Replanning Criteria and Timing Definition for Parotid Protection-Based Adaptive Radiation Therapy in Nasopharyngeal Carcinoma.

The goal of this study was to evaluate real-time volumetric and dosimetric changes of the parotid gland so as to determine replanning criteria and timing for parotid protection-based adaptive radiation therapy in nasopharyngeal carcinoma. Fifty NPC patients were treated with helical tomotherapy; volumetric and dosimetric (D mean, V 1, and D 50) changes of the parotid gland at the 1st, 6th, 11th, 16th, 21st, 26th, 31st, and 33rd fractions were evaluated. The clinical parameters affecting these changes were studied by analyses of variance methods for repeated measures. Factors influencing the actual parotid dose were analyzed by a multivariate logistic regression model. The cut-off values predicting parotid overdose were developed from receiver operating characteristic curves and judged by combining them with a diagnostic test consistency check. The median absolute value and percentage of parotid volume reduction were 19.51 cm(3) and 35%, respectively. The interweekly parotid volume varied significantly (p < 0.05). The parotid D mean, V 1, and D 50 increased by 22.13%, 39.42%, and 48.45%, respectively. The actual parotid dose increased by an average of 11.38% at the end of radiation therapy. Initial parotid volume, initial parotid D mean, and weight loss rate are valuable indicators for parotid protection-based replanning.

Effect of modified Zhuye Shigao Decoction and its components on preventing radiation esophagitis of rats.

OBJECTIVE: To investigate the effect of Modified Zhuye Shigao Decoction (MZSD) and its components on preventing radiation esophagitis of rats. METHODS: One hundred Wistar rats were randomly divided into 5 groups, including the control group, radiation model group, MZSD group, Zhuye Shigao Decoction (ZSD) group, and added ingredients group, 20 rats in each group. The model of radiation esophagitis of rat was established by once local radiation of 40 Gy (330 Mu/min) with a high energy linear accelerator. The administration of Chinese medicine was continued for 14 days from 7 days before radiation application in the three treatment groups. On the 7th and 14th day, the serum was isolated and the levels of inflammatory cytokines tumor necrosis factor (TNF-α), interleukin 1ß (IL-1ß) and IL-8 were tested. The pathological slices of esophagus were obtained, and the pathological changes were observed. During the whole process, weight and food intake were recorded each day. RESULTS: On the 7th day after radiation, the esophagus of rats in the MZSD group was almost intact, and the pathological injury score was significantly lower than that of the radiation model group, ZSD group and added ingredients group (P<0.01). Compared with the control group, the body weight and food intake of rats in the radiation model group were significantly decreased, and the levels of TNF-α, IL-1ß and IL-8 were significantly increased (P<0.05 or P<0.01), while the MZSD group showed a significant increase in body weight and food intake, and a significant decrease in the levels of TNF-α, IL-1ß and IL-8 compared with the radiation model group, ZSD group and added ingredients group (P <0.05 or P<0.01). CONCLUSION: MZSD prevents the development of radiation esophagitis probably by inhibiting the generation and release of the inflammatory cytokines TNF-α, IL-1ß and IL-8.

Management of severe femoral bone defect in revision total hip arthroplasty--a 236 hip, 6-14-year follow-up study.

This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty. A total of 234 patients (involving 236 hips) with Paprosky III and IV femoral bone defects were treated with the revision total hip arthroplasty from June 1998 to Aug. 2006. Impaction bone graft technique was used for 112 hips, with allogeneic freeze-dried bone as bone graft and SPII as prosthesis. With 124 hips, modular distal press-fit fixation and tapered femoral stem (MP stem) were employed. After the operation, the subjects were followed up on regular basis and results were assessed by using the Harris Hip Score (HHS) and 12-item Short Form Health Survey (SF-12). Radiolucence, subsidence and loosening were observed and complications, including infection, fracture, dislocation etc. were recorded. A 6-14-year follow-up showed that prostheses failed, due to infection, in 4 patients of impaction bone graft group and that 6 patients in the press-fit fixation group experienced prosthesis failure, with the survival rates for the two techniques being 96.43% and 95.16%, respectively. One-way ANOVA showed that prosthesis survival was significantly associated with surgery-related complications (P<0.05) and was not related to the type of the bone defects (P>0.05). The rate of complications bore significant association with the type of bone defects in the two groups (P<0.05). Our study showed that the two revision methods could achieve satisfactory mid-term and long-term results for the reconstruction of severe bone defects. It is of great significance for attaining high prosthesis survival rate to select suitable operation on the basis of the type of bone defect. Careful operative manipulation and post-operative rehabilitation aimed at reducing complications are also important.

[Values of computed tomography angiogram in non-cardiac surgery planning and cardiac risk assessment of coronary atherosclerosis during perioperative period].

