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Feasibility Study of Deep Inspiration Breath-Hold Based Volumetric Modulated Arc Therapy for Locally Advanced Left Sided Breast Cancer Patients

  • Swamy, Shanmugam Thirumalai;Radha, Chandrasekaran Anu;Kathirvel, Murugesan;Arun, Gandhi;Subramanian, Shanmuga
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.20
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    • pp.9033-9038
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    • 2014
  • Background: The purpose of this study was to assess the feasibility of deep inspiration breath-hold (DIBH) based volumetric modulated arc therapy (VMAT) for locally advanced left sided breast cancer patients undergoing radical mastectomy. DIBH immobilizes the tumor bed providing dosimetric benefits over free breathing (FB). Materials and Methods: Ten left sided post mastectomy patients were immobilized in a supine position with both the arms lifted above the head on a hemi-body vaclock. Two thermoplastic masks were prepared for each patient, one for normal free breathing and a second made with breath-hold to maintain reproducibility. DIBH CT scans were performed in the prospective mode of the Varian real time position management (RPM) system. The planning target volume (PTV) included the left chest wall and supraclavicular nodes and PTV prescription dose was 5000cGy in 25 fractions. DIBH-3DCRT planning was performed with the single iso-centre technique using a 6MV photon beam and the field-in-field technique. VMAT plans for FB and DIBH contained two partial arcs ($179^{\circ}-300^{\circ}CCW/CW$). Dose volume histograms of PTV and OAR's were analyzed for DIBH-VMAT, FB-VMAT and DIBH-3DCRT. In DIBH mode daily orthogonal ($0^{\circ}$ and $90^{\circ}$) KV images were taken to determine the setup variability and weekly twice CBCT to verify gating threshold level reproducibility. Results: DIBH-VMAT reduced the lung and heart dose compared to FB-VMAT, while maintaining similar PTV coverage. The mean heart $V_{30Gy}$ was $2.3%{\pm}2.7$, $5.1%{\pm}3.2$ and $3.3%{\pm}7.2$ and for left lung $V_{20Gy}$ was $18.57%{\pm}2.9$, $21.7%{\pm}3.9$ and $23.5%{\pm}5.1$ for DIBH-VMAT, FB-VMAT and DIBH-3DCRT respectively. Conclusions: DIBH-VMAT significantly reduced the heart and lung dose for left side chest wall patients compared to FB-VMAT. PTV conformity index, homogeneity index, ipsilateral lung dose and heart dose were better for DIBH-VMAT compared to DIBH-3DCRT. However, contralateral lung and breast volumes exposed to low doses were increased with DIBH-VMAT.

Clinicopathologic and Demographic Evaluation of Triple-Negative Breast Cancer Patients among a Turkish Patient Population: a Single Center Experience

  • Somali, Isil;Ustaoglu, Bahar Yakut;Tarhan, Mustafa Oktay;Yigit, Seyran Ceri;Demir, Lutfiye;Ellidokuz, Hulya;Erten, Cigdem;Alacacioglu, Ahmet
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.10
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    • pp.6013-6017
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    • 2013
  • Background: To evaluate the clinicopathologic and demographic characteristics of triple-negative breast cancer (TNBC) patients and to determine differences from non-triple-negative cases. Materials and Methods: A detailed review of the medical records of 882 breast cancer (BC) patients was conducted to obtain information regarding age, menopausal status, height and weight at the time of diagnosis, presence of diabetes or hypertension, and pathologic characteristics of the tumor (tumor size, lymph node status, histologic grade, ER status, PR status, HER2 status, p53 mutation). Body mass index (BMI) was calculated and a value of ${\geq}30$ was considered as indicative of obesity. Results: 14.9% (n=132) of the patients had TNBC. There was no difference among the patients in terms of median age, comorbid conditions and menopausal status. The proportion of medullary, tubular and mucinous carcinomas was significantly higher (15.9%) in the triple-negative (TN) group, while invasive lobular histology was more frequent (8.2%) among non-triple negative (NTN) cases (p<0.001). Grade 3 (G3) tumors were more frequent in the triple-negative group (p<0.001). The rate of p53 mutation was 44.3% in TN tumors versus 28.2% in the NTN group (p<0.001). The two groups were similar in terms of LN metastasis. In the NTN group, the rate of patients with BMI ${\geq}30$ was 53% among postmenopausal patients, while it was 36% among premenopausal women, and the difference was statistically significant (p<0.001). No significant difference was observed in terms of BMI between postmenopausal and premenopausal patients in the TN group (p=0.08). Conclusions: TNBC rates and clinicopathologic characteristics of the Turkish patient population were consistent with the data from Europe and America. However, no relationship between obesity and TNBC was observed in our study. The association between TNBC and obesity needs to be evaluated in a larger patient population.

