Two new species of Polyalthiopsis (Annonaceae) based on morphological characters and phylogenetic evidence, with a supplementary description of P. chinensis from China.

Two new species of Polyalthiopsis (Annonaceae), P. nigra Y.H. Tan & Bin Yang from Guangxi and Yunnan Provinces and P. xui Y.H. Tan & Bin Yang from Yunnan Province, are described and illustrated. P. nigra is morphologically similar to P. chinensis in having narrowly elliptic-oblong, lemon to yellowish green petals, but differs by having obovoid monocarps, a higher number of leaf secondary veins, leaf blades usually widest above the middle, and a lower ratio of leaf blade length to width. P. xui is morphologically similar to P. floribunda in having axillary inflorescences, 1-3(-4) flowers, elliptic leaves, and elliptic-ovate petals, but differs in the numbers of carpels per flower and ovules per carpel. The molecular phylogenetic analysis using five plastid markers confirm that the two new species belong to the genus Polyalthiopsis and show clear interspecific divergences between P. nigra and P. xui and between them and other species in the genus. Detailed descriptions, colored photographs, and habitat and distribution data for the two new species are provided. In addition, the fruit morphology of P. chinensis is described for the first time, based on living collections. Geographical distributions and a diagnostic key for all Polyalthiopsis species are also presented.

The complete chloroplast genome sequence of Lithocarpus longinux (Fagaceae).

Lithocarpus longinux (Hu) Chun ex Y.C.Hsu & H.Wei Jen is a Critically Endangered tree distributed in Ma-li-po county in the Southeastern Yunnan Province China. Less than ten individuals have been found since the species was established 70 years ago. In this study, we assembled and annotated the complete chloroplast genome of L. longinux. The complete chloroplast genome of the species is 161,420 bp in length and has a GC content of 36.8%, including one large single-copy region (LSC, 90,409 bp), one small single-copy region (SSC, 19,255 bp), and two copies of inverted repeat regions (IRs, 25,878 bp). A total of 112 unique genes were detected, including 81 protein-coding genes, 29 tRNA genes, and 4 rRNA genes. Phylogenetic analysis of 31 representative chloroplast genomes of the Fagales suggests Lithocarpus is monophyletic with strong bootstrap support and that L. longinux is closely related to L. balansae.

[Sexual experience of male bladder cancer patients after transurethral resection of bladder tumor: A qualitative study].

OBJECTIVE: To investigate the efficiency and complications of modified urethral reconstruction with lingual mucosa in the treatment of complicated anterior urethral stricture (CAUS). OBJECTIVE: To investigate the sexual experience and feelings of male patients with bladder cancer after transurethral resection of bladder tumor (TURBT), and provide some evidence for doctors and nurses in giving advice about the sexual problems of the patients. METHODS: This study included 32 male patients with bladder cancer after treated by TURBT from March 2020 to March 2021. The patients were aged 33－63 (51.91 ± 6.75) years, with a disease course of 13－38 (20.56 ± 7.49) month, and the interviews lasting 31－63 (39.06 ± 8.04) minutes. Among them, 10 (31.25%) lived in the rural area, 22 (68.75%) lived in the urban area, 12 (37.5%) had college education or above, 7 (21.88%) had senior high school education, 10 (31.25%) had junior high school education, and 3 (9.37%) had primary school education. Using the semi-structured method, we conducted interviews with the patients about their sexual experience and needs for sexual function rehabilitation and subjected the results of interviews to Colaizzi analysis. RESULTS: The interviews with the patients covered five topics, which showed intentional refraining from sexual life in 6 (18.75%) of the cases, worrying about hurting the partner by sexual contact in 8 (25%), neglecting sexual troubles in 8 (25%), negative emotions in 5 (15.63%), and expecting medical support in 17 (53.13%). CONCLUSIONS: Male patients with bladder cancer have poor sexual experience after TURBT. Doctors and nurses should inform the patients of potential sexual troubles during the treatment and follow-up, and provide relevant active intervention.

In vitro Dosimetric Study of Biliary Stent Loaded with Radioactive 125I Seeds.

