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   Table of Contents - Current issue
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 2018
Volume 14 | Issue 7
Page Nos. 1453-1669

Online since Wednesday, December 19, 2018

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EDITORIAL  

A valuable guideline of radioactive 125I seeds interstitial implantation brachytherapy for pancreatic cancer p. 1453
Yancu Hertzanu, Xin Ye
DOI:10.4103/jcrt.JCRT_726_18  PMID:30589022
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REVIEW ARTICLES Top

Chinese expert consensus on radioactive 125I seeds interstitial implantation brachytherapy for pancreatic cancer Highly accessed article p. 1455
Baodong Gai, Fujun Zhang
DOI:10.4103/jcrt.JCRT_96_18  PMID:30589023
Pancreatic cancer, also known as exocrine pancreatic carcinoma or pancreatic ductal adenocarcinoma, is one of the most challenging tumor entities worldwide, which is characterized as a highly aggressive disease with dismal overall prognosis. Treatment options for patients with locally advanced pancreatic cancer include surgery, chemotherapy, and radiotherapy. In many cases, surgical resection is not possible due to the advanced stage at diagnosis and poor responses to current treatments, therefore, treatment alternatives have to be performed. However, brachytherapy through radioactive 125I seeds (RIS) implantation into pancreatic cancer has been first applied in unresectable carcinoma and made accuracy curative effects. Therapeutic procedures of RIS implantation for pancreatic carcinoma were not identical in domestic medical centers, making it hard to achieve homogeneity and affecting the efficacy seriously at last. To maximize the benefits of RIS for patients with pancreatic cancer, Chinese Medical Doctor Association of Radioactive Seed Implantation Technology Expert Committee and Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, Radioactive Seed Therapy Branch organized and helped establish China expert consensus on RIS implantation for the treatment of pancreatic cancer, to provide a reference for clinical practices.
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Chinese association of ultrasound in medicine and engineering, superficial organs and peripheral vessels committee expert consensus on clinical frequently asked questions in breast ultrasonography, June 2018 p. 1463
Tian'an Jiang, Yuxin Jiang, Wen Chen, Baoming Luo, Yulan Peng, Zhili Wang, Jinfeng Xu, Jianqiao Zhou, Qi Zhou, Lingyun Bao, Li Chen, Lin Chen, Qin Chen, Shuzhen Cong, Kefei Cui, Xinwu Cui, Qinmao Fang, Fengsheng Li, Huiwen Li, Jing Li, Jianchu Li, Junlai Li, Quanshui Li, Tianliang Li, Tao Li, Yanjiang Li, Zhengyi Li, Jia Liu, Yong Liu, Jun Luo, Buyun Ma, Zhe Ma, Fang Nie, Chengzhong Peng, Xiufang Sui, Hongguang Sun, Hongqiao Wang, Jing Wang, Yan Wang, Changjun Wu, Ying Xiao, Huahua Xiong, Dong Xu, Ensheng Xue, Lifang Xue, Songli Yan, Lichun Yang, Qiang Yong, Weiwei Zhan, Sheng Zhang, Xuezhen Zhang, Jianxing Zhang, Xianli Zhou, Xi Lin, Shanyu Yin, Qiyu Zhao
DOI:10.4103/jcrt.JCRT_509_18  PMID:30589024
Ultrasonography, the preferred imaging modality for breast diseases, has merits such as absence of radiation, high diagnostic accuracy, and convenience for follow-up, thus playing an important role in clinical diagnosis and management. The American College of Radiology (ACR) proposed Breast Imaging-Reporting and Data System (BI-RADS ) and has updated for several times. Gradually, the BI-RADS has been accepted and adopted by ultrasound physicians at all levels of hospitals in China, and it has played a certain role in improving the diagnostic level of breast ultrasound in China. In order to standardize breast ultrasound application and raise the status of ultrasound in clinical decision-making of breast diseases, based on the latest edition of ACR BI-RADS Atlas 2013, the committee has reached the “Expert Consensus on Clinical Frequently Asked Questions in Breast Ultrasonography”on a number of controversial Frequently Asked Questions (FAQs) in clinical practice (hereafter referred to as “Consensus”), and will be dedicated to updating the contents of the “Consensus”, through further experience in clinical practice and the advent of new information from further studies. This consensus is only for reference purposes for medical personnel, and the processes outlined are not mandatory by law.
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Therapeutic approaches targeting cancer stem cells Highly accessed article p. 1469
Yunzhi Pan, Sai Ma, Kaiyue Cao, Sufang Zhou, Aiqin Zhao, Ming Li, Feng Qian, Chuanwu Zhu
DOI:10.4103/jcrt.JCRT_976_17  PMID:30589025
Increasing studies have demonstrated that most tumors consisted a subpopulation of cells with stem cell properties, known as cancer stem cells (CSCs). Accumulating evidence indicated that CSCs may be critical driving force for several types of cancer. Hence, it was necessary to develop therapeutic approaches specifically targeting CSCs. In this review, first, the biological properties of CSCs were introduced, including the self-renewal and differentiation, high tumorigenesis and invasiveness, resistance to chemotherapy and radiotherapy, genetic and epigenetic variations. Meanwhile, CSCs-targeted therapeutic strategies were summarized, including targeting cell surface markers, signaling pathways, CSC niches, differentiation therapy, and drug resistance for CSCs. Furthermore, clinical trials on anti-CSCs therapies supported the efficacy of these therapies, as well as their combination with conventional chemotherapy and radiotherapy. CSCs could be significantly eradicated, eventually resulting in inhibited tumor growth, metastasis, and recurrence. Thus, selectively targeting CSCs with various agents may be a novel and promising therapeutic strategy against cancer.
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ORIGINAL ARTICLES Top

Combined effect of 125I and gemcitabine on PANC-1 cells: Cellular apoptosis and cell cycle arrest p. 1476
Dong Li, Yun-Ming Jia, Pi-Kun Cao, Wei Wang, Bin Liu, Yu-Liang Li
DOI:10.4103/jcrt.JCRT_43_18  PMID:30589026
Background: 125I seed implantation has recently become an effective, safe, and feasible treatment for advanced pancreatic cancer in China. Gemcitabine (GEM), superior to fluorouracil, has been widely proved as effective chemotherapy for many solid tumors and become the standard treatment for locally advanced and metastatic pancreatic cancer. The study aimed to evaluate the combined effect of 125I and GEM on pancreatic carcinoma cells (PANC-1) cells and explore the underlying molecular basis. Subjects and Methods: PANC-1 cells were treated with 125I continuously at a low dose of radiation, combined with or without sensitizing concentration of GEM. The clonogenic capacity, cellular proliferation, cell cycle distribution, apoptosis, and molecular pathways of the cells following these treatments were analyzed in vitro. Results: The cell growth could be significantly inhibited after the treatment with GEM or 125I alone, while the inhibition effects would be greater with combination therapy than either monotherapy (72 h, C vs. GEM, t = 16.59, P < 0.01; C vs. 125I, t = 9.808, P < 0.05; C vs. 125I + GEM, t = 17.87, P < 0.01; 125I vs. 125I+GEM, t = 8.191, P < 0.05). GEM increased radiation-induced apoptosis (4 Gy, 125I vs. 125I+GEM, t = 10.43, P < 0.01) and induced the arrest of G1. Caspase-3 expression and the Bax/Bcl2 ratio were lower in cells receiving combination treatment than that of in cells treated with 125I or GEM alone. Conclusion: The combined treatment of 125I and GEM-induced stronger anti-proliferation effect than single-treatment, due to the cell cycle arrest and more cellular apoptosis in PANC-1 cells. The increased Bax/Bcl-2 ratio may lead to enhanced apoptosis.
