Clinically, elderly patients with unresectable bulky hepatocellular carcinoma (HCC) are difficult to manage, especially in those with co-infections of hepatitis B and C virus. Herein, we reported ...such a case treated with radiotherapy (RT) by using combined simultaneously integrated inner-escalated boost and volumetric-modulated arc radiotherapy (SIEB-VMAT). After RT, significant symptoms alleviation and durable tumor control were observed.
At presentation, an 85-year-old male patient complained abdominal distention/pain, poor appetite, and swelling over bilateral lower limbs for 1 month. On physical examination, a jaundice pattern was noted. Laboratory studies showed impaired liver and renal function. Abdominal computed tomography (CT) revealed a 12.5-cm bulky tumor over the caudate lobe of the liver. Biopsy was done, and hepatocellular carcinoma (HCC) was reported histopathologically. As a result, AJCC stage IIIA (cT3aN0M0) and BCLC stage C were classified. Surgery, radiofrequency ablation (RFA), trans-catheter arterial chemoembolization (TACE), and sorafenib were not recommended because of his old age, central bulky tumor, and a bleeding tendency. Thus, RT with SIEB-VMAT technique was given alternatively. RT was delivered in 26 fractions, with dose gradience as follows: 39 Gy on the outer Plan Target Volume (PTV), 52 Gy in the middle PTV, and 57.2 Gy in the inner PTV. Unexpectedly, cyproheptadine (a newly recognized potential anti-HCC agent) was retrospectively found to be prescribed for alleviating skin itching and allergic rhinitis since the last 2 weeks of the RT course (2 mg by mouth Q12h for 24 months).After RT, significant symptoms alleviation and tumor volume reduction were observed for 32 months till multiple bone metastases. Before and after RT, a large tumor volume reduction rate of 88.7% was observed (from 608.4 c.c. to 68.7 c.c.). No severe treatment toxicity was noted during and after RT. The patient died due to aspiration pneumonia with septic shock at 4 months after bone metastases identified.
SIEB-VMAT physically demonstrated double benefits of intratumor dose escalation and extra-tumor dose attenuation. Significant tumor regression and symptoms alleviation were observed in this elderly patient with unresectable bulky HCC. Further prospective randomized trials are encouraged to demarcate effective size of SIEB-VMAT with or without cyproheptadine.
A number of cardiac fluoroscopic interventions have increased rapidly worldwide over the past decade. Percutaneous transluminal coronary angioplasty (PTCA) and stent implantation have become ...increasingly popular, and these advancements have allowed patients to receive repetitive treatments for restenosis. However, these advancements also significantly increase radiation exposure that may lead to higher cumulative doses of radiation. In the present study, a nationwide population-based case-controlled study was used to explore the risk of leukemia after cardiac angiographic fluoroscopic intervention.A total of 5026 patients with leukemia and 100,520 control patients matched for age and sex (1:20) by a propensity score method without any cancer history were enrolled using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan between 2008 and 2010. All subjects were retrospectively surveyed (from year 2000) to determine receipt of cardiac fluoroscopic interventions. Data were analyzed using conditional logistic regression models, and estimated crude and adjusted odds ratios (95% confidence interval).After adjusting for age, gender, and comorbidities, PTCA was found to be associated with an increased risk of leukemia with an adjusted OR of 1.566 (95% CI, 1.282-1.912), whereas coronary angiography alone without PTCA and cardiac electrophysiologic study were not. Our results also showed that an increased frequency of PTCA and coronary angiography was associated with a higher risk of leukemia (adjusted OR: 1.326 to 1.530 all P < 0.05). Gender subgroup analyses demonstrated that men were associated with a higher risk of leukemia compared with women.These results provide additional data in the quantification of the long-term health effects of radiation exposure derived from the cardiac fluoroscopic diagnostic and therapeutic intervention. PTCA alone or PTCA with coronary angiography was associated with an elevated risk of leukemia. Continued follow-up of existing cohorts will be valuable to help assess lifetime risks of cancer.
► An integrated method with the activated sludge model 2d, support vector regression (SVR) and accelerating genetic algorithm (AGA) was developed in this study. ► The integrated model was used to ...simulate and optimize a full-scale Carrousel oxidation ditch wastewater treatment plant. ► The multiple-objective optimization with different weights indexes was used to achieve simultaneous nutrient removal.
