Dosimetric risk factors for radiation esophagitis in patients with breast cancer following regional nodal radiation

BACKGROUND Radiation esophagitis(RE)is one of the most common clinical symptoms of regional lymph node radiotherapy for breast cancer.However,there are fewer studies focusing on RE caused by hypofractionated radiotherapy(HFRT).AIM To analyze the clinical and dosimetric factors that contribute to the development of RE in patients with breast cancer treated with HFRT of regional lymph nodes.METHODS Between January and December 2022,we retrospectively analysed 64 patients with breast cancer who met our inclusion criteria underwent regional nodal intensity-modulated radiotherapy at a radiotherapy dose of 43.5 Gy/15F.RESULTS Of the 64 patients in this study,24(37.5%)did not develop RE,29(45.3%)developed grade 1 RE(G1RE),11(17.2%)developed grade 2 RE(G2RE),and none developed grade 3 RE or higher.Our univariable logistic regression analysis found G2RE to be significantly correlated with the maximum dose,mean dose,relative volume 20-40,and absolute volume(AV)20-40.Our stepwise linear regression analyses found AV30 and AV35 to be significantly associated with G2RE(P<0.001).The optimal threshold for AV30 was 2.39 mL[area under the curve(AUC):0.996;sensitivity:90.9%;specificity:91.1%].The optimal threshold for AV35 was 0.71 mL(AUC:0.932;sensitivity:90.9%;specificity:83.9%).CONCLUSION AV30 and AV35 were significantly associated with G2RE.The thresholds for AV30 and AV35 should be limited to 2.39 mL and 0.71 mL,respectively.

Study on pharmacodynamics and mechanism of nano-Kuiyangye in treating radiation esophagitis in rats

Objective:To explore the curative effect of nano-Kuiyangye on radiation esophagitis in Wistar rats,and to explore its possible mechanism.Methods:Wistar rats were irradiated locally with 30Gy rays to establish an animal model of radiation esophagitis in rats.After irradiation,nano-Kuiyangye,traditional Chinese medicine ulcer solution,Kangfuxin solution,nano-hydrotalcite matrix,and distilled water were used to intervene continuously for 7 d,during which the body weight and food intake of the rats were recorded.On day 7,blood was collected from the abdominal aorta under anesthesia,and the serum was obtained by centrifugation.The expression levels of pain-related factors prostaglandin-2(PGE-2),substance P(SP),and calcitonin gene-related peptide(CGRP)were detected by ELISA.Rats were sacrificed after blood collection,and full-length esophageal tissues were taken.Hematoxylin-eosin(HE)staining was performed to analyze the pathological changes of the rat esophagus,and Western Blotting was used to detect the expression of nuclear factor-κB(NF-κB)inflammatory protein.Results:Compared with the control group,the total food intake and body weight of the rats within 7 d after modeling were significantly decreased(P<0.05),and the expressions of pain-related factors PGE-2,SP,and CGRP were higher than those of the control group(P<0.05).,the esophageal pathological damage score increased(P<0.05),and the expression of NF-κB inflammatory protein increased(P<0.05);after treatment,the total food intake of the rats in the nano-Kuiyangye intervention group within 7 days after modeling was higher than that in other groups(P<0.05),the expressions of pain-related factors PGE-2,SP,and CGRP were lower than those in the model group(P<0.05),the esophageal pathological damage score was lower(P<0.05),and the expression of NF-κB inflammatory proteins was lower(P<0.05).Conclusion:Nano-Kuiyangye increases the food intake of rats with radiation esophagitis,reduces esophageal tissue damage,and reduces the concentration of serum pain factors;the anti-inflammatory effect of nano-Kuiyangye may be related to the reduction of NF-κB inflammatory factor levels.