Effects of Combination of Nitrate with ${\beta}$1-4 Galacto-oligosaccharides and Yeast (Candida kefyr) on Methane Emission from Sheep

  • Sar, C.;Santoso, B.;Gamo, Y.;Kobayashi, T.;Shiozaki, S.;Kimura, K.;Mizukoshi, H.;Arai, I.;Takahashi, J.
    • Asian-Australasian Journal of Animal Sciences
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    • v.17 no.1
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    • pp.73-79
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    • 2004
  • The objective of the present study was to determine whether ${\beta}$1-4 galacto-oligosaccharides (GOS) and Candida kefyr combined with nitrate as manipulators could suppress rumen methanogenesis without nitrate poisoning in sheep. Four rumen fistulated wethers were allocated to a $4{\times}4$ Latin square design. Nitrate (1.3 g $NaNO_3$ $Kg^{-0.75}$body weight) with and without GOS and Candida kefyr were administered into the rumen through fistula as a single dose 30 min after the morning meal. GOS and Candida kefyr were supplemented by sprinkling onto the feed and through rumen fistula, respectively. The four treatments consisted of saline, nitrate, nitrate plus GOS and nitrate plus GOS plus Candida kefyr. Physiological saline was used as the control treatment. Compared to saline treatment, the administration of nitrate alone resulted in a very marked decrease in rumen methanogenesis and an increase in rumen and plasma nitrite production and blood methaemoglobin formation consequently causing a decline in oxygen consumption, carbon dioxide production and metabolic rate. When compared to nitrate alone, the simultaneous administration of nitrate with GOS decreased nitrite accumulation in rumen and plasma and nitrate-induced methaemoglobin, while retaining low methane production. However, GOS could not fully restore metabolic parameters reduced by nitrate. When compared to the simultaneous administration of nitrate with GOS, the simultaneous administration of nitrate with GOS plus Candida kefyr lowered rumen methanogenesis to a negligible level, but did not decrease rumen and plasma nitrite accumulation as well as blood methaemoglobin formation. Thus, these results suggest that combination of nitrate with GOS may be a potent manipulator to suppress rumen methanogenesis with abating the hazards of nitratenitrite toxicity in ruminants.

Outcomes Based on Risk Assessment of Anastomotic Leakage after Rectal Cancer Surgery

  • Gong, Jian-Ping;Yang, Liu;Huang, Xin-En;Sun, Bei-Cheng;Zhou, Jian-Nong;Yu, Dong-Sheng;Zhou, Xin;Li, Dong-Zheng;Guan, Xin;Wang, Dong-Feng
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.707-712
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    • 2014
  • Purpose: Anastomotic leakage (AL) is associated with high morbidity and mortality, high reoperation rates, and increased hospital length of stay. Here we investigated the risk factors for AL after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Data for 460 patients who underwent primary anterior resection with a double stapling technique for rectal carcinoma at a single institution from 2003 to 2007 were prospectively collected. All patients experienced a total mesorectal excision (TME) operation. Clinical AL was defined as the presence of leakage signs and confirmed by diagnostic work-up according to ICD-9 codes 997.4, 567.22 (abdominopelvic abscess), and 569.81 (fistula of the intestine). Univariate and logistic regression analyses of 20 variables were undertaken to determine risk factors for AL. Survival was analysed using the Cox regression method. Results: AL was noted in 35 (7.6%) of 460 patients with rectal cancer. :Median age of the patients was 65 (50-74) and 161 (35%) were male. The diagnosis of AL was made between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate and multivariate analysis, age (p=0.004), gender (p=0.007), tumor site (p<0.001), preoperative body mass index (EMI) (p<0.001), the reduction of TSGF on 5th POD less than 10U/ml (p=0.044) and the pH value of pelvic dranage less than or equal to 6.978 on 3rd POD (p<0.001) were selected as 6 independent risk factors for AL. It was shown that significant differences in survival of the patients were AL-related (p<0.001), high ASA score related (p=0.036), high-level EMI related (p=0.007) and advanced TNM stage related

