Tracheoesophageal fistula closure after staged dose-escalated radiotherapy for esophageal squamous cell carcinoma: a case report.

An esophageal fistula can be caused by an esophageal tumor as well as the surgery, radiotherapy (RT), or chemoradiotherapy used to treat the tumor. The most dangerous complications are massive hemoptysis and asphyxia. This report describes a 58-year-old man with a >1-month history of dysphagia and hemoptysis. Contrast-enhanced computed tomography revealed a tumor in the upper esophagus and a tracheoesophageal fistula. Esophagography revealed a large lesion measuring approximately 8 cm in length. Esophagogastroduodenoscopy showed an ulcerated tumor with raised margins originating 22 cm from the incisors, and histologic examination of a biopsy specimen indicated squamous cell carcinoma. The tumor was finally classified as stage IVA (T4bN0M0) esophageal squamous cell carcinoma. Massive hemoptysis occurred after the patient was admitted to the hospital. Therefore, we applied staged dose-escalated RT in three stages (6.0 Gy in 5 fractions, 7.5 Gy in 5 fractions, and 46.8 Gy in 26 fractions) to decrease the rate of tumor shrinkage brought on by RT and give the normal tissue enough time to close the fistula. Finally, the hemoptysis resolved and the patient's symptoms were significantly improved. Contrast-enhanced chest computed tomography revealed shrinkage of the tumor. In conclusion, staged dose-escalated RT can be applied for esophageal fistula closure.

Mucosa-associated lymphoid tissue lymphoma of the trachea treated with radiotherapy: A case report.

BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphoma originates in the marginal zone of lymphoid tissue. lung is one of the most frequent non-gastrointestinal organs involved, here known as bronchus-associated lymphoid tissue (BALT) lymphoma. BALT lymphoma of unknown etiology, and most patients are asymptomatic. The treatment of BALT lymphoma is controversial. CASE SUMMARY: A 55-year-old man admitted to hospital had a three-month history of progressively coughing up yellow sputum, chest stuffiness, and shortness of breath. Fiberoptic bronchoscopy revealed mucosal visible beaded bumps 4 cm from the tracheal carina at 9 o 'clock and 3 o 'clock, the right main bronchus, and the right upper lobe bronchus. Biopsy specimens showed MALT lymphoma. Computed tomography virtual bronchoscopy (CTVB) showed uneven main bronchial wall thickening and multiple nodular protrusion. BALT lymphoma stage IE was diagnosed after a staging examination. We treated the patient with radiotherapy (RT) alone. A total dose of 30.6 Gy/17 f/25 d was given. The patient had no obvious adverse reactions during RT. The CTVB was repeated after RT and showed that the right side of the trachea was slightly thickened. CTVB was repeated 1.5 mo after RT and again showed that the right side of the trachea was slightly thickened. Annual CTVB showed no signs of recurrence. The patient now has no symptoms. CONCLUSION: BALT lymphoma is an uncommon disease and shows good prognosis. The treatment of BALT lymphoma is controversial. In recent years, less invasive diagnostic and therapeutic approaches have been emerging. RT was effective and safe in our case. The use of CTVB could provide a noninvasive, repeatable, and accurate method in diagnosis and follow-up.

[Advances in the clinical research on acupuncture in treatment of respiratory diseases].

This article reviews the clinical studies on acupuncture in the treatment of asthma, chronic bronchitis, and acute exacerbation and stable phase of chronic obstructive pulmonary disease in China over the past 10 years, and the results suggest that acupuncture has a good clinical effect. At present, there are still several problems in related clinical studies, including lacking of standard operation procedure for acupuncture, unreasonable design of control group, and low quality of clinical research. Therefore, in the future, top-level design should be standardized and large-sample multicenter clinical studies should be conducted to provide stronger evidence of evidence-based medicine for acupuncture in the treatment of respiratory diseases.

The order of multiple excited state proton transfer in ternary complex of norharmane and acetic acids.

