Poly(acryloyl hydrazide)-grafted cellulose nanocrystal adsorbents with an excellent Cr(VI) adsorption capacity.

In this study, we prepared poly(acryloyl hydrazide) (PAH)-grafted cellulose nanocrystal (CNC-PAH) particles via the atom transfer radical polymerization method for application to Cr(VI) adsorption. The closely-packed PAH chains grafted on the cellulose nanocrystal (CNC) surface provide a high density of amine groups that can adsorb Cr(VI) through strong electrostatic, hydrogen bonding and chelating interactions. CNC-PAH exhibited the optimum Cr(VI) adsorption capacity at the solution pH = 3, where its electrostatic attraction with Cr(VI) was maximized. Cr(VI) was chemisorbed in CNC-PAH by following the Langmuir isotherm mechanism (homogeneous monolayer adsorption). The Cr(VI) adsorption kinetics of CNC-PAH was controlled predominantly by intra-particle diffusion resistance imparted by the PAH shell layer. Thermodynamic analysis revealed that Cr(VI) adsorption of CNC-PAH is a spontaneous and endothermic process. Importantly, CNC-PAH grafted with the higher Mw (∼50 kg mol-1) PAH exhibited a rapid Cr(VI) adsorption rate and remarkably high Cr(VI) adsorption capacity (∼457.6 mg g-1 at 298.15 K), exceeding those of previously reported adsorbents owing to its numerous Cr(VI)-adsorptive amine groups provided by the closely-packed grafted PAH polymers. Furthermore, CNC-PAH showed excellent reusability to maintain its high adsorption ability during repeated adsorption-desorption cycles owing to the covalently binding nature of the PAH polymers.

A new suggestion for the radiation target volume after a subtotal gastrectomy in patients with stomach cancer.

PURPOSE: To compare treatment results between the use of two different radiation fields including and excluding remnant stomach and suggest new target volumes excluding remnant stomach after subtotal gastrectomy (STG) in patients with stomach cancer. METHODS AND MATERIALS: We retrospectively analyzed 291 patients treated with adjuvant chemoradiotherapy after STG and D2 dissection at the Samsung Medical Center, Seoul, South Korea. Eighty-three patients registered from 1995 to 1997 underwent irradiation according to the INT 0116 protocol that recommended the inclusion of remnant stomach within the target volume (Group A). After this period, we excluded remnant stomach from the target volume for 208 patients (Group B). Median follow-up was 67 months. RESULTS: Treatment failure developed in 93 patients (32.0%). Local and regional recurrence rates for Group A vs. Group B were 10.8% vs. 5.3% (p = not significant) and 9.6% vs. 6.3% (p = not significant), and recurrence rates for remnant stomach were 7.2% vs. 1.4% (p = 0.018), respectively. Overall and disease-free survival rates were not different between the two groups. Grade 3 or 4 vomiting and diarrhea developed more frequently in Group A than Group B (4.8% vs. 1.4% and 6.0% vs. 1.9%, respectively; p = 0.012; p < 0.001). CONCLUSION: Exclusion of remnant stomach from the radiation field had no effect on failure rates or survival, and a low complication rate occurred in patients treated excluding remnant stomach. We suggest that remnant stomach be excluded from the radiation target volume for patients with stomach cancer who undergo STG and D2 dissection.

An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach.

PURPOSE: The role of adjuvant chemoradiotherapy (CRT) in D2-resected gastric-cancer patients has not been defined yet. We investigated the effect of postoperative chemoradiotherapy on the relapse rate and survival rate of patients with D2-resected gastric cancer. METHODS AND MATERIALS: From August 1995 to April 2001, 544 patients received postoperative CRT after curative D2 resection. During the same period of time, 446 patients received surgery without further adjuvant treatment. The adjuvant CRT consisted of 400 mg/m2 of fluorouracil plus 20 mg/m2 of leucovorin for 5 days, followed by 4,500 cGy of radiotherapy for 5 weeks, with fluorouracil and leucovorin on the first 4 and the last 3 days of radiotherapy. Two 5-day cycles of fluorouracil and leucovorin were given 4 weeks after the completion of radiotherapy. RESULTS: The median duration of overall survival was significantly longer in the CRT group than in the comparison group (95.3 months vs. 62.6 months), which corresponds to a hazard ratio for death of 0.80 (p = 0.0200) or a reduction of 20% in the risk of death in the CRT group. The 5-year survival rates were consistently longer in the CRT group at Stages II, IIIA, IIIB, and IV than those in the comparison group. The CRT was associated with increases in the median duration of relapse-free survival (75.6 months vs. 52.7 months; hazard ratio for relapse, 0.80, p = 0.0160). CONCLUSION: Our results highly suggest that the postoperative chemoradiotherapy in D2-resected gastric-cancer patients can prolong survival and decrease recurrence.