The Effects Of Geumguesingitang And Dohongsamultang On Rats With Nephrosis Induced By Puromycin Aminonucleoside (금궤신기탕 및 도홍사물탕(桃紅四物湯)이 Puromycin Aminonucleoside로 유발(誘發)된 백서(白鼠)의 신증(腎症)에 미치는 영향(影響))

  • Yook, Hyun-Suk;Ahn, Se-Young;Doo, Ho-Kyung
    • The Journal of Korean Medicine
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    • v.18 no.2
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    • pp.283-315
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    • 1997
  • The effects of Geumguesingitang and Dohongsamultang on rats with nephrosis induced by a single tail-intravenous injection of puromycin aminonucleoside(PAN), 2.5mg/l00g of body weight were evaluated in the present study. The effects of Geumguesingitang and Dohongsamultang on PAN nephrosis were evaluated by measuring (1)the concentrations of albumin, total protein, total lipid, cholesterol, triglyceride, creatinine, blood urea nitrogen(BUN) and uric acid in the serum, (2)the concentrations of protein, creatinine, glucose, occult blood and volume of the 24 hours urine and (3)the volume of intake water. The results are summerized as follows; 1. In the Control group as compared to the Normal. the amount of protein of 24 hours urine was significantly increased, the concentrations of albumin and total protein were significantly decreased. Total lipid, cholesterol and triglyceride in the serum were significantly increased. The concentrations of creatinine, BUN, uric acid in the serum, the amount of glucose and occult blood of 24 hours urine were also increased significantly. 2. In the Geumguesingitang group as compared to the Control, the increase in the amount of urinary protein during 24 hours induced by PAN was significantly suppressed, and the concentrations of total protein and albumin in the serum were significantly increased. The concentrations of total lipid, cholesterol and triglyceride in the serum were significantly inhibited. The decrease of the concentrations of creatinine and uric acid in the serum were also observed significantly. 3. In the Dohongsamultang group as compared to the Control, the increase of the amount of protein and glucose of the 24 hours urine induced by PAN were significantly inhibited, and the concentrations of total protein and albumin in the serum were increased significantly. The concentrations of total lipid, cholesterol and triglyceride in the serum were decreased significantly. The decrease of the concentrations of creatinine and uric acid in the serum were observed significantly. It can be inferred that Geumguesingitang has effects on improving proteinuria, hypoproteinemia effectively. It has an effect on hyperlipidemia significantly relieved. And relieving azotemia when nephrotic syndrome is accompanied by the acute renal failure. It can be inferred that Dohongsamultang improves hyperlipidemia effectively. It has effects on proteinuria, hypoproteinemia in nephrotic syndrome significantly relieved. And relieving azotemia when nephrotic syndrome is accompanied by the acute renal failure.

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An Analysis of Tendencies of Studies on Herbal Acupuncture - Focusing on domestic theses since 2001 about anti-inflammation, pain relief and anti-obesity effects, including safety- (약침(藥鍼)의 연구 동향에 대한 분석 - 항염(抗炎) ${\cdot}$ 진통(鎭痛) ${\cdot}$ 비만(肥滿) 및 안전성(安全性)에 관한 연구를 중심으로 -)

  • Kang, Jun-Hyuk;Heo, Dong-Seok;Yoon, Il-Ji;Oh, Min-Seok
    • The Journal of Korean Medicine
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    • v.28 no.2 s.70
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    • pp.93-113
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    • 2007
  • Objective : To research Trends of studies about anti-inflammation and pain relief, obesity, and safety of herbal acupuncture therapy by analyzing domestic theses, published since 2001, about herbal acupuncture therapy. Methods : Domestic theses, published since 2001, mentioning anti-inflammation or pain relief, obesity, or safety of herbal acupuncture therapy were reviewed and analyzed. These theses were then classified by university, year, and subject. Results : The following results were obtained in this study. 1. Among published theses related to anti-inflammation effects of herbal-acupuncture, studies about arthritis comprised the most part, 52. In theses relating to causes of arthritis, 16 were about adjuvant, which was the most, followed by Type II collagen, LPS and carrageenan. Blood test, reactions of inflammation and revelation of cytokine and immune cellswere methods for evaluating anti-inflammation effect. The tendency of experimental methods was to focus on molecular biologic method. 2. In theses related to pain relief, many clinical attempts with herbal injection were carried out, and Carthami Flos and Scolopendrawere used most. Observing reduction of pain inducing factor and checking behavioral change were methods for evaluating pain relief. 3. In theses related to obesity, research focused on effects in association with spots on the body suitable for acupuncture. There were also attempts comparing effectiveness between single injections and complex injections. Astraball Radix, Angelica Gigantis Radix, Coicis Semen and Taeumjowetang were used. Evaluation of anti-obesity effects were by weight loss, food efficiency, blood lipid profile and evaluation of liver function. 4. In theses related to safety of herbal-acupuncture, Herba Chelidonii Chaenonelis Fructus, Clematis Florida Thunb, Corydalidis Tuber, Paeoniae Radix, and Carthami Flos which marked 2 theses each were most studied. Methods of evaluating safety were mostly by observing liver and kidney functions based on blood test, and by applying herbal injections to clinical treatment. Conclusion : Herbal acupuncture is being used in various ways associating with its anti-inflammation, pain relief and anti-obesity effect. Studies on efficacy and mechanism of herbal acupuncture are being conducted even at the molecular biology level.

