Correlation between maximum heart distance and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during deep inspiration breath-hold (DIBH).

BACKGROUND: Cardioprotection is valued in radiotherapy for patients with left-sided breast cancer. Deep inspiration breath-hold (DIBH) technique can achieve cardioprotection well. However, during DIBH, the extent to which the heart enters the radiation field is affected by the movement of the thorax and diaphragm. The aim of this study was to analyze the correlation between the maximum distance of the heart entering the field (maximum heart distance, MHD) and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during DIBH. PATIENTS AND METHODS: Ninety-eight patients with left-sided breast cancer were included in this retrospective study. They performed simulation in Sentinel-guided DIBH, and two sets of CT images were collected under both free breathing (FB) and DIBH, and diaphragm positions, anteroposterior thoracic diameter (ATD), transverse thoracic diameter (TTD), gating window level (GWL), and MHD were measured, and the change (Δ) of each parameter in DIBH relative to that in FB were calculated. Pearson or Spearman test were used to analyze the correlation between ΔMHD and the changes in other parameters. RESULTS: For all patients with DIBH, the average of ΔMHD was -8.3 mm, and the average of ΔATD and ΔTTD were 11.0 and 8.6 mm, and the median of both left diaphragmatic descent (LDD) and right diaphragmatic descent (RDD) were 35.0 mm, and the median of GWL was 11.1 mm. The correlation coefficients between MHD decrease (ΔMHD) and LDD, RDD, and ΔTTD were -0.430 (p = 0.000), -0.592 (p = 0.000) and 0.208 (p = 0.040), respectively, but not significantly correlated with ΔATD or GWL. CONCLUSIONS: The MHD decrease showed a moderate correlation with diaphragmatic descent In Sentinel-guided DIBH for patients with left-sided breast cancer, while there was a weak or no correlation with thoracic diameter changes or GWL. Abdominal breathing can lower diaphragm more and may be more beneficial to the heart stay away from tangential field.

Clinical and pathological characteristics of 107 esophageal neuroendocrine carcinoma / 中华消化杂志

Objective To investigate the clinical and pathological features of patients with esophageal neuroendocrine carcinoma (ENEC).Methods From January 2011 to November 2018,107 patients with pathologically confirmed ENEC were enrolled at the First Affiliated Hospital of Zhengzhou University.The clinical manifestation,tumor location,tumor size,clinical pathological classification and immunohistochemical markers were analyzed.Statistical description was used for measurement data analysis,and chi-square test was performed for classification data analysis.Results Among 107 patients with ENEC,feeling obstruction during eating was the most common initial symptom,accounting for 63.6％ (68/107);followed by chest and back pain,accounting for 13.1％ (14/107).About 60.7％ (65/107) patients were diagnosed by biopsy under endoscopy and 39.3％ (42/107) patients were confirmed by pathological diagnosis after surgery.The proportion of tumor located in the upper thoracic esophagus and middle and lower thoracic segments was 13.1％ (14/107),45.8％ (49/107) and 41.1％ (44/107),respectively.The length of tumor was 0.7 cm to 9.0 cm,and the median was 2.5 cm.Among them,57.0％ (61/107) were less than 2.5 cm and 43.0％ (46/107) were over 2.5 cm.Among 107 patients,50 (46.7％) patients were ulcerative type,32 (29.9％) patients were medullary type,16 (15.0％) patients were mushroom type and nine (8.4％) patients were protrude type.Among 107 patients,96 (89.7％) patients were pure neuroendocrine carcinoma (P-NEC;including 95 small cell types,one large cell type);11 (10.3％) patients were mixed neuroendocrine carcinoma (M-NEC;including nine small cell carcinoma mixed with squamous cell carcinoma,two small cell carcinoma mixed with adenocarcinoma).The positive rates of synaptophysin,CD56 and chromogranin A were 99.0％ (104/105),98.0％ (100/102) and 31.5％ (17/54),respectively.Ki-67 proliferation index of 47.7％ tumors (51/107) was between 90％ and 100％.P-NEC with the maximum diameter over 2.5 cm accounting for 42.1％ (45/107),and M-NEC accounting for 0.9％ (1/107).The maximum diameter of P-NEC group was larger than that of M-NEC group,and the difference was statistically significant (x2 =4.311,P =0.038).Conclusions ENEC is a kind of highly aggressive malignant tumor with nonspecific manifestations.The diagnosis mainly depends on histopathology and immunohistochemistry.

Matrix is the site of indirect effects of propranolol on the ion channelopathies in cardiac remodeling by L-thyroxine.

Cardiac remodeling by chronic L-thyroxine medication causes exaggerated cardiac arrhythmias in relation to ion channelopathies that involve multichannels. The matrix of lipid membrane is likely the key site where channel lesions, possibly will develop and be benefitted by drug intervention. Cardiac remodeling in rats and guinea pigs was developed by L-thyroxine 0.5 mg/kg SC for 10 days. Propranolol was instituted on days 8-10. Whole cell holding was applied to measure ion currents. An increase in HR, dispersion of QTc, mitochondrial Na+/K+ ATPase, Ca2+/Mg2+ ATPase, and LPO production were found in the model. T3 and T4 levels in plasma were high. Propranolol was effective in regressing cardiac remodeling, together with lowering all the parameters and the enhanced I(Ca.L),I(KS), and I(KR) currents, but T3 and T4 remained basically unchanged. The changes in ion channels are likely the consequence of the cardiac remodeling that is formed by oxidative stress and increased energy consumption provoked by L-thyroxine. The benefit of propranolol on the disordered ion channels is mediated by its ability to ameliorate lesions of the matrix.