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Treatment of high-grade gliomas using escalating doses of hypofractionated simultaneous integrated boost-intensity-modulated radiation therapy in combination with temozolomide: A modified Phase I clinical trial p. 1482
Xiaohui Ge, Xiaoying Xue, Huizhi Liu, Yanqiang Wang, Zhiqing Xiao, Lei Tian, Xiaojing Chang, Qiang Lin, Jinming Yu
DOI:10.4103/jcrt.JCRT_51_18  PMID:30589027
Background: Recent studies have shown that hypofractionated simultaneous integrated boost-intensity-modulated radiation therapy (SIB-IMRT) provided certain survival benefits over other fractionation methods for high-grade gliomas. However, the best hypofractionation mode and its efficacy have not been confirmed. The purpose of this study was to investigate the maximum tolerated dose (MTD) of hypofractionated SIB-IMRT with stepwise escalating doses combined with temozolomide (TMZ) for treating malignant gliomas. Methods: The patients received concurrent postoperative radiotherapy and chemotherapy. SIB-IMRT was adopted to increase the dose both in the surgical cavity and residual tumor (planning target volume 1). The dose at each fraction was gradually increased from 2.8 Gy/f (total of 20 times), with an escalating dose interval of 0.4 Gy. The planning target volume 2 involved the 2 cm region around surgical cavity, and residual tumor remained unchanged, with 2.5 Gy each time and a total of 50 Gy/20f. TMZ was administered with a dose of 75 mg/m2/day during radiotherapy. Adjuvant TMZ was given at 150–200 mg/m2/day for 5 days every 28 days. A total of 16 patients were enrolled. Results: Three patients exhibited dose-limiting toxicity (DLT), two cases reported Grade 3 headache in the 3.6 Gy/f and 4 Gy/f dose groups, and one patient developed persistent seizures attacks in the 4 Gy/f dose group. Therefore, 4 Gy/f was considered the DLT and the lower dose level of 3.6 Gy/f was regarded as the MTD in the study, with tolerable adverse reactions. The median overall survival (OS) and median progression-free survival (PFS) in this study were 19 and 16 months, respectively. The 1- and 2-year OS and PFS were 86.7%, 31.0% and 73.7%, 26.7%, respectively. Conclusions: It showed that the treatment of high-grade gliomas with hypofractionated SIB-IMRT combined with TMZ had an MTD of 3.6 Gy/f (72 Gy/20f). In addition, the results preliminarily showed improved survival.
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Quality of life after I-125 seed implantation using computed tomography and three-dimensional-printed template guidance in patients with advanced malignant tumor p. 1492
Panfeng Wang, Li Qiong Shen, Heli Zhang, Muyi Zhang, Zhe Ji, Yuliang Jiang, Baohua Li
DOI:10.4103/jcrt.JCRT_77_18  PMID:30589028
Background: I-125 seed implantation has been widely applied in the local treatment of advanced malignant tumor. It has the advantages of providing a high dose of treatment to the target sites and low dose to normal tissues. It has been mostly applied as palliative treatment for recurrences in advanced malignant tumor (except for prostate cancer), suppressing tumor development and improving the quality of life of patients. Objective: The objective of this study was to investigate changes in quality of life for patients with advanced malignant tumor after receiving I-125 seed implantation using a three-dimensional (3D)-printed individualized template and computed tomography (CT) guidance. Materials and Methods: In this prospective study, convenience sampling was applied for patients with advanced tumors attending a tertiary hospital. The European Organization for Research on Treatment of Cancer Quality of Life Questionnaire-C30 was involved to assess quality of life. Patients completed the questionnaire before and 24 h after seed implantation. The questionnaire of 1 and 3 months after seed implantation was completed by telephonic follow-up. Results: A total of 42 patients were included (24 males and 18 females), with an average age of 58.86 ± 14.13 years (ranged 25–91 years). The average scale score after seed implantation was higher than that of before implantation. The order was the average scale score 1 month after seed implantation >3 months after seed implantation >24 h after seed implantation. Conclusion: The results suggested that the quality of life could be improved with I-125 seed implantation using a 3D-printed individualized template under CT guidance in patients with the advanced malignant tumor.
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Role of dexmedetomidine in reducing the incidence of postoperative cognitive dysfunction caused by sevoflurane inhalation anesthesia in elderly patients with esophageal carcinoma p. 1497
He Zhang, Zuoli Wu, Xin Zhao, Yong Qiao
DOI:10.4103/jcrt.JCRT_164_18  PMID:30589029
Background: Sevoflurane anesthesia is a high-risk factor for postoperative cognitive dysfunction (POCD) in elderly patients. Recently, some studies demonstrated that dexmedetomidine (DEX) could reduce the incidence of POCD caused by sevoflurane anesthesia. We hypothesized that DEX could reduce the incidence of POCD caused by sevoflurane anesthesia through decreasing plasma interleukin (IL-6) and tumor necrosis factor (TNF)-α concentrations. Materials and Methods: A total of 120 patients aged 65–75 years scheduled for esophageal carcinoma resection were randomly assigned to four groups. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to measure patients' cognitive function the day before operation and the 1st, 3rd, and 7th postoperative days. The plasma TNF-α, IL-6, and S100 β protein concentrations were measured by ELISA 10 min before anesthesia administration and the 1st, 3rd, and 7th postoperative days. Results: There were no significant differences in the demographic or clinical characteristics or perioperative hemodynamic status in all groups. Compared with Group M + P, the MMSE and MoCA scores were significantly lower and the plasma TNF-α, IL-6, and S100 β protein concentrations were significantly higher in Group M + S at the 1st, 3rd, and 7th postoperative days (P < 0.05). Compared with Group M + S, the MMSE and MoCA scores were significantly higher and the plasma TNF-α, IL-6, and S100 β protein concentrations were significantly lower in Group D + S at the 1st, 3rd, and 7th postoperative days (P < 0.05). Conclusion: The POCD incidence was higher in elderly patients receiving sevoflurane anesthesia and DEX could alleviate POCD in these patients through decreasing plasma TNF-α and IL-6 concentrations.
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Multifactorial analysis of biliary infection after percutaneous transhepatic biliary drainage treatment of malignant biliary obstruction p. 1503
Haipeng Yu, Sun Yuanyuan, Zhi Guo, Wenge Xing, Tongguo Si, Xiuying Guo, Fang Liu
DOI:10.4103/jcrt.JCRT_256_18  PMID:30589030
Background: The symptoms of patients with malignant biliary obstruction (MBO) could be effectively alleviated with percutaneous transhepatic biliary drainage (PTBD). Postoperative infections were considered as challenging issues for clinicians. In this study, the risk factors of biliary infection in patients after PTBD were analyzed. Methods: From July 2003 to September 2010, 694 patients with MBO received PTBD treatment. Bile specimens were also collected during PTBD. All relevant information and results were collected, including gender, age, obstruction time, types of primary tumor, sites of obstruction, drainage style, tumor stage, hemoglobin, phenotype of peripheral blood monocyte (Treg), total bilirubin, direct bilirubin, albumin, Child–Pugh score, and results of bile bacterial culture. Results: For the 694 patients involved in this study, 485 were male and 209 were female, with a mean age of 62 years (ranged 38–78 years). For the bile culture, 57.1% patients (396/649) were negative and 42.9% patients showed positive (298/694), and then 342 strains of microorganism were identified. The risk factors of biliary system infection after PTBD included: age (χ2 = 4.621, P = 0.032), site of obstruction (χ2 = 17.450, P < 0.001), drainage style (χ2 = 14.452, P < 0.001), tumor stage (χ2 = 4.741, P = 0.029), hemoglobin (χ2 = 3.914, P = 0.048), Child–Pugh score (χ2 = 5.491, P = 0.019), phenotype of peripheral blood monocyte (Treg) (χ2 = 5.015, P = 0.025), and results of bile bacterial culture (χ2 = 65.381, P < 0.001). Multivariate analysis suggested that high-risk factors were drainage style, Child–Pugh score, and results of bile culture. Conclusions: The risk factors of biliary infection after PTBD included: age, site of obstruction, drainage style, tumor stage, hemoglobin, Child–Pugh score, phenotype of peripheral blood monocyte (Treg), and results of bile culture. It was further concluded that drainage style, Child–Pugh score, and results of bile culture were independent risk factors.
