the risk factors of CKD and prediabetes, and association of insulin resistance (IR) with CKD and prediabetes was analyzed.</p><p><b>RESULTS</b>The age-standardized prevalence of CKD was 12.5%, eGFR < 60 ml×min(-1)×1.73 m(-2) was 2.7% and ACR (albumin to creatinine ratio) > 30 mg/g was 10.3%. The age-standardized prevalence of prediabetes was 12.1%. Logistic regression suggests that IR was a common independent risk factor of CKD and prediabetes. Further analysis show that HOMA-IR was increased with the aggravation of kidney injury and FPG.</p><p><b>CONCLUSION</b>CKD and prediabetes have become a major public health problem in Zhuhai, Southern China; insulin resistance may be an important risk factor.</p>

An initial report of cyberknife radiosurgery for primary hepatic carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the efficacy and toxicity of cyberknife radiosurgery for primary hepatic carcinoma.</p><p><b>METHODS</b>From September 2006 to March 2008, 17 patients with clinical stage I-III primary hepatic carcinoma were treated with cyberknife at Tianjin Cancer Hospital. 12 patients received previous treatment of surgery, or interventional therapy or radiofrequency therapy before the cyberknife radiosurgery. Totally 23 lesions in the liver were treatment. The median planning target volume (PTV) was 75 ml (13 - 351 ml). Fiducials were placed in or adjacent to the tumor one week before the CT scan simulation. The median total prescription dose was 45 Gy (range: 39 - 52 Gy) at 3-8 fractions and the median prescription isodose lines was of 78.0% (range: 75.0% - 81.0%.</p><p><b>RESULTS</b>The follow-up time was 3-30 months (median: 14 months). All patients finished the treatment and slightly fatigue was the most common complain. There were 12 patients alive and 5 patients died. All the lesions in liver treated by the cyberknife radiosurgery achieved local control.</p><p><b>CONCLUSION</b>The cyberknife radiosurgery for primary hepatic carcinoma showed a high rate of local control and minimal toxicity. Long time follow-up is necessary to evaluate the survival data and late toxicity.</p>

Brain metastasis treated with Cyberknife / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cyberknife can greatly raise the fractional dose of stereotactic radiosurgery, thus improving its clinical efficacy. We retrospectively analyzed clinical outcomes of brain metastasis treated with Cyberknife.</p><p><b>METHODS</b>We analyzed 40 cases of brain metastases treated with Cyberknife in the Tianjin Cancer Hospital from August 1, 2006 to August 1, 2007, for a total of 68 lesions with maximal diameter of 0.4 - 7.5 cm (average 1.88 cm). Total hypofractional radiated dosage was 18 - 36 Gy (5 - 25 Gy/F, 1 - 5 F) by Cyberknife. We evaluated the remission rate of clinical symptoms, correlation factors to new foci, 3-month local control rates, and 3-month and 1-year survival rates. All patients were followed up for more than 14 months.</p><p><b>RESULTS</b>After 1 week, clinical remission was 90.0% (36/40). After 3 months, the local control rate and therapeutic effective rate were 77.9% (53/68) and 94.1% (64/68), respectively, as observed by cranium augmentation CT or MRI. The three-month, six-month and 1-year survival rates were 97.5% (39/40), 82.5% (33/40) and 67.5% (27/40), respectively. Fourteen patients had neopathy outside the original lesion after 3 months. Neopathy was not correlated with age, whole-brain radiotherapy, number of original lesions, maximum diameter of the original lesion, therapeutic dose per fraction, therapeutic frequency or total therapeutic dose.</p><p><b>CONCLUSIONS</b>Cyberknife got perfect clinical outcomes by higher dosage per fraction. It is an appropriate and valid treatment shortcut for brain metastasis.</p>

