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Extended Field Radiotherapy With or Without Chemotherapy in Patients with Cervical Cancer and Positive Para-Aortic Lymph Nodes: a Single Institution Retrospective Review

  • Ng, Boon Huat;Rozita, AM;Adlinda, A;Lee, Wei Ching;Zamaniah, WI Wan
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.9
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    • pp.3827-3833
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    • 2015
  • Background: Positive para-aortic lymph node (PALN) at diagnosis in cervical cancer patients confers an unfavorable prognosis. This study reviewed the outcomes of extended field radiotherapy (EFRT) and concurrent chemotherapy with extended field RT (CCEFRT) in patients with positive PALN at diagnosis. Materials and Methods: Medical records of 407 cervical cancer patients between 1st January 2002 to 31st December 2012 were reviewed. Some 32 cases with positive PALN were identified to have received definitive extended field radiotherapy with or without chemotherapy. Treatment outcomes, clinicopathological factors affecting survival and radiotherapy related acute and late effects were analyzed. Results: Totals of 13 and 19 patients underwent EFRT and CCEFRT respectively during the period of review. The median follow-up was 70 months. The 5-year overall survival (OS) was 40% for patients who underwent CCEFRT as compared to 18% for patients who had EFRT alone, with median survival sof 29 months and 13 months, respectively. The 5-years progression free survival (PFS) for patients who underwent CCEFRT was 32% and 18% for those who had EFRT. Median PFS were 18 months and 12 months, respectively. Overall treatment time (OTT) less than 8 weeks reduced risk of death by 81% (HR=0.19). Acute side effects were documented in 69.7% and 89.5% of patients who underwent EFRT and CCEFRT, respectively. Four patients (12.5%) developed radiotherapy late toxicity and there was no treatment-related death observed. Conclusions: CCEFRT is associated with higher 5-years OS and median OS compared to EFRT and with tolerable level of acute and late toxicities in selected patients with cervical cancer and PALN metastasis.

Does intrauterine injection of low-molecular-weight heparin improve the clinical pregnancy rate in intracytoplasmic sperm injection?

  • Kamel, Ahmed Mohamed;El-Faissal, Yahia;Aboulghar, Mona;Mansour, Ragaa;Serour, Gamal I;Aboulghar, Mohamed
    • Clinical and Experimental Reproductive Medicine
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    • v.43 no.4
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    • pp.247-252
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    • 2016
  • Objective: Heparin can modulate proteins, and influence processes involved in implantation and trophoblastic development. This study aimed to assess the improvement of clinical pregnancy and implantation rates after local intrauterine injection of low-molecular-weight heparin (LMWH) in patients undergoing intracytoplasmic sperm injection (ICSI). Methods: A randomised case/control design was followed in women scheduled for ICSI. The study arm was injected with intrauterine LMWH during mock embryo transfer immediately following the ovum pickup procedure, while the control arm was given an intrauterine injection with a similar volume of tissue culture media. Side effects, the clinical pregnancy rate, and the implantation rate were recorded. Results: The pregnancy rate was acceptable (33.9%) in the LMWH arm with no significant reported side effects, confirming the safety of the intervention. No statistically significant differences were found in the clinical pregnancy and implantation rates between both groups (p= 0.182 and p= 0.096, respectively). The odds ratio of being pregnant after intrauterine injection with LMWH compared to the control group was 0.572 (95% confidence interval [CI], 0.27-1.22), while the risk ratio was 0.717 (95% CI, 0.46-1.13; p= 0.146). No statistical significance was found between the two groups in other factors affecting implantation, such as day of transfer (p= 0.726), number of embryos transferred (p= 0.362), or embryo quality. Conclusion: Intrauterine injection of LMWH is a safe intervention, but the dose used in this study failed to improve the outcome of ICSI. Based on its safety, further research involving modification of the dosage and/or the timing of administration could result in improved ICSI success rates.