OBJECTIVE: To explore the values of detecting coronary atherosclerosis by computed tomography angiogram (CTA) on non-cardiac surgery planning and cardiac risk assessment of coronary atherosclerosis during perioperative period. METHODS: A total of 89 patients with suspected coronary heart disease (CHD) scheduled for non-cardiac surgery underwent coronary CTA to evaluate luminal stenosis and calculate calcification score. There were 56 males and 33 females with a mean age of 65.1 years. Operative sites included chests (n = 29), abdomens and pelvis (n = 26), large vessels (n = 3), bones and joints (n = 19) and other regions (n = 12). Reasons of abandoned or postponed surgery were documented to analyze the influence of CTA results on surgery planning. Cardiac events were recorded to assess the correlation with coronary atherosclerosis. RESULTS: Among them, 75 patients (84.27%) were diagnosed as atherosclerosis while 10 patients (11.24%) were negative; 2 patients had coronary artery bypass and another 2 had stent implantation. According to the results of CTA, 12 operations (13.48%) were canceled and 8 (8.98%) postponed after interventions. Severe stenosis of coronary lumen had significant effects on surgery planning (P = 0.003) while calcification score did not. In patients undergoing surgery as scheduled or after intervention, 1 had atrial fibrillation at post-operation. CONCLUSION: For the patients with suspected CHD scheduled for non-cardiac surgery, severity of coronary stenosis may greatly influence surgery planning. Preoperative coronary CTA may decrease the incidence of cardiac events during perioperative period.

Meta-analysis of Chinese medicines for prevention and treatment of radiation esophagitis.

OBJECTIVE: To systematically assess the clinical effectiveness of Chinese medicines for prevention and treatment of radiation esophagitis by meta-analysis. METHODS: The articles were mainly retrieved from the "CHKD (China Hospital Knowledge Database) periodical full text databank", the "China periodical full text databank", the "CHKD doctor's and Master's degree student full text databank", and the "China doctor's degree student thesis databank", and they were selected according to the literature selection standard. The effects of Chinese medicines and Western medicines on radiation esophagitis were compared by meta-analysis. RESULTS: Based on 13 articles, we found that the effectiveness of Chinese medicines for prevention and treatment of radiation esophagitis was superior to Western medicines, with no obvious side effects. Meta-analysis showed that the total odds ratio was 0.426 and the 95% confidence interval was 0.368, 0.493. CONCLUSION: Chinese medicines are superior to Western medicines in preventing and treating radiation esophagitis. However, some methodological problems in the literature may have affected the authenticity of the results. Therefore, more rigorous, multi-central, randomized controlled trials with a large sample size should be designed to obtain a more reliable conclusion.

Optimal cut-off values for tumor markers in cerebrospinal fluid with ROC curve analysis.

To select optimal cut-off values of tumor markers in cerebrospinal fluid for the diagnosis of meningeal carcinomatosis, the concentrations of CEA, CA125, CA153, CA199, CA724, CYFRA21-1, AFP and NSE were determined by means of double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) in 21 MC patients, 25 cancer patients without leptomeningeal disease (group one) and 45 meningitis patients (group two) using the Roche E170 modular immunoassay analyzer. Optimal cut-off values were selected based on a receiver-operating characteristic curve. The results showed that CA125 and CEA in CSF were optimal diagnostic indices distinguishing between MC patients and cancer patients without leptomeningeal disease. Cut-off values for CA125 and CEA were 1.715 microliters and 0.274 microgram/l, respectively. In addition, CEA in CSF was the optimal diagnostic index distinguishing MC patients from meningitis patients. The cut-off value for CEA was 4.522 microgram/l.

The burden of headache in China: validation of diagnostic questionnaire for a population-based survey.

The objective of this study was to test the validity, in the Chinese population, of the Lifting The Burden diagnostic questionnaire for the purpose of a population-based survey of the burden of headache in China. From all regions of China, a population-based sample of 417 respondents had completed the structured questionnaire in a door-to-door survey conducted by neurologists from local hospitals calling unannounced. They were contacted for re-interview by telephone by headache specialists who were unaware of the questionnaire diagnoses. A screening question ascertained whether headache had occurred in the last year. If they had, the specialists applied their expertise and ICHD-II diagnostic criteria to make independent diagnoses which, as the gold standard, were later compared with the questionnaire diagnoses. There were 18 refusals; 399 interviews were conducted in 202 women and 197 men aged 18-65 years (mean age 44.4±12.6 years). In comparison to the specialists' diagnoses, the sensitivity, specificity, positive predictive value, negative predictive value and Cohen's kappa (95% CI) of the questionnaire for the diagnosis of migraine were 0.83, 0.99, 0.83, 0.99 and 0.82 (0.71-0.93), respectively; for the diagnosis of tension-type headache (TTH), they were 0.51, 0.99, 0.86, 0.92 and 0.59 (0.46-0.72), respectively. In conclusion, the questionnaire was accurate and reliable in diagnosing migraine (agreement level excellent), less so, but adequate, for TTH (sensitivity relatively low, false negative rate relatively high and agreement level fair to good). The non-specific features of TTH do not lend themselves well to diagnosis by questionnaire.

