Short Treatment Cycle Research Articles

Different fractionation schedules of radiotherapy in preoperative concurrent chemoradiotherapy for thoracic esophageal cancer: a clinical study

Objective To investigate the clinical efficacy and safety of preoperative hypofractionated and conventionally-fractionated chemoradiotherapy for thoracic esophageal cancer. Methods A total of 86 patients with thoracic esophageal cancer receiving chemoradiotherpy in Sichuan Cancer Hospital between 2002 and 2011 were enrolled and randomized into the preoperative hypofractionated chemoradiotherapy group (group A, n=41, 30 Gy in 10 fractions for 2 weeks) and conventionally-fractionated chemoradiotherapy group (group B, n=45, 40 Gy in 20 fractions for 4 weeks). Surgery was performed at 2-6 weeks after chemoradiotherapy. The probability of patients’ survival was estimated by Kaplan-Meier method and analyzed by log-rank test. Results In groups A and B, the pathological downstaging rates were 68% and 56%(P=0.270), the R0 resection rates were 95% and 89%(P=0.437) and the pCR rates of 32% and 24%(P=0.480). The 1-, 3-and 5-year overall survival (OS) rates were 78% and 69%, 44% and 44%, 29% and 33%(P=0.114, 0.223, 0.289), and the progression-free survival (PFS) rates were 71% and 62%, 39% and 38%, 24% and 29%(P=0.211, 0.689, 0.331), respectively. The incidence rate of chemoradiothery-and surgery-related adverse events did not differ between two groups (P=0.089-0.872). The average length of hospital stay, radiotherapy cost and preoperative treatment costs in group A were significantly less compared with those in group B (P=0.000, 0.000, 0.000). Conclusions Both preoperative hypofractionated and conventionally-fractionated chemoradiotherapy can be used as the regimen of preoperative chemoradiotherapy in patients with resectable thoracic esophageal carcinoma. Compared with conventionally-fractionated chemoradiotherapy, preoperative hypofractionated chemoradiotherapy has shorter treatment cycle, shorter length of hospital stay and lower radiotherapy cost, which is more easily accepted by patients. Key words: Esophageal neoplasm/preoperative chemoradiotherapy; Hypofractionated; Conventional fractionated; Prognosis

Feasibility and performance of high-rate psychrophilic dry anaerobic digestion of high solids content dairy manure

The main purpose of the R&D was to develop a novel high-rate psychrophilic dry anaerobic digestion (PDAD) for processing a mixture of cow feces and wheat straw (CFWS) in sequencing batch bioreactor (SBR) operated at high organic loading rate (OLR). The main research question was to assess the feasibility of operating the PDAD-SBR at OLR of 9.0 and 10.0 g TCOD kg−1 inoculum day−1. Two pairs of 40 L duplicate bioreactors located in a temperature-controlled room (20 °C) were operated as sequencing batch reactors (SBRs) and were fed CFWS (27 % total solids) at OLRs of 9.0 and 10.0 g TCOD kg−1 inoculum day−1 during three successive treatment cycles of 21 days each. The biogas production, biogas composition, volatile fatty acids, and volatile solids were monitored to assess the performance of the PDAD-SBRs. The PDAD process fed with cow feces and wheat straw (TS of 27 %) at OLR 9.0 and 10.0 g TCOD kg−1 inoculum day−1 (6.53 ± 0.06 and 7.27 ± 0.12 g VS kg−1 inoculum day−1) resulted in average specific methane yields (SMYs) of 134.0 ± 7.7, 136.4 ± 4.9 NL CH4 kg−1 VS fed, respectively, with an average volatile solids removal of 35 % at the ends of treatment cycles (21 days). This study reports for the first time successful operation of psychrophilic (20 °C) dry anaerobic digestion (PDAD) of cow feces with wheat straw (CFWS) at 27 % total solids and OLR of 9.0 and 10.0 g TCOD kg−1 inoculum day−1 in relatively short treatment cycle length (21 days).

