Impact on Pulmonary Function in a Randomized Trial of Single-Fraction and Multifraction Stereotactic Body Radiation Therapy for Pulmonary Oligometastatic Disease: An Analysis of TROG 13.01 (SAFRON II).

PURPOSE: The TROG 13.01 (SAFRON II) trial was a phase 2 multicenter trial comparing single-fraction (SF) and multifraction (MF) stereotactic body radiation therapy. Patients with 1 to 3 peripheral pulmonary oligometastases were randomized 1:1 between 28 Gy in 1 fraction and 48 Gy in 4 fractions. There were no differences between arms in efficacy or toxicity. We performed an analysis to assess changes in pulmonary function tests (PFTs) between arms over time and assessed the effect of the number and total volume of targets on PFT change over time. METHODS AND MATERIALS: A linear mixed model was used to describe the PFTs by treatment arm over time. The effect of number and volume of targets on PFTs at 6 and 12 months was assessed by a simple linear model. RESULTS: Ninety patients were randomized; 87 were treated for 133 pulmonary oligometastases. Forty-four were randomized to the SF arm and 43 to the MF arm. There were no differences in absolute or relative PFT measures of forced expiratory volume in 1 second (FEV1), diffusing capacity of the lungs for carbon monoxide (DLCO), or forced vital capacity (FVC) between the 2 arms. At 12 months, there was a reduction in absolute DLCO from baseline (-1.7 mL/min/mm Hg [95% CI, -2.5 to -1.0]), relative DLCO (-5.5% [95% CI, -8.4% to -2.6%]), absolute FEV1 (-0.17 L [95% CI, -0.23 to -0.11]), and absolute FVC (-0.20 L [95% CI, -0.27 to -0.13]). In patients with multiple pulmonary targets, increase in target number (per lesion) was associated with a reduction in the absolute FEV1 at 6 months of -0.10 L (95% CI, -0.18 to -0.03; P = .007), FEV1 at 12 months of -0.10 L (95% CI, -0.20 to -0.01; P = .04), FVC at 6 months of -0.11 L (95% CI, -0.20 to -0.03; P = .014), and FVC at 24 months of -0.13 L (95% CI, -0.25 to -0.01; P = .036). Reduction in FEV1 was also seen per 10-mL increase in PTV at 12 months (-0.03 L [95% CI, -0.06 to -0.00], P = .036). The number of targets and PTV were not associated with DLCO. CONCLUSIONS: Treating multiple targets resulted in increased loss of FEV1 and FVC but not DLCO. There were no significant differences in PFT decline between SF and MF stereotactic body radiation therapy.

Artabotrys pachypetalus (Annonaceae), a new species from China.

Artabotrys pachypetalus sp. nov. is described from Guangdong, Guangxi, Guizhou, Hunan and Jiangxi in China. A detailed description, distribution data, along with a color plate and a line drawing are provided. In China, specimens representing this species were formerly misidentified as A. multiflorus or A. hongkongensis (= A. blumei). Artabotrys blumei typically has a single flower per inflorescence, whereas both Artabotrys pachypetalus and A. multiflorus have multiple flowers per inflorescence. In addition, A. pachypetalus is readily distinguished from A. multiflorus in having thicker and shorter petals, and connivent and somewhat trigonal or terete inner petal blades. Artabotrys pachypetalus is most similar to A. punctulatus because both have multi-flowered inflorescences and similar petal length, but A. pachypetalus differs in having cream petals in vivo, connivent inner petal blades, and a short, raised rim above the inner petal claw. Artabotrys multiflorus should be excluded from the flora of China because none of the Chinese specimens of Artabotrys collected so far fall within the variation of A. multiflorus.

Tigridiopalma exalata, a new and endangered species of Melastomataceae from China.

A new species of the genus Tigridiopalma, formerly considered monotypic, is here described as T. exalata and illustrated based on molecular and morphological evidence. It is morphologically similar to T. magnifica in having a short stem, huge basal leaves, scorpioid cymes, and 5-merous flowers, but differs in having ribbed and pale yellow puberulent petioles, purple petals with a small white apical patch, connectives of longer stamens with a distinct dorsal short spur at their base, and wingless capsules. Due to the restricted distribution, small populations and horticultural potential of this new species, it should be categorized as an Endangered species (EN).

Morphology and molecules support the new monotypic genus Fenghwaia (Rhamnaceae) from south China.