Clinical Prognostic Score for Predicting Disease Remission with Differentiated Thyroid Cancers

  • Somboonporn, Charoonsak;Mangklabruks, Ampica;Thakkinstian, Ammarin;Vatanasapt, Patravoot;Nakaphun, Suwannee
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.6
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    • pp.2805-2810
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    • 2016
  • Background: Differentiated thyroid cancer is the most common endocrine malignancy with a generally good prognosis. Knowing long-term outcomes of each patient helps management planning. The study was conducted to develop and validate a clinical prognostic score for predicting disease remission in patients with differentiated thyroid cancer based on patient, tumor and treatment factors. Materials and Methods: A retrospective cohort study of 1,217 differentiated thyroid cancer patients from two tertiary-care hospitals in the Northeast of Thailand was performed. Associations between potential clinical prognostic factors and remission were tested by Cox proportional-hazards analysis in 852 patients (development cohort). The prediction score was created by summation of score points weighted from regression coefficients of independent prognostic factors. Risks of disease remission were estimated and the derived score was then validated in the remaining 365 patients (validation cohort). Results: During the median follow-up time of 58 months, 648 (76.1%) patients in the development cohort had disease remission. Five independent prognostic factors were identified with corresponding score points: duration from thyroid surgery to $^{131}I$ treatment (0.721), distant metastasis at initial diagnosis (0.801), postoperative serum thyroglobulin level (0.535), anti-thyroglobulin antibodies positivity (0.546), and adequacy of serum TSH suppression (0.293). The total risk score for each patient was calculated and three categories of remission probability were proposed: ${\leq}1.628$ points (low risk, 83% remission), 1.629-1.816 points (intermediate risk, 87% remission), and ${\geq}1.817$ points (high risk, 93% remission). The concordance (C-index) was 0.761 (95% CI 0.754-0.767). Conclusions: The clinical prognostic scoring model developed to quantify the probability of disease remission can serve as a useful tool in personalized decision making regarding treatment in differentiated thyroid cancer patients.

Investigation of chlamydophilosis from naturally infected cats

  • Wasissa, Madarina;Lestari, Fajar Budi;Nururrozi, Alfarisa;Tjahajati, Ida;Indarjulianto, Soedarmanto;Salasia, Siti Isrina Oktavia
    • Journal of Veterinary Science
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    • v.22 no.6
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    • pp.67.1-67.7
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    • 2021
  • Background: Chlamydophila felis, formerly known as Chlamydia psittaci var. felis, is frequently associated with ocular, respiratory, and occasionally reproduction tract infections. Even though the infection is sometimes asymptomatic, it potentially results in a latent immunosuppressive infection. Objective: This study aimed to identify occurrences of feline chlamydophilosis, rarely reported in cats in Indonesia. Methods: The observation was conducted in three cats with clinical signs of Cp. felis infection, particularly relapsing conjunctivitis. The cats' histories were recorded based on owners' information. Conjunctival swabs were sampled for cytology examination and molecular assay detection. A phylogenetic tree was generated using MEGA-X software to reveal group clustering. A post-mortem examination was performed on the cat that died during an examination. Results: Cp. felis was detected in both cytological examination and polymerase chain reaction assay. The phylogenetic tree demonstrated that the Cp. felis isolated in this study clustered with several other isolates from the other countries. Cp. felis can be isolated from cats with different clinical manifestations and levels of severity. The chronic fatal infection demonstrated interstitial broncho-pneumonia under histopathological examination. Conclusions: Molecular assay of Cp. felis is always recommended to obtain a definitive diagnosis of feline chlamydophilosis since the disease can have various clinical manifestations. Even though it may be subclinical and is often not fatal, an infected cat may be a carrier that could spread the pathogen in the surrounding environment. Serious disease management is suggested to avoid high costs associated with regularly relapsing disease.

Comparison of pregnancy outcomes using a time-lapse monitoring system for embryo incubation versus a conventional incubator in in vitro fertilization: An age-stratification analysis

  • Chera-aree, Pattraporn;Thanaboonyawat, Isarin;Thokha, Benjawan;Laokirkkiat, Pitak
    • Clinical and Experimental Reproductive Medicine
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    • v.48 no.2
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    • pp.174-183
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    • 2021
  • Objective: The aim of this study was to compare the pregnancy outcomes of in vitro fertilization with embryo transfer between embryos cultured in a time-lapse monitoring system (TLS) and those cultured in a conventional incubator (CI). Methods: The medical records of 250 fertilized embryos from 141 patients undergoing infertility treatment with assisted reproductive technology at a tertiary hospital from June 2018 to May 2020 were reviewed. The study population was divided into TLS and CI groups at a 1 to 1 ratio (125 embryos per group). The primary outcome was the live birth rate. Results: The TLS group had a significantly higher clinical pregnancy rate (46.4% vs. 27.2%, p=0.002), implantation rate (27.1% vs. 12.0%, p=0.004), and live birth rate (32.0% vs. 18.4%, p=0.013) than the CI group. Furthermore, subgroup analyses of the clinical pregnancy rate and live birth rate in the different age groups favored the TLS group. However, this difference only reached statistical significance in the live birth rate in women aged over 40 years and the clinical pregnancy rate in women aged 35-40 years (p=0.048 and p=0.031, respectively). The miscarriage rate, cleavage rate, and blastocyst rate were comparable. Conclusion: TLS application improved the live birth rate, implantation rate, and clinical pregnancy rate, particularly in the advanced age group in this study, while the other reproductive outcomes were comparable. Large randomized controlled trials are needed to further explore the ramifications of these findings, especially in different age groups.