Topical problems of antiviral therapy for chronic hepatitis C

Antiviral therapy using interferon-free regimens for chronic hepatitis C (CHC) is being more frequently practiced by hepatologists due to the high efficiency of a short treatment cycle and the lowest rate of adverse events. The review discusses the most topical problems that will present themselves in practicing hematologists when treating patients with CHC under the present-day conditions. The use of direct-acting antiviral drugs requires knowledge and skills for physicians to orient themselves in the list of these drugs to create their based regimens, the efficiency and safety of which are proven in the context of evidence-based medicine. The review gives data on the efficiency and safety of 3D therapy for CHC according to the baseline characteristics of patients.

Differential Influence of Components Resulting from Atmospheric-Pressure Plasma on Integrin Expression of Human HaCaT Keratinocytes

Adequate chronic wound healing is a major problem in medicine. A new solution might be non-thermal atmospheric-pressure plasma effectively inactivating microorganisms and influencing cells in wound healing. Plasma components as, for example, radicals can affect cells differently. HaCaT keratinocytes were treated with Dielectric Barrier Discharge plasma (DBD/air, DBD/argon), ozone or hydrogen peroxide to find the components responsible for changes in integrin expression, intracellular ROS formation or apoptosis induction. Dependent on plasma treatment time reduction of recovered cells was observed with no increase of apoptotic cells, but breakdown of mitochondrial membrane potential. DBD/air plasma increased integrins and intracellular ROS. DBD/argon caused minor changes. About 100 ppm ozone did not influence integrins. Hydrogen peroxide caused similar effects compared to DBD/air plasma. In conclusion, effects depended on working gas and exposure time to plasma. Short treatment cycles did neither change integrins nor induce apoptosis or ROS. Longer treatments changed integrins as important for influencing wound healing. Plasma effects on integrins are rather attributed to induction of other ROS than to generation of ozone. Changes of integrins by plasma may provide new solutions of improving wound healing, however, conditions are needed which allow initiating the relevant influence on integrins without being cytotoxic to cells.

Urethral realignment and simultaneous internal fixation for pelvic fracture associated with posterior urethral disruption

Objective To investigate the outcome of the urethral realignment simultaneous internal fixation in treatment of pelvic fracture associated with posterior urethral disruption. Methods The study included 33 patients with pelvic fracture associated with posterior urethral disruption treated simultaneously by urethral realignment and internal fixation from December 2003 to August 2009. According to AO classification, two patients were with type A2 fracture, six with type B1 ,seven with type B2,five with type B3 ,six with type C1 ,four with type C2 and three with type C3. All the patients were found with complete posterior urethral disruption. Primary urethral realignment combined with emergency open reduction and internal fixation of pelvic fracture were performed in 12 patients. Due to unstable condition, 21 patients underwent primary suprapubic cystostomy and external fixation, sequentially delayed urethral realignment and internal fixation.Results The mean follow-up time of all patients was 37 months ( range, 3-63 months). Of all the patients, 25 patients (76%) regained good without urethral dialation or needed only short term urethral dilatation, and eight patients (24%) suffered from urethral stricture and needed further complex surgery. The incidences of urinary incontinence and erectile dysfunction were 6%(2/33) and 18% (6/33). The erectile dysfunction of two patients was ascribed to sacral nerve injury.At the final follow-up, the mean score was 90.3 points (range, 66-100) according to the Majeed' s scoring system, which showed that the result was excellent in 24 patients, good in eight and fair in one.Conclusions Urethral realignment and simultaneous internal fixation can attain good clinical results for pelvic fracture associated with posterior urethral disruption. It takes advantages of minor surgical trauma,short treatment cycle, good outcome and low complication rate. Key words: Pelvis; Fracture fixation, internal; Urethra; Disruption

Development of a Toughness Testing Method for the Effect of Short Heat Treatment Cycles on High-strength Filler Materials Using Subsized Charpy V-Specimens

