Adverse Effects Of Radiotherapy Research Articles

Logistic Regression Analysis Of Factors Related To Preoperative Concurrent Chemoradiotherapy Resistance In Locally Advanced Rectal Cancer

Preoperative concurrent chemoradiotherapy (CCRT), as an important part of the comprehensive treatment of locally advanced rectal cancer (LARC), has been widely applied in clinic practice with an effective rate of approximately 40-80%. However, there are still many patients cannot benefit from this treatment. If these patients receive preoperative CCRT, not only cannot improve the efficacy, but also may affect the prognosis due to the adverse effects of radiation and the postponement of operation time. The aim of this study is to investigate the influencing factors of preoperative CCRT resistance in LARC patients. A total of 79 patients were included in this prospective study. Fifteen factors that might affect the resistance to CCRT were included in this logistic regression analysis, these factors include the general clinical data of patients, the expression status of tumor stem cell marker CD44v6 and the volumetric imaging parameters of primary tumor lesions. The resistance status to preoperative CCRT was positively correlated with the real tumor volume (RTV), the total surface area of tumor (TSA), and CD44v6 expression, whereas negatively correlated with the tumor compactness (TC). According to the results of logistic regression analysis, we established two regression models for predicting the resistance and drew two nomograms for clinicians to predict the probability of preoperative CCRT resistance. The Area Under Curve (AUC) of the two models and those significant measurement data (RTV, TC, TSA) were 0.900, 0.858, 0.771, 0.754, 0.859, the sensitivity were 95.8%, 79.17%, 62.50%, 95.83%, 62.5%, the specificity were 70.9%, 74.55%, 83.64%,47.27%, 96.36%, the positive predictive values were 58.96%, 57.58%, 62.51%,44.23%, 88.23%, the negative predictive values were 97.48%, 89.13%, 83.64%, 96.29%, and 85.48%, respectively. The logistic regression models and nomograms we obtained are methods for prediction of patients' suitability for preoperative CCRT. The application of this method would reduce the risk probability of those patients, who are not sensitive to CCRT, from suffering the radiation complications as well as longer waiting periods for surgery and would also provide evidence for individualized treatment options for LARC patients.

Therapeutic effect of decellularized extracellular matrix-based hydrogel for radiation esophagitis by 3D printed esophageal stent

Radiation esophagitis, the most common acute adverse effect of radiation therapy, leads to unwanted consequences including discomfort, pain, an even death. However, no direct cure exists for patients suffering from this condition, with the harmful effect of ingestion and acid reflux on the damaged esophageal mucosa remaining an unresolved problem. Through the delivery of the hydrogel with stent platform, we aimed to evaluate the regenerative capacity of a tissue-specific decellularized extracellular matrix (dECM) hydrogel on damaged tissues. For this, an esophagus-derived dECM (EdECM) was developed and shown to have superior biofunctionality and rheological properties, as well as physical stability, potentially providing a better microenvironment for tissue development. An EdECM hydrogel-loaded stent was sequentially fabricated using a rotating rod combined 3D printing system that showed structural stability and protected a loaded hydrogel during delivery. Finally, following stent implantation, the therapeutic effect of EdECM was examined in a radiation esophagitis rat model. Our findings demonstrate that EdECM hydrogel delivery via a stent platform can rapidly resolve an inflammatory response, thus promoting a pro-regenerative microenvironment. The results suggest a promising therapeutic strategy for the treatment of radiation esophagitis.

Optimasi Asam Glikolat dan Asam Sitrat dalam Krim Tabir Surya Kombinasi Titanium Dioksida, Avobenzone dan Octyl Methoxycinnamate

Ultraviolet (UV) radiation is the main cause of sunburn and skin cancer. The adverse effects of UV radiation are solved by sunscreen as protection for longer outdoors. In this study, optimization of glycolic acid and citric acid in sunscreen cream combination of titanium dioxide, avobenzone, and octyl methoxycinnamate were investigated using simplex lattice design method. The sunscreen cream evaluation includes physicochemical testing (organoleptic, homogeneity, emulsion type, spreadability, viscosity, and pH) and sunscreen effectiveness (SPF, % erythema transmission, and % pigmentation transmission). The value of physicochemical testing are 5,96 cm - 6,3 cm of spreadability testing; 83,33 dPa.s – 108,33 dPa.s of viscosity testing; 4,06 – 4,67 of pH testing. The value of sunscreen effectiveness are 9,79 – 13,35 of SPF testing; 4,55x10-06 - 0,15x10-06% of % erythema transmission; 5,77 – 7,16 % of % pigmentation transmission. The optimum formula was obtained by combining glycolic acid 2% and citric acid 0% with a desirability value of 0,649.