BACKGROUND: A novel radioactive 125I seed-loaded biliary stent has been used for patients with malignant biliary obstruction. However, the dosimetric characteristics of the stents remain unclear. Therefore, we aimed to describe the dosimetry of the stents of different lengths - with different number as well as activities of 125I seeds. METHODS: The radiation dosimetry of three representative radioactive stent models was evaluated using a treatment planning system (TPS), thermoluminescent dosimeter (TLD) measurements, and Monte Carlo (MC) simulations. In the process of TPS calculation and TLD measurement, two different water-equivalent phantoms were designed to obtain cumulative radial dose distribution. Calibration procedures using TLD in the designed phantom were also conducted. MC simulations were performed using the Monte Carlo N-Particle eXtended version 2.5 general purpose code to calculate the radioactive stent's three-dimensional dose rate distribution in liquid water. Analysis of covariance was used to examine the factors influencing radial dose distribution of the radioactive stent. RESULTS: The maximum reduction in cumulative radial dose was 26% when the seed activity changed from 0.5 mCi to 0.4 mCi for the same length of radioactive stents. The TLD's dose response in the range of 0-10 mGy irradiation by 137Cs γ-ray was linear: y = 182225x - 6651.9 (R2=0.99152; y is the irradiation dose in mGy, x is the TLDs' reading in nC). When TLDs were irradiated by different energy radiation sources to a dose of 1 mGy, reading of TLDs was different. Doses at a distance of 0.1 cm from the three stents' surface simulated by MC were 79, 93, and 97 Gy. CONCLUSIONS: TPS calculation, TLD measurement, and MC simulation were performed and were found to be in good agreement. Although the whole experiment was conducted in water-equivalent phantom, data in our evaluation may provide a theoretical basis for dosimetry for the clinical application.

Prognostic significance of PD-L1 expression in patients with gastric cancer in East Asia: a meta-analysis.

The overexpression of programmed cell death-ligand 1(PD-L1) has been observed in gastric cancer (GC). However, whether the expression of PD-L1 in tumor cells or blood serum is associated with the prognosis of patients with GC remains unclear. Therefore, we performed a meta-analysis to evaluate the prognostic significance of PD-L1 expression in GC. Electronic databases were searched systematically. Studies that met the inclusion criteria were included in the meta-analysis. Data concerning the hazard ratio (HR) for overall survival and disease-free survival with a 95% confidence interval (CI) according to the expression status of PD-L1 evaluated by immunohistochemistry or enzyme-linked immunosorbent assay were extracted. The data were analyzed using a random effects model. Subgroup analyses were proposed. Our results showed that eight studies with 950 patients met the inclusion criteria and were included in the meta-analysis. The pooled HR for overall survival indicated that patients with PD-L1-positive expression had significantly shorter survival time compared with the PD-L1-negative group (HR 1.60, 95% CI 1.09-2.36, P=0.012). The pooled HR for disease-free survival demonstrated that the difference between the two groups was not statistically significant (HR 1.02, 95% CI 0.32-3.20, P=0.98). In conclusion, our results indicate that the evaluation of PD-L1 overexpression in GC tissue or blood serum may be useful in the future as a novel prognostic factor.

[Errors in six degree-of-freedom pose estimation of spine tumors assessed by image guided radiotherapy].