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Application value of coaxial biopsy system in needle cutting biopsy for focal ground glass-like density nodule p. 1509
Hualong Yu, Chuanyu Zhang, Shihe Liu, Gang Jiang, Shaoke Li, Liang Zhang, Enhao Kang, Bingping Zhang, Wenjian Xu
DOI:10.4103/jcrt.JCRT_382_18  PMID:30589031
Objective: The objective of the study is to evaluate the clinical efficacy and accuracy of coaxial biopsy puncture applied to make a diagnosis in 76 patients diagnosed with focal ground-glass density nodule (GGN). Materials and Methods: In total, 76 patients were diagnosed with pure GGN (pGGN), 24 males and 52 females, aged (52 ± 1.2) years on average (range: 47–72 years). All patients underwent computed tomography (CT)-guided coaxial biopsy puncture to localize the position and measure the size of pGGN. The maximal diameter of the pGGN and the length of puncture needle into the lung were quantitatively measured. The diagnostic accuracy rate of CT-guided biopsy was subsequently validated by histological pathological examination. The incidence of postoperative complications was observed after biopsy. Results: The pGGN diameter was measured from 5 to 45 mm, 21 mm on average. The pGGN depth ranged from 0 to 48 mm with a mean depth of 15 mm. Compared with the final diagnosis, the sensitivity, specificity, and accuracy rates of CT-guided needle aspiration biopsy in the diagnosis of pGGN were calculated as 97.3% (54/56), 85.0% (17/20), and 93.4% (71/76), respectively. Fourteen cases (18.4%) suffered from slight pneumothorax, 17 (22.4%) with mild errhysis surrounding the biopsy needle or lesions. Conclusion: CT-guided needle aspiration biopsy yields higher diagnostic accuracy and similar postoperative complications compared with the conventional histological diagnosis. For those undiagnosed by conventional CT scan and nontolerable of surgery, CT-guided needle aspiration biopsy serves as a safe and effective intervention.
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Metastases to the thyroid gland: A retrospective analysis of 21 patients Highly accessed article p. 1515
Xiaowei Wang, Yuan Huang, Zengguang Zheng, Wenming Cao, Bo Chen, Xiaojia Wang
DOI:10.4103/jcrt.JCRT_435_16  PMID:30589032
Background: Metastases to the thyroid gland are uncommon and often occur in patients with advanced metastatic diseases. The management and prognosis of secondary thyroid malignancies (STMs) are not well established. This retrospective study reported the incidence, clinical characteristics, treatment, and prognosis of STM in patients with metastatic tumors. Subjects and Methods: A total of 21 cases (1.2% incidence) diagnosed by fine-needle aspiration between January 2006 to December 2014 in a single center were reviewed. Survival analysis was made by Kaplan–Meier method. Results: The primary malignancies included esophagus cancer (7/21, 33.33%), breast cancer (6/21, 28.57%), head and neck cancer (3/21, 14.29%), unknown primary cancer (3/21, 14.29%), and lung cancer (2/21, 9.52%). The mean overall survival (OS) from diagnosis of primary malignancies was 57.26 months (95% confidence interval [CI]: 31.19–83.34) and the 2-year OS rate was 61.9%, and the mean OS from diagnosis of thyroid metastases was 31.20 months (95% CI: 12.23–50.18) and the 2-year OS rate was 34.3%. Patients with the head and neck cancer and breast cancer had better survival than other patients (from diagnosis of primary malignancies, P < 0.001; from diagnosis of thyroid metastases, P = 0.03). Histological types were also related to OS (from diagnosis of primary malignancies, P = 0.039; from diagnosis of thyroid metastases, P = 0.130). In addition, thyroidectomy may improve OS for patients with isolated metastases. Conclusion: The prognosis of STMs basically depends on the anatomic sites and histological types of primary cancers, and thyroidectomy may be considered for patients with isolated metastases.
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Downregulation of basic fibroblast growth factor increases cisplatin sensitivity in A549 non-small cell lung cancer cells p. 1519
Long He, Yousheng Meng, Zhihui Zhang, Yanguo Liu, Xiuwen Wang
DOI:10.4103/jcrt.JCRT_481_18  PMID:30589033
Objectives: The objective of the study is to investigate the role of basic fibroblast growth factor (bFGF) in sensitivity to cisplatin in non-small cell lung cancer (NSCLC) A549 cells and its effect on the stemness characteristics of NSCLC cells, revealing possible mechanisms of cisplatin resistance. Materials and Methods: After A549 cells were treated with cisplatin, bFGF protein expression was analyzed by Western blot. A549 cells were transfected with bFGF small interfering RNAs (siRNAs), and the knockdown efficiency was confirmed by quantitative reverse transcription polymerase chain reaction and Western blot. After bFGF downregulation, A549 cell proliferation was assessed by Cell Counting Kit-8 assay. The effect of bFGF siRNA on the sensitivity to cisplatin was evaluated by cell viability assays and flow cytometry for cell apoptosis. Colony formation assay was performed to explore whether bFGF affected the stemness characteristics of A549 cells, and OCT-4 protein expression was analyzed by Western blot after bFGF siRNA treatment. Results: Cisplatin treatment enhanced bFGF expression in A549 cells. After A549 cells were transfected with bFGF siRNAs, bFGF expression was significantly decreased compared to that in the negative control siRNA group. In addition, bFGF knockdown inhibited A549 cell proliferation. bFGF siRNA treatment enhanced the inhibitory effect of different concentrations of cisplatin on cell viability and promoted cisplatin-induced apoptosis in A549 cells. Further analyses showed that bFGF siRNA treatment not only significantly decreased colony formation in A549 cells but also downregulated OCT-4 protein expression. Conclusion: bFGF decreased NSCLC sensitivity to cisplatin in vitro, while it enhanced colony formation ability and increased OCT-4 expression of A549 cells, which might account for its involved mechanisms of cisplatin resistance.
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Expression profile analysis identifies a two-gene signature for prediction of head and neck squamous cell carcinoma patient survival p. 1525
Xue Xu, Mengzhi Li, Jun Hu, Zheng Chen, Jinyu Yu, Yan Dong, Chengtao Sun, Junqing Han
DOI:10.4103/jcrt.JCRT_557_18  PMID:30589034
Aim: The aim of this study is to identify a gene prognostic signature for the head-and-neck squamous cell carcinoma (HNSCC). HNSCC is one of the most common malignancies worldwide; however, the molecular mechanisms underlying the malignancy are unclear. Materials and Methods: We analyzed the gene expression profiles of GSE2379, GSE53819, and GSE59102 derived from the gene expression omnibus, and the cancer genome atlas (TCGA) HNSC databases. The R software was used to identify the differentially expressed genes (DEGs) between HNSCC tissues and normal controls. Gene ontology, Kyoto Encyclopedia of Genes and Genomes pathway, protein-protein interactions network, and survival analyses of common DEGs were also performed. Results: A total of 52 upregulated and 31 downregulated DEGs were identified. Functional analyses demonstrated that these DEGs were mainly enriched in extracellular matrix-receptor interaction, focal adhesion, tyrosine metabolism, and cytokine-cytokine receptor interaction. According to the survival analyses, PLAU and SERPINE1 could predict the overall survival of HNSCC patients from the TCGA cohort. Multivariable Cox regression analyses showed that the PLAU and SERPINE1 were independent prognostic factors for HNSCC patients. The prediction power of this two-gene signature was evaluated through receiver operating characteristic curve analysis and achieved a better prognostic value than PLAU (area under curve 0.613 [95% confidence interval 0.569–0.656] vs. 0.577 [0.533–0.621]; P = 0.008) or SERPINE1 (0.613 [0.569–0.656] vs. 0.586 [0.541–0.629]; P = 0.043) when considered alone. Conclusions: The study has identified a set of novel genes and pathways that play significant roles in the carcinogenesis and progression of HNSCC. This two-gene signature may prove to be a useful therapeutic target for HNSCC.