Sex-Specific Cognitive Deficits Following Space Radiation Exposure.

The radiation fields in space define tangible risks to the health of astronauts, and significant work in rodent models has clearly shown a variety of exposure paradigms to compromise central nervous system (CNS) functionality. Despite our current knowledge, sex differences regarding the risks of space radiation exposure on cognitive function remain poorly understood, which is potentially problematic given that 30% of astronauts are women. While work from us and others have demonstrated pronounced cognitive decrements in male mice exposed to charged particle irradiation, here we show that female mice exhibit significant resistance to adverse neurocognitive effects of space radiation. The present findings indicate that male mice exposed to low doses (≤30 cGy) of energetic (400 MeV/n) helium ions (4He) show significantly higher levels of neuroinflammation and more extensive cognitive deficits than females. Twelve weeks following 4He ion exposure, irradiated male mice demonstrated significant deficits in object and place recognition memory accompanied by activation of microglia, marked upregulation of hippocampal Toll-like receptor 4 (TLR4), and increased expression of the pro-inflammatory marker high mobility group box 1 protein (HMGB1). Additionally, we determined that exposure to 4He ions caused a significant decline in the number of dendritic branch points and total dendritic length along with the hippocampus neurons in female mice. Interestingly, only male mice showed a significant decline of dendritic spine density following irradiation. These data indicate that fundamental differences in inflammatory cascades between male and female mice may drive divergent CNS radiation responses that differentially impact the structural plasticity of neurons and neurocognitive outcomes following cosmic radiation exposure.

Moxibustion Enhances Chemotherapy of Breast Cancer by Affecting Tumor Microenvironment.

IntroductionChemotherapeutic drugs often cause obvious toxicity and side effects. Moxibustion can improve the immunity of cancer patients, enhance cellular immunity, and reduce the toxicity and adverse effects of radiotherapy and chemotherapy. In this study, the efficacy of moxibustion combined with paclitaxel on breast cancer was evaluated.MethodsA breast cancer mouse model was established. Hematoxylin and eosin staining was used to analyze tumor necrosis in mouse tumors. Immunohistochemistry, Western blot, and qPCR were used to detect the expression of CD34, hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor A(VEGFA), programmed death-1 (PD-1), and programmed death-1 ligand (PD-L1) in tumor tissues.ResultsMoxibustion combined with paclitaxel significantly inhibited weight loss in breast cancer-burdened mice and increased the survival rate. Moxibustion combined with paclitaxel increased the number of white blood cells, thymus index, and spleen index, and enhanced immune function by upregulating interferon-gamma and interleukin-2 and downregulating interleukin-10 and transforming growth factor-β1. Notably, moxibustion combined with paclitaxel inhibited the angiogenesis of tumors through the downregulation of CD34, HIF-1α, and VEGFA, and overcame the immunosuppressive microenvironment by inhibiting the PD-1/PD-L1 signaling pathway.ConclusionMoxibustion improves the body’s immune function and enhances the efficacy of chemotherapy by overcoming the immunosuppressive microenvironment.

Individuals with back and neck pain on medical forums: What do they mention? What do they fear?