A full-scale Carrousel oxidation ditch wastewater treatment plant (WWTP) was simulated and optimized through integrating the activated sludge model 2d (ASM2d), support vector regression (SVR) and accelerating genetic algorithm (AGA). The ASM2d model after calibration and validation with the operating data was used to simulate the process. Operating parameters, including hydraulic retention times (HRTs) of anaerobic, anoxic and aerobic tanks, solids retention time (SRT) and internal recirculation ratio were subjected to optimization using SVR and AGA. The simulation results were normalized and SVR was employed to correlate the operating factors and the effluent quality. Then, the AGA approach was used to obtain the optimal operating conditions. The multiple-objective optimization with different weights indexes was adopted to achieve simultaneous nutrient removal. Compared with the present operating conditions, the HRT of the anoxic tank, the internal recirculation ratio and the SRT should be reduced, while the HRT of the aerobic tank should be prolonged to achieve better effluent quality. Such an integrated approach in this study offers an effective and useful tool to optimize the oxidation ditch process of WWTPs.
Soil microbe plays an important role in carbon cycling, however, the effect of land use on soil microbe remain unclear. In present study, soil samples were collected from a long-term field experiment ...(Pantang Agroecosystem) in subtropical China (established in 1989), including paddy-rice (PR), upland-crop (UC), and paddy rice-upland crop rotation (PU) on soil bacterial (bacteria and Archaea) community structures. The effects of long-term different land uses were determined using terminal restriction fragment length polymorphism (T-RFLP) and quantitative PCR (RT-PCR) of the 16S rRNA gene. The abundance of soil microbial 16S rRNA genes ranged from 2.5 x 10(9)-1.5 x 10(10) copies x g(-1) dry soil. Compared with the PR, UP and UC led to a significant reduction in 16S rRNA genes abundance (P < 0.05). The soil microbial communities were dominated by bacteria such as Proteobacteria (76 and 90 and 327 bp; relative abundance of 47% - 53%) and Chloroflexi (65 bp; relative abundance of 10% - 12%). RDA statistical analys
To evaluate the experience of induction chemotherapy followed by concurrent chemoradiationwith helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC).
Between August 2006 and December 2009, 28 ...patients with pathological proven nonmetastatic NPC were enrolled. All patients were staged as IIB-IVB. Patients were first treated with 2 to 3 cycles of induction chemotherapy with EP-HDFL (Epirubicin, Cisplatin, 5-FU, and Leucovorin). After induction chemotherapy, weekly based PFL was administered concurrent with HT. Radiation consisted of 70 Gy to the planning target volumes of the primary tumor plus any positive nodal disease using 2 Gy per fraction.
After completion of induction chemotherapy, the response rates for primary and nodal disease were 96.4% and 80.8%, respectively. With a median follow-up after 33 months (Range, 13-53 months), there have been 2 primary and 1 nodal relapse after completion of radiotherapy. The estimated 3-year progression-free rates for local, regional, locoregional and distant metastasis survival rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively. The estimated 3-year overall survival was 83.5%. Acute grade 3, 4 toxicities for xerostomia and dermatitis were only 3.6% and 10.7%, respectively.
HT for locoregionally advanced NPC is feasible and effective in regard to locoregional control with high compliance, even after neoadjuvant chemotherapy. None of out-field or marginal failure noted in the current study confirms the potential benefits of treating NPC patients by image-guided radiation modality. A long-term follow-up study is needed to confirm these preliminary findings.
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•Metabolic pathways and corresponding functional microbes are presented.•Main challenges for restricting MCCs are introduced.•Application and suitable operational conditions for ...enhancing MCCs are summarized.•Future research perspective to expand MCCs production scale are discussed.
The fast increase in fossil-based energy consumption has induced continuously rising energy prices and the urgent need for alternative chemicals. Producing medium-chain carboxylates (MCCs) through anaerobic fermentation from organic wastes provides an economical and sustainable strategy to generate renewable chemicals. To better improve MCCs production from open-culture fermentation, a comprehensive analysis of understanding MCCs produce, metabolism, functional microbes, restriction factors and corresponding resolve methods is currently needed. To this end, the formation pathways and functional microbes of MCCs were comprehensively introduced. Then, the restrictive factors and competitive reactions for MCCs production were summarized, followed by the corresponding resolve strategies with appropriate application conditions. The potential research need and future perspective were last suggested according to this review.