Suppressive effect of dexamethasone on the neutrophil expression of CD18 in rats with radiation induced brain edema

BACKGROUND： Stereo-tactic radiation therapy （SRT） is widely used to treat intracranial diseases, but some patients suffered from radiation induced brain edema after SRT. Once radiation induced brain edema occurs, the treatment is quite difficult, and it always leads to a poor outcome. Dexamethasone has certain therapeutic effect on traumatic brain edema, but the biological mechanism is still unclear. OBJECTIVE ： To observe the effect of dexamethasone on the neutrophil expression of CD18.DESIGN ： A randomized control observation.SETTING： Changhai Hospital of the Second Military Medical University of Chinese PLA. MATERIALS ： The experiment was carried out in Changhai Hospital of the Second Military Medical University of Chinese PLA from January 1999 to December 1999. Twenty SD rats （male and female each in half） weighing （250±50） g were used. METHODS： Twenty SD rats were divided into four groups at random. ① Blank control group （n=5）： The rats were not treated without dexamethasone or irradiation;② Irradiation group （n=5）： The rats were given irradiation but no dexamethasone treatment; ③ Irradiation＋1 mg/kg dexamethasone group （n=5）; The rats were treated with irradiation and dexamethasone of 1 mg/kg; ④Irradiation＋5 mg/kg dexamethasone group （n=5）： The rats were treated with irradiation and dexamethasone of 5 mg/kg. The heads of the rats were irradiated with 10 MeV X-ray （30 Gy）, and brain tissue was removed after 2 weeks to observe the pathological changes. Blood samples were taken from the carotid artery, gradient centrifugation was used, and neutrophile layer was obtained, the level of neutrophile expression of CD18 mRNA and quantity of membrane proteins in blood were detected with Northern blot and flow cytometry respectively. MAIN OUTCOME MEASURES： ① Blood cell count; ② Pathological results; ③ level of neutrophile expression of CD18 mRNA and quantity of membrane proteins. RESULTS ： All the 20 SD rats were involved in the analysis of results without deletion. At 2 weeks after irradiation, obvious cell injury could be observed under light microscope. The level of neutrophile expression of CD18 mRNA and quantity of membrane proteins in blood were obviously increased, but the severity of cell injury was relieved in the irradiation＋1 and 5 mg/kg dexamethasone groups, and the CD18 expression was markedly suppressed （P 〈 0.05）, and the suppression was more obvious in the irradiation＋5 mg/kg dexamethasone group than in the irradiation＋1 mg/kg dexamethasone group （P 〈 0.01 ）. CONCLUSION： Dexamethasone can reduce the radiation induced brain edema by inhibiting the expression of CD18.

Significance of radiation esophagitis:Conditional survival assessment in patients with non-small cell lung cancer

Purpose:This study aimed to examine the effect of radiation esophagitis(RE)and the dynamics of RE on subse-quent survival in non-small cell lung cancer(NSCLC)patients who underwent radiotherapy.Experimental Design:Patients with NSCLC treated with fractionated thoracic radiotherapy enrolled in prospective trials were eligible.RE was graded prospectively according to Common Terminology Criteria for Adverse Events(CTCAE)v3.0 per protocol requirement weekly during-RT and 1 month after RT.This study applied conditional survival assessment which has advantage over traditional survival analysis as it assesses the survival from the event instead of from the baseline.P-value less than 0.05 was considered to be significant.The primary endpoint is overall survival.Results:A total of 177 patients were eligible,with a median follow-up of 5 years.The presence of RE,the maximum RE grade,the evolution of RE and the onset timing of RE events were all correlated with subsequent survival.At all conditional time points,patients first presented with RE grade1(initial RE1)had significant inferior subsequent survival(multivariable HRs median:1.63,all P-values<0.05);meanwhile those with RE progressed had significant inferior subsequent survival than those never develop RE(multivariable HRs median:2.08,all P-values<0.05).Multivariable Cox proportional-hazards analysis showed significantly higher C-indexes for models with inclusion of RE events than those without(all P-values<0.05).Conclusion:This study comprehensively evaluated the impact of RE with conditional survival assessment and demonstrated that RE is associated with inferior survival in NSCLC patients treated with RT.

