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Objective To assess the value of SPECT/CT lung perfusion imaging (SPECT/CT-LPI) in evaluation of the regional lung function and the correlation between lung perfusion defects (LPD) and the clinical findings in NSCLC patients.Methods A total of 48 NSCLC patients (43 males,5 females;average age 61.06 years) who underwent pulmonary function tests (PFT),CT and 99Tcm-MAA SPECT/CT-LPI from December 2006 to March 2013,were retrospectively studied.LPD were divided into four grades:grade 0 (no lung perfusion defect was identified),grade 1 (the area of lung perfusion defect (LPDA) was similar to the size of local tumor),grade 2 (the LPDA was larger than local tumor and extends to 1 pulmonary lobe),grade 3 (the LPDA exceeded 1 pulmonary lobe).x2 test,one-way analysis of variance and Logistic regression analysis were used to analyze the correlation of the lung perfusion function and clinical findings.Results LPD were found in 44 patients (91.67％,44/48),including 18 with grade 1,15 with grade 2,11 with grade 3.The abnormal results of PFT were found in 16 patients (33.33％,16/ 48).The abnormal findings by SPECT/CT-LPI were more than that by PFT (x2=34.844,P＜0.01).The rates of LPD with grade ≥ 2 were significant different between patients with central lung cancer and those with peripheral lung cancer (x2 =8.392,P＜0.01),and between hilar lymph nodes positive group and negative group (x2=10.801,P＜0.01).The degree of LPD was related to tumor location (1 was assigned for central lung cancer,2 was assigned for peripheral lung cancer),tumor size (1 was assigned for maximum diameter ≤3.0 cm,2 was assigned for ＞3.0 cm and ≤5.0 cm,3 was assigned for ＞5.0 cm) and hilar lymph node (1 was assigned for with metastasis,0 was assigned for no metastasis) (Wald=8.176,5.352,10.100,all P＜0.05).Conclusions Compared with PFT,SPECT/CT-LPI has a more significant value in assessment of the regional lung function in NSCLC patients.Tumor location,tumor size and metastasis of hilar lymph nodes may be helpful for LPD grading.SPECT-LPI may be beneficial for patients with central lung cancer,large tumor and hilar lymph nodes metastasis.
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Objective To evaluate the treatment efficacy and treatment-related toxicity of late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy (CHT) for locally advanced esophageal squamous cell carcinoma (ESCC).Methods A total of 46 patients with histologically confirmed ESCC,11 in the stage Ⅱa,3 in the stage Ⅱb,and 32 in the stage Ⅲ,underwent conventional fractioned radiation of 40 Gy in 20 fractions on the primary and metastatic lymph nodes,and high-risk lymph node drainage regions,and then the primary and metastatic lymph nodes were irradiated as boost with an additional dose of 19.6 Gy in 14 fractions (1.4 Gy twice a day),and the total prescribed dose was 59.6 Gy in 34 fractions.Two cycles of CHT were administered concurrently during the radiotherapy.The 1-,3-,and 5-year overall survival (OS) rates and local control rates (LCRs) were evaluated by Kaplan-Meier method,and treatment-related toxicity was analyzed based on the RTOG and CTCAE criteria 3.0.Results All patients received the whole course of treatment.The median followup time was 34.4 months (6-67 months).The overall response rate was 91.3％ (42/46).The median OS was 38.5 months (95％ CI 29.6-47.4 months).The 1-,3-,and 5-year OS rates and LCRs were 78.6％,49.4％,and 39.9％,and 84.3％,68.2％,and 61.4％ respectively.The incidence of ≥ G3 radiationinduced esophagitis was 23.9％.Three kinds of serious (≥G3) hematologic toxicities were recorded,including leucopenia (26.1％),thrombocytopenia (13.0％),and anemia (10.9％).Esophagotracheal fistula was recorded in 2 patients (4.3％).Conclusion LCAHRT plus CTH can be favorable for the patients with locally advanced ESCC,however,the treatment-related toxicities may be serious.