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Ligation of thoracic duct during thoracoscopic esophagectomy can lead to decrease of T lymphocyte p. 1535
Rui-Feng Yang, Ting-Ting Liu, Peng Wang, Run-Qi Zhang, Chao Li, Bo Han, Xue-Xin Gao, Lei Zhang, Zhong-Min Jiang
DOI:10.4103/jcrt.JCRT_596_17  PMID:30589035
Background: Video-assisted thoracoscopic esophagectomy has been one of the most preferable surgical treatments for early esophageal cancer. Some scholars suggested that the thoracic duct should be routinely ligated to reduce the incidence of postoperative chylothorax, while another group raised an objection. As a classic indicator of immune function, T lymphocyte subsets can be applied to assess the effects of prophylactic thoracic duct ligation during thoracoscopic esophagectomy. Methods: A total of 60 patients were recruited and randomized into thoracic duct ligation group and nonligation group. Venous blood was collected before and after video-assisted esophagectomy. The lymphocyte count and percentage, T lymphocyte subsets percentage were measured with fully automatic hemacytometer analyzer and flow cytometry. The difference between two groups was compared with t-test and the classified data were compared with Chi-square test. Results: No significant difference was observed in peripheral blood CD3+, CD3+CD4+, and CD3+CD8+ lymphocyte percentage between the two groups before operation (P > 0.05). The mean value of peripheral blood CD3+, CD3+CD4+ lymphocyte percentage in ligation group was obviously less than that of in nonligation group after operation (P < 0.05). The mean of CD3+CD8+ lymphocyte percentage in ligation group was obviously higher than that of in nonligation group after operation (P < 0.05). Conclusion: Ligation of thoracic duct during esophagectomy could lead to decreased percentage of T lymphocyte and CD4+ Tlymphocyte, especially after arch of azygos vein had been transected. The thoracic duct should be selectively ligated during esophagectomy.
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Selenocystine inhibits JEG-3 cell growth in vitro and in vivo by triggering oxidative damage-mediated S-phase arrest and apoptosis p. 1540
Ming Zhao, Yajun Hou, Xiaoting Fu, Dawei Li, Jingyi Sun, Xiaoyan Fu, Zhigang Wei
DOI:10.4103/jcrt.JCRT_864_17  PMID:30589036
Background: Selenocystine (SeC) is a nutritionally available selenoamino acid presenting novel anticancer potential against human cancers. However, neither the effects nor mechanism of SeC against choriocarcinoma growth has been clarified yet. This study investigated the anticancer effects and mechanism of SeC against JEG-3 human choriocarcinoma growth in vitro and in vivo. Materials and Methods: The in vitro anticancer efficiency was evaluated with cell viability, apoptosis, and oxidative stress. JEG-3 cell viability was determined with 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide assay. Cell cycle distribution and apoptosis were examined by flow cytometric analysis. Oxidative damage was detected with immunofluorescence and western blotting. The in vivo anticancer efficiency was evaluated in immunodeficient mouse model of choriocarcinoma. The mechanism was also investigated. Results: SeC dose and time dependently inhibited the viability of JEG-3 cells in vitro. The result of flow cytometry (FCM) analysis showed that obvious S-phase arrest and cell apoptosis were initiated by SeC in JEG-3 cells, which was further convinced by the decreased levels of cyclin A, poly-ADP-ribose polymerase cleavage, and activation of caspase-3,-7, and-9. In addition, SeC resulted in significant generation of reactive oxygen species (ROS) and superoxide anion, followed by the activation of DNA damage. However, SeC-induced oxidative damage and apoptosis were effectively blocked after ROS inhibition. Further investigation indicated that SeC effectively suppressed JEG-3 choriocarcinoma tumor xenograft growth in vivo. The mechanism may be the induction of cell apoptosis and oxidative damage through inhibiting cell proliferation (Ki-67) and angiogenesis (CD-31). Conclusions: Our findings supported that human choriocarcinoma growth could be inhibited by SeC in vitro and in vivo through triggering oxidative damage-mediated S-phase arrest and apoptosis. Thus, SeC may be promising in the treatment of human choriocarcinoma.
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The safety and efficacy of interstitial 125I seed implantation brachytherapy for metastatic epidural spinal cord compression p. 1549
Jian Lu, Wei Huang, Zhongmin Wang, Ju Gong, Xiaoyi Ding, Zhijin Chen, Ning Xia, Nannan Yang, Zhiyuan Wu, Chen Wang, Jun Chen
DOI:10.4103/jcrt.JCRT_938_17  PMID:30589037
Objective: The objective of this study is to investigate the safety and efficacy of 125I seed interstitial implantation brachytherapy for metastatic epidural spinal cord compression (MESCC) as well as the life quality of patients. Materials and Methods: From April 2009 to May 2015, 28 patients who met the eligibility criteria were retrospectively reviewed. The number of implanted 125I seeds ranged from 7 to 62, with appropriate activity of 0.5–0.8 mCi. The postplan showed that the matched peripheral dose (MPD) of tumors was 80–140 Gy. The duration of follow-up ranged from 1 to 32 months with a median of 18 months. Visual analog scale (VAS), Karnofsky Performance Scale (KPS), and motor performance were evaluated before and after treatment. Results: Seed implantation was well tolerated by all patients. Pain was obviously alleviated in all patients. VAS score of patients was significantly decreased from 4.89 ± 1.52 before treatment to 1.61 ± 1.20 after treatment, and KPS score was significantly increased from 73.93 ± 12.27 to 86.76 ± 10.90 (P < 0.05). The local control rates of 1, 2, and 3 years were 77%, 34%, and 14%, respectively, with a median of 19 months (7–32 months). The survival rates of 1, 2, and 3 years were 81%, 54%, and 14%, respectively, with a median of 25 months. Seven (100%) nonwalking patients regained motor ability. No myelopathy or other neurologic sequelae were encountered. Conclusion: Interstitial 125I seed implantation brachytherapy may be a promising local therapy, which was an alternative and palliative way for treating MESCC.
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Liver computed tomographic perfusion for monitoring the early therapeutic response to sorafenib in advanced hepatocellular carcinoma patients p. 1556
Xiaojun Shen, Dong Wu, Min Tang, Huichuan Sun, Yuan Ji, Cheng Huang, Mengsu Zeng
DOI:10.4103/jcrt.JCRT_979_17  PMID:30589038
Background: Sorafenib is the only approved treatment for advanced hepatocellular carcinoma (HCC). However, it is a diagnostic challenge to monitor its early treatment effects on HCC. Purpose: The purpose of this study is to investigate the effects of sorafenib on HCC with liver computed tomography perfusion (CTP) and investigate its efficacy in assessing the early therapeutic response of sorafenib for advanced HCC. Materials and Methods: A total of 23 HCC patients were included in this study. Sorafenib was continuously administered orally at a dose of 400 mg twice daily. CTP was performed before and after 2 weeks of sorafenib treatment, and the changes of perfusion parameters were obtained with a 320-detector row CT scanner including hepatic artery flow (HAF), portal vein flow (PVF), and perfusion index. The modified response evaluation criteria in solid tumor (mRECIST) assessment were performed after two and 4 months of treatment. Results: According to the result of mRECIST, three patients (13%) showed partial response, eight patients (34.7%) showed stable disease (SD) and 12 patients (52.2%) showed progressive disease (PD) after 2 months of treatment, whereas 10 patients (43.5%) showed SD and 13 (56.5%) showed PD after 4 months of treatment. The group that responded to sorafenib showed a significantly decreased HAF value after 2 months compared to that of baseline, whereas nonresponder group showed a significant increase in HAF. The patients with PD showed significantly higher HAF compared to that of SD patients. Conclusions: CTP might be applied to evaluate therapeutic effects of sorafenib in advanced HCC, where HAF could potentially serve as imaging biomarkers for monitoring early therapeutic effects after treatment.
