Dosimetric and efficiency comparison of high-dose radiotherapy for esophageal cancer: volumetric modulated arc therapy versus fixed-field intensity-modulated radiotherapy.

The aim of this study was to compare high-dose volumetric modulated arc therapy (VMAT) and fixed-field intensity-modulated radiotherapy (ff-IMRT) plans for the treatment of patients with middle-thoracic esophageal cancer. Eight patients with cT2-3N0M0 middle-thoracic esophageal cancer were enrolled. The treatment planning system was the version 9 of the Pinnacle(3) with SmartArc (Philips Healthcare, Fitchburg, WI, USA). VMAT and ff-IMRT treatment plans were generated for each case, and both techniques were used to deliver 50 Gy to the planning target volume (PTV(50)) and then provided a 16-Gy boost (PTV(66)). The VMAT plans provided superior PTV(66) coverage compared with the ff-IMRT plans (P = 0.034), whereas the ff-IMRT plans provided more appropriate dose homogeneity to the PTV(50) (P = 0.017). In the lung, the V(5) and V(10) were lower for the ff-IMRT plans than for the VMAT plans, whereas the V(20) was lower for the VMAT plans. The delivery time was significantly shorter for the VMAT plans than for the ff-IMRT plans (P = 0.012). In addition, the VMAT plans delivered fewer monitor units. The VMAT technique required a shorter planning time than the ff-IMRT technique (3.8 ± 0.8 hours vs. 5.4 ± 0.6 hours, P = 0.011). The major advantages of VMAT plans are higher efficiency and an approximately 50% reduction in delivery time compared with the ff-IMRT plans, with comparable plan quality. Further clinical investigations to evaluate the use of high-dose VMAT for the treatment of esophageal cancer are warranted.

An HDAC inhibitor enhances cancer therapeutic efficiency of RNA polymerase III promoter-driven IDO shRNA.

Histone deacetylase (HDAC) inhibitors are used in treating certain human malignancies. Our laboratories demonstrated their capability in enhancing antitumor effect of DNA vaccine driven by an RNA polymerase II (RNA pol II) promoter. However, it is unknown whether HDAC inhibitors enhance the therapeutic short hairpin RNA (shRNA) expressed by an RNA polymerase III (RNA pol III) promoter. We investigated whether HDAC inhibitors augmented antitumor effect of indoleamine 2,3 dioxygenase (IDO) shRNA. HDAC inhibitor OSU-HDAC42 and suberoylanilide hydroxamic acid enhanced RNA pol III-driven U6 and H1 promoter activity in three different cell types in vitro: 293, NIH3T3 and dendritic cell line DC2.4. Subcutaneous injection of OSU-HDAC42 enhanced U6 and H1 promoter activity on abdominal skin of mice in vivo. Combination of IDO shRNA and OSU-HDAC42 increased antitumor effect of IDO shRNA in MBT-2 murine bladder tumor model. IDO shRNA induced tumor-infiltrating CD8⁺ and CD4⁺ T cells, whereas OSU-HDAC42 treatment induced tumor-infiltrating CD4⁺ T cells. Combination of OSU-HDAC42 and IDO shRNA further induced tumor-infiltrating natural killer cells and enhanced interferon-γ in lymphocytes, but suppressed interleukin (IL)-4 expression of lymphocytes. In addition, OSU-HDAC42 treatment did not alter mRNA expression of IL-12 and tumor necrosis factor-α. In conclusion, HDAC inhibitor OSU-HDAC42 may serve as adjuvant of the therapeutic shRNA expressed by an RNA pol III promoter.

Phase-specific cone beam computed tomography reduces reconstructed volume loss of moving phantom.

PURPOSE: The accurate volumetric calculation of moving targets/organs is required to use cone-beam computed tomography (CBCT) for replanning purposes. This study was aimed to correct the reconstructed volume losses of moving phantoms by phase-specific CBCT. MATERIALS AND METHODS: Planning fan-beam CT (FBCT) of five hepatobiliary/gastrointestinal/pancreatic cancer patients were acquired under active breathing control and compared with free-breathing CBCT for kidney volumes. Three different-sized ball phantoms were scanned by FBCT and CBCT. Images were imported to a planning system to compare the reconstructed volumes. The phantoms were moved longitudinally on an oscillator with different amplitudes/frequencies. The phase-specific projections of CBCT for moving phantoms were selected for volume reconstruction. RESULTS: The differences in reconstructed volumes of static small, medium, large phantoms between FBCT and CBCT were - 6.7%, - 2.3%, and - 2.0%, respectively. With amplitudes of 7.5-20 mm and frequencies of 8-16 oscillations/min, volume losses on CBCT were comparable with FBCT in large moving phantoms (range 9.1-27.2%). Amplitudes were more subject to volume losses than frequencies. On phase-specific CBCT, volume losses were reduced to 2.3-6.5% by reconstruction using 2-3 projections at end/midoscillation phase. CONCLUSION: Amplitude had more impact than frequency on volume losses of moving phantoms on CBCT. Phase-specific CBCT reduced volume losses.