Development of nonantibiotic-associated pseudomembranous colitis has been reported in patients receiving chemotherapy. Herein, we report a case of a 70-year-old man with diabetes mellitus and ...hypertension who received concurrent chemoradiation therapy after surgery for stage III pT3N1M0 rectal cancer. After completion of the therapy, the patient presented with a 2-week history of intermittent watery diarrhea (seven to nine times per day). However, the patient was afebrile and laboratory examination revealed no evidence of leukocytosis. Computed tomography disclosed inflammation of the sigmoid colon, infiltrative changes around the anastomotic site, and edematous changes straddling the serosal surface. Colonoscopic examination revealed multiple whitish patches within the radiation field, a finding suggestive of pseudomembranous colitis. No concomitant antibiotics were used during the period of concurrent chemoradiation therapy. Empirical oral metronidazole (500 mg every 8 hours) was administrated for 2 weeks. At the end of this treatment, stool culture was negative for Clostridium difficile. Physicians should be aware of the potential for the development of pseudomembranous colitis following concurrent chemoradiation therapy.
The combination of Glycyrrhizae Radix et Rhizoma and Aconiti Lateralis Radix Preparata can increase efficacy and decrease toxicity. This study started from the phenomena of protein self-assembly in ...the mixed decoction of Glycyrrhizae Radix et Rhizoma with Aconiti Lateralis Radix Preparata. The attenuated mechanism was explored between the combination of Glycyrrhizae Radix et Rhizoma and Aconiti Lateralis Radix Preparata by using the protein of Glycyrrhizae Radix et Rhizoma and aconitine which was the major toxic component of Aconiti Lateralis Radix Preparata. Glycyrrhizae Radix et Rhizoma protein with aconitine could form stable particles which particle mean diameter was (206.2 ± 2.02) nm and (238.20 ± 1.23) nm at pH 5.0 in normal temperature. Through the mouse acute toxicity experiment found that injection of aconitine monomer all mice were killed, and injection of Glycyrrhizae Radix et Rhizoma protein-aconitine particles with the same content of aconitine all mice survived. Survey the stability of Glycyrrhizae Radix et Rhizoma protein-aconitine shows that the colloid particles is stable at room temperature, and it has the possibility to candidate drug carrier. Glycyrrhizae Radix et Rhizoma protein can reduce the toxicity of aconitine through self-assembly.
Anaerobic digestion (AD) is a promising technique for waste management, which can achieve sludge stabilization and energy recovery. This study successfully prepared Fe
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@ceramsite from WAS and ...applied it as an additive in sludge digestion, aiming to improve the conversion of organics to biomethane efficiency. Results showed that after adding the Fe
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@ceramsite, the methane production was enhanced by 34.7% compared with the control group (88.0 ± 0.1 mL/g VS). Further mechanisms investigation revealed that Fe
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@ceramsite enhanced digesta stability by strong buffering capacity, improved sludge conductivity, and promoted Fe (III) reduction. Moreover, Fe
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@ceramsite has a larger surface area and better porous structure, which also facilitated AD performance. Microbial community analysis showed that some functional anaerobes related to AD such as Spirochaeta and Smithella were enriched with Fe
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@ceramsite treatment. Potential syntrophic metabolisms between syntrophic bacteria (Syntrophomonas, associated with DIET) and methanogens were also detected in the Fe
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@ceramsite treatment AD system.
利用植物化感作用抑制藻类具有生态安全和灵敏高效等优点,对水体富营养化的生态控制具有极其重要的意义。本文研究了利用植物化感作用抑藻的进展,从化感物质对藻细胞光合作用、酶活性、细胞膜、细胞超微结构、基因表达的影响方面探究了植物化感抑藻作用的机理。并分别就水生植物和陆生植物中提取的各类化感抑藻物质的抑藻效果进行分析比较,尤其探讨了木本植物抑藻的潜在价值,为开发新的抑藻剂提供理论指导。本文还针对目前的研究现状,提出植物抑藻领域存在的问题及前景展望。 The use of plant allelopathy for inhibiting harmful algae,with the advantages of high efficiency and sensitivity to algae controlling and ecological security to aquatic organisms,will play a significant role on ecological control of water eutrophication. The advance research on allelopathy effects of plants for inhibiting harmful algae was introduced,in which the mechanisms of algal-inhibition were analyzed from aspects of photosynthesis,enzyme activities,cell mem brane,cell ultrastructure,gene expression. And the effect of allelochemical extracting from the aquatic plants and terrestrial plants on anti-algae was compared,especially the value of woody plants was explored,which would provide the theory guide for developing new algicide. The probroms of allelophathy of plants on algae were po
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