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Safety and efficacy of transarterial interventional therapy for treatment of hepatocellular carcinoma with peritoneal metastases p. 1563
Feng Duan, Yanhua Bai, Li Cui, Xiaohui Li, Jieyu Yan
DOI:10.4103/jcrt.JCRT_984_17  PMID:30589039
Purpose: The aim of this study was to evaluate the safety and efficacy of transarterial interventional therapy for the treatment of hepatocellular carcinoma (HCC) patient with peritoneal metastases. Materials and Methods: A total of 7 HCC patients with peritoneal metastases were treated by interventional therapy. Combined treatment with transarterial chemoembolization for intrahepatic lesions and transarterial embolization for peritoneal metastases was performed through hepatic artery, gastroduodenal artery, and superior mesenteric artery. Results: Treatment resulted in an objective response of 85.7% Modified Response Evaluation Criteria in Solid Tumors. No severe adverse effects were observed. Conclusions: Transarterial interventional therapy can be performed safely and may improve the prognosis of HCC patients with peritoneal metastases.
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The clinical significance of ultrasound grayscale ratio in differentiating markedly hypoechoic and anechoic minimal thyroid nodules p. 1567
Zhi-Kai Lei, Ming-Kui Li, Ding-Cun Luo, Zhi-Jiang Han
DOI:10.4103/jcrt.JCRT_1031_17  PMID:30589040
Purpose: This study explored ultrasound grayscale ratios (USGRs) for differentiating markedly hypoechoic and anechoic minimal thyroid nodules. Materials and Methods: Longitudinal scan images of 193 markedly hypoechoic papillary thyroid microcarcinoma (PTMC) lesions from 184 patients were retrospectively reviewed using RADinfo and compared with 123 anechoic micronodular goiters (MNGs) from 110 patients. Final diagnosis was validated by pathological examination; MNGs predominantly manifested with cyst formation. Grayscale values of PTMC, MNG, and normal surrounding tissues were obtained from grayscale histograms; USGRs (grayscale ratios of pathologic tissue to surrounding normal tissue) of PTMC and MNG were calculated. Optimal USGRs for differentiating PTMC and MNG were determined with receiver operating characteristic (ROC) curves. Results: Among 193 PTMC and 123 MNG lesions, USGRs were 0.24–0.51 (mean ± standard deviation [SD]: 0.41 ± 0.07) and 0.01–0.38 (mean ± SD: 0.12 ± 0.08), respectively. The area under the ROC curve for distinguishing markedly hypoechoic PTMC and anechoic MNG was 0.992. As USGRs decreased, sensitivity decreased and specificity increased for MNG diagnosis. At a USGR of 0.26, the Youden index was high (0.933), corresponding to 94.3% sensitivity and 99% specificity for predicting anechoic MNG. At a USGR of 0.23, sensitivity and specificity for diagnosing anechoic MNG were 92.7% and 100%, respectively. In contrast, as USGR increased, sensitivity decreased and specificity increased for predicting PTMC. At a USGR of 0.38, sensitivity and specificity for diagnosing markedly hypoechoic PTMC were 68.4% and 100%, respectively. Conclusions: USGRs could objectively quantize grayscale values of markedly hypoechoic and anechoic lesions, enabling accurate and quantitative determination of nodular properties.
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Serum miR-20a and miR-486 are potential biomarkers for discriminating colorectal neoplasia: A pilot study p. 1572
Qinglan Yang, Shuiming Wang, Jianfeng Huang, Chengwan Xia, Heiying Jin, Yimei Fan
DOI:10.4103/jcrt.JCRT_1198_16  PMID:30589041
Aim: Recent advances in circulating microRNAs (miRNAs) as noninvasive biomarkers have provided promising prospect in detecting colorectal cancer (CRC). However, the capability of miRNAs for detecting colorectal neoplasia (CRN, including precancerous lesions and curable stage CRCs) remains unclear. This study aimed to identify the potential of serum miRNAs (miR-20a, miR-486, miR-92a, and miR-135b) selected from the literature for discriminating CRN patients. Materials and Methods: The serum samples from 46 CRN patients and 33 healthy controls were analyzed with quantitative reverse transcription-polymerase chain reaction. Results: Serum miR-20a and miR-486 were significantly downregulated in CRN patients compared to that of in healthy controls (fold change = 0.697 and 0.696, P = 0.01 and 0.05, respectively). The serum level of miR-92a was not significantly different between two groups, while miR-135b level in serum was too low to be accurately quantified. In addition, serum miR-486 level was much more downregulated in tubulovillous adenoma and high-grade intraepithelial neoplasia patients than that of in healthy controls. For miR-20a and miR-486, the area under the receiver operating characteristic curve for discriminating CRN patients were 0.676 and 0.629, respectively, while their combined value was 0.698. No significant correlation was observed between miR-20a and miR-486 serum levels with age, gender, location, or lesion size. Conclusion: The results suggested that serum miR-20a and miR-486 could be potential noninvasive biomarkers for identifying CRN patients.
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Diagnosis and treatment of hemangiopericytoma in the central nervous system p. 1578
Fang Liu, Boning Cai, Yu Du, Yurong Huang
DOI:10.4103/jcrt.JCRT_210_18  PMID:30589042
Objective: This study aimed to explore the clinical characteristics and treatment of the hemangiopericytoma (HPC) in the central nervous system. Materials and Methods: Clinical data from 14 patients with HPC in the central nervous system who were followed up for 12–107 months were retrospectively analyzed, and relevant literature was reviewed. Results: All 14 patients underwent surgery and postoperative pathologic diagnosis, including 8 cases of total excision, 3 cases of subtotal excision, and 3 cases of partial excision. There were 7 recurrent cases (50%, 4 cases of total excision, 1 case of subtotal excision, and 2 cases of partial excision, none of them received postoperative radiotherapy) with a median relapse time of 39 months, where the median relapse time after total excision was 41.5 months, and after nontotal excision was 17 months. In addition, patients could survive for a long time after reoperation following relapse and after receiving postoperative radiotherapy. Conclusion: The diagnosis of HPC depends on the pathology. Currently, the surgery and postoperative radiotherapy provide a good treatment results, while the wholeness of surgical resection is of particular importance.
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Effect of preintravenous injection of parecoxib, combined with transversus abdominis plane block in strategy of enhanced recovery after radical resection of colorectal cancer p. 1583
Jiangbo Zheng, Zhaoming Feng, Junfeng Zhu
DOI:10.4103/jcrt.JCRT_215_18  PMID:30589043
Objective: The objective of this study was to investigate the effect of preintravenous injection of parecoxib, combined with transversus abdominis plane (TAP) block and postoperative patient-controlled intravenous analgesia (PCIA) pump, in strategy of enhanced recovery after surgery for patients with radical resection of colorectal cancer. Materials and Methods: In this prospective study, 80 patients that underwent radical resection for colorectal cancer were randomly divided into four groups: (1) the parecoxib group, with preintravenous injection of parecoxib and postoperative PCIA after surgery; (2) the TAP group, with TAP block and postoperative PCIA; (3) the parecoxib + TAP group, with parecoxib combined with TAP block and postoperative PCIA; and (4) the control group, with only postoperative PCIA and preinjection of normal saline. The visual analog score was used to measure the pain. The mean operative time, PCIA pressing time, time for first out-of-bed activity, first anus exhaust time, hospital stay duration, and complications were recorded. Results: Operative time of the TAP group and parecoxib + TAP group was significantly longer than that of the parecoxib group and control group. The first out-of-bed activity time, first anus exhaust time, and hospital stay time of the parecoxib + TAP group were significantly shorter than those of the other groups, while the control group was all significantly higher than the other groups. Complication rates in all strategy groups were significantly lower than in the control group; however, no significant difference was found among the strategy groups. Conclusion: The combination of parecoxib, TAP, and PCIA pump could significantly reduce patient postoperative pain and enhance recovery.