Clinical Evaluation of Yangyin Qingre Shengji Decoction(养阴清热生肌汤)in Preventing and Treating Acute Radiation Esophagitis

Objective:To explore the prevention and treatment effect of Yangyin Qingre Shengji Decoction(养阴清热生肌汤)on acute radiation esophagitis.Methods:From May 2020 to February 2021,60 patients with malignant tumor who underwent radiotherapy were selected as the research objects.They were divided into two groups by odd and even number drawing,30 cases in the control group and 30 cases in the observation group.The control group took mixed solution orally,while the observation group took Yangyin Qingre Shengji Decoction.The clinical effects,occurrence time,duration,grading of acute radiation esophagitis and TCM syndrome scores of dry mouth and constipation were compared between the two groups.Results:The effective rate of the observation group was significantly higher than that of the control group(P<0.05);Compared with the control group,the time of acute radiation esophagitis was prolonged and the duration of symptoms was shortened in the observation group(P<0.05);The incidence of above gradeⅡin the observation group was significantly lower than that in the control group,and the incidence of below gradeⅠwas significantly higher than that in the control group(P<0.05);There was no significant difference in the scores of dry mouth and constipation between the two groups before treatment(P>0.05),the scores of the two groups were decreased after treatment,and the observation group was lower than the control group(P<0.05).Conclusion:Yangyin Qingre Shengji Decoction(养阴清热生肌汤)has a positive effect on prevention and treatment of acute radiation esophagitis in patients with malignant tumor undergoing radiotherapy,which can be popularized.

An isolate alpha-fetoprotein producing gastric cancer liver metastasis emerged in a patient previously affected by radiation induced liver disease

We report a case of an isolated hepatic neoplasia which originated in a site of the liver previously affected by radiation induced liver disease (RILD) in a patient resected for gastric cancer and referred to us for high serum alpha-fetoprotein (AFP) levels. This case challenged us in distiguishing, even histologically, between primary liver cancer and AFP producing gastric cancer metastasis. Only a panel of immunohis-tochemical markers allowed the definitive diagnosis of liver metastasis of endodermal stem cell-derived and AFP producing gastric cancer. We discuss the criteria for a differential diagnosis, as well as the possible link between RILD and emergence of liver neoplasia.

Effect of nano-SiO_2 films on the electron radiation induced conductivity of polyimide

The radiation induced conductivity （RIC） behaviors in nano-SiO2 deposited polyimide （PI） were investigated using the in situ measurement technique. The results indicate that, by comparison with the case of virgin polyimide, the RIC in nano-SiO2/polyimide shows low steady state values. Moreover, the steady state RIC is a power function of the dose rate with a power index of 0.659, lower than that of 0.76 in the virgin polyimide. The interfacial barrier and trapping effects are the main reasons for the change. Meanwhile, both of the interfacial effects also result in a unipolar carrier transportation mechanism in nano-SiO2 deposited PI from the dipolar one in the virgin PI. The mechanisms of the RIC behaviors are discussed in the paper.

3-49 X-ray Radiation Induced Caspase-8 and Caspase-9 Activation in Human Colon Cancer Cells

Caspases as critical components in cell signaling pathways have been proved to be involved in events such asapoptosis, cell growth and differentiation. Two distinct apoptotic pathways related to the Caspase cascade have beenidentified; death receptor-induced apoptosis and mitochondrial stress-induced apoptosis. Death receptors triggerCaspase-8 and the mitochondria subsequently release apoptogenic factors (cytochrome c, Apaf-1, AIF), leading tothe activation of Caspase-9. The mitochondrial and death receptor apoptotic pathways are intimately connected[1].

3-48 High-LET Radiation Induced Mitophagy and Mitochondrial Apoptosis in Breast Cancer Cells

To elucidate mitochondrial damage induced by high-LET radiation, human breast cancer MDA-MB-231 andMCF-7 cells were irradiated with carbon ions of 75 keV/m at different doses. Mitochondrial ΔΨm was stainedby JC-1 and measured by means of flow cytometry at 1, 4 and 24 h after irradiation, respectively. We found thatΔΨm had no or a slight change when the radiation dose was as low as about 0.2 or 0.5 Gy at any time point whiledissipating at higher doses in MDA-MB-231 cells (Fig. 1). This suggests that the mitochondrial membrane potential had no significant change under low stress conditions.However, high levels of cell stress led to the serious mitochondrialdysfunction.