Efficacy of point-of-entry copper--silver ionisation system in eradicating Legionella pneumophila in a tropical tertiary care hospital: implications for hospitals contaminated with Legionella in both hot and cold water.

A medical centre in Southern Taiwan experienced an outbreak of nosocomial Legionnaires' disease, with the water distribution system thought to be the source of the infection. Even after two superheats and flush, the rate of Legionella positivity in distal sites in hospital wards and intensive care units (ICUs) was 14% and 66%, respectively. Copper-silver ionisation was therefore implemented in an attempt to control Legionella colonisation in both hot- and cold-water systems. Environmental cultures and ion concentration testing were performed to evaluate the efficacy of ionisation. When the system was activated, no significant change in rate of Legionella positivity in the hospital wards (20% vs baseline of 30%) and ICUs (28% vs baseline of 34%) of the test buildings over a three-month period was found, although all Legionella positivity rates were below 30%, an arbitrary target for Legionnaires' disease prevention. When ion concentrations were increased from month 4 to month 7, however, the rate of Legionella positivity decreased significantly to 5% (mean) in hospital wards (P=0.037) and 16% (mean) in ICUs (P=0.037). Legionella positivity was further reduced to 0% in hospital wards and 5% (mean) in ICUs while 50% sites were still positive for Legionella in a control building. Although Legionella was not completely eradicated during the study period, no culture- or urine-confirmed hospital-acquired Legionnaires' disease was reported. Ionisation was effective in controlling Legionella for both hot and cold water, and may be an attractive alternative as a point-of-entry systematic disinfection solution for Legionella.

Different risks of symptomatic brain necrosis in NPC patients treated with different altered fractionated radiotherapy techniques.

PURPOSE: To report our observation of excessive temporal lobe necrosis in nasopharyngeal carcinoma (NPC) patients treated with 160 cGy b.i.d. radiotherapy technique. During the same period, patients treated with 120 cGy b.i.d. have not shown a similar tendency. Our experience may be useful for designing unconventional radiotherapy regimens for NPC patients. METHODS AND MATERIALS: During the period from October 1991 to January 1998, 81 M0, previously untreated NPC patients completed altered fractionated radiotherapy. Seventy patients were treated with the hyperfractionated technique, and 11 were treated using the accelerated-hyperfractionated scheme. Hyperfractionated radiotherapy was delivered using 120 cGy b.i.d. separated by 6-h intervals throughout the course. A minimum tumor dose of 8000 cGy was the standard dose over an 8-week period. With the accelerated-hyperfractionated scheme, 160 cGy was given twice daily, also with an interval of 6 h. The minimum tumor dose ranged between 6840 and 7640 cGy, with 7 of the 11 patients receiving 7000 cGy. The arrangement of portals was the same for both regimens. The follow-up period for patients alive was from 32 to 102 months with a median of 61 months for the hyperfractionated patients. For the accelerated-hyperfractionated group, it ranged from 67 to 82 months with a median of 72 months. No patient was lost to follow-up. RESULTS: At the time of analysis, 49 of the 70 patients in the hyperfractionated group were alive. In the accelerated group, 8 of the 11 patients were alive. The estimated radiation dose to the temporal lobe for the hyperfractionated group was 6000-7440 cGy with a median of 7080 cGy. For the accelerated-hyperfractionated group, the dose range was 4480-6700 cGy with a median of 6400 cGy. Of the 70 patients treated with hyperfractionated radiotherapy, none developed symptomatic brain necrosis, despite the higher total dose to the temporal lobe in general. In contrast, 3 of the 11 (27%) patients irradiated using the accelerated-hyperfractionated regimen suffered from temporal lobe necrosis at 16, 19, and 40 months after completion of radiotherapy. CONCLUSION: An excessive incidence of temporal lobe necrosis was noted when an accelerated-hyperfractionated regimen with 160 cGy b.i.d. was used in NPC patients with a median brain dose of 6400 cGy. There has been no such event in patients treated using a hyperfractionated regimen with 120 cGy and a median brain dose of 7000 cGy. The real causes of this discrepancy are not known. However, a high sensitivity of the human brain to a change in fraction size may play a role.

