Vitamin D deficiency is associated with increased risk of bacterial infections after kidney transplantation.

BACKGROUND/AIMS: There may be an association between vitamin D levels and allograft outcomes in kidney transplant recipients (KTRs). However, few studies have been conducted to determine the association between vitamin D levels and post-transplant infections. This study investigated the impact of vitamin D deficiency on the risk of infection after kidney transplantation. METHODS: We measured 25-hydroxyvitamin D (25(OH)D) levels prior to kidney transplantation. Vitamin D deficiency was defined as a serum 25(OH)D level < 20 ng/mL. We examined the incidence of various post-transplant infections during follow-up period. We used Cox proportional hazards regression analysis to determine factors associated with increased risk of post-transplant infections during the follow-up period. RESULTS: A total of 164 KTRs were followed up for a mean of 24.8 ± 10.7 months. Among them, 135 patients (82.3%) had vitamin D deficiency. Patients with vitamin D deficiency had a significantly higher incidence of urinary tract infection (p = 0.027) and any bacterial infection (p = 0.010) compared to those without vitamin D deficiency. Vitamin D deficiency was not significantly associated with incidence of viral or fungal infections. Cox proportional hazards regression analysis revealed that vitamin D deficiency (hazard ratio, 11.07; 95% confidence interval, 1.46 to 84.03; p = 0.020) was independent risk factor for post-transplant bacterial infections. CONCLUSIONS: Pre-transplant vitamin D deficiency was a significant risk factor for bacterial infections after kidney transplantation. Further studies are needed on possible benefits of vitamin D supplementation for preventing post-transplant bacterial infection.

Platinum-based combination chemotherapy vs. weekly cisplatin during adjuvant CCRT in early cervical cancer with pelvic LN metastasis.

AIM: Adjuvant concurrent chemoradiation (CCRT) should be considered in surgically-treated patients with early-stage cervical cancer (ECC) who exhibit pelvic lymph node (LN) metastasis. Platinum-based chemotherapy is usually recommended during adjuvant CCRT, however, it is unclear which regimen has better prognostic outcomes. PATIENTS AND METHODS: We reviewed the electronic medical records to find patients with primary ECC (FIGO stages IB-IIA) who underwent type III radical hysterectomy and adjuvant CCRT due to pelvic LN metastasis at the Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, Korea, from November 1997 to September 2007. RESULTS: Among 75 patients, 34 received weekly cisplatin. Combination chemotherapy was performed without consolidation in 21 patients and with consolidation in 20 patients. The mean follow-up period was 59.0 months and the five-year survival rate was 84.4%. In multivariate analysis, combination chemotherapy with and without consolidation was associated with improved disease-free survival [hazard ratio (HR)=0.23, 95% confidence interval (CI)=0.06-0.88, p=0.032, and HR=0.29, 95% CI=0.09-0.91, p=0.034, respectively]; combination chemotherapy with consolidation significantly improved overall survival (HR=0.11, 95% CI=0.02-0.87, p=0.037) when compared to weekly cisplatin. CONCLUSION: We found that platinum-based combination chemotherapy during adjuvant CCRT after surgery promoted better survival than a weekly cisplatin regimen in ECC patients with pelvic LN metastasis.

Nanosurface-confined nucleation and patterned growth of Pt and TiO2.

The nanosurface-confined nucleation and growth processes of Pt and TiO2 were investigated when Pt was sputter deposited and TiO2 was sol-gel coated on a unique surface-designed substrate. The substrate was an anodic aluminum oxide (AAO) film with self-assembled grouped nanopores (SGNPs). The SGNPs gave rise to unique nucleation sites comprising very small-sized boundaries and nanopores. Pt sputter deposition onto the SGNPs showed restricted growth of nanogranules. The TiO2 sol-gel coating onto the SGNPs resulted in unique formations of nanopore and network structures. The unique nucleation phenomena of Pt and TiO2 on the nanometer-sized surfaces are explained by a combination of two effects: confinement of the degree of freedom at the nucleation sites and growth direction. This is different from conventional surface nucleation that yields the growth of islands, layer-by-layer deposition, and epitaxy.

The prognostic significance of tumor volume regression during radiotherapy and concurrent chemoradiotherapy for cervical cancer using MRI.