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Objective To compare 18 F-FDG PET/CT and electronic endoscopy for measuring the length of esophageal squamous cell carcinoma (ESCC) and to evaluate the optimal SUV threshold for contour determination of the size of the lesion.Methods Twenty-four patients (19 males and 5 females,median age:59 years) with histologically confirmed ESCC were enrolled.Three patients had stage Ⅱ,14 had stage Ⅲ and 7 had stage Ⅳ diseases.PET studies were performed before treatment.The length of ESCC was measured on FDG PET imaging using different SUV thresholds of 2.0 (L2.0),2.5 (L2.5),3.0 (L3.0),3.5 (L3.5),and 35％(L35),40％(L40),45％(L45),50％(L50),55％(L55) of SUVmax.The length of ESCC on PET imaging was compared with the length of gross tumor in vivo measured by electronic endoscopy (Lst) to determine the optimal threshold of SUV using paired t test.Pearson correlation analysis was used to assess the correlation.Results The SUVmax of primary tumor was 14.51±5.72 and the Lst was (5.27± 2.45) cm.The length was in a descending order of L2.0,L2.5,Lst,L3.0,L3.5,L35,L40,L45,L50 and L55 when using different criteria.There were significant differences between the Lst and the lengths measured on PET except those by L2.5 and L3.0((5.65±2.69) cm,(5.11±2.51) cm; t=-1.74 and 0.76,both P＞0.05).The lengths measured on PET by all criteria were significandy correlated with the Lst,respectively,with the better r values by L3.5(0.935),L2.5(0.920) and L3.0(0.919) (all P＜0.01).When SUVm~＜15,there were no significant differences between the Lst ((4.82±2.14) cm) and L2.5((4.95±2.76) cm),L3.0((4.45±2.50) cm) and L35((4.42±1.85) cm),respectively (t=-0.439,1.299,2.011,all P＞0.05).The best correlation (r=0.953,P＜0.05) was between Lst and Lz5.When SUVmax ≥ 15,there was no significant difference between Lst ((5.67±2.64) cm) and L3.0((6.11±2.61) cm; t=-0.897,P＞0.05; r=0.791,P＜ 0.05).Conclusions For better correlation of ESCC lesion size,it is suggested that the optimal threshold of SUV for contouring is 2.5 for tumor SUVmax＜15,and 3.0 for tumor SUVmax ≥ 15.A larger sampling size is needed for further confirmation or modification.
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Objective To assess the efficacy and the adverse effects of improved late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy for locally advanced esophageal squamous cell carcinoma (ESCC).Methods 68 Patients with pathologically confirmed ESCC were enrolled.Conventional fractionation was implemented to 40 Gy/20 fractions,followed by LCAHRT delivered 2 fractions of 1.4 Gy with an interval of 6-8 hours per day to 14 fractions,thus the total dose was 59.6 Gy.Two cycles of cisplatin-based chemotherapy were administered concurrently,followed by two more cycles.The short-term efficacy of treatment,overall survival for 1-,3-,5-year,and treatment-related toxicity were evaluated.Results All patients successfully completed LCAHRT and the overall response rate was 91.6％ (62/68).The overall survival rate of 1-,3-,and 5-year was 75.5％,46.5％,22.7％,respectively.The incidence of radiation esophagitis (grade 3 or greater) was 26.4％,and no patients developed grade 3 or worse radiation pneumonitis.The radiation-induced skin injury were most of grade 0 or 1.Grade 3 of leucopenia and neutropenia were observed in 29.4％ and 7.4％ of patients,respectively,and grade 4 were both in 2.9％.During long-term follow-up,no esophageal stenosis and severe pulmonary fibrosis was developed except for two cases(2.9％)of esophageal mediastinal fistula.Conclusion Late course accelerated hyperfractionated radiotherapy combined with chemotherapy yields promising long-term survival,with lower treatment-related toxicity for patients of locally advanced esophageal squamous cell carcinoma.
