A new platform for ultra-high dose rate radiobiological research using the BELLA PW laser proton beamline.

Radiotherapy is the current standard of care for more than 50% of all cancer patients. Improvements in radiotherapy (RT) technology have increased tumor targeting and normal tissue sparing. Radiations at ultra-high dose rates required for FLASH-RT effects have sparked interest in potentially providing additional differential therapeutic benefits. We present a new experimental platform that is the first one to deliver petawatt laser-driven proton pulses of 2 MeV energy at 0.2 Hz repetition rate by means of a compact, tunable active plasma lens beamline to biological samples. Cell monolayers grown over a 10 mm diameter field were exposed to clinically relevant proton doses ranging from 7 to 35 Gy at ultra-high instantaneous dose rates of 107 Gy/s. Dose-dependent cell survival measurements of human normal and tumor cells exposed to LD protons showed significantly higher cell survival of normal-cells compared to tumor-cells for total doses of 7 Gy and higher, which was not observed to the same extent for X-ray reference irradiations at clinical dose rates. These findings provide preliminary evidence that compact LD proton sources enable a new and promising platform for investigating the physical, chemical and biological mechanisms underlying the FLASH effect.

Cost for treatment and follow-up of thyroid cancer increases according to the severity of disease.

BACKGROUND: The aim of this study was to provide an analysis of thyroid cancer-related health care costs over a 5-year period, according to the extent of thyroid surgery. METHODS: The study included 33 patients from our institutional database who underwent thyroid cancer surgery in 2010. Patients were divided into four groups based on surgical extent: (1) hemithyroidectomy, (2) total thyroidectomy, (3) total thyroidectomy with ipsilateral radical neck dissection, and (4) total thyroidectomy with bilateral radical neck dissection and mediastinal dissection. Costs for admission and outpatient follow-up for 5 years were analyzed. RESULTS: Costs for outpatient follow-up and admission, and overall cost increased with increasing stage of disease and increasing extent of thyroid surgery. Patients who underwent only hemithyroidectomy had the lowest costs for outpatient follow-up and admission, as well as the lowest overall cost. CONCLUSION: Over the 5-year follow-up period, surgery performed at an early disease stage was the most cost-effective.

Screening of the optimized prescription from Suqingwan in terms of its therapeutic effect on DSS-induced ulcerative colitis by its regulation of inflammatory and oxidative mediators.

ETHNOPHARMACOLOGICAL RELEVANCE: Suqingwan (SQW), a traditional Chinese medicine used for treating ulcerative colitis (UC), is composed of 13 kinds of Traditional Chinese medicines (TCMs). According to TCM theory, we investigated whether a simplified prescription composed of the herbs with some functions, would have similar effects to SQW and examined its potential treatment mechanism of action. MATERIALS AND METHODS: We categorized the herbs in SQW into four groups according to their traditional functions and used an orthogonal experimental design to obtain nine separated prescriptions (SPs) of SQW. A dextran sulfate sodium (DSS)-induced UC mouse model was used to evaluate the anti-ulcer colitis effects of the nine SPs and the calculated prescription (CP) was obtained based on the orthogonal t values of the disease activity index (DAI) of the nine SPs. The effect of the CP and SP8 were verified in the DSS-induced UC model, and the DAI and histopathology of the UC mice were examined. Myeloperoxidase (MPO), malondialdehyde (MDA), tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, IL-6, IL-4 and IL-10 of the mice in SP8 were investigated to explore the mechanism of action of the optimized prescription with regard to anti-inflammatory and anti-oxidation effects. RESULTS: Among the 9 SPs, separate prescription 6, 7 and 8 (SP6, SP7 and SP8) and the SQW formulation all significantly reduced the DAI of the UC mice and, in particular, SP8 had an effect similar to SQW, which consists of Sanguisorba officinalis L., Rehmannia glutinosa Libosch. and four other herbal medicines. In a further investigation, SP8 was found to improve the ulcerative colitis in mice in terms of both clinical symptoms and histopathology. The mortality of mice in the SP8 group was 33.3%, better than CP based on the orthogonal t values (83.3%). SP8 could also reduce the levels of TNF-α, IL-1ß, IL-6, MPO and MDA and increase the levels of IL-4 and IL-10 in colon tissue of UC mice in comparison with those of the model group (p<0.05). CONCLUSIONS: An optimized prescription (SP8) from SQW was obtained based on an orthogonal experimental design, which involved 6 herbal medicines, with significantly fewer herbs than in the original prescription. SP8 displayed a similar anti-ulcerative colitis activity to SQW, and its in vivo mechanism of action is related to up-regulation of anti-inflammatory cytokines and down-regulation of pro-inflammatory and oxidative factors.

