Proton beam therapy in a patient with secondary glioblastoma (32 years after postoperative irradiation of medulloblastoma): case report and literature review.

OBJECTIVE: This report details the experience of a patient who developed a second primary glioblastoma (GB), offering insights into the treatment process and reviewing relevant literature. CASE PRESENTATION: A male patient, who was diagnosed with medulloblastoma at age 9, received treatment with cobalt-60 craniospinal irradiation (CSI) (36 Gy/20 fractions) and a tumor bed boost (total of 56 Gy). After 32 years, at age 41, an MRI revealed a space-occupying mass in the left cerebellar hemisphere. Surgical resection was performed, and postoperative pathology confirmed a diagnosis of radiation-induced glioblastoma (RIGB). Given the history of irradiation and the current tolerability of brainstem doses, proton beam therapy (PBT) combined with Temozolomide (75 mg/m2) was chosen. The treatment plan included 60 Gy on the gross tumor bed and 54 Gy on the clinical target volume, delivered in 30 fractions. The patient underwent regular follow-up and achieved a complete response. CLINICAL DISCUSSION: For childhood cancer survivors, the development of a second primary tumor significantly impacts prognosis. RIGB is a rare form of secondary tumor with distinct molecular characteristics compared to primary GB and recurrent secondary GB. Molecular markers such as IDH and MGMT status can help differentiate between primary GB, recurrent secondary GB, and radiation-induced secondary GB in patients with a history of prior radiation therapy. Surgical resection remains a primary treatment option, while PBT is preferred for postoperative treatment due to its superior protection of normal tissues and the ability to deliver high-dose irradiation. CONCLUSION: RIGB is a rare second primary tumor that requires strategic molecular profiling and individualized management. Proton beam therapy provides effective high-dose irradiation in the postoperative phase and is the preferred treatment option for such cases.

The Effectiveness and Feasibility of Combining Bloom's Taxonomy Theory with PBL and TBL in Teaching Internal Medicine to MBBS Students.

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Lactulose vs Polyethylene Glycol for Bowel Preparation: A Single-Center, Prospective, Randomized Controlled Study Based on BMI.

INTRODUCTION: Colonoscopy is currently considered as one of the principal techniques to diagnose the colorectal diseases. Admittedly, qualified bowel preparation before colonoscopy is a premise for high-quality examination. Lower quality bowel preparation might seriously impede visualization of the intestinal mucosa, resulting in missed and misdiagnosed intestinal lesions. Therefore, it is necessary to choose the appropriate oral laxative based on the guarantee of safety and efficacy. METHODS: This prospective randomized controlled study was conducted to compare lactulose oral solution and polyethylene glycol (PEG) electrolyte powder for bowel preparation using the following indicators: Boston Bowel Preparation Scale, Bowel Bubble Score, detection rate of adenoma and lesion, patients' satisfaction, and adverse effects. Our study investigated the suitability of 2 bowel preparation reagents for patients with different body mass indices mainly based on body mass index (BMI). RESULTS: In the lactulose group, there was a significant improvement in the quality of bowel preparation compared with those in the PEG group ( P < 0.05), especially in people with normal BMI and higher BMI. Compared with the PEG group, individuals in the lactulose group had a significantly higher adenoma detection rate (50% vs 33.5%, P < 0.05) and taste scores (8.82 vs 6.69, P < 0.05), as well as significantly fewer adverse reactions (6.5% vs 32.5%, P < 0.05). DISCUSSION: Lactulose oral solution is superior to PEG in bowel preparation quality and taste, especially in normal BMI and higher BMI groups. It can be used clinically as a potential and promising bowel preparation agent in the future. Clinical Trial registration number: ChiCTR2100054318.

Comparative study of antimicrobial action of aloe vera and antibiotics against different bacterial isolates from skin infection.

Aloe vera is reputed to have medicinal properties. For centuries, it has been used for an array of ailments such as mild fever, wounds and burns, gastrointestinal disorders, diabetes, sexual vitality and fertility problems to cancer, immune modulation, AIDS and various skin infections. In present study, antibacterial activity of aloe vera gel extracts was tested against some common skin infection pathogens, that is, Escherichia coli, Shigella, Salmonella spp. and Staphylococcus aureus all were recorded positive. Antibiotic resistance and susceptibility pattern of above isolates were also studied against 10 clinically significant antibiotics (ampicillin [AMC], amoxicillin, augmentin, cefotaxime, ceftazidime [CAZ], cefuroxime [CXM], ciprofloxaci, tetracycline, cefpodoxime and imipenem). AMC and CXM were found to be most effective antibiotic followed by CXM with highest efficacy against Gram-negative bacteria. In case of CAZ showed highest efficacy was showed against Gram-positive bacteria. Aloe vera leave gel was extracted with four different solvent-like aloe vera leaf extract, root extract, leaf ethanol extract and root ethanol extract; however, Gram-negative as well Gram-positive isolates was found highest susceptibility with aloe leaf and aloe root ethanol extract. Moderate sensitivity observed with aloe leaf extract and aloe root extract against both Gram-positive as well as Gram-negative bacterial isolates. This result showed that ethanol extracts of aloe vera both leaf and root can be used alongside conventional antibiotics to fight agents of infections that are so prevalent in the skin infection.