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Objective To analyze the clinical and dosimetric risk factors for acute radiation esophagitis (ARE) in non-small cell lung cancer (NSCLC) patients treated with three-dimensional conformal radiotherapy (3D-CRT),and to find significant risk factors for clinical therapy.Methods A total of 102 NSCLC patients treated with 3D-CRT were retrospectively analyzed.ARE was scored according to the Radiation Therapy Oncology Group (RTOG) criteria with grade 2 or worse.Patients were divided into non-concurrent chemoradiotherapy group and concurrent chemoradiotherapy group.The clinical and dosimetric factors associated with grade 2 or worse ARE were analyzed using univariate logistic regression,multivariate logistic analysis and receiver operating characteristic ( ROC ) curve.Results There were no grade 4 or5 ARE observed in the 102 patients.Nineteen developed grade 2,15 developed grade 3.In nonconcurrent chemoradiotherapy group,multivariate analysis showed that V55 was the only risk factor of grade 2/3 ARE.For ROC curve analysis,the cut-off point of V55 was 16.0 while the area under ROC curve was 0.870 ( 95 ％ CI:0.782 - 0.957,P ＜ 0.05 ).In concurrent chemoradiotherapy group,multivariate analysis showed that V35 and chemotherapy regimens during radiotherapy were risk factors of grade 2/3 ARE.The cut-off point of V35 was 23.75 while the area under ROC curve was 0.782 (95％ CI:0.636 -0.927,P ＜0.05).Vinorelbine and cisplatin regimen showed low incidence of ARE contrast with gemcitabine/docetaxel and cisplatin regimens (33.3％ and 66.7％ ).Conclusions V55 is the only statistically significant risk factor associated with grade 2 or worse ARE for patients who don't accepted concurrent chemotherapy.V35 and chemotherapy regimens during radiotherapy are statistically significant risk factors associated with grade 2 or worse ARE for patients who accept concurrent chemotherapy.Vinorelbine and cisplatin regimen during radiotherapy shows low incidence of ARE.
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Objective To explore the relationship between the typing of lower eyelid bag and surgical procedures and their clinical efficacy. Methods The eyelid bag was divided into three types and seven subtypes according to the clinical manifestation in 216 cases. Congenital structural abnoma-lities caused type Ⅰ of lower eyelid bag, long-term ophthalmokopia caused type Ⅱ of lower eyelid bag. Anaplasia of tissue and bone caused type Ⅲ of lower eyelid bag. Seven surgical methods were per-formed for lower eyelid blepharoplasty by various type. Results 159 of 216 cases were followed-up for 3 - 12 months, and most of the patients had excellent clinical results. Conclusion This simple typing is valuable for adopting surgical methods.
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<p><b>OBJECTIVE</b>To investigate the potential role of intestinal bifidobacteria in the pathogenesis of gut-origin bacteria/endotoxin translocation in scalded rats.</p><p><b>METHODS</b>Wistar rats inflicted with 30% III degree scalding on the back were employed as the model with the rats undergoing sham injury as the control. The intestinal bacteria/endotoxin translocation and the changes in cecal mucosal microflora were determined by routine methods. And the plasma IL-6 concentration was measured with ELISA.</p><p><b>RESULTS</b>The incident of bacterial translocation into internal organs increased markedly in scalded rats (P = 0.001). The plasma LPS levels on 1, 3 and 5 postburn days (PBDs) in scalded rat group were much higher than those in sham injury group. The number of bifidobacteria decreased sharply 20 - 250 fold, the fungi increased 5 - 60 fold and E. coli increased 0.5 - 30 fold in the caecal mucosal microflora in the scalding group. The ratio of bifidobacteria to E. coli in the scalding group (4 - 800:1) was much lower than that in the sham injury group (25000:1). Furthermore, the plasma IL-6 level increased evidently in the scalding group. It was indicated by further analysis that compared with the rats without bacterial translocation, the bifidobacteria decreased 120 fold, the fungal number increased 50 fold and the E. coli number increased 30 fold in the scalded rats. The bifidobacterial number in the caecal mucosal microflora was negatively correlated with the plasma concentrations of IL-6 and LPS (P < 0.01) in the scalding rat group, and the plasma concentration of IL-6 was significantly and positively correlated with that of LPS.</p><p><b>CONCLUSION</b>Severe scalding injury could lead to an the imbalance of intestinal microflora and the increased intestinal translocation of bacteria and LPS. The decrease of the ratio and number of bifidobacteria in the caecal mucosal microflora might be a contribute to the occurrence of postburn intestinal bacteria/endotoxin translocation.</p>