Vinorelbine, ifosfamide, and cisplatin combination as salvage chemotherapy in advanced non-small cell lung cancer.

BACKGROUND: Platinum-based chemotherapy improves survival and quality of life as compared with the best supportive care alone in advanced non-small cell lung cancer. In addition, several recent studies using new drugs such as docetaxel have demonstrated that second-line chemotherapy may be of value. METHODS: We studied the efficacy of combination treatment with vinorelbine, ifosfamide, and cisplatin (NIP) as salvage chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). From March 1998 to December 1999, 44 previously treated patients (etoposide/cisplatin (EP): 36, EP--> taxane/cisplatin: 8) were treated with a chemotherapy regimen consisting of vinorelbine (25 mg/m(2) i.v. on days 1, 15 and 12.5 mg/m(2) i.v. on day 8), ifosfamide (3 g/m(2) i.v. on day 1 with mesna) and cisplatin (60 mg/m(2) i.v. on day 1). The cycles were repeated every 4 weeks. RESULTS: All patients were evaluable for response. The median follow-up duration was 19.1 months (range, 4.4-28.3 months). The objective response rate was 27.3% (95% CI, 14.1%-40.5%) with one complete response and 11 partial responses. The median response duration was 4.1 months (range, 1.5-13 months). The median time to progression was 2.9 months (range, 0.7-15.3 months). The main toxicity was hematologic in the 138 evaluable courses, granulocytopenia (>or=grade III) and anemia (>or=grade III) were observed in 3.6% and 0.7% of the patients, respectively. Non-hematologic toxicities were minor and easily controlled. Four episodes of febrile neutropenia were reported. There were no treatment-related deaths. CONCLUSION: In this study, the combination of vinorelbine, ifosfamide and cisplatin showed a significant efficacy with acceptable toxicities as salvage chemotherapy in previously treated advanced NSCLC patients.

The Efficacy and Safety of DA-3030 (Recombinant Human Granulocyte Colony-Stimulating Factor) in Neutropenia after the Remission Induction Chemotherapy in Patients with Acute Myelogenous Leukemia.

PURPOSE: This study was conducted to determine the efficacy and safety of DA-3030 (a recombinant methionyl human granulocyte colony-stimulating factor, rhG-CSF), after remission induction chemotherapy, in patients with acute myelogenous leukemia (AML). MATERIALS AND METHODS: After the remission induction chemotherapy, with idarubicin (12 mg/m2/day for 3 days) and cytarabine (200 mg/m2/day for 7 days), 26 patients with newly diagnosed AML were assigned to receive DA-3030 (200mug/m2/day), starting 24 hours after the completion of the remission induction chemotherapy, until their neutrophil count recovered to greater than 1, 000/muL for 3 consecutive days. RESULTS: The median time from the initiation of the chemotherapy to the neutrophil recovery of 1, 000/muL was 21 days (range, 12~41). Treatment with DA-3030 was not associated with significant adverse side effects. The most frequently reported side effects were musculo-skeletal pain (13%) and headache (13%). CONCLUSION: The DA-3030 is a safe rhG-CSF for the treatment of neutropenia after remission induction chemotherapy in patients with AML.

Importance of open lung biopsy in the diagnosis of invasive pulmonary aspergillosis in patients with hematologic malignancies.