The use of online medical forums is on the rise globally. Data scraping is a method of extracting website content using an automated computer program. We scraped users' questions regarding back and neck pain (BNP) from popular Israeli online medical forums. We aimed to identify the sort of questions being asked about BNP, and to analyse explicit themes that characterize their questions. Six leading Israeli BNP forums were identified. In phase 1, Python scripts scraped 12,418 questions into a data set. In phase 2 - five themes were identified: Surgery (n=2,957); health care professions (n=2,361); Sports (n=2,304); drugs (n=1,419) and interpretation of imaging (n=845). Phase 3 - included the categorization of explicit fear-related words by the authors. Phase 4 - analysis of explicit fear-related themes yielded 402 questions. Gender was identified for 394 users, and age was identified for 181 users. A total of 248 users (61.6%) were women and 146 men (36.3%). Mean age 36.3±16.15 for women and 35.5±16.1 for men. The most commonly expressed fears were related to: invasive procedures, 30.9% (131 questions); fear of serious condition or misdiagnosis, 17.0% (72 questions); General concerns, 13.7% (58 questions); fear of worsening or relapse, 12.3% (52 questions); adverse effects of oral drugs or radiation, 10.8% (46 questions) and concerns related to lifestyle, 9.7% (41 questions). Web scraping is a feasible strategy with which to explore medical forums and the above-mentioned themes, all of which are of potential clinical significance. Using automated algorithms, a total of 12,369 questions from online back and neck medical forums were scraped and analysed. Secondary analysis categorized fear-related themes that were mentioned by users. Identifying and addressing patients' fear has potential to improve communication and therapeutic outcome. For example, questions regarding surgery were typically asked after the option was mentioned by a physician. This insight should encourage physicians to devote extra time explaining the possible implications of surgery, should they consider it as an option.

Knowledge, Attitude and Practice of Radiation Protection among Dental Students

Radiology is one the key cornerstone of investigation in Dentistry. The application of radiology in Dental practice has grown by leaps and bounds in the years gone by. Along with this there is an increase in the number of radiation hazards. The effect of radiation on human beings is very negative. This survey was conducted with the intent of studying the awareness and knowledge of radiation protection in practice. The survey consisted of 10 closed ended questions which were circulated among 100 interns of a dental college. The data collected was entered into microsoft excel and the data was analysed for an association between the gender and the responses using Chi-square analysis. The majority of the participants were females and they believed that radiation causes harm to humans and surprisingly they had also believed that ionised radiation remains suspended in the air after making a radiographic exposure where there was no statistically significant difference between the genders(p>0.05). The questions also assessed whether a clinical examination is advised before a radiographic examination and the majority were of the view it is necessary which was statistically significant(p<0.05). From this study we could infer that students are well aware of the adverse effects of radiation but in terms of safety practices being followed in Dental clinics, there are some pitfalls noticeable.

Abstract LB-071: Cross talk between T lymphocytes and macrophages promotes progression of radiation induced lung fibrosis

Abstract Background: Fractionated radiotherapy (RT) is integral part of standard treatment for locally advanced lung cancer. However radiation-induced lung disease limits the application of curative radiation doses and therapy intensification efforts of concurrent chemoradiotherapy, leading to fatal outcomes by local recurrence or metastatic disease even when accepting side effects that decrease the quality of life. So far, no predictive biomarkers exist and no mechanism-based therapies are in clinical use that prevent or treat dose-limiting pneumonitis and lung fibrosis. Own previous work revealed a pathogenic role of the immunomodulatory CD73/adenosine system and of macrophages in radiation-induced pulmonary fibrosis1,2. Moreover, clinical observations associated CD4+ T lymphocytes with adverse effects of RT in the skin and the lung of cancer patients3,4. However, the contribution of RT-induced immune changes to RT-induced lung disease require further definition. Here, we studied the functional role of lymphocytes in radiation-induced lung fibrosis, with a focus on CD4+ T cells. Methods: C57BL/6 wildtype (WT) and RAG-2 knockout (RAG-2-/-) mice received a single dose of whole thorax irradiation with 0 Gy (sham controls) or 15 Gy without or with additional adoptive transfer of CD4+ T cells. We characterized time-dependent immuno-modulation and pathogenesis of lung tissue in flow cytometry, histological and immunohistochemical as well as RNA analyses in comparison to our earlier analyses in or CD73 knockout (CD73-/-) mice. Results: CD4+ T lymphocytes, particulary Treg, accumulated in irradiated lungs of WT mice during the chronic fibrotic phase. While deficiency of B and T cells in RAG2-/- mice led to an earlier onset of fibrosis compared to WT mice, adoptive transfer of CD4+ T cells into RAG2-/- mice led to further aggravation of pulmonary fibrosis. Analysis of immune cell subtypes in adoptively transferred RAG2-/- mice revealed that CD4+ T cells were enhanced, and this was associated with a phenotypic switch in the macrophage population towards M2-like phenotypes that was not observed in CD73-/- mice. Conclusions: We conclude that a reciprocal crosstalk between CD4+ T lymphocytes and macrophages in the irradiated lung environment promotes disease progression, amongst others by regulating macrophage polarization in a microenvironment-dependent manner. 1) Wirsdörfer et al., Cancer Res 2016;76:3045-56. 2) de Leve S et al., FASEB J 2017, 31;2869-2880; Veldwijk MR et al. Clin Cancer Res., 2019, 25:562-572; Nakayama Y et al., Int J Radiat Oncol Biol Phys 1996, 34:459-467. This work was supported by grants of the University Hospital Essen (IFORES) to FW and the DFG (JE275/4-1; GRK1739/2) to VJ. Citation Format: Florian Wirsdörfer, Lena Gockeln, Simone de Leve, Martin Stuschke, Verena Jendrossek. Cross talk between T lymphocytes and macrophages promotes progression of radiation induced lung fibrosis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-071.