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Animales , Femenino , Masculino , Ratas , Infecciones Bacterianas , Sangre , Microbiología , Traslocación Bacteriana , Fisiología , Bifidobacterium , Fisiología , Quemaduras , Microbiología , Recuento de Colonia Microbiana , Escherichia coli , Fisiología , Interleucina-6 , Sangre , Intestinos , Microbiología , Riñón , Microbiología , Lipopolisacáridos , Metabolismo , Hígado , Microbiología , Ganglios Linfáticos , Microbiología , Ratas Wistar , Bazo , Microbiología , Factores de TiempoRESUMEN
The current study was conducted to analyze the risk factors associated with the development of intestinal bacterial translocation in rats following major burns. Wistar rats were subjected to 30% total body surface area skin full thickness thermal injury, and samples were collected on postburn days 1, 3, and 5. Univariate analysis and multivariate logistic regression analysis were performed to evaluate the correlations among intestinal mucosal barrier, biological barrier and immunologic barrier associated with gut derived bacterial translocation. The results showed that the total bacterial translocation rate was 53 9% (69 in 128) after burns. According to univariate analysis, the levels of plasma endotoxin and interleukin 6, the counts of mucosal fungi and E. coli, and the score of intestinal lesion markedly increased in animals with bacterial translocation compared with those without ( P =0 000～0 005). But intestinal mucus sIgA and the mucosal bifidobacteria count were significantly reduced in animals with bacterial translocation compared with those without ( P =0 000). Multivariate logistic regression revealed that intestinal lesion scores (odds ratio 45 52, 95% confidence interval 5 25～394 80) and the counts of mucosal bifidobacteria (OR 0 039, 95% CI 0 0032～0 48) were independent predictors associated with gut derived bacterial translocation secondary to severe burns. These results suggested that the increase in intestinal lesion score and decrease in bifidobacteria count in mucosal flora were independent risk factors related to bacterial translocation, and specific interventions targeting these high risk factors should be instituted to attenuate gut derived bacterial translocation.
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AIM To investigate the potential effect of riboflavin on the growth of probiotic strains Bifidobacterium adolescentis ( B. adolescentis) and Bacillus cereus ( B. cereus) . METHODS By means of routine bacterial quantitative culture, Gram's staining, and light microscopy, changes in B. adolescentis and B. cereus counts were detected in the presence of riboflavin at different concentrations (1, 0 5, 0 25, 0 g?L -1 ). RESULTS ①The counts of B. adolescentis increased by 10 to 100 fold in 1g?L -1 riboflavin group after 48 h, and 10 to 390 fold in 0 5 g?L -1 and 0 25 g?L -1 riboflavin groups within 72 h as compared to that without riboflavin supplement. Meanwhile, the chain lengths of B. adolescentis were markedly longer in culture system with riboflavin than those without. ②Compared with 0 g?L -1 riboflavin group, the count of B. cereus increased significantly in 0 5 g?L -1 riboflavin group at 36 h, and in 0 25 g?L -1 riboflavin group within 72 h, while it decreased by 50 to 100 000 fold in 1 g?L -1 riboflavin group within 72 h. Likewise, the chain length of B. cereus was markedly longer in 0 5 g?L -1 and 0 25 g?L -1 riboflavin groups, together with the delayed spore formation of B. cereus. ③The 6 month survival rates of B. adolescentis and B. cereus counts in preparations (depositing at 4℃) with 0 5 g?L -1 riboflavin were much higher than those without riboflavin supplement. CONCLUSION Riboflavin in concentrations of 0 5 g?L -1 and 0 25 g?L -1 could markedly enhance the growth of B. adolescentis and B. cereus. 0 5 g?L -1 riboflavin might be beneficial to improve the survival rate of B. adolescentis as well as B. cereus when storing for a long term.
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High-mobility-group B1 (HMGB1), an abundant, highly conserved cellular protein, is widely known as a nuclear DNA-binding protein that stabilizes nucleosome formation, and facilitates gene transcription. Recent studies suggested that HMGB1 could be overexpressed and released from cellular nucleosome upon endotoxin and cytokine stimulation, or other stress challenge including burns, shock, as well as infection. Therefore, extracellular HMGB1 might be involved in the pathogenesis of sepsis and subsequent multiple organ dysfunction syndrome. Moreover, experimental data showed that extracellular HMGB1 might play vital roles in nerves development, tumor metastasis, atherosclerosis and restenosis after vascular damage.