Direct effects of propylthiouracil on testosterone production in monkeys.

Propylthiouracil (PTU) is an anti-thyroid drug. However, the direct effects of PTU on the endocrine functions of non-thyroid glands are unclear. In the present study, we examined the acute effects of PTU on testosterone secretion in monkeys. Male monkeys were infused intravenously with PTU for 30 min. Blood samples were collected at several time intervals. Monkey testicular interstitial cells were cultured with PTU, human chorionic gonadotropin (hCG), or forskolin, at 34 degrees C for 1 h. In another study, steroidogenesis in monkey testicular interstitial cells were examined. PTU decreased plasma testosterone but not plasma thyroxine (T4) and luteinizing hormone (LH) levels in monkeys. Administration of PTU resulted in a dose-dependent inhibition of basal and hCG-, as well as forskolin-stimulated testosterone release by monkey testicular interstitial cells. PTU also diminished the stimulatory effects induced by androstenedione. These results suggest that PTU inhibits testosterone secretion via a mechanism independent of the secretion of T4 and LH in primates. The inhibitory mechanism of PTU on testosterone production involves a decreased activity of 17beta-hydroxysteroid dehydrogenase (17beta-HSD) and post-cAMP pathways.

Presence of F-like OriT base-pair sequence on the virulence plasmids of Salmonella serovars Gallinarum, Enteritidis, and Typhimurium, but absent in those of Choleraesuis and Dublin.

The 90 kb virulence plasmids of Salmonella biosers Gallinarum and Pullorum (expressed as serovar Gallinarum) are non-conjugative. They were, however, found to be readily mobilized by IncFI and IncFIV plasmids, but not by conjugative IncA, IncB = C, IncH, IncL and IncM R plasmids. No virulence plasmids of serovars Choleraesuis, Dublin, Enteritidis, and Typhimurium were mobilized by any of these conjugative plasmids. The 90 kb virulence plasmid of Gallinarum was shown to hybridize to the Tra genes region of IncFI and IncFIV plasmids, suggesting it contains some F Tra genes region. It also hybridized with 75% homology to the virulence plasmid of Typhimurium, and, in decreasing order, to those of Dublin, Enteritidis, and Choleraesuis. A probe made of 319 basepairs of the F OriT region hybridized with approximately 45% homology to the virulence plasmid of Gallinarum, 63% to that of Typhimurium and 50% to that of Enteritidis. The probe, however, failed to hybridize to the plasmid DNAs of IncA, IncB = C, IncH, IncL and IncM, and to the virulence plasmids of Choleraesuis and Dublin.

Imported Opisthorchis viverrini and parasite infections from Thai labourers in Taiwan.

In order to determine the prevalence of intestinal parasites among labourers from Thailand in Taiwan, the stool samples from 1364 Thai labourers were examined by the formalin-ether concentration method and 18.0% were found to be infected with one or more parasites. The infection rates of hookworm, Opisthorchis viverrini, Strongyloides stercoralis, Enterobius vermicularis, Ascaris lumbricoides, Hymenolepis nana, Capillaria philippinensis, Schistosoma japonicum, Echinostoma sp., Entamoeba coli, Giardia lamblia, and Entamoeba histolytica, were 7.6%, 7.0%, 3.2%, 0.5%, 0.3%, 0.1%, 0.1%, 0.1%, 0.1%, 0.4%, 0.2%, and 0.1% respectively. The prevalence was highest among the 21-25 age group (24.8%). Among the 245 infected persons, 91% were infected with one parasite, 8% with two parasites and 1% with three parasites. The finding that parasitic infections are prevalent among Thai labourers demonstrates the need for control measures in foreign labourers in Taiwan and further studies to determine the susceptibility of O. viverrini to the snail hosts of Clonorchis sinensis.

A new method for biliary tract reconstruction for primary bile duct stones.

Twelve patients with repeated episodes of jaundice and infection due to primary biliary duct stones were treated by interposing a 50-cm segment of the jejunum between the proximal common duct below the liver and the first portion of the duodenum. The interposed jejunum was positioned in a retrogastric position. There were no postoperative deaths, and laboratory data indicate no alteration in gastric secretion, gastrin levels, or barium reflux into the liver. After a mean follow-up period of 11.67 months, there was no need for further operations in these patients, all of whom had had previous multiple episodes of cholangitis and biliary colic.