Fenghwaia, a new monotypic genus, along with the new species Fenghwaia gardeniicarpa, is described from Guangdong Province, China. The combined features of inferior ovary, cylindrical drupaceous fruits and orbicular and dorsiventrally-compressed seeds with an elongate and pronounced basal appendage make the new genus significantly different from other genera of the family. In addition, its pollen morphology also showed great similarity to other species of this stenopalynous family. The molecular phylogenetic analysis, based on nuclear ribosomal internal transcribed spacer (ITS) and plastid trnL-F intron spacer (trnL-F) DNA sequence data from the new genus and the other 375 species representing 58 genera of Rhamnaceae, indicates that Fenghwaia is nested within the 'rhamnoid' group and sister to the tribe Rhamneae and then both sister to the tribe Maesopsideae. A taxonomic classification key to the 'rhamnoid' group is provided, based on morphological characters. A global conservation assessment is also performed and classifies Fenghwaia gardeniicarpa as Near Threatened (NT).

Incidence of hippocampal metastases in non-small-cell lung cancer.

OBJECTIVES: Patients with locally advanced non-small-cell lung cancer (LA-NSCLC) develop brain metastases in 25-50% of cases during the course of their disease. Data on the incidence of metastases occurring in the hippocampus/perihippocampal zones are limited. This is important when considering hippocampal-sparing brain radiation (HS-BR), a method that could potentially reduce the neurocognitive impact of such treatment. The aim of this study was to assess the incidence of hippocampal/perihippocampal metastases in a cohort of patients with advanced NSCLC treated at our institution. METHODS: This retrospective cohort study included NSCLC patients discussed at our institutional lung cancer multidisciplinary meeting between 2000 and 2016. MRI and contrast-enhanced CT (ceCT) brain images were reviewed to assess the incidence of hippocampal/perihippocampal metastases including metastases within the hippocampal subgranular zone and a 5 mm margin (hippocampal avoidance region) defined as per the RTOG 0933 study. RESULTS: Of 2146 patients reviewed, 357 (16.6%) had brain metastases. A total of 335 patients had available MRI/ceCT brain images for review. Thirty (9%) patients had brain metastases in the hippocampal avoidance region, 8 (2.4%) with hippocampal metastases and 22 (6.6%) with perihippocampal metastases. Univariate analyses did not show an association between developing metastases in the hippocampal avoidance region and age (P = 0.75), gender (P = 0.91) and tumour type (P = 0.298). CONCLUSION: The incidence of metastases in the hippocampal avoidance region in our large cohort of patients was 9%. With low rates of metastases in this region, HS-BR can be considered a feasible option in the management of patients with advanced NSCLC.

Nutritional and Functional Properties of Wild Food-Medicine Plants From the Coastal Region of South China.

Food-medicine plants play an important role in providing nutrition and treating chronic diseases, especially in many minority communities and developing regions. The coastal region of South China has abundant resources of medicinal plants. A long history of cross-cultural medicinal practices among different minority groups has facilitated the development of a remarkable dietary culture by using food-medicine plants. However, integrative ethnobotanical research on both nutritional and functional properties of the food-medicine plants in this region is still limited. In this study, 27 commonly used wild food-medicine plants were recorded and analyzed from the coastal region of South China. Most of them are good sources for calcium (47.83-1099.89 mg/100 g fresh weight), dietary fiber (3.00-31.87 mg/100 g fresh weight), iron (1.17-24.73 mg/100 g fresh weight), and vitamin C (0.44-68.32 mg/100 g fresh weight). Solanum americanum has the highest average nutritive value and is also considered to be good sources for proteins (7.90 g/100 g fresh weight). Medicinal properties of the studied species can be classified into 8 categories: treatment of the damp-heat syndrome, digestive diseases, urologic diseases, arthropathy, respiratory diseases, gynecological diseases, snake or insect bites, and uses as a tonic. Treating the damp-heat syndrome or expelling warm pathogenic factors is the most commonly used ethnomedicinal practice in the study area. The present study highlights that the local ethnomedicinal practices are deeply influenced by local natural conditions and customs. Food-medicine plants with superior key nutrients have been used regularly in the diet as medicinal food to alleviate common endemic diseases.

Development of microsatellite markers for a monotypic and globally endangered species, Glyptostrobus pensilis (Cupressaceae).