OBJECTIVE: To evaluate the six-degree setup errors of tumors of cervical vertebra, thoracic vertebra and lumbar vertebra by image guided radiotherapy. METHODS: From May 2013 to June 2014, 30 patients with spinal malignant tumors(10 patients of cervical vertebra, thoracic vertebra and lumbar vertebra respectively) were treated with Elekata Synergy accelerator (Elekta company,Sweden). Six-degree set up errors were corrected using HexaPODTMevoRT bed under image of on board cone beam computed tomography (CBCT) guided. All the patients received kilovoltage CBCT before receiving radiotherapy and after correction. The acquired images were co-registered with planning CT with bone window. The data of 838 CT images were analyzed and the errors of translational directions X(lateral), Y(lngitudinal),Z(vertical)and rotational directions RX(pitch), RY(roll), RZ(yaw) were recorded. The data were compared by t-test using SPSS 13.0. RESULTS: The absolute translational setup errors in X, Y and Z axes of cervical vertebra before correction were (1.71 ± 0.10) mm, (1.81 ± 0.11) mm and (1.94 ± 0.09) mm respectively: (3.17 ± 0.19) mm, (4.26 ± 0.28) mm and (2.18 ± 0.12) mm for thoracic vertebra, and (2.69 ± 0.24) mm, (3.33 ± 0.26) mm and (2.86 ± 0.21) mm for lumbar vertebra. The residual setup errors in X, Y and Z axes of cervical vertebra were (0.5 ± 2.4) mm,(0.01 ± 2.4) mm and (2.4 ± 1.4) mm, respectively after correction;(1.17 ± 0.11) mm,(0.26 ± 0.30) mm and (0.08 ± 0.12) mm for thoracic vertebra and (1.09 ± 0.24) mm,(2.03 ± 1.26) mm and (0.06 ± 0.51) mm for lumbar vertebra. The t-test of paired data of set up errors before and after CBCT showed significant difference in three translational directions of cervical vertebra and thoracic vertebra, only Z(t=-3.518,P<0.001) for lumbar vertebra. The absolute rotational setup errors in RX,RY and RZ axes of cervical vertebra before correction were 0.67° ± 0.04°,1.06° ± 0.06° and 0.78° ± 0.05° respectively. 0.62° ± 0.05°, 0.75° ± 0.06°, and 0.84° ± 0.06° for thoracic vertebra, 0.59° ± 0.06°, 0.80° ± 0.07°, and 0.73° ± 0.06° for lumbar vertebra. The rotational directions RX, RY and RZ axes of cervical vertebra were 0.27° ± 0.14°, 1.20° ± 0.04° and 0.28° ± 0.05° respectively; 0.02° ± 0.20°, 0.05°±0.26° and 0.64° ± 0.16° for thoracic vertebra and 0.09° ± 0.26°, 0.50°±0.05°,and 0.03°±0.16° for lumbar vertebra. The t-test of paired data of set up errors before and after CBCT showed significant difference in three rotational directions of cervical vertebra and lumbar vertebra, only RY(t=7.106, P<0.001)for thoracic vertebra. All the patients acquired pain relief and there was no radiation-induced toxicity detected clinically during a median follow-up of 6 months. CONCLUSION: Six-degree set up errors of spine tumors were corrected effectively with HexaPODTMevoRT bed under CBCT image guided and its feasibility in day-to-day clinical practice has been demonstrated.

Permanent implantation of iodine-125 seeds as a salvage therapy for recurrent head and neck carcinoma after radiotherapy.

Seventeen patients with head and neck recurrent carcinoma underwent (125)I seed implantation under CT or ultrasound guidance. The actuarial D90 of the (125)I seeds implanted was 90-160 Gy (median, 126 Gy). Median follow-up was 10 months (range, 3-48 months). The median local control time was 16 months; the 1- and 2-year local control rates were 66.5% and 49.9%, respectively. The 1- and 2-year survival rates were 51.3% and 38.5%, respectively (median, 16 months). None of the patients experienced grade 4 toxicity. (125)I seed implantation was a feasible and effective salvage treatment for patients with recurrent head and neck cancers.

Percutaneous computed tomography/ultrasonography-guided permanent iodine-125 implantation as salvage therapy for recurrent squamous cell cancers of head and neck.

OBJECTIVE: To assess the feasibility, efficacy, and morbidity of permanent percutaneous 125I seed implantation under computed tomography (CT)/ultrasonography guidance for recurrent squamous cell carcinomas of head and neck. METHODS: Twenty-five patients underwent 125I seed implantation under CT or ultrasonography guidance. Postoperative dosimetry was routinely performed for all the patients. The actuarial D90 of the implanted 125I seeds ranged from 90 Gy to 160 Gy (median: 130 Gy). The activity of 125I seed ranged from 0.35 mCi to 0.8 mCi (median: 0.6 mCi). The total number of seeds implanted ranged from 3 to 61 (median: 22). The follow-up period ranged from 3 to 40 months (median: 8 months). RESULTS: The median local disease-free progression was 12 months (95% CI, 4.8-19.2), and the 1- and 2-year local tumor control rates were 48.7% and 39.9%, respectively. The 1- and 2-year survival rates were 42.5% and 28.3%, respectively (median: 11 months) (95% CI, 8.2-13.8). Of the 25 patients, 6 (24%) died of local recurrence and 5 (20%) died of metastases; 2 patients showed recurrences at 3 and 8 months after seed implantation and subsequently died of pneumonia. One patient died of heart disease. One developed ulceration with tumor progression. Blood vessel damage and neuropathy were not observed. CONCLUSION: The high local tumor control rates, minimal invasion, and low morbidity suggest that percutaneous 125I seed implantation is a feasible and safe salvage for patients with recurrent squamous cell carcinomas of the head and neck.