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Feature of cerebral infarction with tsutsugamushi disease (쯔쯔가무시병과 동반된 뇌경색의 특징)

  • Choi, Pahn Kyu;Kang, Hyun Goo
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.10
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    • pp.178-184
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    • 2017
  • This study was performed on 16 patients diagnosed with tsutsugamushi disease and cerebral infarction from January 2007 to December 2015. An acute cerebral infarction was diagnosed by brain MRI and MRA. Tsutsugamushi disease was diagnosed using a polymerase chain reaction. To distinguish the difference between the generalized cerebral infarction and infarction with tsutsugamushi disease, the blood pressure and body temperature were measured uponadmission. In general, the blood pressure increases during an acute cerebral infarction. Interestingly, in this study, 12 patients showed a systolic blood pressure less than 130 mmHg uponadmission. The location of the cerebral infarction and whether single or multiple cerebral infarction were examined. Thirteen patients had a cerebral infarction in anterior circulation and 3 patients developed in posterior circulation. To evaluate the coagulation disorders, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, fibrinogen, fibrin degradation product (FDP). D-dimer, which is generally known to increase in an acute cerebral infarction, showed a significant increase in the 13 patients. Fibrin degradation products (FDP) showed a significant increase in 15 patients. The pathophysiological mechanism of tsutsugamushi disease is known as vasculitis, which may result in an endothelial cell injury and proliferation of the endothelial wall, which may lead to a cerebral infarction accompanied by coagulopathy. Without endothelial cell damage and proliferation, a vasospasm caused by vasculitis may cause vasoconstriction and cerebral infarction.

Influence of Dietary Supplementation of Condensed Tannins through Leaf Meal Mixture on Intake, Nutrient Utilization and Performance of Haemonchus contortus Infected Sheep

  • Pathak, A.K.;Dutta, Narayan;Banerjee, P.S.;Pattanaik, A.K.;Sharma, K.
    • Asian-Australasian Journal of Animal Sciences
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    • v.26 no.10
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    • pp.1446-1458
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    • 2013
  • The study assessed the effect of dietary supplementation of leaf meal mixture (LMM) containing condensed tannins (CT) on feed intake, nutrient utilization and performance of sheep infected with Haemonchus contortus. Eighteen adult sheep of similar age and body weight ($25.03{\pm}1.52$) were included in this study and out of these, 12 sheep were infected with single dose of infective third stage larvae of H. contortus at 2,000 larvae per sheep. The experimental sheep were allocated in three different groups' i.e. negative control (NC; no infection), control (C; H. contortus infected) and treatment (T; H. contortus infected+CT at 1.5% of the DM through LMM) and the experiment was conducted for a period of 90 d. The intake of dry matter (DM), organic matter (OM) and digestibility of DM, OM, neutral detergent fibre (NDF) and acid detergent fibre (ADF) were comparable among three animal groups. However, digestibility of crude protein (CP) and ether extract (EE) were significantly (p<0.05) higher in NC group as compared to both C and T groups. Nitrogen (N) retention (g/d or % of N intake) was significantly (p = 0.038) lower in C group as compared to T and NC groups. Daily intake (g/kg $W^{0.75}$) of digestible crude protein (DCP), digestible organic matter (DOM) and total digestible nutrient (TDN) did not differ significantly (p<0.05) in the three groups. Haemoglobin (Hb) and packed cell volume (PCV) were significantly (p<0.001) higher in treatment group as compared to control. The level of Hb and PCV reduced (p<0.001) after 30 days of experimental feeding. CT significantly (p<0.001) reduced serum urea in T group as compared to NC and C groups. Serum proteins differed significantly (p<0.01) among the three groups. The activity of serum enzymes AST, ALT, ALP and LDH were also statistically non significant (p<0.05) among treatments. The weight of abomasal lymph nodes (ALN) in T group was higher (p<0.05) than in C group. Treatment group had lower (p<0.05) total worms and fecal egg count compared to control group. It may be concluded that dietary supplementation of CT through LMM significantly improved the N retention, and inhibited the different developmental stages of Haemonchus contortus in experimental sheep.