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Prolonged overall survival in metastatic gastric cancer treated with ipilimumab and lapatinib p. 1589
Yanfang Ju, Shengjie Sun, Shunchang Jiao
DOI:10.4103/jcrt.JCRT_508_17  PMID:30589044
Objective: Gastric cancer is one of the most important common tumors in the world. It remains the second leading cause of cancer-related death worldwide. The prognosis of patients with unresectable or metastatic gastric cancer remains poor. New targeted drugs were evaluated in clinic, such as lapatinib. The potential for making beneficial progress is to investigate innovative therapeutic strategies, such as immunotherapy. Methods: We used combination therapy including immunotherapy for treating gastric cancer. We treated a patient of metastatic gastric cancer for which lapatinib plus ipilimumab was effective after progression on trastuzumab. Results: The patient has prolonged overall survival after treatment. Positron emission tomography-computed tomography examination showed that some of the cervical lymph nodes and retroperitoneal lymph nodes reduced and glucose metabolism decreased. In blood examination, the tumor marker (carcinoembryonic antigen) decreased. The patient has been lived for 4 years after multiple lymph node metastasis. Conclusion: Targeted therapy combined with immunotherapy might be a useful option for metastatic gastric.
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Standardized nursing and therapeutic effect of oxycontin on oral mucosal pain in nasopharyngeal carcinoma patients p. 1594
Wen Hu, Linmin Chen, Cong Wang, Ling Guo, Xin Hua, Yucong Cai, Yuying Fan
DOI:10.4103/jcrt.JCRT_551_18  PMID:30589045
Aim: This study aims to explore the standardized nursing and therapeutic effect of OxyContin on oral mucosal pain in nasopharyngeal carcinoma (NPC) patients with concurrent chemoradiotherapy. Materials and Methods: From March 2016 to December 2017, 60 patients with NPC were selected from the Sun Yat-Sen University Cancer Center. Patients consuming OxyContin for moderate and severe pain were divided into the experimental group and control group, respectively. All the patients were given OxyContin 10 mg orally, and the dose was adjusted according to the degree of pain relief until it was significantly relieved. At the same time, the combination of analgesic drugs with standardized nursing intervention for pain was granted, and the analgesic effect, adverse effects, and quality of life of both groups were analyzed. Results: There was no significant difference between the total dose of radiotherapy and OxyContin. OxyContin could significantly improve the quality of life in patients with moderate pain (P < 0.05), while the effect was not significant in patients with severe pain. Conclusion: Patients with NPC having oral mucosal pain after radiotherapy and chemotherapy need intervention at the earliest. The application of OxyContin and cancer pain standardized nursing care can improve the analgesic efficacy, reduce drug adverse effects, and improve the patient's quality of life.
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Comparison of treatment efficacy between adjuvant intravenous chemotherapy and intravenous chemotherapy combined with intraperitoneal perfusion chemotherapy to treat postresection colon cancer p. 1600
Tao Jiang, Rui Feng, Zhangchi Pan, Qian Xu, Wenyu Gao, Sheng Yang, Qiang Chen
DOI:10.4103/jcrt.JCRT_613_17  PMID:30589046
Background: Surgery has been the definitive treatment for locoregional colon cancer. But approximately 40% of patients died from peritoneal seeding and tumor recurrence. To prevent peritoneal recurrence, the eradication of intraperitoneal cancer cells has been critical for improving postoperative survival. This study focused on the role of IPC in postoperative treatment of colon cancer. Patients and Methods: Seventy colon cancer patients who underwent radical resection from September 2009 to September 2012 received adjuvant therapy. Specifically, 39 individuals received intravenous chemotherapy (IVC), and 31 received combined IVC and intraperitoneal perfusion chemotherapy (IVC + IPC). Disease-free survival (DFS) for those received IVC (20.71 months) was shorter than those received IVC + IPC (25.71 months). DFS in IVC group was also shorter than that in the IVC + IPC group, for patients with Stage III pathological tumor staging, T4 invasion depth, N2 lymph node metastasis, and low to undifferentiated tumor tissue. Peritoneal metastasis in the IVC + IPC group was less, but the toxicity was similar. No significant difference was observed among IPC treatment groups using three drugs. In the IVC + IPC group, DFS of patients received >5 or 3–5 times of IPC was longer than those received <3 times of treatment. No significant difference was observed in DFS between patients who received >5 times or 3–5 times of IPC. Conclusion: After radical resection, patients who received IVC + IPC showed prolonged DFS than those received IVC, as well as fewer peritoneal metastasis. Compared to IPC, no significantly increased side effects or complications were occurred after IVC + IPC. More work should be performed to confirm that IVC + IPC was superior to IVC for treating postresection colon cancer.
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Transurethral endoscopic submucosal en bloc dissection for nonmuscle invasive bladder cancer: A comparison study of HybridKnife-assisted versus conventional dissection technique p. 1606
Yong-yi Cheng, Yi Sun, Jing Li, Liang Liang, Tie-jun Zou, Wei-xing Qu, Ya-zhuo Jiang, Wei Ren, Chun Du, Shuang-kuan Du, Wen-cai Zhao
DOI:10.4103/jcrt.JCRT_786_17  PMID:30589047
Subjects: The aim of this study is to compare the efficacy and safety of en bloc bladder tumor-endoscopic submucosal dissection (BT-ESD) and conventional transurethral resection of BT (TURBT) in nonmuscle invasive bladder cancer (NMIBC) patients. Methods: A retrospective cohort study was carried out in Shaanxi Provincial People's Hospital. A total of 193 eligible NMIBC (Ta/T1) patients were enrolled in this study (95 cases in BT-ESD group and 98 cases in TURBT group), between November 2013 and January 2017. The operation time, blood loss, postoperative bladder irrigation time, catheter indwelling time, hospital stay time, and complications were compared. Data were presented as median (range). Chi-squared or rank-sum test, two-way ANOVA, and Mantel–Cox (Log-Rank) test were performed using statistical software. A threshold of P < 0.05 was defined as statistically significant. Results: The average operation time in the BT-ESD group was longer than that of in the TURBT group (40.0 [5.0, 100.0] min vs. 19.5 [3.0, 55.5] min); however, no significant longer operating time (P < 0.05) were observed in the smaller tumor (0 cm–3 cm). The postoperative bladder irrigation time, catheter indwelling time, and hospital stay in BT-ESD group were significantly shorter than that of in TURBT group (9.0 [5.0, 18.0] h, 2.5 [1.0, 4.0] d and 3.5 [2.0, 5.0] d for BT-ESD; 18.0 [12.0, 48.0] h, 3.5 [2.0, 7.0] d, and 4.5 [3.0, 8.0] d for TURBT). In addition, the BT-ESD group showed the decreased overall incidence of complications (2.1% vs. 9.2%). The univariate and multivariate analyses indicated an association between surgical option and tumor recurrence (hazard ratio = 5.624, odds ratio = 95% confidence interval = 1.582–19.991), Kaplan–Meir analysis showed significant difference in recurrence-free survival (RFS) (94.7% for ESD group vs. 78.4% for TURBT group) at 33 months. Conclusions: The application of the HybridKnife lead to a decrease in complications and RFS rate, which was a more safe and effective approach for NMIBC than conventional TURBT.
