The use of carbon fiber/polyetheretherketone (CF/PEEK) in pedicle screw fixation for spinal neoplasms-potential advantages in postoperative imaging and radiotherapy planning.

Background: Titanium pedicle screw fixation complicates postoperative care in patients with spinal neoplasms due to postoperative imaging artefacts and dose perturbation. This study aims to measure the benefits of using carbon fiber/polyetheretherketone (CF/PEEK) pedicle fixation compared to titanium in postoperative imaging, radiotherapy planning and delivery for spinal neoplasms treated with conventional external beam radiotherapy with a commercial treatment planning system. Methods: The properties of CF/PEEK pedicle fixation systems were compared to titanium in radiotherapy dose planning accuracy and postoperative computed tomography (CT) image quality. Dose profiles through the screw, tulip and longitudinal axis of the screw were acquired with radiochromic films and compared to a collapsed cone algorithm simulation, to measure dose agreement. The image quality of postoperative CTs were compared by defining four regions of interest around the vertebrae and screws in water phantom models and previous planning CTs, and comparing calculated artefact indexes (AIs). Results: CF/PEEK screws have non-inferior dosimetric prediction accuracy up to 50 mm beneath the screw for collapsed-cone algorithm planning systems. There is a statistically significant reduction in the absolute difference between calculated and measured dose at a depth of 2 mm beneath the screw. There is minimal attenuation with CF/PEEK relative to the surrounding dose, extending to 50 mm beneath the screw. There is a statistically significant improvement in CT imaging quality with reduced AIs in CF/PEEK fixation compared to titanium in both model and patient CT plans. Conclusions: CF/PEEK pedicle fixation can provide benefits in postoperative imaging and photon radiotherapy planning and delivery to patients with spinal neoplasms.

Pembrolizumab with Chemoradiation as Treatment for Muscle-invasive Bladder Cancer: Analysis of Safety and Efficacy of the PCR-MIB Phase 2 Clinical Trial (ANZUP 1502).

BACKGROUND: Radiation may improve the efficacy of immune checkpoint inhibition. This study investigates the combination of pembrolizumab and chemoradiation (CRT) for muscle-invasive bladder cancer (MIBC). OBJECTIVE: To assess the feasibility and safety of pembrolizumab combined with CRT for MIBC. DESIGN, SETTING, AND PARTICIPANTS: A single-arm phase 2 trial was performed with 28 participants having cT2-T4aN0M0 MIBC (Eastern Cooperative Oncology Group performance status 0-1; estimated glomerular filtration rate ≥40 ml/min; no contraindications to pembrolizumab) suitable for CRT. INTERVENTION: Whole bladder radiation therapy (RT; 64 Gy in 32 daily fractions, over 6.5 wk, combined with cisplatin (35 mg/m2 intravenously [IV] weekly, six doses) and pembrolizumab (200 mg IV q3 weeks, seven doses), both starting with RT. Surveillance cystoscopy/biopsy and computerised tomography scans performed 12 and 24 wk after CRT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was feasibility, determined by a prespecified satisfactory low rate of grade 3 or worse nonurinary toxicity or completion of planned CRT according to defined parameters. Secondary endpoints were complete cystoscopic response, locoregional progression-free survival (LRPFS), distant metastasis-free survival (DMFS), and overall survival (OS). RESULTS AND LIMITATIONS: Twenty-eight patients were enrolled with a 31-mo median follow-up. Six had Grade >3 nonurinary adverse events during/within 12 wk after treatment; three had more than one cisplatin dose reduction. The 24-wk post-CRT complete response (CR) rate was 88%. Eight patients developed metastatic disease, and three had nonmetastatic progression. The DMFS at 2 yr is 78% (95% confidence interval [CI] 54-90%), with LRPFS at 2 yr of 87% (95% CI 64-96%) and median OS of 39 mo (95% CI 17.1-not evaluable). Limitations are the single-arm design and sample size. CONCLUSIONS: Combining pembrolizumab with CRT for MIBC was feasible, with manageable toxicity and promising CR rates. PATIENT SUMMARY: Immunotherapy treats nonmetastatic/metastatic bladder cancer effectively. We combined pembrolizumab with chemotherapy and radiation to assess its safety and impact on treatment delivery. The combination was feasible with encouraging early activity. Further larger trials are warranted.

Polycyclic aromatic hydrocarbons in 30 river ecosystems, Taiwan: Sources, and ecological and human health risks.