Numerical Study of a Phase Change Material Integrated Solar Thermoelectric Generator

The numerical modelling of a phase change material (PCM) attached to a hybrid three-dimensional truncated compound parabolic concentrator and thermoelectric module is performed under transient and non-uniform variation in solar radiation. To demonstrate the higher performance of the system, the performance parameters of a stand-alone system (without PCM), SAS, and incorporated system (with PCM), IS, are modelled and studied using the ANSYS 2020 R1 software and MATLAB R2020a Simulink software. The PCM is placed at the hot junction of the solar thermoelectric generator (STEG) in order to act as a re-concentrating lens via the phase-change lensing effect and to decrease the adverse effect of transient and non-uniform solar radiation on the STEG. The results demonstrate an increase in the light transmissivity and refractive index of the PCM after melting and the efficacy of the PCM in shielding the STEG under extremely concentrated solar radiation intensities. The optimum heat input required to maximise the STEG efficiency and power output while minimising the challenge of excess heat dissipation in STEG systems is obtained and discussed. Finally, the results obtained show that the maximum temperature gradient, power output and efficiency from the stand-alone were higher than those from the incorporated system. The results obtained from this study will provide useful information in the design of STEGs under fluctuating meteorological conditions coupled with solar concentrators, which generate varying solar radiation.

Outcomes of Urinary Diversion for Late Adverse Effects of Gynecologic Radiotherapy

To describe the risks of urinary diversion performed to address adverse effects of gynecologic radiation, with the hypothesis that high grade complications would be more common in sarcopenic women and in those undergoing continent diversion (vs noncontinent) or concomitant cystectomy (vs bladder-sparing diversion). A retrospective review was performed of patient records of women who underwent urinary diversion for urinary adverse effects of gynecologic radiotherapy during the period of 2008-2018 from 3 tertiary centers. Skeletal muscle index was calculated to assess for sarcopenia based on preoperative computed tomography scans. Outcomes include high-grade postoperative complications within 90 days of surgery, 30-day readmission rate, and long-term (>90 days) outcomes. Among 34 women who met the inclusion criteria, the majority were white/Caucasian (73.5%). Twenty-six of 34 (76.5%) underwent noncontinent diversion. Seventy nine percent (27/34) (79.4%) of women experienced complications within 90 days; 9 of 34 (26.5%) experienced high-grade (Clavien grade ≥3) complications. Thirty-two percent (11/34) were readmitted within 30 days. Rates of high-grade complications were not significantly impacted by diversion type (P=.49), concurrent cystectomy (P=.70), or sarcopenia (P=1.0). Urinary diversion for late adverse effects of gynecologic radiotherapy is associated with high peri-operative risk, even in skilled hands. In this series, neither sarcopenia, nor continent diversion, nor cystectomy were associated with increased complications. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, however further study is needed to elucidate significant preoperative markers which may predispose patients to significant complications.