Dolores Reyman et al. found the norharmane (9H-pyrido [3,4-b] indole) (NHM) and two acetic acid molecules can form the ternary complex (NHM-2A) in component solvent of dichloromethane and acetic acid via the hydrogen bond chain (J. Lumin. 2014, 148, 64). But the specific reaction details during this process were rarely reported. In this study, we will give an insight into the reasons which promote the occurrence of this reaction as well as its reaction order. The hydrogen bond enhancing behavior in first excited state (S1) is verified through the analysis of geometric configurations, infrared spectra, frontier molecular orbitals and potential energy curves. The absorption and fluorescence spectra we calculated are well coincident with the experimental results. Meanwhile, it is obvious that the hydrogen bond intensity is gradually enhanced from N1H2⋯O3, O4H5⋯O6 to O7H8⋯N9 by analyzing the reduced density gradient (RDG) isosurface. The hydrogen bond strengthening mechanism has been confirmed in which the hydrogen bond interaction acts as driving force for excited state proton transfer (ESPT) reaction. In order to provide a reliable description of the reaction energy profiles, we compare the barrier differences obtained by m062x and B3LYP methods. We might safely draw the conclusion that the multiple ESPT is a gradual process initiated by the proton transfer of O7H8⋯N9. And we further proof the ESPT process can be completed via the NHM-2A → NHM-2AS → NHM-2AD → NHM-2AT in S1 state. Theoretical research of NHM-2A has been carried out by density functional theory (DFT) and time-dependent density functional theory (TDDFT). It is worth noting that we predicted that the fluorescence at 400 nm observed in experiment is more likely to be emitted by NHM-2AS in S1 state.

Globally Accurate Potential Energy Surface for HCS(A2A″) by Extrapolation to the Complete Basis Set Limit.

A global potential energy surface (PES) representation of the C(3P) + SH(X 2Π) → H(2S) + CS(a 3Π) system is developed by fitting plenty of precise energies obtained through the ab initio calculation with aug-cc-pV QZ and aug-cc-pV5Z basis sets via extrapolation to the complete basis set limit. The topographical characteristics of the PES are examined in detail, and it is found that they agree well with previous calculations available in the literature. By utilizing the PES of HCS(A2A″), the corresponding reaction is investigated using the quasi-classical trajectory (QCT) method in the collision energy range of 0.08-1.0 eV. The minimum energy paths (MEPs) calculated on the basis of the present PES indicate that the C(3P) + SH(X 2Π) → H(2S) + CS(a 3Π) reaction is exothermic, with the exothermicity ∼0.204 eV. The calculation for the capture time indicates that the reaction is mainly governed by the indirect mechanism at the lower collision energy, while, for higher collision energy, the direct mechanism is in coexistence with the indirect mechanism, and the latter one plays a dominant role.

Effect of H2O Adsorption on Negative Differential Conductance Behavior of Single Junction.

Large negative differential conductance (NDC) at lower bias regime is a very desirable functional property for single molecular device. Due to the non-conjugated segment separating two conjugated branches, the single thiolated arylethynylene molecule with 9,10-dihydroanthracene core (denoted as TADHA) presents excellent NDC behavior in lower bias regime. Based on the ab initio calculation and non-equilibrium Green's function formalism, the NDC behavior of TADHA molecular device and the H2O-molecule-adsorption effects are studied systematically. The numerical results show that the NDC behavior of TADHA molecular junction originates from the Stark effect of the applied bias which splits the degeneration of the highest occupied molecular orbital (HOMO) and HOMO-1. The H2O molecule adsorbed on the terminal sulphur atom strongly suppresses the conductance of TADHA molecular device and destroys the NDC behavior in the lower bias regime. Single or separated H2O molecules adsorbed on the backbone of TADHA molecule can depress the energy levels of molecular orbitals, but have little effects on the NDC behavior of the TADHA molecular junction. Aggregate of several H2O molecules adsorbed on one branch of TADHA molecule can dramatically enhance the conductance and NDC behavior of the molecular junction, and result in rectifier behavior.

Effects of epiphytic algae on biomass and physiology of Myriophyllum spicatum L. with the increase of nitrogen and phosphorus availability in the water body.