Associations of periodontal status in periodontitis and rheumatoid arthritis patients

  • Rovas, Adomas;Puriene, Alina;Punceviciene, Egle;Butrimiene, Irena;Stuopelyte, Kristina;Jarmalaite, Sonata
    • Journal of Periodontal and Implant Science
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    • v.51 no.2
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    • pp.124-134
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    • 2021
  • Purpose: The aim of this study was to assess the association between the clinical status of rheumatoid arthritis (RA) and periodontitis (PD) in patients diagnosed with PD and to evaluate the impact of RA treatment on the severity of PD. Methods: The study included 148 participants with PD, of whom 64 were also diagnosed with RA (PD+RA group), while 84 age-matched participants were rheumatologically healthy (PD-only group). PD severity was assessed by the following periodontal parameters: clinical attachment loss, probing pocket depth (PPD), bleeding on probing (BOP), alveolar bone loss, and number of missing teeth. RA disease characteristics and impact of disease were evaluated by the Disease Activity Score 28 using C-reactive protein, disease duration, RA treatment, the RA Impact of Disease tool, and the Health Assessment Questionnaire. Outcome variables were compared using parametric and non-parametric tests and associations were evaluated using regression analysis with the calculation of odds ratios (ORs). Results: Participants in the PD+RA group had higher mean PPD values (2.81 ± 0.59 mm vs. 2.58 ± 0.49 mm, P=0.009) and number of missing teeth (6.27±4.79 vs. 3.93±4.08, P=0.001) than those in the PD-only group. A significant association was found between mean PPD and RA (OR, 2.22; 95% CI, 1.16-4.31; P=0.016). Within the PD+RA group, moderate to severe periodontal disease was significantly more prevalent among participants with higher RA disease activity (P=0.042). The use of biologic disease-modifying antirheumatic drugs (bDMARDs) was associated with a lower BOP percentage (P=0.016). Conclusions: In patients with PD, RA was associated with a higher mean PPD and number of missing teeth. The severity of PD was affected by the RA disease clinical activity and by treatment with bDMARDs, which were associated with a significantly lower mean BOP percentage.

Anthraquinones with Antibacterial Activities from Crucianella maritima L. Growing in Egypt

  • El-Lakany, Abdalla M.;Aboul-Ela, Maha A.;Abdel-Kader, Maged S.;Badr, Jihan M.;Sabri, Nawal N.;Goher, Yousry
    • Natural Product Sciences
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    • v.10 no.2
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    • pp.63-68
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    • 2004
  • From the extracts of Crucianella maritima L. (Rubiaceae), five new anthraquinones namely; 1-hydroxy-2-methyl-6-methoxy anthraquinone, 6-methoxy-2-methyl quinizarin, 6-methyl-anthragallol-2,3-dimethyl ether, 6-methyl-anthragallol-2-methyl ether, and 1-hydroxy-2-carbomethoxyanthraquinone were isolated and identified. In addition, deacetyl asperulosidic acid 6'-glucoside sodium salt, a new iridoid diglucoside, along with twelve known anthraquinones, three flavonols, three sterols, and one triterpene were also isolated and identified for the first time from this plant. Their chemical structures were established by physical, chemical and spectroscopic data, including UV, MS, ID- and 2D-NMR analyses. The antimicrobial, cytotoxic activities and a preliminary clinical trial of the crude extracts and some isolates are also presented. Chemotaxonomical aspects are briefly discussed.