Invasive pulmonary aspergillosis is a serious infectious complication in immunocompromised patients. Recent reports indicate its favorable clinical outcomes by early diagnosis with chest computed tomography scan. We retrospectively analyzed our experiences with histopathological evaluation by open lung biopsy in 31 patients (32 cases) with hematologic malignancies, suspected of having invasive pulmonary aspergillosis clinically and radiologically. Although the initial computed tomography findings of all cases were highly indicative of invasive pulmonary aspergillosis by demonstrating nodules or masses with a halo sign (16 cases), segmental area of consolidation with ground-glass attenuation (7 cases), both nodules or masses with a halo sign and segmental area of consolidation with ground-glass attenuation (7 cases) and poorly defined centrilobular nodules (2 cases), we could histopathologically confirm invasive fungal infections only in 17 cases (53.1%) by open lung biopsy. There were 13 cases of invasive pulmonary aspergillosis, two cases of aspergilloma, and two cases of mucormycosis. No fungal hyphae were found in the other 15 cases: organizing pneumonia in seven cases, pulmonary hemorrhage in three cases, brochiolitis obliterans with organizing pneumonia in two cases, and CMV pneumonia, pulmonary tuberculosis, candida pneumonia in one case each, respectively. We could perform open lung biopsy without mortality and significant morbidity. In view of the low positive predictive value of chest computed tomography scan and the very low morbidity of open lung biopsy, this procedure is recommendable for the diagnosis of invasive pulmonary aspergillosis and determination of its treatment.

Sexuality and quality of life after hematopoietic stem cell transplantation.

BACKGROUND: The quality of sexuality is significantly affected by physical changes following hematopoietic stem cell transplantation (HSCT) and the dissatisfied and/or dysfunctional sexuality may cause deterioration in the quality of life (QOL). METHODS: With two models of questionnaires, we interviewed thirty-eight patients who remained in the disease-free status after HSCT and had sex partners, to assess: 1) the changes in sexuality, 2) QOL in physical, psychological, social and spiritual domains and 3) the correlation between sexuality and QOL. RESULTS: The common physical changes that may affect sexuality in women were secondary amenorrhea (69.2%), loss of sexual interest (53.8%), diminished vaginal secretion (50%), menopausal syndrome (34.6%), dyspareunia (30.8%) and failure to orgasm (23.1%), while men complained of impotence (41.7%) and difficulty in ejaculation (16.7%). For sexuality, satisfaction of sexual activity, attainment of orgasm and frequency of intercourse decreased significantly after HSCT as compared with the pre-transplant levels. A score measuring, QOL after HSCT marked 5.91 on a full score of 10; social domain ranked the lowest (5.01) while physical domain the highest (6.70). Among the items of sexuality, only sexual desire was significantly correlated with QOL; satisfaction, orgasm and frequency were not significantly correlated with QOL. CONCLUSION: Although sexuality is affected by the physical changes following HSCT, we should not overlook the psychological and social effects on the sexuality of post-transplant patients. Therefore, educational and counseling programs are very important to restore and improve their sexuality.

Adenocarcinoma of unknown primary site.

BACKGROUND: Metastatic cancer of unknown primary site occupies 0.5-10% of all diagnosed cancer patients and includes various tumors with diverse responses to systemic chemotherapy. Adenocarcinoma of unknown primary site (ACUPS), the most common subtype, has no standard treatment, rarely responds to conventional treatment and has a poor survival rate. METHODS: The retrospective study was performed to investigate the clinical characteristics and the treatment outcomes of ACUPS. RESULTS: Eighty-one patients with ACUPS diagnosed at Samsung Medical Center from May 1995 to July 1999 were included. The median age was 58 years (range, 29-77). The common sites of metastases were the lymph node, liver, lung and bone in order. In 49 of 81 patients (60.5%), the dominant tumor location was below the diaphragm. The majority of patients (76 of 81) were initially treated with systemic chemotherapy including cisplatin. Responses were evaluable in 70 of 76. Eighteen of 70 patients (25.7%) responded to chemotherapy and complete remission was observed in 6 patients. The overall median survival of 81 patients was 5.6 months. The median survival of the responding patients was 18.3 months but the median survival of the nonresponding patients was 4.6 months (p < 0.01). In univariate and multivariate analysis, age, performance status and response to initial chemotherapy were significant prognostic factors for overall survival. CONCLUSION: We observed poor response to the treatment and survival rate in ACUPS, but complete remission and long-term survival were observed in a small number of patients.