Durch den immer haufiger werdenden Einsatz von hochfesten Feinkornbaustahlen steigen auch die Anforderungen an die benotigten Schweiszusatzwerkstoffe. Fur die Entwicklung neuer Schweiszusatzwerkstoffe sind aufgrund der meist sehr geringen Blechstarke des Grundmaterials auch neue Methoden zur Prufung der Zahigkeit erforderlich. Dazu wurde eine Prufmethode mittels Mikrokerbschlagproben entwickelt, welche es erlaubt, auch Schweisverbindungen von Blechen mit ca. 5 mm Dicke zu untersuchen. Fur die Entwicklung und Evaluierung der Methode wurden ein hochfester Feinkornbaustahl (S1100QL) und ein hochfester Schweiszusatz (alform 960-IG) verwendet und verschiedene Kurzeitwarmebehandlungen, wie sie zum Beispiel bei Mehrlagenschweisungen auftreten, am Dilatometer simuliert. In der Folge wurden Zahigkeit und Harte durch die Kerbschlagbiegeprufung und die Hartemessung nach Vickers ermittelt sowie metallografische Untersuchungen durchgefuhrt. Die Ergebnisse zeigen, dass die Methode gute Ergebnisse liefert und sich fur die Simulation von Kurzeitwarmebehandlungen durch den breiten Parameterbereich des Dilatometers gut eignet.

Microstructural changes during short-cycle heat treatments of cold-work tool steels

Short heat treatment cycles like for induction hardening are rarely investigated on alloyed cold–work tool steels. Therefore little is still known on the microstructural changes during austenitising, quenching and tempering under these conditions. As these investigations show there are significant changes in the alloy distribution depending on the austenitising parameters. Subsequent quenching can lead to high contents of retained austenite. During short cycle tempering the transformation of the tetragonal martensite and the decomposition of the retained austenite is shifted to significantly higher temperatures. When applying appropriate austenitising and tempering parameters similar hardness and toughness properties can be achieved as for standard heat treatment condition leading to good hardness values with a fine ductile fracture surface.

Application of shortened heat treatment cycles on A356 automotive brake calipers with respective globular and dendritic microstructures

Since the automotive industry has many possible applications for semi-solid metal (SSM)-high-pressure die casting (HPDC) parts, the newly developed heat treatment cycles, as well as the traditional heat treatment cycles, were applied to A356 brake calipers cast using a LK DCC630 HPDC machine. Vickers hardness measurements at a cross section of the brake calipers were performed, indicating that similar values can be obtained when using the significantly shorter heat treatment cycles. Finally, the typical tensile properties that can be obtained for SSM-HPDC A356 brake calipers are compared with those manufactured by gravity die casting. Results indicate that the differences in microstructures (globular or dendritic) do not have a noteworthy effect on the heat treatment response. This implies that the short heat treatment cycles originally developed for globular SSM-HPDC A356 castings can be successfully applied to dendritic liquid A356 castings too.

Treatment-induced neuroplasticity following intensive naming therapy in a case of chronic Wernicke's aphasia

Background: Renewed interest in the effects of intensity on treatment has led to development of short-term, intensive treatment protocols, such as Constraint-Induced Language Therapy (CILT), in which participants with chronic aphasia begin to show statistically significant language improvements in as little as 2 weeks. Given its relatively short treatment cycle, CILT is also a good choice of treatment methodology for studying brain/behaviour plasticity in post-stroke aphasia. Aims: This study aimed to examine differences between two short, intensive treatment protocols in a participant with chronic Wernicke's aphasia both in terms of treatment outcomes and changes in patterns of BOLD signal activation. Methods & Procedures: The participant (ACL) participated in language testing and an fMRI overt speech confrontation-naming paradigm pre and post 2 weeks of CILT, post 2 weeks of unconstrained language therapy (PACE), and 6 months post-CILT. He named 48 black/white line drawings from each of four conditions: treated (CILT or PACE), untreated, or consistently correctly named pictures. Outcomes & Results: Naming treated pictures improved, even in the scanner, while naming untreated pictures did not. About one third of PACE and three-fourths of CILT gains were maintained. Rather than a distinct pattern of activation distinguishing treated from untreated or CILT from PACE pictures, ACL recruited a frontal network during naming of all pictures that included left middle and inferior frontal cortex, SMA and pre-SMA, and that varied in spatial extent and degree of activation according to accuracy and performance expectation. In post-hoc analyses of accuracy, this frontal network was most active during incorrect trials. At 6 months post-CILT, compared to controls, incorrect naming recruited a large and significant bilateral network including right Wernicke's area homologue. Conclusions: Results suggest that short, intensive therapy can improve naming and jumpstart language recovery in chronic aphasia, whether responses are constrained to the speech modality or not. Modulation of a left frontal network was associated with accuracy in naming and may represent compensatory adaptation to improve response selection, self-monitoring, and/or inhibition.