3-74 miR-21 May Take Part in Medium-mediated Radiation Induced Bystander Effects

It is now well accepted that ionizing radiation (IR) induces DNA damage responses in cells that are not hit directly by IR[1]. The irradiated cells are capable of transmitting signals into the neighboring cells through gap junction and/or culture medium, resulting in a series of biological responses in non-irradiated cells. These responses are termed as radiation induced bystander effects (RIBE), which have been identified both in vitro and in vivo[2].

ELECTRON RADIATION INDUCED VOID SWELLING AND GRAIN BOUNDARY SEGREGATION IN AN Fe-Cr-Mn AUSTENITIC ALLOY

The behavior of void swelling and segregation in Fe-15Cr-xMn alloys and an alloy con- taining small amount of W and V was investigated by electron-irradiation.The compositional analysis in the irradiated regions including grain boundaries was performed.The resultdts show that there are many common features of irradiuation tehavior in the Fe-Cr-Mn and Fe-Cr-Ni systems while there are some significant differences,In the Fe-Cr-Mn alloy sys- tems void swelling was rematrkably suppressed and at the same time the radiation-induced segregation was also retarded,furthermore,the segregation was strongly retarded in an Fe-15Cr-15Mn alloy containing small amount of W and V.The results also show that Ni re- placed by Mn does not in general confer immunity from either swelling or phase instabilities. The phase instability is due to the different diffusion behavior of Ni and Mn in reponse to the operation of the inverse-Kirkendall effecr.Fe segregates to the microstructural sinks in the Fe-Cr-Mn alloys.The segregation of Fe often leads to the formation of ferrite.This fact is beneficial to reducing the swelling rate and segregation on the grain boundaries.

Effect of Compound Zhuye Shigao Granule(复方竹叶石膏颗粒)on Acute Radiation-Induced Esophagitis in Cancer Patients:A Randomized Controlled Trial

Objective： To observe the efficacy and safety of the Chinese medicine（CM） Compound Zhuye Shigao Granule（复方竹叶石膏颗粒, CZSG） on acute radiation-induced esophagitis（ARIE） in cancer patients. Methods： In a blinded, randomized, Kangfuxin Solution（康复新液, KFX）-controlled, single-centre clinical trial, 120 patients with lung, esophagus or mediastinal cancer were prospectively enrolled and assigned to the treatment group（60 cases） and control group（60 cases） by the random number table method. All patients received concurrent or sequential radiotherapy（2 Gy per day, 5 times per week, for 4 weeks） and were treated for 4 weeks since the radiation therapy. Patients in the treatment group were given 12 mg CZSG orally, thrice daily, while patients in the control group were given 10 m L KFX orally, thrice daily. The major indicators were observed, including the incidence and grade of esophagitis, time of occurrence and duration. Minor indicators were changes of CM symptoms, weight and Karnofsky Performance Status（KPS） Scale during 4 weeks from the beginning, recorded once a week. Blood routine examination and hepatorenal function were detected at the 2nd and 4th weeks. Results： The incidence and grade of ARIE were significantly decreased in the treatment group compared with the control group（P〈0.05）. CZSG appeared to significantly delay the time of ARIE occurrence and reduce the duration compared with KFX（P〈0.05）. The scores of CM symptoms, KPS and weight were improved significantly in the treatment group compared with the control group（P〈0.05）. There were no blood routine and hepatorenal function abnormal or obvious side-effects in both groups. Hemoglobin was improved and neutrophil and interleukin 6 were decreased in both groups after 4-week treatment compared with before treatment（P〈0.05）, and there was no significant difference between the two groups（P〉0.05）. Conclusions： CZSG can decrease the incidence and grade of ARIE, delay the time of occurrence, reduce duration and alleviate the damage of ARIE. It is safe and effective in the prevention and cure of ARIE.

Biomarkers Associated with Radiation-Induced Lung Injury in Cancer Patients

Radiotherapy (RT) is a common and effective non-surgical treatment for thoracic solid tumors, and radiation-induced lung injury (RILI) is the most common side effect of radiotherapy. Even if RT is effective in the treatment of cancer patients, severe radiation pneumonitis (RP) or pulmonary fibrosis (PF) can reduce the quality of life of patients and may even lead to serious consequences of death. Therefore, how to overcome the problem of accurate prediction and early diagnosis of RT for pulmonary toxicity is very important. This review summarizes the related factors of RILI and the related biomarkers for early prediction of RILI.