The disappearance of submerged vascular macrophytes in shallow eutrophic lakes is a common phenomenon in the world. To explore the mechanism of the decline in submerged macrophyte abundance due to the growth of epiphytic algae along a nutrient gradient in eutrophic water, a 2 × 3 factorial experiment was performed over 4 weeks with the submerged macrophyte (Myriophyllum spicatum L.) by determining the plant's biomass and some physiological indexes, such as chlorophyll (Chl) content, malondialdehyde (MDA) content, and superoxide dismutase (SOD) activity in the leaves of M. spicatum L. on days 7, 14, 21, and 28, which are based on three groups of nitrogen and phosphorus levels in the water body (N-P [mg L-1]: NP1 0.5-0.05, NP2 2.5-0.25, NP3 4.5-0.45) and two levels of epiphytic algae (the epiphytic algae group and the control group). Epiphytic algal biomass was also assayed. The results indicated that epiphytic algal biomass remarkably enhanced in the course of the experiment with elevated levels of nitrogen and phosphorus in the water. Under the same level of nutrient condition, plants' biomass accumulation and Chl content were higher in the control group than that in the epiphytic algae group, respectively, while MDA content and SOD activity in the former were lower than that in the latter. The influences of epiphytic algae on the biomass accumulation and Chl content and MDA content became greater and greater with elevated levels of nutrients. In general, in this experiment, water nutrients promoted the growth of both epiphytic algae and submerged plants, while the growth of epiphytic algae hindered submerged macrophytes' growth by reducing Chl content and promoting peroxidation of membrane lipids in plants.

Globally accurate potential energy surface for the ground-state HCS(X2A') and its use in reaction dynamics.

A globally accurate many-body expansion potential energy surface is reported for HCS(X2A') by fitting a wealth of accurate ab initio energies calculated at the multireference configuration interaction level using aug-cc-pVQZ and aug-cc-pV5Z basis sets via extrapolation to the complete basis set limit. The topographical features of the present potential energy surface are examined in detail and is in good agreement with the raw ab initio results, as well as other theoretical results available in literatures. By utilizing the potential energy surface of HCS(X2A'), the dynamic studies of the C(3P) + SH(X2Π) → H(2S) + CS(X1∑+) reaction has been carried out using quasi-classical trajectory method.

[Spatial and Temporal Distribution Characteristics of Different Forms of Phosphorus in Three Sorts of Rivers around Lake Taihu].

Different forms of phosphorus from the upper reaches of river to lower reaches of river in nine rivers were analyzed to clarify the pollution characteristics of industrial effluent, agriculture effluent and sanitary wastewater to Lake Taihu in February (low water period), May (average water period) and August (abundant water period) of 2009. The results showed that total phosphorus (TP) dissolved total phosphorus (DTP) and soluble reactive phosphorus ( SRP) mass concentration all showed decreasing trend while enzymatic phosphorus (EHP) mass concentration increased with the increase of algal biomass from low water period to abundant water period. Mass concentrations of several forms of phosphorus were all the highest in the rivers impacted by sanitary wastewater, but sanitary wastewater's self-purification capabity from the upper reaches of river to lower reaches of river was the best, and the pollution to Lake Taihu was the lowest. Pollution from rivers impacted by industrial effluent was the highest. Mass concentration of EHP was higher than that of SRP in most cases, so EHP played an important role in Cyanbacterial harmful algal blooms events in Lake Taihu.

The physiological responses of Vallisneria natans to epiphytic algae with the increase of N and P concentrations in water bodies.

To reveal the mechanism of submerged plants decline in progressively eutrophicated freshwaters, physiological responses of Vallisneria natans to epiphytic algae were studied in simulation lab by measuring plant physiological indexes of chlorophyll content, malondialdehyde (MDA) content, and superoxide dismutase (SOD) activity based on a 2 × 4 factorial design with two epiphytic conditions (with epiphytic algae and without) and four levels of N and P concentrations in water (N-P[mg.L(-1)]: 0.5, 0.05; 2.5, 0.25; 4.5, 0.45; 12.5, 1.25). Compared with control (non-presence of epiphytic algae), chlorophyll contents of V. natans were significantly decreased (p < 0.01) for the presence of epiphytic algae under any concentrations of N and P in water bodies. While the presence of epiphytic algae induced peroxidation of membrane lipids, MDA contents of V. natans had significantly increased (p < 0.05) by comparing with control. SOD activity significantly enhanced (p < 0.05) with the presence of epiphytic algae in the treatments of T2 and T3 in the whole culture process by comparing with control, sometimes reaching an extremely significant level (p < 0.01). However, in the treatments of T1 and T4, SOD activity had no obvious change with the presence of epiphytic algae (p < 0.05) by comparing with control. At the end of the experiment, the effects of epiphytic algae on chlorophyll content and SOD activity in the leaves of V. natans were increased at first and then decreased with the concentrations of N and P in water, and MDA content became higher with the increase of N and P. concentrations. Repeated measurement data testing showed that the effects of epiphytic algae on the chlorophyll content and MDA content and SOD activity were significant, respectively (p < 0.001), the effects of epiphytic algae were combining with effects of concentrations of N and P (p < 0.001), respectively, and their interaction (p < 0.001). Our observations confirmed that this prediction: the growth of epiphytic algae directly produced adverse effects on physiology of V. natans and epiphytic algal biomass were positively correlated with nutrient available in the water column.