Efficacy of moxifloxacin combined with levofloxacin in the treatment of drug-resistant tuberculosis.

Drug-resistant tuberculosis is a clinically common respiratory-borne chronic infectious disease. Fluoroquinolone drugs can inhibit the replication and transcription of bacterial DNA and cause bacteria to die, and the antibacterial spectrum of such drugs is broad, especially for Mycobacterium tuberculosis-induced diseases. This article observes and compares the clinical efficacy of levofloxacin and moxifloxacin in the treatment of multidrug-resistant tuberculosis (MDR-TB). At the end of the course of treatment, the treatment success rate was 76.4% in the control group and 68.2% in the treatment group. The difference between the two groups was not statistically significant (P<0.05). The cavity reduction rate was 70.1% in the control group and 62.5% in the treatment group. Adverse reaction rate, the control group was 14.7% and the treatment group was 18.1%. There was no significant difference between the two groups (P >0.05). For multidrug-resistant tuberculosis, levofloxacin tablets and moxifloxacin tablets have similar effects in the treatment of multidrug-resistant tuberculosis, adverse drug reactions, and economically difficult multidrug-resistant patients. Drug sensitivity indicates that they are sensitive to levofloxacin.

Diffusion Kurtosis Imaging of Microstructural Changes in Gray Matter Nucleus in Parkinson Disease.

Objective: To explore the microstructural damage of extrapyramidal system gray matter nuclei in Parkinson disease (PD) using diffusion kurtosis imaging (DKI). Materials and Methods: We enrolled 35 clinically confirmed PD patients and 23 healthy volunteers. All patients underwent MR examination with conventional MRI scan sequences and an additional DKI sequence. We subsequently reconstructed the DKI raw images and analyzed the data. A radiologist in our hospital collected the Mini-Mental State Examination (MMSE) score of all subjects. Results: In the PD group, the mean kurtosis and axial kurtosis level decreased in the red nucleus (RN) and thalamus; the radial kurtosis increased in the substantia nigra (SN) and globus pallidus (GP). Fractional anisotropy decreased in the putamen. The largest area under the ROC curve of mean diffusion in GP was 0.811. Most kurtosis parameters demonstrated a positive correlation with the MMSE score, while several diffusion parameters showed a negative correlation with the same. Conclusion: DKI can qualitatively distinguish PD from healthy controls; furthermore, DKI-derived parameters can quantitatively evaluate the modifications of microstructures in extrapyramidal system gray matter nucleus in PD.

Regulation of Hormone-Related Genes in Ericerus pela (Hemiptera: Coccidae) for Dimorphic Metamorphosis.

Insect hormones regulate metamorphosis including that leading to sexual dimorphism. Using RNA-Seq, we discovered that the second-instar male larva (SM) of the white wax insect, Ericerus pela, have 5,968 and 8,620 differentially expressed transcripts compared with the second-instar female larva (SF) and the first-instar male larva (FM), respectively. The expression levels of genes involved in the apoptosis of old tissues and the reconstruction of new ones in the SM significantly enhanced, while the SF mainly has enhanced expression levels of anabolic genes such as chitin. We predicted that the second-instar larvae are the developmental origin of sexual dimorphic metamorphosis. Meanwhile, in the juvenile hormone (JH) metabolic pathway, CYP15A1 and JH esterase (JHE) are differentially expressed; and in the 20-hydroxyecdysone (20E) metabolic pathway, CYP307A1, CYP314A1, and CYP18A1 are differentially expressed. In the SM, the expression levels of CYP307A1 and CYP314A1 are significantly increased, whereas the expression level of CYP18A1 is significantly decreased; in the SF, the expression levels of the above genes are opposite to that of the SM. Expression trends of RNA-seq is consistent with the expression level of qRT-PCR, and seven of them are highly correlated (R ≥ 0.610) and four are moderately correlated (0.588 ≥ R ≥ 0.542).

p53-induced long non-coding RNA PGM5-AS1 inhibits the progression of esophageal squamous cell carcinoma through regulating miR-466/PTEN axis.

A growing body of evidence suggests that long non-coding RNA (lncRNA) is aberrantly expressed in human cancer and linked to cancer initiation and development. We previously identified Homo sapiens PGM5 antisense RNA 1 (PGM5-AS1) as a novel esophageal squamous cell carcinoma (ESCC)-related lncRNA by performing high-throughput RNA sequencing. However, its clinical implication and biological function in ESCC are still uncharacterized. In the present study, we found that PGM5-AS1 was frequently downregulated in ESCC tissues, plasma, and cell lines, and low PGM5-AS1 expression was positively correlated with poor differentiation, advanced tumor node metastasis (TNM) stage, and lymph node metastasis. Importantly, PGM5-AS1 was identified to be an effective diagnostic and prognostic biomarker for ESCC patients. Functional experiments revealed that exogenous expression of PGM5-AS1 significantly suppressed the proliferation, migration, and invasion of ESCC cells in vitro as well as tumor growth in vivo. Mechanistically, PGM5-AS1 was transcriptionally activated by p53 and it could directly interact with and sequester miR-466 to elevate PTEN expression, thereby inhibiting ESCC progression. Overall, our data indicate that PGM5-AS1 is a novel tumor suppressor in ESCC and restoration of PGM5-AS1 may be a promising avenue for treatment of ESCC patient.