Mechanism of Thermally Radiative Prandtl Nanofluids and Double-Diffusive Convection in Tapered Channel on Peristaltic Flow with Viscous Dissipation and Induced Magnetic Field

The application of mathematical modeling to biological fluids is of utmost importance, as it has diverse applicationsin medicine. The peristaltic mechanism plays a crucial role in understanding numerous biological flows. In thispaper, we present a theoretical investigation of the double diffusion convection in the peristaltic transport of aPrandtl nanofluid through an asymmetric tapered channel under the combined action of thermal radiation andan induced magnetic field. The equations for the current flow scenario are developed, incorporating relevantassumptions, and considering the effect of viscous dissipation. The impact of thermal radiation and doublediffusion on public health is of particular interest. For instance, infrared radiation techniques have been used totreat various skin-related diseases and can also be employed as a measure of thermotherapy for some bones toenhance blood circulation, with radiation increasing blood flow by approximately 80%. To solve the governingequations, we employ a numerical method with the aid of symbolic software such as Mathematica and MATLAB.The velocity, magnetic force function, pressure rise, temperature, solute (species) concentration, and nanoparticlevolume fraction profiles are analytically derived and graphically displayed. The results outcomes are compared withthe findings of limiting situations for verification.

Effect of Modified Zhuye Shigao Decoction(加味竹叶石膏汤) and Its Components on Preventing Radiation Esophagitis of Rats

Objective： To investigate the effect of Modified Zhuye Shigao Decoction （加味竹叶石膏汤, MZSD） and its components on preventing radiation esophagitis of rats. Me,otis： One hundred Wistar rats were randomly divided into 5 groups, including the control group, radiation model group, MZSD group, Zhuye Shigao Decoction （竹叶石膏汤, ZSD） group, and added ingredients group, 20 rats in each group. The model of radiation esophagitis of rat was established by once local radiation of 40 Gy （330 Mu/min） with a high energy linear accelerator. The administration of Chinese medicine was continued for 14 days from 7 days before radiation application in the three treatment groups. On the 7th and 14th day, the serum was isolated and the levels of inflammatory cytokines tumor necrosis factor （TNF-α）, interleukin 1 β （IL-1 β） and IL-8 were tested. The pathological slices of esophagus were obtained, and the pathological changes were observed. During the whole process, weight and food intake were recorded each day. Resale： On the 7th day after radiation, the esophagus of rats in the MZSD group was almost intact, and the pathological injury score was significantly lower than that of the radiation model group, ZSD group and added ingredients group （P〈0.01）. Compared with the control group, the body weight and food intake of rats in the radiation model group were significantly decreased, and the levels of TNF-α, IL-1 β and IL-8 were significantly increased （P〈0.05 or P〈0.01）, while the MZSD group showed a significant increase in body weight and food intake, and a significant decrease in the levels of TNF- α, IL-1 β and IL-8 compared with the radiation model group, ZSD group and added ingredients group （P〈0.05 or P〈0.01）. Conclusion： MZSD prevents the development of radiation esophagitis probably by inhibiting the generation and release of the inflammatory cytokines TNF- α, IL-1βand iL-8.

Meta-analysis of Chinese Medicines for prevention and treatment of radiation esophagitis

OBJECTIVE:To systematically assess the clinical effectiveness of Chinese medicines for prevention and treatment of radiation esophagitis by meta-analysis.METHODS:The articles were mainly retrieved from the "CHKD(China Hospital Knowledge Database) periodical full text databank",the "China periodical full text databank",the "CHKD doctor's and Master's degree student full text databank",and the "China doctor's degree student thesis databank",and they were selected according to the literature selection standard.The effects of Chinese medicines and Western medicines on radiation esophagitis were compared by meta-analysis.RESULTS:Based on 13 articles,we found that the effectiveness of Chinese medicines for prevention and treatment of radiation esophagitis was superior to Western medicines,with no obvious side effects.Meta-analysis showed that the total odds ratio was 0.426 and the 95% confidence interval was 0.368,0.493.CONCLUSION:Chinese medicines are superior to Western medicines in preventing and treating radiation esophagitis.However,some methodological problems in the literature may have affected the authenticity of the results.Therefore,more rigorous,multi-central,randomized controlled trials with a large sample size should be designed to obtain a more reliable conclusion.