Physicochemical treatments of melasma

Pphysicochemical treatments of melasma include intense pulsed light, radiofrequency technology, laser, chemical peeling, etc. Since their short treatment cycle and high efficiency, physicochemical treatments of melasma have attracted more and more attention and considerable progress has been made in this field. Among these treatments, intense pulse light, short wavelength laser and chemical peeling are suitable for the treatment of epidermal type melasma, while mixed type and dermal-type melasma are indications for fractional lasers, long wavelength laser plus short wavelength laser, exfoliative laser and intense pulsed light. Key words: Chloasma; Physical medicine; Chemexfoliation

Short cycle hardening and tempering behaviour of low alloy tool steel 60WCrV7

AbstractThe effect of short heat treatment cycles, typical of induction or laser hardening, on the low alloy steel 60WCrV7, was simulated using a quench dilatometer. The heat treated material was examined using optical and scanning electron microscopy, microhardness testing, X-ray diffraction and microimpact testing. The effects of variation in austenitising time and temperature as well as tempering parameters on the hardness and toughness obtained are reported, and the metallurgical reasons for this behaviour are discussed. The results provide conclusions for optimum rapid cycle heat treatments and reveal significant potential for strongly reduced heat treatment cycles, which may have applications in areas besides surface hardening.

Reluctance of medical professionals in adopting natural-cycle and minimal ovarian stimulation protocols in human clinical assisted reproduction

Recent clinical evidence would suggest that natural cycle and minimal ovarian stimulation protocols in clinical assisted reproduction could be advantageous for younger women with indications for either male-partner or mild female-factor sub-fertility. The benefits include reduced medical fees associated with lower or nil dosages of recombinant gonadotrophins, a shorter treatment cycle and reduced risk of ovarian hyperstimulation syndrome. Additionally, there is also evidence to suggest improved quality of retrieved oocytes and better endometrial receptivity. Nevertheless, fertility clinics and doctors have conflicting interests that make them reluctant to incorporate natural-cycle and minimal stimulation protocols in their treatment programme. Firstly, the use of low or nil dosages of recombinant gonadotrophins would drastically cut profits from drug prescription sales to patients. Secondly, fertility clinics are also concerned by the apparent reduction in success rates for natural-cycle and minimal ovarian stimulation protocols. Moreover, refunding of medical bills by health insurance is usually based on a limited number of attempts, thereby hampering the introduction of natural-cycle and minimal stimulation protocols, which have lower efficacy on a per cycle basis. Lastly, the adoption of natural-cycle and minimal stimulation protocols would drastically reduce the numbers of surplus oocytes and embryos available for donation to other patients.

New protocol for commencing the GnRH antagonist in assisted conception treatment cycles: elimination of the premature LH surge with similar pregnancy rates

GnRH antagonists have been used with increasing frequency in assisted reproduction treatments over the past few years and have been associated with quicker and more profound LH suppression and shorter treatment cycles than conventional GnRH agonists. Usually, these are commenced on day 6 of FSH stimulation without allowing for patient variation in response to treatment. The study was aimed at individualising this protocol to the patients' ovarian response. The control group included 215 treatment cycles where the GnRH antagonist was commenced on day 6 of FSH stimulation. A new individualised protocol was formulated, applied to practice and 172 treatment cycles following that were analysed. The study group had no premature LH surges (LH > 10 iu x mL(-1)) compared to the control group who had a rate of 4.1%. There was also a higher fertilisation and clinical pregnancy rate in the study group (P = 0.06). It is concluded that the new individualised GnRH antagonist protocol eliminates premature LH surges in assisted conception treatment cycles and may improve clinical pregnancy rates compared to the conventional protocol of "day 6 commencement".

Relationship between follicular fluid hormone levels, embryo quality, and maternal age during in vitro fertilization after the short or long protocol with a gonadotropin releasing hormone agonist.