Basic research of the relationship between irradiation dose and volume in radiation-induced pulmonary injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Irradiation dose and volume are the major physical factors of radiation-induced lung injury. The study investigated the relationships between the irradiation dose and volume in radiation-induced lung injury by setting up a model of graded volume irradiation of the rat lung.</p><p><b>METHODS</b>Animals were randomly assigned to three groups. The ELEKTA precise 2.03 treatment plan system was applied to calculate the irradiation dose and volume. The treatment plan for the three groups was: group 1 received a "high dose to a small volume" (25% volume group) with the mean irradiation volume being 1.748 cm(3) (25% lung volume); the total dose and mean lung dose (MLD) were 4610 cGy and 2006 cGy, respectively (bilateral AP-PA fields, source to axis distance (SAD) = 100 cm, 6MVX, single irradiation); Group 2 received a "low dose to a large volume" (100% volume group) with the mean irradiation volume being 6.99 cm(3) (100% lung volume); the total dose was 1153 cGy. MLD was 2006 cGy, which was the same as that of group 1 (bilateral AP-PA fields, SAD = 100 cm, 6MVX, single irradiation); Group 3 was a control group. With the exception of receiving no irradiation, group 3 had rest steps that were the same as those of the experimental groups. After irradiation, functional, histopathological, and CT changes were compared every two weeks till the 16th week.</p><p><b>RESULTS</b>Functionally, after irradiation breath rate (BR) increases were observed in both group 1 and group 2, especially during the period of 6th - 8th weeks. The changes of BR in the 100% volume group were earlier and faster. For the 25% volume group, although pathology was more severe, hardly any obvious increase in BR was observed. Radiographic changes were observed during the early period (the 4th week) and the most obvious changes manifested during the mediated period (the 8th week). The extensiveness of high density and the decreased lung permeability were presented in the 100% volume group, and ground glass opacity and patchy consolidation were presented in the 25% volume group without pleural effusion, pleural thickening, and lung shrinking. Morphologically, the 100% volume group mainly presented signs of vascular damage, including signs of vascular wall edemas, hypertrophy, and sclerosis. The 25% volume group mainly presented with erythrocyte cell exudation, inflammation, and parenchymal damage.</p><p><b>CONCLUSIONS</b>The delivery of a small dose of radiation to a large volume is not safe. A low dose smeared out over large volumes, albeit reversible, may lead to fatal respiratory dysfunction. Damage to the lung may be more dependent on the volume of irradiation than on the radiation dose. Clinically, the safest approach is to limit both the volume of the irradiated normal lung and the amount of received radiation.</p>

Radiosensitization of paclitaxel combined with radiation on nasopharygneal carcinoma cells (CNE-I) in vitro / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the radiosensitization of paclitaxel combined with radiation on nasopharygneal carcinoma cells( CNE-I) in vitro.</p><p><b>METHODS</b>Human CNE-I cells were used for this study. Clonogenic assay was used to determine the drug dose of IC10, IC50 and IC90 for CNE-I Cells. The cells treated with different concentration of paclitaxel for 24 hours before or after radiation (dose ranged from 0 - 10 Gy ) were used to evaluate the radiosensitizing effect of paclitaxel combined with radiation. DNA flow cytometry was performed to define the cell cycle characteristics of cell populations treated for 0, 2, 6, 12, 18, 24 h with 0.1 nmol/L, 0.5 nmol/L, 1.0 nmol/L, 2.5 nmol/L paclitaxel, respectively.</p><p><b>RESULTS</b>The dose of IC10, IC50 and IC90 for paclitaxel in CNE-I cells was 0.05 nmol/L, 1.0 nmol/L and 2.5 nmol/L, respectively. Paclitaxel treatment at concentration of 0.05 nmol/L and 1.0 nmol/L for 24 hours combined with X-ray irradiation before or after radiation showed radiosensitivity-enhansing effects in CNE-I cells. G2/M block was present when the drug concentrations were 2.5 nmol/L and 10.0 nmol/L, and it peaked at 18 hours.</p><p><b>CONCLUSION</b>With an optimal paclitaxel/radiation combination, paclitaxel may exert a radiosensitizing effect on CNE-I cells. The effect might be related to the G2/M block caused by paclitaxel.</p>

Radiosensitivity detected by "comet" assay in two human tumor cell lines / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of the "comet" assay in detecting the radiosensitivity in human tumor cell lines.</p><p><b>METHODS</b>The radiation-induced primary DNA damage and repair were detected by the comet assay in CNE-1 and 973 cell lines. The tail moment was used as the end point, to quantitate the primary DNA damage and subsequent repair ability. The cell-survival curve was plotted by the classical colony assay, to detect the D(0) value and Dq value. The results from the above two assays were compared.</p><p><b>RESULTS</b>1. With the increment of irradiation doses, under the same experimental condition, the radiation-induced primary DNA damage was more severe in CNE-1 cells than in 973 cells (P < 0.01). From the cell-survival curves, the D(0) value was 1.631 and 1.822 in CNE-1 and CNE-1 973 cells respectively, indicating that CNE-1 cells were more sensitive to irradiation than 973 cells. The radiosensitivity detected by comet assay and by colony assay in the two cell lines tended to be consistent. 2. The half-repair time of 973 and CNE-1 cell line was 33 min and 41 min detected by comet assay, which indicats that the ability of DNA damage and repair in CNE-1 cells was weaker than in 973 cells. The Dq value of the cell survival curve was 2.152 for 973 and 0.626 for CNE-1 cell line detected by the colony assay, which indicates that the sublethal damage repair in 973 cells being much faster than in CNE-1 cells. The repair ability reflected by the results in the two cell lines was consistent.</p><p><b>CONCLUSION</b>The radiosensitivities reflected by the results of the primary DNA damage and repair detected by both comet assay and colony assay in CNE-1 and 973 cells are consistent. It suggests that comet assay is a good method for detecting the radiosensitivity of tumor cells.</p>