[Physiological response of Vallisneria natans to nitrogen and phosphorus contents in eutrophic waterbody].

The response of Vallisneria natans to the increase contents of nitrogen and phosphorus were studied under laboratory conditions by measuring chlorophyll fluorescence parameters of V. natans using a pulse-amplitude modulated fluorometer (Diving-PAM), combined with measuring some other physiological indexes of V. natans. The results showed that V. natans responded quickly to water nitrogen and phosphorus concentration changes, the maximum quantum yield decreased significantly after 2 h and 6 h, the maximum quanta yield returned to normal levels 12 h after the treatment. There was no significant difference between treatment groups for the maximum quantum yield. Inhibitory effect of light intensity on photosynthesis of V. natans was more obvious under higher (treatment D) or lower (treatment A) concentrations of nitrogen and phosphorus. The average quantum yields of four measurements in the treatment B or C was significantly higher than that of A or D (p < 0.05). Within a certain range, chlorophyll content increased significantly with the nitrogen and phosphorus concentrations. When nitrogen and phosphorus concentrations further increased and reached the level of D treatment, chlorophyll content of V. natans decreased. Malondialdehyde (MDA) content of V. natans changed in the different treatment groups, MDA content of treatment B was the lowest while treatment D was the highest. It shows that V. natans is more suitable for growing in eutrophic waterbodies, but excessive nitrogen and phosphorus could inhibit the physiological activities of V. natans.

TGF-beta1 in serum and induced sputum for predicting radiation pneumonitis in patients with non-small cell lung cancer after radiotherapy.

BACKGROUND AND OBJECTIVE: Research has confirmed that transforming growth factor-beta1 (TGF-beta1) is one of the cytokines related to radiation pneumonitis. But the level of TGF-beta1 in serum needed to predict radiation pneumonitis is still not clear. This study assessed the value of TGF-beta1 in both serum and induced sputum in predicting radiation pneumonitis, providing a reference for the radiotherapy of patients with non-small cell lung cancer (NSCLC). METHODS: A total of 23 patients with NSCLC treated with three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) in our department between November 2007 and January 2009 were analyzed and evaluated. TGF-beta1 levels in both serum and sputum were detected before and near the end of radiotherapy for all the patients. The TGF-beta1 level in serum was measured with enzyme-linked immunosorbent assay (ELISA). Immunocytochemistry assays were used to detect TGF-beta1 expression in sputum sediment. Radiation pneumonitis was graded according to Radiation Therapy Oncology Group (RTOG) radiation scoring criteria every 3 weeks from the start to 3 months after the end of treatment. RESULTS: Radiation pneumonitis was noted in 9 patients in this cohort. The total incidence of radiation pneumonitis was 39.1% (9/23) and those with Grade II or worse was 30.4% (7/23). The absolute TGF-beta1 level in serum after radiotherapy was higher than before radiotherapy, but there was no statistical difference (P = 0.139). Patients with increased levels of TGF-beta1 had a higher incidence of radiation pneumonitis (45.5%) than those with decreased TGF-beta1 levels post-radiotherapy (40.0%). Though there was a tendency of higher incidence of radiation pneumonitis with increases in TGF-beta1 level, no statistical difference was found (P = 1.000). Patients with tumor response had higher incidence of radiation pneumonitis (50.0%) than patients without when TGF-beta1 levels in serum increased, but there was no statistical difference (P = 0.792). TGF-beta1 was positively expressed (brown yellow) in sputum on immunocytochemistry assays and located in the cytoplasm of either macrophages or epithelial cells. Macrophages were the main cells expressing TGF-beta1. A significantly higher positive expression rate (71.4%) was found in sputum post-radiotherapy than pre-radiotherapy (28.6%) (P = 0.015). The higher incidence of radiation pneumonitis (46.7%) was found in patients with positive TGF-beta1 expression in sputum post-radiotherapy than those with negative expression post-radiotherapy (14.3%) (P = 0.193). CONCLUSION: It may be more reasonable to predict radiation pneumonitis by combining the change of TGF-beta1 levels in serum with tumor response than just the change of TGF-beta1 levels in serum alone. TGF-beta1 can positively express in the sputum of patients with NSCLC, located in macrophages and epithelial cells, with macrophages as the main areas of expression. Patients with positively expressed TGF-beta1 in sputum after radiotherapy have a higher incidence of radiation pneumonitis than those with negative expressions. The positive expression of TGF-beta1 in sputum is expected to become a factor for predicting radiation pneumonitis.