Understanding American Indian Perceptions Toward Radiation Therapy.

Many American Indian (AI) and Alaska native (AN) patients do not complete guideline-concordant cancer care for the 4 most common cancers. Our aim was to better understand AI/AN attitudes toward radiation therapy (RT). Patients eligible for this survey study were AI/AN patients with cancer at the Phoenix Indian Medical Center who either received previous RT or were recommended to receive RT. An 18-item questionnaire was administered to each of the 50 participants from October 1, 2018, through February 15, 2019. Willingness to travel for RT was compared to respondent characteristics, concerns regarding RT, and obstacles to obtain RT. Duration of RT was important to 78% of patients: 24% would consider traveling 25 miles or more for a standard course, and 48% would travel that distance for a shorter course (P < .001). The top-ranked barriers to RT were transportation, cost of treatment, and insurance compatibility. The top-ranked concerns about RT were adverse effects, cost of treatment, and fear of RT. Concerns about adverse effects were associated with the radiation team’s inability to explain the treatment (P = .05). Transportation concerns were significantly associated with accessibility (P = .02), communication with the RT team (P = .02), and fear of RT (P = .04). AI/AN patients are concerned about the adverse effects of RT and the logistics of treatment, particularly costs, transportation, and insurance compatibility. Use of culturally specific education and hypofractionation regimens may increase acceptance of RT for AI/AN patients with cancer, and this hypothesis will be tested in a future educational intervention-based study.

Jak zvládnout nežádoucí účinky radioterapie

Přehledový clanek obsahuje princip vzniku nežadoucich ucinků při radioterapii a doporuceni pro jejich prevenci a zakladni lecbu.

Effects of solar radiation and an update on photoprotection

Sunburn, immunodepression, photoaging, and photocarcinogenesis, are some of the most significant adverse effects of solar radiation in humans. Children are a population group of special vulnerability, due to the fact that exposure to the sun has more pronounced biological effects compared to adults. Furthermore, childhood is a critical period for promoting the development of photo damage and photocarcinogenesis in the later stages of life if adequate measures are not put into place. This is because it is estimated that between 18 and 20 years of age 40–50% of the accumulative exposure to ultraviolet radiation up to 60 years of age is received. The most important strategy for the photoprotection of children is changes in behaviour and habits associated with exposure to the sun at all levels (school, society, family, etc.). Resorting to the shade, reduction in overall time of exposure to the sun, and physical protection (clothes, hats, and sunglasses) are the best and least costly photoprotection strategies. The photoprotectors must be incorporated into the daily routine of children in the same way as adults, and must complete a series of requirements in order to make them effective, safe, and in line with the environment.

Abstract A64: Exosomal miRNA as a noninvasive prediction marker of normal tissue toxicity after radiotherapy for prostate cancer