Polycyclic aromatic hydrocarbons (PAHs) are diverse contaminants of global concern because of their ubiquity, toxicity, and carcinogenicity to many organisms, including humans. This study determines the distribution and sources of PAHs in sediments and fish from 30 major rivers in Taiwan, and the risks these PAHs pose to river ecosystems and human health. The total concentrations of 26 PAHs in sediments and fish were 0.016-7.44 mg/kg dw and 0.096-5.51 mg/kg ww, respectively. The PAH composition in sediments differed from that in fish, indicating that sediments may not be the major contributor of PAHs to fish. The accumulation of different PAH compounds in fish was species-specific, depending on the lipid content, living pattern, and trophic level of each fish species, and on the level of environmental contamination. The diagnostic ratios revealed that PAHs in the sediment primarily originated from pyrogenic sources, with some contribution from petrogenic sources. The contribution of each source varied with the sampling site and season. Several water and air quality variables were found to significantly correlate with PAH concentration in sediments and fish, suggesting that PAHs were mainly derived from wastewater discharge and combustion emissions. The 95th percentile risk quotient values suggested that PAHs in sediment from six rivers pose high ecotoxicological risks. The toxic equivalents of benzo[a]pyrene for 16 PAHs in fish were 12-108 µg/kg dw. A human risk assessment using the 95th percentile values of hazard quotient, hazard index, and margin of exposure revealed that the consumption of contaminated fish muscle poses no remarkable risk to human health. However, the 95th percentile carcinogenic risk values indicated that benzo[a]pyrene concentrations in some fish muscles may pose a carcinogenic risk. Benzo[a]pyrene risk management measures are, therefore, necessary.

Synthesis of diagnostic quality cancer pathology images by generative adversarial networks.

Deep learning-based computer vision methods have recently made remarkable breakthroughs in the analysis and classification of cancer pathology images. However, there has been relatively little investigation of the utility of deep neural networks to synthesize medical images. In this study, we evaluated the efficacy of generative adversarial networks to synthesize high-resolution pathology images of 10 histological types of cancer, including five cancer types from The Cancer Genome Atlas and the five major histological subtypes of ovarian carcinoma. The quality of these images was assessed using a comprehensive survey of board-certified pathologists (n = 9) and pathology trainees (n = 6). Our results show that the real and synthetic images are classified by histotype with comparable accuracies and the synthetic images are visually indistinguishable from real images. Furthermore, we trained deep convolutional neural networks to diagnose the different cancer types and determined that the synthetic images perform as well as additional real images when used to supplement a small training set. These findings have important applications in proficiency testing of medical practitioners and quality assurance in clinical laboratories. Furthermore, training of computer-aided diagnostic systems can benefit from synthetic images where labeled datasets are limited (e.g. rare cancers). We have created a publicly available website where clinicians and researchers can attempt questions from the image survey (http://gan.aimlab.ca/). © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Antibiotic instillation for a chronic lung abscess.

INTRODUCTION: Antibiotic treatment of lung abscesses fails in 10-20% of cases and require surgery, however, some are unsuitable for resection. Alternative options carry significant morbidity. CASE REPORT: A 47 year old man with inoperable non-small cell lung cancer developed a lung abscess following definitive radiotherapy. Initial antibiotic therapy was successful, however four years later his symptoms recurred. Despite multiple courses his symptoms recurred despite long-term antibiotics. Immediately following a diagnostic aspiration, ceftriaxone and metronidazole were instilled into the abscess with subsequent clinical and radiological resolution. DISCUSSION: Lung abscesses are an uncommon complication of radiotherapy. Antibiotic therapy can fail for a number of reasons. Although instillation of antibiotics has not been described in the management of lung abscesses, the direct application of antifungals for aspergillomas is well documented and case series report success in other abscess sites. CONCLUSION: Direct antibiotic instillation following lung abscess aspiration adds minimal risk and is potentially curative.

Emergent contaminants in sediments and fishes from the Tamsui River (Taiwan): Their spatial-temporal distribution and risk to aquatic ecosystems and human health.

The occurrence of emergent contaminants, 24 polybrominated diphenyl ethers (PBDEs), di(2-ethylhexyl)phthalate (DEHP), dibutyl phthalate (DBP), butyl benzyl phthalate (BBP), diethyl phthalate (DEP), dimethyl phthalate (DMP), di-n-octyl phthalate (DnOP), bisphenol A (BPA) and nonylphenol (NP), was investigated in sediments and fishes collected from the Tamsui River system to determine the factors that influence their distribution and their risk to aquatic ecosystems and human health. The concentrations of total PBDEs, DEHP, DBP, BBP, DEP, DMP, DnOP, BPA and NP in sediments were 1-955, ND-23570, <50-411, <50-430, ND-80, ND-<50, ND-<50, 1-144, 3-19624 µg/kg dw, respectively. The spatial-temporal distribution trends of these compounds in sediments could be attributed to urbanization, industrial discharge and effluents from wastewater treatment plants. The PBDE congener distribution patterns (BDE-209 was the dominant congener) in sediments reflected the occurrence of debromination of BDE-209 and the elution of penta-BDE from the treated products. The concentrations of total PBDEs, DEHP, DBP, BBP, DEP, DMP, DnOP, BPA and NP in fish muscles were 2-66, 17-1046, <10-231, <10-66, <30, ND-<30, ND-<30, 0.4-7 and 3-440 µg/kg ww, respectively. The species-specific bioaccumulation of these compounds by fish was found and four species particularly showed high bioaccumulation potential. BDE-47 was the predominant BDE congener in fish muscles, suggesting high bioavailability and bioaccumulation of this compound. The results of biota-sediment accumulation factors showed that BDE-47, 99, 100, 153 and 154 had relatively high bioavailability and bioaccumulation potential for some fish species. The ecological risk assessment showed that the concentrations of BPA and NP in sediments were likely to have adverse effects on aquatic organisms (risk quotients > 1). The human health risk assessment according to hazard quotients (HQs) and carcinogenic risks (CRs) revealed no remarkable risk to human health through consumption of fish contaminated with BDE-47, 99, 100, 154, 209, DEHP, BPA and NP.