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Induction chronomodulated chemotherapy plus radiotherapy for nasopharyngeal carcinoma: A Phase II prospective randomized study p. 1613
Xiao-Xia Gou, Feng Jin, Wei-Li Wu, Jin-Hua Long, Yuan-Yuan Li, Xiu-Yun Gong, Guo-Yan Chen, Xiao-Xiao Chen, Li-Na Liu
DOI:10.4103/jcrt.JCRT_883_17  PMID:30589048
Purpose: The aim of this study was to evaluate the efficacy and toxicities of induction chronomodulated chemotherapy in comparison with conventional induction chemotherapy for nasopharyngeal carcinoma (NPC). Patients and Methods: Between 2003 and 2004, 60 patients with pathologically confirmed NPC were included and randomly assigned to two groups. Patients in the chronomodulated chemotherapy group (n = 30, CC group) received cisplatin at 80 mg/m2 through intravenous infusion from 10:00 to 22:00 and 5-fluorouracil (5-FU) at 1000 mg/m2 plus citrovorum factor at 200 mg/m2 from 22:00 to 10:00 each day for 3 days. Patients in the routine chemotherapy group (n = 30, RC group) received cisplatin infusion within 1 h and 5-FU infusion for about 24 h. The dose in the RC group was the same as that in the CC group. The total irradiation dose in each group was 70 Gy for the whole nasopharynx. Results: One month after induction chemotherapy, the overall response rate was 96.7% in the CC group versus 73.3% in the RC group (P = 0.011). By the end of the 10-year follow-up, 11 patients (36.7%) in the CC group had experienced local recurrence versus 11 patients (36.7%) in the RC group (P > 0.999). The overall survival rates at 1, 5, and 10 years were 96.7%, 53.3%, and 43.3%, respectively, in the CC group, and 96.7%, 43.3%, and 33.3%, respectively, in the RC group (P = 0.346). During induction chemotherapy, the incidence rates of leukocytopenia (43.3% vs. 80%, P = 0.003), thrombocytopenia (26.7% vs. 56.7%, P = 0.018), and nausea/vomiting (40% vs. 66.7%, P = 0.038) were significantly lower in the CC group than in the RC group. The incidence of radiation-induced complications was similar in these two groups. Conclusion: Compared with conventional chemotherapy, induction chrono-chemotherapy seemed to reduce chemotherapy-related toxicities and improve average local relapse time in patients treated with combined chemoradiotherapy for NPC.
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Folate-receptor-positive circulating tumor cells as an efficacious biomarker for the diagnosis of small pulmonary nodules p. 1620
Yang Xue, Wei Cong, Shenglong Xie, Jun Shu, Gang Feng, Hong Gao
DOI:10.4103/jcrt.JCRT_905_17  PMID:30589049
Objective: The objective of this study is to investigate the clinical significance of folate-receptor-positive circulating tumor cells (FR+CTC) for the diagnosis of lung cancer, especially in early-stage patients. Materials and Methods: A total of 72 lung cancer patients, including 31 with stage I diseases and two with stage 0 diseases, were enrolled in this study. Twenty-four patients with benign lung diseases and two healthy volunteers served as the control group. Three milliliters of peripheral blood were collected from each participant for FR+CTC analysis on enrollment. FR+CTC enumeration was performed using immunomagnetic leukocyte depletion and ligand-targeted polymerase chain reaction techniques. Results: The study results revealed that using a cutoff value of 8.7 CTC Units/3 mL, the sensitivity, and specificity of FR+CTC for diagnosis of lung cancer were 81.94% and 73.08%, respectively. Such high sensitivity (74.19%) and specificity (73.08%) persisted even if only stage I lung cancer patients were retained in the analysis. In receiver operating characteristic analysis, the performance of FR+CTC (area under the curve = 0.8153) was superior to other clinical biomarkers such as carcinoembryonic antigen, neuron-specific enolase, and cytokeratin 19 fragments. In a subgroup analysis, patients with nodule size of >3 cm showed an improved sensitivity (88.46%); although, the specificity appeared to decrease (40%). All five patients with benign diseases in this subgroup had inflammatory diseases, indicating that large inflammatory nodules may also release FR -expressing cells into the circulatory system. Conclusion: FR+CTC is a reliable biomarker for the early diagnosis of small-sized lung cancer. Further study with larger sample size is required to assess the diagnostic efficiency of FR+CTC in patients with large nodule sizes.
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Favorable progression-free survival in women with two different histopathological subtypes of bilateral breast cancer p. 1627
Yuyi Wang, Chi Du, Li Tu, Feng Luo, Xi Yan
DOI:10.4103/jcrt.JCRT_997_17  PMID:30589050
Purpose: The aim of this study was to classify bilateral breast cancers (BBCs) into two groups according to histopathological or molecular subtypes of the two breast diseases in each patient and to study their characteristics in relation to survival outcomes. Methods: Fifty-six BBC patients were enrolled in the study. They were classified according to whether the two breast diseases were of the same or different histopathological subtypes (defined as S-his or D-his groups) and molecular subtypes (defined as S-mole and D-mole groups). Progression-free survival (PFS), overall survival (OS), and important characteristics were then compared between the groups. Results: We observed that the PFS and OS of the S-mole and D-mole groups failed to reach a significant difference. However, D-his BBC patients enjoyed longer PFS than their S-his counterparts, although the OS was similar. To explore the reason for the extended PFS in D-his BBC patients, we first focused on the possible prognostic contribution by various histopathological subtypes in the groups. We compared the proportion of infiltrating ductal carcinoma, infiltrating lobular carcinoma, and other breast cancer subtypes in the D-his and S-his groups, and demonstrated that they were not associated with longer PFS. We then examined age, menopausal status, tumor, node, and metastasis (TNM) stage, expressions of estrogen receptor (ER), progesterone receptor (PR) and Ki67, and metastasis to lymph nodes, viscera, and bone. The results indicated no significant between-group differences in age, TNM stage, ER/PR expression, and metastasis to viscera and bone. However, significantly lower levels of Ki67and decreased lymph node metastasis rate were associated with D-his BBC patients, which might explain the observed longer PFS. Conclusions: In comparison to S-his, D-his BBC patients had longer PFS, which was associated with lower levels of Ki67 and a decreased lymph node metastasis rate.
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Clinical application of planar puncture template-assisted computed tomography-guided percutaneous biopsy for small pulmonary nodules p. 1632
Zhe Ji, Guan Wang, Baoming Chen, Yuwei Zhang, Li Zhang, Fuchun Gao, Shude Chai, Bin Huo, Guangjun Zheng, Xiaodong Huo, Baoming Wang, Xudong Zhu, Dan Meng, Lejun Liu, Rui Zhu, Mingyong Han, Ying Zhang, Kaixian Zhang, Junjie Wang
DOI:10.4103/jcrt.JCRT_1017_17  PMID:30589051
Aims: The aims of this study were to evaluate the clinical application of planar puncture template (PPT) in computed tomography (CT)-guided percutaneous needle lung biopsy. Subjects and Methods: A total of 56 patients with small pulmonary nodules who received CT-guided percutaneous lung biopsy assisted by PPT were included in the study. Five steps were included in the study: fixing position, CT scanning and designing needle pathway, installing navigation system and template, puncturing fixation needle, and performing biopsy needle insertion and biopsy. The success rate of puncture, pathological results, and complications were analyzed. In addition, the factors that influenced the success rate and complications were analyzed. Results: Biopsy was successfully completed in all 56 patients. The nodule diameter was 0.45–3 cm. The fixation needle technique was applied in 47 cases. Biopsy was performed 1 time in 50% of patients and 2 times in 38% of patients. For pathology, only one case showed no positive result, with a puncture success rate of 98%. The diagnostic rate of malignant tumor was 73%. For complications, the incidence of needle tract bleeding was 68%, the incidence of pneumothorax was 30%, and the thoracic drainage was required in two patients. Hemoptysis was observed in two cases. Univariate analysis: The nodule size was related to both the rate of 1-time biopsy and incidence of complications. Smaller nodule was relevant to lower rate of 1-time biopsy (P = 0.01) and higher incidence of complications (P < 0.05). The fixation needle was related to 1-time biopsy rate. The 1-time biopsy rate was significantly higher in patients with fixation needle than those without fixation needle (P = 0.001). Meanwhile, no significant difference was observed in the incidence of complications in different number of fixation needles (P > 0.05). Conclusions: PPT-assisted lung biopsy technology can provide high success rate and low complication incidence. It would be helpful to make the puncture procedures more standard for better clinical applications.