Association of Polymorphism Harbored by Tumor Necrosis Factor Alpha Gene and Sex of Calf with Lactation Performance in Cattle

  • Yudin, N.S.;Aitnazarov, R.B.;Voevoda, M.I.;Gerlinskaya, L.A.;Moshkin, M.P.
    • Asian-Australasian Journal of Animal Sciences
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    • v.26 no.10
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    • pp.1379-1387
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    • 2013
  • In a majority of mammals, male infants have heavier body mass and grow faster than female infants. Accordingly, male offspring nursing requires a much greater maternal energy contribution to lactation. It is possible that the maternal-fetal immunoendocrine dialog plays an important role in female preparation for lactation during pregnancy. Immune system genes are an integral part of gene regulatory networks in lactation and tumor necrosis factor alpha ($TNF{\alpha}$) is a proinflammatory cytokine that also plays an important role in normal mammary gland development. The aim of this study was to evaluate the influence of the sex of calf and/or the -824A/G polymorphism in the promoter region of $TNF{\alpha}$ gene on milk performance traits in Black Pied cattle over the course of lactation. We also studied the allele frequency differences of -824A/G variants across several cattle breeds, which were bred in different climatic conditions. The G allele frequency decreased gradually over the course of lactation events in the Black Pied dairy cattle because of a higher culling rate of cows with the G/G genotype (p<0.001). In contrast to the genotypes A/A and A/G, cows with G/G genotype showed significant variability of milk and milk fat yield subject to sex of delivered calf. Milk yield and milk fat yield were significantly higher in the case of birth of a bull calf than with a heifer calf (p<0.03). The G allele frequency varies from 48% to 58% in Grey Ukrainian and Black Pied cattle to 77% in aboriginal Yakut cattle. Our results suggest that the $TNF{\alpha}$-824A/G gene polymorphism may have an influence on the reproductive efforts of cows over the course of lactation events depending on the sex of progeny. Allocation of resources according to sex of the calf allows optimizing the energy cost of lactation. This may be a probable reason for high G allele frequency in Yakut cattle breeding in extreme environmental conditions. Similarly, the dramatic fall in milk production after birth of a heifer calf increases the probability of culling for the cows with the G/G genotype in animal husbandry.

Association of Interleukin 10 Haplotype with Low Bone Mineral Density in Korean Postmenopausal Women

  • Park, Byung-Lae;Han, In-Kwon;Lee, Ho-Sa;Kim, Lyoung-Hyo;Kim, Sa-Jin;Shin, Joon-Shik;Kim, Shin-Yoon;Shin, Hyoung-Doo
    • BMB Reports
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    • v.37 no.6
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    • pp.691-699
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    • 2004
  • Osteoporosis is a disease characterized by exaggerated loss of bone mass, with as much as 50 to 85% of the variation in bone mineral density (BMD) commonly accepted as being genetically determined. Although intensive studies have attempted to elucidate the genetic effects of polymorphisms on BMD and/or osteoporosis in several genes, the genes involved are still largely unknown. The possible associations of genetic variants in five-candidate genes (IL10, CCR3, MCP1, MCP2 and GC) with spinal BMD were investigated in Korean postmenopausal women (n = 370). Fourteen SNPs in five candidate genes were genotyped, and the haplotypes of each gene constructed. The associations of adjusted spinal BMD by age, year since menopause (YSM) and body mass index (BMI), with genetic polymorphisms, were analyzed using multiple regression models. Genetic association analysis of Korean postmenopausal women revealed that IL10 -592A > C and/or IL10 ht2 were associated with decreased bone mass, whereas no significant associations were observed with all polymorphisms in other genes. The levels of spinal BMD in individuals bearing the IL10 -592CC genotype were lower ($0.78{\pm}0.16$) than those in others ($0.85{\pm}0.17$) (P = 0.02), and the BMD of IL10 ht2 bearing individuals were also lower ($0.82{\pm}0.15$) than those in others ($0.85{\pm}0.17$) (P = 0.04). Our results suggest that variants of IL10 might play a role in the decreased BMD, although additional study might need to be followed-up in a more powerful cohort.