OBJECTIVE: The purpose of this study was to determine the prognostic significance of tumor volume regression rate during radiotherapy (RT) measured by three serial magnetic resonance imaging (MRIs) studies performed in patients treated with RT alone and compare the results with patients treated with concurrent chemoradiotherapy (CCRT). METHODS: We evaluated 81 patients with uterine cervical cancer who underwent three serial MR examinations, i.e., at the start of RT, at 36-45 Gy of external RT and 1 month after the end of RT. Forty-three patients were treated with RT alone and 38 patients were treated with CCRT. Pre-RT tumor volume (V1), the tumor volume regression rate measured during the fourth week of RT and residual tumor volume at 1 month after the end of RT (V3) were determined for each patient. The cut-off value used for the three parameters studied was the one that made the largest outcome difference. These volume parameters were analyzed to determine a difference in the treatment outcome. RESULTS: In the patients treated with CCRT, the mean value of the V1 was larger and the mean value of the V3 was smaller than in patients treated with RT alone. The mean value of the mid-RT regression rate was somewhat higher in patients treated with CCRT than in patients treated with RT alone; however, this difference was not statistically significant (79% vs. 69%). In both the RT alone and the CCRT group, the patients with a mid-RT regression >/=75% had 100% 5-year local control rates and a better disease free survival than the patients with mid-RT regression <75%. The patients with V3=0 cm(3) also had a better 5-year local control rate than the patients with a V3>0 cm(3), but statistical significance was found only in the patients treated with CCRT. CONCLUSIONS: The mid-RT tumor volume regression rate, at 36-45 Gy of external RT, was a predictor of local control rate in both RT and CCRT patient groups. However, in the patients who were treated with CCRT, the local control rate difference was even larger by post-RT residual volume than by the mid-RT tumor regression rate. Further studies on appropriate evaluation timing for mid-RT response in patients receiving CCRT are needed.

Phase II study of consolidation chemotherapy after concurrent chemoradiation in cervical cancer: preliminary results.

PURPOSE: Our aim was to determine the efficacy of consolidation chemotherapy after concurrent chemoradiation (CCRT) using high-dose-rate brachytherapy in patients with locally advanced cervical carcinoma. METHODS AND MATERIALS: Patients with cervical carcinoma (FIGO stage IB2-IVA) were treated with external beam radiation therapy to the whole pelvis (50.4 Gy) and high-dose-rate brachytherapy (24 Gy to point A). Cisplatin 60 mg/m(2) (Day 1) and 5-fluorouracil 1000 mg/m(2) (Days 1-5) were given every 3 weeks starting concurrently with the radiation and followed by 3 more cycles of consolidation for a total of 6 cycles. RESULTS: Thirty patients (94%) received 3 more cycles of post-CCRT consolidation chemotherapy and were evaluable for the toxicity and efficacy of consolidation. The most common toxicities of Grade 2 or higher were nausea or vomiting (47%) and anemia (33%). Late complications of the rectum and bladder occurred in 13% and 6% of the patients, respectively. The clinical complete response rate was 87% (95% CI, 75%-99%). During a median follow-up of 27 months (range, 6-58 months), 5 patients (17%) had recurrence; the sites of failure were 3 (10%) inside the radiation field and 2 (7%) outside the radiation field. The estimated 3-year progression-free survival rate was 83% (95% CI, 67%-99%) and overall survival rate was 91% (95% CI, 79%-100%). CONCLUSIONS: Consolidation chemotherapy after CCRT is well tolerated and effective in patients with locally advanced cervical carcinoma. A prospective randomized trial to compare this treatment strategy with standard CCRT seems to be worthwhile.

A major constituent of green tea, EGCG, inhibits the growth of a human cervical cancer cell line, CaSki cells, through apoptosis, G(1) arrest, and regulation of gene expression.

A constituent of green tea, (-)-epigallocatechin-3-gallate (EGCG) has been known to possess antiproliferative properties. In this study, we investigated the anticancer effects of EGCG in human papillomavirus (HPV)-16 associated cervical cancer cell line, CaSki cells. The growth inhibitory mechanism(s) and regulation of gene expression by EGCG were also evaluated. EGCG showed growth inhibitory effects in CaSki cells in a dose-dependent fashion, with an inhibitory dose (ID)(50) of approximately 35 microM. When CaSki cells were further tested for EGCG-induced apoptosis, apoptotic cells were significantly observed after 24 h at 100 microM EGCG. In contrast, an insignificant induction of apoptotic cells was observed at 35 microM EGCG. However, cell cycles at the G1 phase were arrested at 35 microM EGCG, suggesting that cell cycle arrests might precede apoptosis. When CaSki cells were tested for their gene expression using 384 cDNA microarray, an alteration in the gene expression was observed by EGCG treatment. EGCG downregulated the expression of 16 genes over time more than twofold. In contrast, EGCG upregulated the expression of four genes more than twofold, suggesting a possible gene regulatory role of EGCG. This data supports that EGCG can inhibit cervical cancer cell growth through induction of apoptosis and cell cycle arrest as well as regulation of gene expression in vitro. Furthermore, in vivo antitumor effects of EGCG were also observed. Thus, EGCG likely provides an additional option for a new and potential drug approach for cervical cancer patients.