Abstract Introduction: A potential limiting feature for radiotherapy (RT) in the treatment of cancer is the toxicity that arises due to damage to normal tissues as a result of the radiation. This risk of toxicity is a particular concern in men with localized prostate cancer. Radiation-induced proctitis (RIP) is a common adverse effect of RT in treatment for prostate cancer. RIP limits radiation dose and treatment volumes, interrupts treatment, and lowers patients’ quality of life. Exosomes are 30- to 150-nm-wide nanovesicles originating from the endosomal network and are found in most body fluids. Exosomes are a fundamental driver of intercellular communication by transferring proteins, lipids, and miRNA. Exosomes miRNA signatures may serve as noninvasive prediction biomarkers of late toxicities such as RIP. Methods: Twelve prostate cancer patients (pts) treated with curative intent with different grades of post-irradiation toxicity were enrolled on an IRB-approved study. Pts were evaluated prospectively weekly during RT and at prescribed intervals following completion of RT for the development of toxicity using a standardized instrument of physician-reported toxicity (CTCAE v4). Blood samples were collected one day before and one year after RT. The 101Bio kit was used to isolate exosomes from plasma of pts. For the miRNAs expression profiling we used ExiLENT SYBR® Green Maser Mix (Exiqon). The expression of 179 miRNA commonly found in human serum/plasma were analyzed by Serum/plasma PCR Panel (QIAGEN) for each sample. Results: Exosomes miRNAs were analyzed from the plasma of prostate pts divided into two groups: (i) low toxicity grade 0-1 (6 pts) and (ii) high toxicity grades 2-4 (6 pts). Out of the 179 miRNAs analyzed, three miRNAs exhibited differential expression at post-RT compared to pre-RT for low toxicity pts (LTP): miR-132-5p (upregulated, p=0.001), miR-23a-3p (downregulated, p=0.020) and miR-1-3p (upregulated, p=0.047). Four miRNAs exhibited differential expression at post-RT compared to pre-RT for high toxicity pts (HTP): miR-132-5p (downregulated, p=0.003), miR-197-3p (upregulated, p=0.017), miR-151a-5p (upregulated, p=0.031), miR-18b-5p (upregulated, p=0.020). The most interesting results were observed with miR-132-5p. Before RT it showed significantly higher expression in HTP compared to the LTP. However, after RT miR-132-5p expression showed 10.76-fold increase in LTP and 7.87-fold decrease in the HTP. As a result of these dynamic changes, expression of miR-132-5p after RT became significantly higher in LTP compared to the HTP. Conclusions: Our investigation has revealed miR-132-5p as a potential marker for risk of significant rectal injury following RT for prostate cancer, and changes in the expression of miR-1-3p, miR-18b-5p, miR-23a-3p, miR-151a-5p, and miR-197-3p may reflect the ongoing inflammatory process responsible for radiation-induced rectal injury. Citation Format: Pratip Rana, Preetam Ghosh, Mitchell S. Anscher, Ross B. Mikkelsen, Vasily A. Yakovlev. Exosomal miRNA as a noninvasive prediction marker of normal tissue toxicity after radiotherapy for prostate cancer [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr A64.

A randomized controlled trial of a self-administered, online decision-aid (“Navya Patient Preference Tool”) to reduce decisional conflict in women with early breast cancer.

7033 Background: Shared decision making to confront choices with clinical equipoise, has been the privilege of those patients with access to time intensive consults with oncologists. We conducted a randomized controlled trial for breast cancer patients to use an online, self-administered, out-of-the-medical-encounter decision aid (DA) to choose between breast conserving surgery (BCS) and mastectomy. Methods: Navya Patient Preference Tool (Navya PPT) is a multilingual DA based on adaptive conjoint analysis of tradeoffs between cost, adverse effects of radiation, and breast conservation. Prior analysis established high internal reliability and external validity of the Navya PPT. Eligible cT1/2, cN0 breast cancer patients planned for surgery were block randomized, in 1:1:1 ratio, to receive the research questionnaire (RQ) to measure decisional conflict on choice of surgery (control, arm 1), Navya PPT followed by RQ (experimental, arm 2) or Navya PPT followed by RQ administered with key male family member (experimental, arm 3). Groups were stratified with respect to age, socio-economic status (SES) and educational level. The study was powered to detect a decrease in Decisional Conflict Index (DCI) by 0.25 (β-0.8, two sided α- 0.01). Results: Between June 2017 and December 2019, 247/255 patients were randomized to arm 1 (83), arm 2 (84), and arm 3 (80). Median age was 48 years (IQR 23-76), and median pT size was .5 cm (0.5-6 cm). 59% of patients were middle or lower SES and 46.2% had ≤ 12th grade education. DCI was significantly reduced in arm 2 as compared with arm 1 (1.34 vs. 1.65, Cohen’s d 0.49 (± 0.31) p&lt;0.05) as well as in arm 3 as compared with arm 1 (1.30 vs. 1.65, Cohen’s d 0.54 (± 0.31) p&lt;0.05). 80% (± 6%) of patients underwent surgery of choice as determined by Navya PPT. BCS rate was similar in all three arms (85.2, 88.9 and 86.5% respectively (p=0.779). Conclusions: Online, self-administered, adaptive DAs used out of the medical encounter can reduce decisional conflict and increase access to shared decision making for every patient; especially in practices with low doctor to patient ratios. Clinical trial information: IEC/0116/1619/001 .