Partitioning of Aromatic Constituents into Water from Jet Fuels.

A comprehensive study of the most commonly used jet fuels (i.e., Jet A-1 and JP-8) was performed to properly assess potential contamination of the subsurface environment from a leaking underground storage tank occurred in an airport. The objectives of this study were to evaluate the concentration ranges of the major components in the water-soluble fraction of jet fuels and to estimate the jet fuel-water partition coefficients (K fw) for target compounds using partitioning experiments and a polyparameter linear free-energy relationship (PP-LFER) approach. The average molecular weight of Jet A-1 and JP-8 was estimated to be 161 and 147 g/mole, respectively. The density of Jet A-1 and JP-8 was measured to be 786 and 780 g/L, respectively. The distribution of nonpolar target compounds between the fuel and water phases was described using a two-phase liquid-liquid equilibrium model. Models were derived using Raoult's law convention for the activity coefficients and the liquid solubility. The observed inverse, log-log linear dependence of the K fw values on the aqueous solubility were well predicted by assuming jet fuel to be an ideal solvent mixture. The experimental partition coefficients were generally well reproduced by PP-LFER.

Biodegradation of carbamate pesticides by natural river biofilms in different seasons and their effects on biofilm community structure.

This study investigated the ability of natural river biofilms from different seasons to degrade the carbamate pesticides methomyl, carbaryl and carbofuran in single and multiple pesticide systems, and the effects of these pesticides on algal and bacterial communities within biofilms. Spring biofilms had the lowest biomass of algae and bacteria but showed the highest methomyl degradation (>99%) and dissipation rates, suggesting that they might contain microorganisms with high methomyl degradation abilities. Degradation of carbofuran (54.1-59.5%) by biofilms in four seasons was similar, but low degradation of carbaryl (0-27.5%) was observed. The coexistence of other pesticides was found to cause certain effects on pesticide degradation and primarily resulted in lower diversity of diatoms and bacteria than when using a single pesticide. The tolerant diatoms and bacteria potentially having the ability to degrade test pesticides were identified. River biofilms could be suitable biomaterials or used to isolate degraders for bioremediating pesticide-contaminated water.

Biodegradation of methyl tert-butyl ether (MTBE) by Enterobacter sp. NKNU02.

We previously isolated and identified Enterobacter sp. NKNU02 as a methyl tert-butyl ether (MTBE)-degrading bacterial strain from gasoline-contaminated water. In this study, tert-butyl alcohol, acetic acid, 2-propanol, and propenoic acid were detected using gas chromatography/mass spectrometry when MTBE was degraded by rest cells of Enterobacter sp. NKNU02 cells. We also found that biodegradation of MTBE was decreased, but not totally inhibited in mixtures of benzene, toluene, ethylbenzene and xylene. The effects of MTBE on the biology of Enterobacter sp. NKNU02 were elucidated using 2D proteomic analysis. The cytoplasmic proteins isolated from these MTBE-treated and -untreated cells were carried out for proteomic analysis. Results showed that there were 6 differential protein spots and 8 differential protein spots, respectively, as compared to their corresponding control (without MTBE addition), at the indicated incubation times when 40% and 60% of 100 mg/L of MTBE had been removed, Among these proteins, nine were successfully identified with matrix-assisted laser desorption ionization-time of flight-mass spectrometry. Proteins identified included extracellular solute-binding protein, periplasmic-binding protein ytfQ, cationic amino acid ABC transporter, isocitrate dehydrogenase, cysteine synthase A, alkyl hydroperoxide reductase (AhpC), transaldolase, and alcohol dehydrogenase. Based on these differential proteins, we discuss the bacterial responses to MTBE at the molecular level.

Impact of cadmium on the bacterial communities in the gut of Metaphire posthuma.