PREMISE OF THE STUDY: Microsatellite markers were developed to facilitate studies of genetic diversity and structure in Glyptostrobus pensilis, a critically endangered and monotypic conifer species. METHODS AND RESULTS: Using restriction site-associated DNA sequencing (RAD-Seq), we developed 10 polymorphic and 27 monomorphic microsatellite markers. Polymorphism was characterized using 333 individuals from nine populations. The number of alleles per locus ranged from one to 14 at the population level. The levels of observed and unbiased expected heterozygosities varied from 0.058 to 0.844 and 0.219 to 0.583, respectively. Nine of these 10 polymorphic markers were successfully cross-amplified in Taxodium distichum, the species most closely related to G. pensilis. CONCLUSIONS: These microsatellite markers can be used to reveal the genetic diversity in existing populations of G. pensilis, enabling its conservation and restoration.

Deep inspiration breath hold in breast cancer: Development and analysis of a patient experience questionnaire.

INTRODUCTION: Evidence that Deep Inspiration Breath Hold (DIBH) can reduce cardiac dose during left-sided breast radiation therapy (RT) has led to widespread uptake of this technology. There is a paucity of published information documenting the impact of this technique on the patient's treatment experience. The aim of this study was to develop a tool to assess the patient's experience with the introduction of DIBH using the Elekta® Active Breathing Coordinator (ABC) in a single institution. METHODS: A patient experience questionnaire was developed and was completed at three different stages of the patient's treatment; at planning, during the second week of treatment (day 6-10) and during the final week of treatment. RESULTS: Questionnaire data were collected from 30 patients, who underwent DIBH breast treatment during the period March 2016 to May 2017. Patients were very happy with their use of the ABC equipment and most felt they were well supported and informed during their treatment. Levels of general fatigue and personal anxiety were identified to significantly increase from planning to the conclusion of treatment (P = 0.002 and P < 0.001 respectively). CONCLUSIONS: This study produced a useful tool to measure patient experience during DIBH treatment. It demonstrated that the use of the technique was acceptable to patients and did not increase their distress. It provided a compelling case for the provision of tailored, well-communicated information, consistent routine and emotional support for patients throughout their entire treatment. The tool could be employed to assess the patient experience as new technologies are introduced into RT.

[Multi-point fixation with absorbable cartilage screws for the treatment of osteochondral fracture caused by patellar instability].

OBJECTIVE: To study clinical effects of multi-point fixation with bioabsorbable cartilage screws for the treatment of osteochondral fracture caused by patellar instability. METHODS: During the period from August 2014 to Steptember 2016, there were 21 patients with osteochondral fracture caused by patellar dislocation, including 7 males and 14 females, ranging in age from 12 to 42 years old, with an average of 27 years old. During the operation, free fractures fragments of cartilage were found with a open surgery, and the patients were treated with fixation by absorbable cartilage screws combined with lateral retinaculum release and medial retinaculum shrinkage. The Lysholm scoring scale was used to evaluate the knee joint functions before and after operation. The retrospective study analyzing the data was carried out. RESULTS: All the patients underwent successful surgeries and were followed up with a mean period of 12 months(ranged, 8 to 22 months). The CT and X-ray examinations were performed after the operation which showed the fracture fragments were on good positon. The exercise level in all the patients basically returned to the pre-injury level. The postoperative Lysholm score was 86.11±4.97. CONCLUSIONS: The absorbable cartilage nail can effectively fix the free cartilage fragments of the osteochondral fracture due to the patellar instability, which is a simple operation, and worthy of clinical promotion.

Outcomes treating stage III non-small cell lung carcinoma with curative-intent radiotherapy and concurrent carboplatin-paclitaxel chemotherapy.