Phase II study: Induction chemotherapy &amp; transoral surgery as definitive treatment (Tx) for locally advanced oropharyngeal squamous cell carcinoma (OPSCC): An update and retrospective review of non-study patients.

e18549 Background: The standard of care for OPSCC includes chemoradiation (CRT) or surgery with adjuvant radiation (RT). However, RT is associated with significant life long morbidity. We assessed the efficacy of a two-drug induction regimen, followed by transoral robotic assisted surgery (TORS) &amp; neck dissection for locally advanced OPSCC. Methods: This is an IRB approved single-arm phase II study for untreated stage III or IVA (AJCC 7th edition) OPSCC patients (pts) with an ECOG &lt; 2 and GFR &gt; 50 cc. Induction cisplatin 75 mg/m2 and docetaxel 75 mg/m2 was administered every 21 days for 3 cycles. Patients then underwent TORS and neck dissection(s). At post-op visits, flexible laryngoscopy, blood tests, and imaging with PET/CT and/or MRI were done. Short and long term toxicity, progression-free survival, overall survival, and quality of life (QOL) were evaluated in all pts. Results: Twenty oropharyngeal pts were treated, 19 were male, 17 were Caucasian, and 19 were HPV+. Median age at dx was 57. Three pts were stage III, and 17 were stage IVA. Pathologic CR at the primary site occurred in 15 pts and CR among LN neck dissections occurred in 13 pts. Four pts were given dose-reduced chemo and 1 pt was changed to carboplatin per protocol because of renal dysfunction. Pre vs post tx QOL scores did not change. At a mean follow-up of 40.7 months (range 13 to 55), 18 pts are alive and NED. Three pts recurred a mean of 2.2 mos after surgery, and were treated with salvage CRT. Two pts died of metastatic disease, the third is alive and well. All 3 pts had positive LN (9 LN, 3 LN and 1 LN) at surgery. A fourth pt had 12 pos LN and received radiation. He has not recurred. A retrospective review of an additional 20 twenty pts treated in the same way, were also reviewed for efficacy. Mean age was 61.5. Two pts died of metastatic disease. Twenty pts have been followed for &gt; 13 mos (17 are alive and well, 2 died, and 1 LFU), and their mean follow-up is 43.5 mos. Conclusions: Cisplatin + docetaxel followed by TORS &amp; neck dissection(s) appears to be an effective model for the definitive treatment for OPSCC, while avoiding the adverse effects of RT. Clinical trial information: NCT02760667.

English

BACKGROUND Working length determination is a fundamental step in the endodontic treatment of primary and permanent teeth. Radiography is most commonly used for this purpose. However, it requires patient cooperation and is associated with adverse effects of radiation. Apex locators can serve as an efficient alternative for this purpose. We wanted to compare the accuracy of Root ZXII and Raypex 5 electronic apex locators for working length determination in primary teeth. METHODS This in vitro study was performed on 154 canals of 58 extracted primary teeth. Access cavity was prepared, and a K-file was introduced into the canal until its tip was visible at the apex under a microscope. 0.5 mm was subtracted from this length to determine the actual working length. The canal length was then measured again using Root ZXII and Raypex 5 apex locators. The obtained values were compared with the actual value. Data was analysed using SPSS version 21 via paired t-test with intraclass correlation coefficient (ICC) at P<0.05 level of significance. RESULTS The mean difference in values measured by Root ZXII and Raypex 5 and the actual working length was 0.77 +/- 0.65 mm and 0.62 +/- 0.58 mm, respectively. No significant difference existed in the accuracy of the two apex locators for determination of actual working length (P=0.54). The actual working length had a strong correlation with the values measured by Root ZXII (ICC=0.97) and Raypex 5 (ICC=0.95). CONCLUSIONS Both apex locators have acceptable accuracy as an alternative to radiography for working length determination in primary teeth.