The effects of cadmium (Cd) contamination in soil onto the bacterial communities of the guts pooled from ten Metaphire posthuma were addressed during 14 days' incubation. We found that about 50% of Cd (5mg/kg, dry weight soil) in the contaminated soil was bio-accumulated into the earthworms. DNA was extracted from the guts of M. posthuma and their dwelling soil irrespective of Cd treatment for the analysis of the bacterial communities of guts in M. posthuma and in soil by PCR-DGGE (polymerase chain reaction-denaturing gradient gel electrophoresis). A distinctive cluster of bacterial communities of the guts in the earthworm with and without Cd treatment using the analysis of unweighted pair-group method using arithmetic averages (UPGMA) was observed, indicating that the bacterial community of guts could be changed by Cd. However, no differences in the bacterial communities in soil irrespective of Cd treatment were observed, which could be resulted from the bioremediation of Cd by earthworms leading to insignificant effect of Cd on bacterial communities in soil. For the sequencing of some of the dominant bands in the DGGE profile, Bradyrhizobium japonicum, Stenotrophomonas sp. D2, and Labrys, sp. CC-BB4, whose sequences display an identity of more than 97% using blast program against a known sequence in the GeneBank database and Ribosomal database, were identified. Collectively, our results showed that earthworm treatment can decrease the concentrations of Cd in soil, and Cd cause a shift in the bacterial communities in the guts of M. posthuma. The application of M. posthuma for Cd bioremediation would be desired.

Assessment of genotoxicity of methyl-tert-butyl ether, benzene, toluene, ethylbenzene, and xylene to human lymphocytes using comet assay.

Methyl-tert-butyl ether (MTBE) is a gasoline oxygenate and antiknock additive substituting for lead alkyls currently in use worldwide. Benzene, toluene, ethylbenzene, and xylene (BTEX) are volatile monoaromatic hydrocarbons which are commonly found together in crude petroleum and petroleum products such as gasoline. The aim of this study is to evaluate the genotoxic effects of these tested chemicals in human lymphocytes. Using the alkaline comet assay, we showed that all of the tested chemicals induce DNA damage in isolated human lymphocytes. This effect could follow from the induction of DNA strands breaks. The neutral version of the test revealed that MTBE, benzene, and xylenes induce DNA double-strand breaks at 200 microM. Apart from MTBE, the spin traps, 5,5-dimethyl-pyrroline-N-oxide (DMPO) and N-tert-butyl-alpha-phenylnitrone (PBN) can decrease the level of DNA damage in BTEX at 200 microM. This indicated that DNA damage could result from the participation of free radicals in DNA-damaging effect, which was further supported by the fact that post-treatment of formamidopyrimidine-DNA glycosylase (Fpg), enzyme recognizing oxidized DNA purines, gave rise to a significant increase in the extent of DNA damage in cells treated with benzene, and xylene at 200 microM. The results obtained suggested that MTBE and BTEX could induce a variety type of DNA damage such as single-strand breaks (SSBs), double-strand breaks (DSBs), and oxidative base modification.

Performance characteristics of the limulus amebocyte lysate assay and gas chromatography-mass spectrum analysis of lipopolysaccharides relative to nitric oxide production by peritoneal exudates of cells.

Limulus amebocyte lysate (LAL) assay and gas chromatography-mass spectrum (GC-MS) analysis are usually used for the quantification of lipopolysaccharides (LPS) from the environment. The LAL assay measures endotoxin units to represent the LPS biological function but GC-MS analysis measures decanoic (C(10:0)) and dodecanoic (C(12:0)) 3-hydorxy fatty acids (3-OH FA) concentration to represent the LPS chemical composition. A study was carried out using these methods to evaluate their degree of correlation. Using the culture supernatants of 30 independent strains of Pseudomonas aeruginosa, the bacterial supernatants gave of 0.53+/-0.45 and 2.49+/-1.75mg/l of C(10:0) and C(12:0) 3-OH FA, respectively, compared to 17.96+/-13.28mg/l of LPS with the LAL assay (1ng/ml of LPS congruent with0.78EU/ml). The 3-OH FA concentration relative to the endotoxin unit dose in the supernatants exhibited a positive correlation (r(2)=0.5182, C(10:0); r(2)=0.4359, C(12:0)). When supernatants having a high level of endotoxin were used to treat peritoneal exudates cells, nitric oxide (NO) was generated in a dose-dependent manner (r(2)=0.6174). To determine if either C(10:0) or C(12:0) 3-OH FA can act as an indictor of LPS quantity was correlated with this immunostimulatory effect, the correlation of these 3-OH FA concentrations against the produced NO levels was evaluated. This also exhibited a positive correlation; however, the two indicators of 3-OH FA gave different dose-responsible performances (r(2)=0.3211, C(10:0); r(2)=0.4527, C(12:0)).