BACKGROUND AND AIM: Thoracic radiotherapy administered concurrently with chemotherapy is the standard of care for patients with inoperable stage III non-small cell lung cancer, but the optimal chemotherapy regimen is not clearly established. The objective of this study was to assess outcomes in a large cohort of patients treated with curative-intent using carboplatin and paclitaxel. METHODS: Consecutive patients undergoing curative-intent radiotherapy to 60-66 Gy in 30-33 daily fractions with concurrent weekly carboplatin (AUC = 2) and paclitaxel (45 mg/m(2) /week) between March 2004 and May 2012 were identified from a prospective database and reviewed individually. A minimum follow-up of 3 months was required unless death occurred sooner. Response to treatment was defined according to established guidelines on re-staging computed tomography scan at 3 months. Toxicities were assessed using a standardised scoring system. RESULTS: One hundred and seven patients were analysed. The median follow-up was 43.5 months. Three months after treatment, a complete or partial response was observed in 72 patients (68%), and nine patients (8%) had already died. The overall locoregional failure rate was 47%, and failure eventually occurred at any site in 75 patients (70%). Median progression-free survival, and median survival were 15 and 22 months, respectively. Grade 3-4 neutropaenia, thrombocytopaenia, nephrotoxicity, oesophagitis and pneumonitis were observed in 15%, 1%, 3%, 11% and 9% of patients during treatment, respectively. There was one episode of fatal radiation pneumonitis. CONCLUSION: Treatment with thoracic radiotherapy and concurrent carboplatin and paclitaxel chemotherapy is feasible. Survival and toxicity outcomes compare favorably to those reported using cisplatin-based regimens.

Comparing encapsulation efficiency and ultrasound-triggered release for protein between phospholipid-based microbubbles and liposomes.

This work was to compare the encapsulation efficiency and ultrasound-triggered release for protein between microbubbles and liposomes. Bovine serum albumin (BSA) was used as a model. Final ratios between BSA and HPC in microbubbles and liposomes were 1:5, 1:7 and 1:10, respectively. Morphologic characteristics and contrast enhancement of loaded microbubbles and liposomes were measured. Encapsulation efficiency and ultrasound-stimulated release profile were detected. The mean size of loaded microbubbles and liposomes was 3.4 microm and 1.7 microm, respectively. Encapsulation efficiency of microbubbles had an inverse relationship with the ratio between BSA and HPC, while loaded liposomes remained nearly unchanged in the designed range of the ratio between BSA and HPC. Microbubbles resulted in significant enhancement of CnTi images. After ultrasound, more than 90% of the entrapped BSA was released from microbubbles, but less than 5% of BSA released from liposomes. Microbubbles are a promising delivery system for proteins.

Phospholipid-based ultrasonic microbubbles for loading protein and ultrasound-triggered release.

BACKGROUND: Ultrasonic microbubbles are used as ultrasound-triggered delivery carriers for protein drugs. AIM: This work was to prepare stabilized protein-loaded phospholipid-based ultrasonic microbubbles (PUM) and to determine its value as a protein delivery system. METHOD: Bovine serum albumin (BSA) was used as a model protein drug. BSA-containing PUM were prepared by dissolving lyophilized PUM powder in BSA solution. The particle size and microbubble concentration of BSA-containing PUM were measured. The BSA encapsulation efficiency as a function of BSA concentration was determined. Contrast enhancement of BSA-containing PUM in vivo was detected. The release profile of BSA from PUM was also investigated. RESULTS: The mean particle size and microbubble concentration of PUM were unchanged by the presence of BSA for at least 30 minutes after preparation. The net amount of BSA entrapped in PUM was maintained unchanged with increasing BSA concentration. BSA-containing PUM were shown easily to be visible in in vivo rabbit kidney. There was no difference in echogenicity between the loaded and unloaded PUM. Ultrasound duration had a positive relationship with BSA release. Ultrasound of 30 seconds stimulated 94.1% and 93.3% of BSA release from PUM solutions containing 0.3% and 1.5% BSA, respectively. CONCLUSIONS: Protein-loaded PUM exhibited satisfactory physical characteristics and were potent for using in ultrasound-triggered delivery.

[Molecular identification of medicinal plant genus Uncaria in Guizhou].

OBJECTIVE: To analyze rDNA ITS regions of the Medicinal Plant Genus Uncaria in Guizhou and construct their phylogenetic tree in order to supply molecular evidence of taxonomy and identification of these Medicinal Plants in genetic level. METHODS: The ITS gene fragments of the 4 Medicinal Plants were PCR amplified and sequenced. The rDNA ITS regions were analyzed by means of the software of ClustalX, BioEdit and PAUP* 4.0 beta 10. RESULTS: The entire sequences of rDNA ITS1, ITS2, and 5.8S rDNA were obtained, The Maximum-parsimony tree of four ITS regions together with those of similar sequences from GenBank were found, as Mitrayna rubrostipulata (AJ492621 ) and Mitragyna rubrostipulata (AJ605988) were designated as outgroup. CONCLUSION: The 4 medicinal plants are the 4 species in the genus Uncaria, and are mostly similar to the Uncaria rhynhcophylla.