Adverse Effects of Ultraviolet Radiation on Growth, Behavior, Skin Condition, Physiology, and Immune Function in Gilthead Seabream (Sparus aurata)

Ultraviolet B (UVB) radiation has recently been recognized as a major stressor for marine vertebrates, particularly fish confined to aquaculture cages. Here, we investigate the harmful effects of UVB radiation on gilthead seabream (Sparus aurata), which is a widely cultured species. We exposed juveniles to three UVB conditions (UVB-H - high UVB, 12 kJ m-2 d-1; UVB-M - moderate UVB, 6 kJ m-2 d-1; UVB-L - low UVB, 2.4 kJ m-2 d-1) that are representative of natural underwater UVB levels throughout the water column in the Red Sea. We used one experimental treatment without UVB exposure as a control. We evaluated the adverse effects of UVB after short- (10 days) and long-term (43 days) exposure. The results indicated that short- and long-term exposure to UVB retarded growth and decreased survival rates. UVB exposure resulted in behavioral changes, mainly in UVB-H and UVB-M exposed fish. Swimming activity was reduced; most of the fish tried to avoid exposure and showed a stationary behavior with slow caudal and dorsal fins movements (UVB-H), or a slow displacement behavior (UVB-M). Moreover, we observed a reduction in appetite, reflected by a remarkable increase in the time required to consume the food. Lesions on the skin occurred in the three UVB treatments, and the incidence and severity increased under long-term UVB exposure. We also observed physiological changes, including a decrease in total protein and total cholesterol concentrations (all UVB treatments). We detected a potential suppression of the innate immune system (reduction of total anti-protease and total peroxidase activities) (UVB-M, UVB-L). Our results suggest that exposure to solar underwater UVB radiation levels has the potential to interfere and affect the health of S. aurata. Indeed, aquaculture fish species growing at locations where water transparency and UVB incidence is as high as the Mediterranean in summer, and the Red Sea year-round, may be affected, and their welfare, resistance to pathogens, and survival may be compromised. Strategies should be considered to mitigate the adverse effects of UVB exposure, such as deeper and more-shaded cages, or the development of functional foods.

Effect of X-rays on transcript expression of rat brain microvascular endothelial cells: role of calcium signaling in X-ray-induced endothelium damage.

Radiation-induced brain edema is a serious adverse effect of radiotherapy. Although there are many causes of radiation-induced brain edema, the pathogenesis is not clear and clinical treatment is not ideal. Therefore, knowing the differential expression of the brain microvascular endothelial cell (BMEC) transcriptome after brain radiotherapy may shed light on the pathogenesis of radiation-induced brain edema. The present study used RNA-Seq technique to identify 383 BMEC transcripts differentially expressed (many 2-fold or higher; P < 0.05) between control and X-ray–treated primary cultured rat BMECs. Compared with controls, X-ray–treated BMECs had 183 significantly up-regulated transcripts and 200 significantly down-regulated transcripts. The differentially expressed genes were associated with the biological processes of the cell cycle, apoptosis, vascular permeability, and extracellular junctions. The functional changes identified in the X-ray–treated BMECs included Ca2+ signaling, phosphoinositide 3-kinase–Akt signaling, and methionine degradation. These results indicated that transcript expression was substantially affected by radiation exposure and the proteins encoded by these differentially expressed genes may play a significant role in radiotherapy-induced brain edema. Our findings provide additional insight into the molecular mechanisms of radiation-induced brain edema and may be helpful in the development of clinical treatment of this adverse reaction to radiotherapy.

EFFECT OF RADIATION EXPOSURE FROM X-RAY MACHINES AND METAL DETECTORS ON THE HEALTH OF SAFETY OFFICERS OF CORRUPTION INSTITUTIONS

Health and safety environtment are an important issue and must be materialized in every task execution. As an officer at the forefront of correctional institutions, P2U officers often do not know the magnitude of the impact of radiation exposure to their health. The impact often can be minimized by given the knowledge to the officers P2U related dangers that can cause health problems for them. Therefore, in this study conducted case study on the magnitude of the dose radiation exposure officers who can provide a prudent effect in carrying out the task through laboratory tests. This research can provide knowledge not only to the officers, but also the community that will later visit the Correctional Institution. According to the data listed in the correctional Database system until March 2020 it has been recorded as many as 9,917 guards who every day were on the machine that had a negative impact on their health. With this research, officers need to implement strict protocols in order to avoid the adverse effects of radiation on their health.