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Probing pathway-related modules in invasive squamous cervical cancer based on topological centrality of network strategy Highly accessed article p. 1638
Xiu-Hua Fu, Yu-Fang Wu, Fang Xue
DOI:10.4103/0973-1482.187352  PMID:30589052
Objective: Our work aimed to identify pathway-related modules and hub genes involved in invasive squamous cervical cancer (SCC) based on topological centralities analysis of networks. Materials and Methods: To determine the functional modules changed in SCC, functional enrichment analyses were performed for differentially expressed genes (DEGs) between invasive SCC samples and normal controls. Then, co-expression network was constructed using EBcoexpress approach based on the DEGs. Moreover, pathway-related modules were probed from the global co-expression network based on pathway genes and their adjacent genes. Finally, topological centralities for co-expression network and pathway-related subnetworks were carried out to explore hub genes and significant pathway-related functional modules. Results: Functional analyses revealed that DEGs mainly involved in three biological processes (metabolic process, cellular process, and cellular component organization) and 8 significant pathways. Furthermore, the co-expression network with 659 nodes and 1087 edges and 8 pathway-related modules were obtained. Topological centralities indicated two significant modules (cell cycle and base excision repair pathway-related modules), in which the common hub gene ARFGAP3 showed the most significant importance. Conclusions: The bioinformatics elucidation of certain pathway-related modules and hub genes might be beneficial to understand the molecular pathogenesis and reveal their potential as novel molecular markers of SCC to a great extent.
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Personalized discovery of disrupted pathways and significant genes in preeclampsia based on accumulated normal tissue data Highly accessed article p. 1644
Ying Luo, Xiao-Chen Ma, Qing Gao, Lu-Quan Cao
DOI:10.4103/0973-1482.203603  PMID:30589053
Purpose: This study was designed to identify disrupted pathways in an individual with preeclampsia (PE) using accumulated normal sample data based on individualized pathway aberrance score (iPAS) method. Materials and Methods: Pathway data were obtained from the Reactome database. Next, the average Z algorithm was utilized to compute the iPAS. The disrupted pathways in a PE sample were identified by means of t test according to the pathway statistics values of normal and PE samples. In addition, we screened the differential expressed genes (DEGs) using SAMR package and constructed the differential co-expression network comprising DEGs. Subsequently, topological analysis for the co-expression network was conducted to identify hub genes. Results: Under the threshold of false discovery rate <0.05, 69 disrupted pathways were selected. Among them, formation of tubulin-folding intermediates by containing t-complex polypeptide 1 (CCT)/TCP1 ring complex (TriC) was the most remarkable pathway. Degree analysis for co-expression network of DEGs suggested that there were several hub-disrupted pathway-related genes, for instance, TCP1 and TUBA1A. More importantly, these two hub genes were enriched in the most significant pathway of formation of tubulin-folding intermediates by CCT/TriC. Conclusion: The iPAS method is suitable for identifying disrupted pathways in PE. Pathway of formation of tubulin folding intermediates by CCT/TriC might play important roles in PE.
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Cerebral air embolism during percutaneous computed tomography scan-guided liver biopsy p. 1650
Dengjun Sun, Ping Sui, Weiwei Zhang, Liangming Zhang, Hao Xu
DOI:10.4103/jcrt.JCRT_1035_17  PMID:30589054
Purpose: The objective of the study is to explore the etiology, clinical manifestations, imaging features, diagnosis, treatment, and prognosis of cerebral air embolism complicated computed tomography (CT) scan-guided percutaneous liver biopsy. Materials and Methods: A case of air embolism was developed in the brain during a CT-guided percutaneous needle biopsy of the liver. In addition, retrospective analysis was performed on the previously reported typical cases of cerebral air embolism secondary to CT-guided percutaneous lung biopsy. Results: Cerebral air embolism has been recognized as a potentially fatal but extremely rare complication following CT-guided percutaneous liver or lung biopsy. It was usually caused by cough, positive pressure ventilation, incorrect puncture position, repeated punctures, cavity or cyst in the target sites, and vascular inflammatory lesions. Conclusions: Clinicians should focus on timely and correct diagnosis of this complication during their interventional procedures. The current main treatment for this complication has been hyperbaric oxygen therapy.
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Expression of leukocyte immunoglobulin-like receptor B2 in hepatocellular carcinoma and its clinical significance p. 1655
Xinwen Li, Xiaojuan Wei, Huirong Xu, Zuowei Sha, Aiqin Gao, Yuping Sun, Juan Li, Liyou Xu
DOI:10.4103/jcrt.JCRT_542_18  PMID:30589055
Background: Leukocyte immunoglobulin-like receptor B2 (LILRB2) has recently been considered a promising tumor promoter in human cancers. Materials and Methods: In this study, the expression of LILRB2 was assessed in 82 samples of surgically resected human hepatocellular carcinoma (HCC) tissues using immunohistochemistry (IHC). Results: LILRB2 was overexpressed in HCC tissues and its expression was positively and significantly correlated with poor prognostic features of HCC patients, including poor cell differentiation, larger primary tumor size, and shorter overall survival. In addition, there was a positive correlation between the expression of LILRB2 and its classical ligand human leukocyte antigen G in human HCC tissues. Conclusion: LILRB2 might play an important role in HCC progression and correlate with poor prognosis of HCC.
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125I seeds implantation for an elderly patient of skin squamous cell carcinomas with ulcer guided by ultrasound p. 1660
Yansong Liang, Xuemin Di, Zezhou Liu, Jinxin Zhao, Zeyang Wang, Jing Zhao, Aixia Sui, Hongtao Zhang, Juan Wang
DOI:10.4103/jcrt.JCRT_1032_17  PMID:30589056
The skin squamous cell carcinoma (SCC) is a kind of malignancy of keratinocytes. SCC was originated within the epidermis or relevant appendages, which commonly occurred on sunlight exposure sites, such as the head and neck. This case report described an 85-year-old female patient with skin SCC at the right frontal, accompanied with skin ulcer. This patient suffered from indications that were not suitable for surgical resection, including old age, Alzheimer's disease (AD), lacunar infarction, hydropericardium, and some other concomitant diseases. In addition, the external beam radiotherapy was rejected by the relatives of this patient. Then, the patient received 125I seeds interstitial brachytherapy guided by bedside ultrasound. The tumor response was evaluated based on the response evaluation criteria in solid tumors version 1.1 criteria. Complete response was achieved 4 months after brachytherapy. No complications and recurrence were observed during 8-month follow-up. As the sole modality, the 125I seeds implantation could be a reasonable and safe alternative for treating skin SCC with ulcer, especially for the elderly patients.
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Clinical characteristics of Poland's syndrome associated with breast cancer: Two case reports and a literature review p. 1665
Yan Huang, Hanmin Pang, Shujuan Jin, Xiaowei Han, Xiaojing Liu, Liuchun Yang, Si Zuo, Jianpeng Li, Di Meng
DOI:10.4103/jcrt.JCRT_814_17  PMID:30589057
Poland's syndrome is a rare congenital malformation that is characterized by a congenital defect of the pectoralis major. It is associated with various ipsilateral upper extremity anomalies and homolateral breast hypoplasia. There have been reports of Poland's syndrome being associated with different malignancies. Here, we report two cases of Poland's syndrome associated with breast cancer (BC) and review the literature. To date, 21 cases (including our two cases) of Poland's syndrome associated with BC have been reported. The clinical characteristics of the disease are analyzed in this report.
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