Clinical features, treatment and prognosis of 136 patients with primary non-Hodgkin's lymphoma of the nasopharynx / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics, international prognostic index and treatment of primary non-Hodgkin's lymphoma (NHL) of the nasopharynx.</p><p><b>METHODS</b>From January 1983 to December 1997, 136 patients with previously untreated NHL of the nasopharynx were retrospectively reviewed. All patients were confirmed pathologically and classified by Working Formulation system. There were 18 patients with high-grade, 77 intermediate, 2 low-grade and 39 unclassifiable lymphoma. According to Ann Arbor classification, 25 patients had stage I, 91 stage II, 12 stage III and 8 stage IV lesions. Primary therapy was radiotherapy alone in 13 patients and radiotherapy combined with chemotherapy in 12 patients with stage I disease. In 88 patients with stage II, radiotherapy alone was given to 31 patients, and a combination of radiotherapy and chemotherapy to 57 patients. Chemotherapy was primary treatment for advanced stage III/IV diseases.</p><p><b>RESULTS</b>The overall survival rate (OS), cancer specific survival rate (CSS) and disease-free survival rate (DFS) at 5 and 10 years for all patients were 56.2%, 61.2%, 51.1% and 48.3%, 58.0%, 46.5%, respectively. As for international prognostic index (IPI), the 5-year CSS was 70.9% for 0 risk factor, 44.9% for 1 risk factor, 30.0% for 2 or 3 risk factors, respectively (P = 0.004). For stage I patients, the 5-year CSS was 83.1% for RT alone and 82.2% for combined modality therapy, respectively (P = 0.779). For patients with stage II, the 5-year CSS was 46.0% for radiotherapy alone and 70.9% for combined modality therapy. There was significant difference between them (P = 0.04). Multivariate analysis by Cox regression showed that Ann Arbor stage, B symptom and IPI were independent prognostic factors.</p><p><b>CONCLUSION</b>International prognostic index is an important prognostic factor for Non-Hodgkin's lymphoma of the nasopharynx and the combined modality therapy may be optimal for the stage II patients.</p>

Treatment of early stage primary tonsil non-Hodgkin's lymphoma / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the treatment for patients with early stage primary tonsil non-Hodgkin's lymphoma (NHL).</p><p><b>METHODS</b>Two hundred and thirteen patients with previously untreated early stage primary tonsil NHL were reviewed. All patients were pathologically confirmed. According to Ann Arbor classification, 35 patients were stage I, 178 stage II. The primary treatment for stage I was radiotherapy alone in 12 and combined modality therapy (CMT) in 23 patients. The primary treatment for stage II was radiotherapy alone in 57,chemotherapy alone in 2, and CMT in 119 patients.</p><p><b>RESULTS</b>The 5-year overall survival, cancer specific survival (CSS) AND disease-free survival (DFS) for the early stage primary tonsil non-Hodgkin's lymphoma were 65%, 70% and 61%, respectively. The 5-year CSS was 63% for the radiotherapy alone group and 72% for the CMT group (p = 0.064), and the 5-year DFS were 56% for the radiotherapy alone group and 62% for the CMT group. For patients with stage I disease, The 5-year CSS were 100% in both radiotherapy alone and CMT groups, and the 5-year DFS were 100% and 80% in these two groups (p = 0.148), respectively. There was no significant difference of efficacy between the two treatment s for the patients with stage I disease. For the patients with stage II disease, the 5-year CSS was 58% in radiotherapy alone group and 66% in CMT group (p = 0.051). However, CMT significantly improved DFS in stage II disease, with a 5-year DFS of 46% for radiotherapy alone and 60% for CMT (P = 0.046).</p><p><b>CONCLUSION</b>Patients with stage I tonsil non-Hodgkin's lymphoma treated with radiotherapy alone or CMT can achieve an excellent outcome. CMT significantly improve the DFS in stage II patients. There was a trend that CMT improved the survival rates in the patient with early stage disease. It was suggested that CMT should be used for the patients with early stage primary tonsil non-Hodgkin's lymphoma.</p>