Molecular Mechanisms of Apoptosis and Roles in Cancer Development and Treatment

  • Goldar, Samira;Khaniani, Mahmoud Shekari;Derakhshan, Sima Mansoori;Baradaran, Behzad
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.6
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    • pp.2129-2144
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    • 2015
  • Programmed cell death (PCD) or apoptosis is a mechanism which is crucial for all multicellular organisms to control cell proliferation and maintain tissue homeostasis as well as eliminate harmful or unnecessary cells from an organism. Defects in the physiological mechanisms of apoptosis may contribute to different human diseases like cancer. Identification of the mechanisms of apoptosis and its effector proteins as well as the genes responsible for apoptosis has provided a new opportunity to discover and develop novel agents that can increase the sensitivity of cancer cells to undergo apoptosis or reset their apoptotic threshold. These novel targeted therapies include those targeting anti-apoptotic Bcl-2 family members, p53, the extrinsic pathway, FLICE-inhibitory protein (c-FLIP), inhibitor of apoptosis (IAP) proteins, and the caspases. In recent years a number of these novel agents have been assessed in preclinical and clinical trials. In this review, we introduce some of the key regulatory molecules that control the apoptotic pathways, extrinsic and intrinsic death receptors, discuss how defects in apoptotic pathways contribute to cancer, and list several agents being developed to target apoptosis.

Mixed Method Research Investigating Evidence-Based Practice Self-efficacy, Course Needs, Barriers, and Facilitators: From the Academic Faculty and Clinical Nurse Preceptors (근거기반실무(Evidence-based Practice) 자기효능감, 교과목 요구도, 장애요인 및 촉진요인 탐색을 위한 혼합연구: 교수 및 임상실습 프리셉터를 중심으로)

  • Oh, Eui Geum;Yang, You Lee;Yoo, Jae Yong;Lim, Ji Yun;Sung, Ji Hyun
    • Journal of Korean Academy of Nursing
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    • v.46 no.4
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    • pp.501-513
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    • 2016
  • Purpose: The current challenges faced by nurses in providing high quality and evidence-based practice (EBP) supported care require profound changes in nursing education. To understand the changes needed to strengthen EBP education, the researchers examined EBP self-efficacy, course needs, barriers, and facilitators for academic faculty and clinical nurse preceptors to teach EBP in undergraduate nursing curricula. Methods: For this study, mixed-method approach was used with survey data collected from 73 academic faculty members from 54 universities. Further, 17 clinical nurse preceptors in three academic hospitals provided qualitative data for exploration of barriers and facilitators to teaching EBP. Data analysis used SPSS/WIN 21.0 and content analysis. Results: Quantitative data showed that although the overall level of self-efficacy among faculty was moderate, the implementation levels were relatively low. Most faculty members agreed with the need to integrate EBP courses into undergraduate nursing curricula. The qualitative data showed that the barriers to teaching EBP were lack of knowledge, skill, and initial investment for teaching EBP; hierarchical, rules-oriented nursing culture; potential learner overloads in processing EBP; limited research dissemination and application. Facilitators were identified as the importance of EBP to the profession of nursing; collaboration in schools and hospitals; and continuing education in teaching/utilizing EBP. Conclusion: The findings indicate that for successful integration of EBP ni nursing education there is a need for faculty training and integrated EBP courses.

L-carnitine Supplemented Extender Improves Cryopreserved-thawed Cat Epididymal Sperm Motility

  • Manee-In, S.;Parmornsupornvichit, S.;Kraiprayoon, S.;Tharasanit, T.;Chanapiwat, P.;Kaeoket, K.
    • Asian-Australasian Journal of Animal Sciences
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    • v.27 no.6
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    • pp.791-796
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    • 2014
  • Cryopreservation of epididymal sperm is an effective technique to preserve genetic materials of domestic cats and wild felids when they unexpectedly die. However, this technique inevitably causes detrimental changes of cryopreserved-thawed spermatozoa, for example, by physical damage and excessive oxidative stress. L-carnitine is an antioxidant that has been used to improve sperm motility in humans and domestic animals. This study aimed to investigate the effects of L-carnitine on cat epididymal sperm quality following cryopreservation and thawing. After routine castration, cauda epididymides were collected from 60 cat testes. The epididymal spermatozoa from 3 cauda epididymides were pooled as 1 replicate. Spermatozoa samples (16 replicates) were examined for spermatozoa quality and then randomly divided into 4 groups: 0 mM L-carnitine (control), 12.5 mM, 25 mM and 50 mM L-carnitine. The sperm aliquots were then equilibrated and conventionally frozen. After thawing, sperm motility, plasma membrane integrity, DNA integrity and acrosome integrity were evaluated. The 25 mM L-carnitine significantly improved sperm motility compared with a control group (p<0.05), although this was not significantly different among other concentrations. In conclusion, supplementation of 25 mM L-carnitine in freezing extender improves cauda epididymal spermatozoa motility. The effects of L-carnitine on the levels of oxidative stress during freezing and thawing remains to be examined.