[Preventive and therapeutic effects of Chinese herbal medicine Compound Zhuye Shigao Granule in rats with radiation-induced esophagitis].

OBJECTIVE: To explore the preventive and therapeutic effects of Compound Zhuye Shigao Granule (CZSG), a compound Chinese herbal medicine, on radiation-induced esophagitis in rats. METHODS: Fifty-six Wistar rats were randomly divided into 5 groups: normal control group (8 rats), model group (12 rats), and high-, medium- and low-dose CZSG groups (12 rats in each group). The rats in the normal control and model groups were given normal saline 10 mL/kg body weight and those in the CZSG-treated groups were given solution of CZSG at doses of 1.15, 2.30, or 4.60 g/kg body weight respectively by intragastric administration once a day for 7 days. Then esophagitis was induced by local irradiation of (60)Co ray (490.25 cGy/min, totaled 30 Gy). The administration was continued for another 7 days or 14 days, meanwhile body weight and daily food intake of the rats were recorded. Seven days after the irradiation, 4 rats in each group were sacrificed under anesthesia, then, the esophageal tissue was obtained for histopathological examination and the degrees of esophageal tissue injury and neutrophil infiltration were scored. Fourteen days after the irradiation, all the survival rats were dealt in the same way. RESULTS: (1) Seven days after the irradiation, the esophageal tissue sections in the model group showed typical histopathological changes of radiation-induced esophagitis, whereas in the CZSG groups the histopathological changes were lessened dose-dependently and in the high-dose CZSG group the esophageal tissue remained basically intact. (2) The scores of esophageal tissue injury and cellular infiltration in the high- and medium-dose CZSG groups were both significantly less than in the model group (P<0.05). (3) The body weight of the rats increased in the normal control group, whereas it decreased obviously in the model group. In the medium- and high-dose CZSG groups, it did not decrease significantly. The decrease of body weight in the high-dose CZSG group was less than that in the model group (P<0.05). (4) Compared with the normal control group, the daily food intake was reduced in the other groups. However, it was significantly greater in the low, medium- and high-dose CZSG groups than in the model group (P<0.05). CONCLUSION: In rats with radiation-induced esophagitis, CZSG can effectively relieve the esophageal tissue injury and cellular infiltration, increase daily food intake, and prevent rats from lose of body weight dose-dependently, which show that CZSG has the preventive and therapeutic effects for radiation-induced esophagitis in rats.

[The determination of medical reference values for tumor markers in cerebrospinal fluid].

OBJECTIVE: To determine medical reference values for tumor markers in cerebrospinal fluid. METHODS: Concentrations of CEA, CA125, CA15-3, CA19-9, CA72-4, CYFRA21-1, AFP, NSE, SCC and HCG were determined by means of double-antibody sandwich ELISA in 110 patients excluding primary tumors and meningeal carcinomatosis using Roche E170 modular immunoassay analyzer. RESULTS: The determined medical reference values for tumor biomarkers in cerebrospinal fluid were as follows: CEA<0.573 microg/L, CA125<2.591 U/ml, CA15-3<2.045 U/ml, CA19-9<2.272 U/ml, CA72-4<1.252 U/ml, CYFRA21-1<1.44 ng/ml, AFP<0.968 microg/L, NSE<57.666 ng/ml, SCC<0.5 microg/L, HCG<0.769 U/L. There was no correlation between any tumor marker and age (P>0.05). Concentrations of tumor markers were not affected by gender (P>0.05). CONCLUSION: Medical reference values for CEA, CA125, CA15-3, CA19-9, CA72-4, CYFRA21-1, AFP, NSE, SCC and HCG in cerebrospinal fluid were first determined.

[Screening of differentially expressed genes in colorectal cancer using human whole genomic oligonucleotide microarrays].

OBJECTIVE: To screen the differentially expressed genes in human colorectal cancer (CRC) tissue. METHODS: Affymetrix oligonucleotide microarrays HG-U133 representing 32,264 human genes including 19,308 known genes and 12,956 expressed sequence tags (ESTs) were used to detect the gene expressions of CRC tissue paired with normal mucosa tissue. The microarray findings were confirmed by real-time quantitative reverse transcriptase-polymerase chain reaction (FQ-PCR). The gene expression profiles were analyzed by intersection and complement, rank sum test and t test. RESULTS: Totally 3,125 genes and ESTs expressed differentially were detected in normal and cancer tissues, consisting of 974 up-regulated and 2,151 down-regulated genes with 247 ESTs present in CRC tissue and absent in normal mucosa and 162 ESTs absent in CRC tissue but present in normal mucosa. A percent of 80.1% of the differentially expressed genes were not reported in the literatures. CONCLUSION: The strategy of data mining provides a foundation for filtering molecular markers and interpreting molecular carcinogenesis of CRC.