ESTABLISHMENT OF DIFFERENTIAL DISPLAY mRNA AND ITS APPLICATION IN THE STUDY ON THE MECHANISM OF LUNG CANCER INDUCED BY RADIATION

Objective: A method for separating mRNAs by means of the polymerase chain reaction (differential display mRNA), and identifying the genes related to radiation-induced lung cancer was introduced. Methods: The RNAs were isolated from two pairs of samples, SV40-immortalized human fetal tracheal fibroblast cell (SHTF) versus αSHTF cell (transformed SHTF cell induced by α particles) and lung cancer tissue versus normal lung tissue obtained from one miner, and amplified by RTPCR. The differential expressed gene fragments were displayed by autoradiograph or silver nitrate stain. Results: The differential display mRNA method was established using both cell and tissue samples. The bands stained by silver nitrate were clearer than those on X-ray film. The rate of reamplification of differentially expressed gene fragments stained by silver nitrate is 80%, higher than that by autoradiograph, 50%. Conclusion: Differential display mRNA method was established successfully on both cell and tissue samples. The modified method for staining band increased the rate of reamplification and established the basis for confirming relative genes.

A Modified Monte Carlo Model of Speckle Tracking of Shear Wave Induced by Acoustic Radiation Force for Acousto-Optic Elasticity Imaging

A modified Monte Carlo model of speckle tracking of shear wave propagation in scattering media is proposed. The established Monte Carlo model mainly concerns the variations of optical electric field and speckle. The two- dimensional intensity distribution and the time evolution of speckles in different probe locations are obtained. The fluctuation of speckle intensity tracks the acoustic-radiation-force shear wave propagation, and especially the reduction of speckle intensity implies attenuation of shear wave. Then, the shear wave velocity is estimated quantitatively on the basis of the time-to-peak algorithm and linear regression processing. The results reveal that a smaller sampling interval yields higher estimation precision and the shear wave velocity is estimated more efficiently by using speckle intensity difference than by using speckle contrast difference according to the estimation error. Hence, the shear wave velocity is estimated to be 2.25 m/s with relatively high accuracy for the estimation error reaches the minimum （0.071）.

Effect of Cycloheximide on the Adaptive Response Induced by Low Dose Radiation

Human lymphocytes pre-exposed to 10 mGy or 50 mGy of X-rays become less sensitive to subsequent large dose irradiation, exhibited lower rate of chromosome aberration than expected. This adaptive response could be inhibited by cycloheximide, a protein synthesis inhibitor for successive 2 h period ranging from 0.5h before to 4h after the low dose exposure, indicating that the adaptive response was directly related with the protein synthesis.

Radiation-induced osteosarcoma of the maxilla and mandible after radiotherapy for nasopharyngeal carcinoma

Background:The increasing incidence of radiation-induced osteosarcoma of the maxilla and mandible(RIOSM) has become a significant problem that can limit long-term survival.The purpose of this study was to analyze the association of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma(NPC).Methods:We reviewed the medical records of 53,760 NPC patients admitted to Sun Yat-sen University Cancer Center during the period August 1964 to August 2012.Of these patients,47 who developed RISOM and met inclusion criteria were included in this study.Two of these 47 patients refused treatment and were then excluded.Results:For all patients treated for NPC at Sun Yat-sen University Cancer Center during the study period,the total incidence of RIOSM after radiotherapy was 0.084%(47/53,760).Two patients(4.4%) had metastases at the diagnosis of RIOSM.Thirty-nine of the 45(86.7%) patients underwent surgery for RIOSM;most patients(24/39;61.5%) who underwent resection had gross clear margins,with 15 patients(38.5%) having either a gross or microscopic positive margin.All patients died.The 1-,2-,and 3-year overall survival(OS) rates for the entire cohort of 45 patients were 53.3%,35.6%and 13.5%,respectively.The independent prognostic factors associated with high OS rate were tumor size and treatment type.Conclusions:RISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely intervention.Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.