CT-guided radioactive seed implantation for recurrent rectal carcinoma after multiple therapy.

The recurrent carcinoma has been difficult to manage after surgery and radiotherapy, extensive resection of locally recurrent rectal cancer is associated with significant morbidity and mortality. Re-irradiation, even in combination with chemotherapy has shown very short survival. We assess the feasibility and efficacy of CT-guided interstitial permanent brachytherapy with (125)I or (103)Pd seeds for recurrent rectal cancer after multiple treatments. Fifteen patients with locally recurrent rectal carcinoma received (125)I or (103)Pd seed implants under CT guidance. The minimal peripheral dose of seed implants was 110-165 Gy (median 150 Gy). Two weeks after seed implantation, a 50 Gy of stereotactic radiotherapy was given to one patient; four patients received 2-4 cycles of chemotherapy. A median follow-up was 8 months (range 4-50 months). The duration of pain-free survival was 0-50 months (median 7 months). Local control was maintained for 3-50 months (median 7 months). The 1- and 2-year local controls were 16.2 and 8.1%, respectively. Eleven patients died: two (18.2%) of local recurrence, seven (63.6%) of local recurrence and metastases, and two (18.2%) of metastases. Four patients (26.7%) survived the median survival was 9 months. The 1- and 2-year actuarial overall survival rates were 42.9% and 10.7%, respectively. One patient (7.6%) experienced a grade 4 toxic event; there was no associated neuropathy. CT-guided radioactive seed implantation is feasible and safe as a salvage or palliative pain relief treatment for patients with recurrent rectal cancers after surgery and radiotherapy.

[Dosimetric comparison between helical tomotherapy and step-and-shoot intensity modulated radiation therapy for endometrial carcinoma].

BACKGROUND AND OBJECTIVE: Helical tomotherapy (HT) has shown its dosimetric advantages in the radiotherapy for many cancers. To date, no published studies have performed a dosimetric evaluation of whole pelvic radiotherapy (WPRT) using HT for postoperative endometrial cancer. This study was to compare the dosimetric characteristics of HT and step-and-shoot intensity modulated radiation therapy (SaS-IMRT) for endometrial cancer patients undergoing postoperative WPRT, and to explore whether whole pelvic HT for postoperative endometrial cancer has the advantage of dosimetry. METHODS: Ten patients with endometrial cancer undergoing postoperative WPRT were enrolled in this study. SaS-IMRT and HT Plans were developed for each patient. The dose distributions of the targets, organs at risk and normal tissue were analyzed and compared. RESULTS: The mean PTV100 were 95.6% and 95.8% (P=0.72) for the SaS-IMRT and HT plans, respectively. The mean homogeneity indexes were 1.10 and 1. 07 (P=0.00). The mean conformity indexes were both 0.87. The mean doses to rectum and bladder for HT were decreased by 1.3 Gy and 3.0 Gy compared with SaS-IMRT, respectively, while the mean dose to pelvic bones was increased by 1.1 Gy. The volumes of small intestine and colon, pelvic bones receiving moderate and low dose also increased. The V5, V10 and V20 of normal tissue were increased by 13.0%, 18.0%, and 5.0% (P=0.00). The mean dose to normal tissue was increased by 2.5 Gy (P=0.00). CONCLUSIONS: Compared with SaS-IMRT, HT resulted in more homogeneous PTV dose distribution, better sparing of rectum and bladder. The volumes of small intestine and colon, pelvic bones and normal tissue receiving moderate and low dose for HT increased. The clinical significance of the dosimetric differences needs further investigations.