Purpose: To examine the relationship between embryo quality and follicular fluid hormonal level in short and long protocol gonadotrophin releasing hormone agonist treatment cycles. Methods: A total of 90 patients had non-polycystic ovary syndrome (non-PCOS) and 10 had PCOS. A total of 100 subjects underwent in vitro fertilization (IVF). Thirty-six subjects underwent conventional IVF and 64 subjects underwent intracytoplasmic sperm injection (ICSI). The dominant follicles were initially retrieved and a hormonal assay was done. A total of 32 patients underwent a short protocol and 66 patients were treated with the long protocol. Estradiol (E2), progesterone (P4), total testosterone (TTE) and androstenedione (ASG) levels in follicular fluid (FF) were compared in the two treatment groups (short and long protocol), in regard to maternal age and oocyte/embryo quality. Results: The retrieval FF volume was not significantly different between the PCOS and non-PCOS patients; however, P4 was significantly lower with PCOS (P<0.01). Analysis of four different hormone levels was not significantly different between the short and long protocol groups. No significant relationship was found between four hormone levels in regard to oocyte morphology and embryo quality. The levels of P4 of younger women was significantly lower than that of older women; furthermore, a significantly higher TTE and ASG were found in the younger women. Progesterone was found to statistically significantly increase with FF volume. Conclusion: Follicular fluid P4 from the younger group was significantly lower, and TTE and ASG was significantly higher when compared to the older group. Analysis of four different hormone levels revealed no significant difference between the short and long protocol groups. No significant relationship was found between four hormone levels, oocyte morphology, and embryo quality. (Reprod Med Biol 2003; 2: 165-169).

Gonadotropin-releasing hormone antagonists: impact of IVF practice and potential non-assisted reproductive technology applications.

To provide the clinician with updated knowledge of the most recent findings on the clinical use of gonadotropin-releasing hormone antagonists. Gonadotropin-releasing hormone antagonists, which have recently been introduced in clinical practice, cause an immediate suppression of gonadotropin secretion by competitive blocking of pituitary gonadotropin-releasing hormone receptors. Thus, they are effective in preventing the premature luteinizing hormone surges during ovarian stimulation for in-vitro fertilization and may improve the patient's response to lower doses of gonadotropins. Better patient acceptance, shorter treatment cycles and fewer follicles and oocytes are also reported. Data existing so far concerning the necessity of luteal phase support after the use of gonadotropin-releasing hormone antagonists show that it might not be mandatory when used in clomiphene citrate costimulated cycles or in intrauterine insemination cycles. The use of gonadotropin-releasing hormone antagonists seems to be safe for pregnant women and their offspring. All sex-hormone-dependent disorders, currently treated with gonadotropin-releasing hormone agonists, may in future be indications for a gonadotropin-releasing hormone antagonist, including endometriosis, leiomyoma, and breast cancer in women, benign prostatic hypertrophy and prostatic carcinoma in men, and central precocious puberty in children. The vast majority of the available clinical data up till now, however, are in assisted reproduction and prostate cancer. It is expected that the availability of gonadotropin-releasing hormone antagonist will lead to the use of 'softer' ovarian stimulation protocols, which will be shorter, cheaper and safer compared with the conventional protocols.

Monitoring during gonadotrophin-releasing hormone antagonist protocols

The results of the four large industry sponsored multicentre clinical trials comparing gonadotrophin-releasing hormone (GnRH) antagonists and agonists in controlled cycles of assisted reproduction are reviewed from the perspective of implications for monitoring ovarian responses. The simplicity and consistency of antagonist-controlled cycles in normal women indicate that patients in assisted reproduction programmes should undergo fewer assessments and will receive shorter treatment cycles. However, the two-stage pattern of follicular recruitment in antagonist-controlled cycles leads to follicles of different size profiles at the end of the follicular phase compared with those obtained in agonist-controlled cycles (one recruitment process only). Increasing the dose of follicle-stimulating hormone (FSH) may increase oocyte yield, but does not obviate the difference between the two types of cycle. This difference has implications for the criteria used to determine timing of administration of the luteinization signal before oocyte retrieval.

Retention and Outcome at ACI, a Unique Therapeutic Community

A study was conducted of retention and outcome of the first 100 clients at ACI, a therapeutic community in New York City that is unique in its combination of a relatively short treatment cycle, fee for service funding, early reentry, use of guided scream therapy and bonding, and implementation of the Casriel theory of the New Identity Process. Retention rates at 3, 6, 9, and 12 months were 95%, 90%, 86%, and 80%, respectively. Excellent or good outcomes were achieved by 80 clients. Some reasons for these very favorable results are discussed, in terms of previous studies of therapeutic community procedures and results.