Combination of surgical subcision and intralesional corticosteroid injection as a cost-effective and minimally invasive treatment for postoperative adhesive thyroidectomy scars.

BACKGROUND: Postoperative adhesive symptoms (swallowing difficulty or pulling sensation during neck extension) are one of the major complications of thyroidectomy. Moreover, adhesive scars are often visible and cause cosmetic concerns. OBJECTIVE: To evaluate the efficacy and safety of combined treatment with surgical subcision and intralesional corticosteroid injection for postoperative adhesive thyroidectomy scars. METHODS: A retrospective analysis was performed of 16 Korean patients with postoperative adhesive thyroidectomy scars treated with three sessions of surgical subcision and intralesional corticosteroid injection. RESULTS: The Vancouver Scar Scale score decreased significantly after treatment (P < .001). Follow-up revealed that six of the 16 patients (37.5%) had clinical improvement of 51% to 75%, six (37.5%) had moderate clinical improvement of 26% to 50%, and three (18.8%) had improvement of 76% to 100%; one patient (6.3%) demonstrated minimal to no improvement. After three sessions of treatment, the mean clinical improvement grade was 2.68, which means moderate to marked improvement compared to before treatment. Post-treatment erythema was observed in most patients, and notable bruising after treatment observed in five patients resolved spontaneously within 7 days. CONCLUSION: Combined treatment with surgical subcision and intralesional corticosteroid injection is a cost-effective and minimally invasive treatment for postoperative adhesive thyroidectomy scars.

How comorbidities and preoperative expenditures correlate with postoperative adverse outcomes.

OBJECTIVES: To examine the correlation of preexisting illnesses and preoperative medical expenditures with postoperative major adverse outcomes among geriatric surgical patients. STUDY DESIGN: Retrospective cohort study using claims from Taiwan's National Health Insurance Research Database. METHODS: All geriatric patients aged >65 years receiving inpatient surgeries during 2004 to 2007 under universal healthcare coverage were included. Surgical patients aged 55 to 64 years were the reference group. Risk-adjusted 30-day postoperative complication and mortality rates among elderly patients in various age sectors were analyzed and correlated with the preexisting illnesses and preoperative medical expenditures quantitatively. RESULTS: Among 432,614 elderly surgical patients in specific age sectors and 238,802 controls, the prevalence of preexisting illnesses and the risk-adjusted postoperative adverse outcome rates were highly age dependent and illness related. When comparing patients aged >85 years with patients aged 55 to 64 years, the adjusted odds ratios were 2.74 (95% confidence interval [CI], 2.67-2.82) and 3.56 (95% CI 3.31-3.84) for incidence of major postoperative complications and mortality after major complications, respectively. Numbers of preexisting illnesses increased in an age-dependent pattern and the preoperative 24-month medical expenditures increased incrementally with the numbers of comorbidities. Postoperative major complications, but not mortality rates, were highly correlated with the numbers of comorbidities and increased parallel with preoperative 24-month comorbidity-related medical expenditures, especially in the younger age group. CONCLUSIONS: Adjusting for preexisting covariates, geriatric patients had an age-dependent, illness-related, and expenditure-associated pattern of higher postoperative complication and mortality rates. The numbers of comorbidities and preoperative medical expenditures had high predictive value for postoperative adverse outcomes.