The value of radiotherapy in patients with T1 and T2 breast cancer with one to three positive nodes after modified radical mastectomy.

BACKGROUND AND OBJECTIVE: The role of adjuvant radiotherapy to the regional nodes in women with T1 to T2 breast cancer and one to three positive nodes is controversial. This study compared and analyzed the prognosis of patients with T1-T2 breast cancer with one to three positive nodes after modified radical mastectomy with or without postoperative radiotherapy. METHODS: The cases of 434 women patients with T1 to T2 breast cancer with one to three positive lymph nodes after modified radical mastectomy were reviewed, of which 196 patients received postoperative radiotherapy and 238 patients did not. The ipsilateral chest wall and supraclavicular fossa were irradiated with doses of 46-50 Gy in 23-25 fractions. RESULTS: For all patients, the 3- and 5-year rates of overall survival (OS) were 94.7% and 85.7% respectively, local control (LC) 96.5% and 95.6%;, and disease-free survival (DFS) 89.3% and 82.3% respectively. The 3- and 5-year OS rates for patients without radiotherapy were 92.7% and 97.1% and for those with radiotherapy were 82.4% and 89.2%, both with significant differences (P = 0.039). The 3- and 5-year LC rates for patients without radiotherapy were 94.8% and 98.4% and for those with radiotherapy were 93.6% and 97.7%, again with significant differences (P = 0.041). The 3- and 5-year DFS rates for patients without radiotherapy were 87.8% and 91.3% and for patients with radiotherapy were 78.5% vs 86.1% (P = 0.047). CONCLUSIONS: Postoperative radiotherapy confers better rates of OS, LC, and DFS in patients with T1 to T2 breast cancer with one to three positive nodes after modified radical mastectomy.

[Photosynthetic fluorescence characteristics of floating-leaved and submersed macrophytes commonly found in Taihu Lake].

Some aquatic macrophytes commonly found in Taihu Lake, including Trapa bispinosa, Nymphyoides peltatum, Vallisneria natans, and Hydrilla verticillata were collected, and their maximal quantum yield of photosystem II (Fv/Fm) as well as the rapid light curves (RLCs) under conditions of light adaptation and dark adaptation were measured in situ by using a submersible and pulse-amplitude modulated fluorometer (Diving-PAM). The results showed that floating-leaved plants T. bispinosa and N. peltatum had higher potential maximum photosynthetic capacity than submerged macrophytes V. natans and H. verticillata. The measured maximal quantum yield of T. bispinosa, N. peltatum, V. natans, and H. verticillata was 0.837, 0.831, 0.684, and 0.764, respectively. Both the maximal relative electron transport rate and the half saturation point of light intensity of T. bispinosa and N. peltatum were higher than those of V. natans and H. verticillata, especially under the condition of light adaptation.

[Effects of epiphyte on submerged macrophyte in Taihu Lake].

With the eutrophicated Meiliang Bay and macrophyte-dominated Gonghu Bay of Taihu Lake as test areas, this paper studied the biomass of epiphyte and its effect on submerged macrophyte during the vigorous growth season (May-June) of submerged macrophyte in 2005. The results showed that the biomass of epiphyte attached on macrophyte was higher in Gonghu Bay than in Meiliang Bay, and varied within different macrophyte species. The epiphyte inhibited the photosynthetic rate of submerged plant significantly, which could be up to 91.9% in June, and this effect increased with increasing epiphyte biomass but varied with different host plants.