Effects of Epstein-Barr virus viral load and different treatment modality for stage III nasopharyngeal carcinoma.

BACKGROUND: We investigated treatment results, the effects of different treatment modality, and pretreatment Epstein-Barr virus (EBV) viral load for stage III nasopharyngeal carcinoma (NPC) patients. METHODS: The initial definitive treatment for 356 stage III NPC patients consisted of concurrent chemoradiotherapy (CCRT) or induction chemotherapy plus radiotherapy (IndCT-RT). The pretreatment EBV DNA level separated patients into a high (n = 106) or low (n = 250) viral load (≥ or < 1000 copies/mL) subgroup. Outcome measures include relapse rates and various survivals. RESULTS: The 5-year rates of overall survival (OS), progression-free survival (PFS), distant metastasis failure-free survival (DMFFS), and locoregional failure-free survival (LRFFS) were 88.6%, 83.0%, 90.5%, and 90.5%, respectively. Patient characteristics and pretreatment viral load between IndCT-RT and CCRT were no significant differences except for a higher percentage of N2 disease in the IndCT-RT subgroup. Both treatment modality resulted in similar relapse rates (P = .56), OS (P = .20), PFS (P = .53), DMFFS (P = .89), and LRFFS (P = .35). However, patients with a high viral load experienced a higher relapse rate (33.0% vs 12.4%, P < .001) and worse OS (5-year rate, 79.0% vs 92.8%, P < .001), PFS (73.7% vs 88.4%, P < .001), DMFFS (80.2% vs 95.0%, P < .001), and LRFFS (85.6% vs 92.6%, P = .005) than those with a low viral load. CONCLUSION: Long-term treatment results for stage III NPC patients are rather good. IndCT-RT can achieve the same treatment outcome as CCRT. Risk grouping by pretreatment viral load identified a subgroup (30%) of patients associated with a significantly higher relapse rates and worse survivals. These high-risk patients need to strengthen treatment intensity in future trials.

Prognostic factors related to intratumoral hemorrhage in pediatric intracranial germ cell tumors.

BACKGROUND: Certain types of pediatric intracranial germ cell tumors (PIGCTs) are prone to intratumoral hemorrhaging (TH) and associated with poor survival outcome. However, the impact of TH on the functional prognosis of patients with PIGCTs has not been well studied. This study aimed to evaluate the clinical and MR findings in PIGCT patients with TH to identify the factors related to patient survival and functional outcome. METHODS: This study included 17 patients diagnosed with PIGCT and TH between 2002 and 2016 and evaluated TH-associated clinical and MR findings. The modified Rankin scale (mRS) was used to evaluate functional outcome, which was poor when mRS ≧ 3. The volumes of hematomas and tumors were manually tracked within each brain magnetic resonance imaging slice. RESULTS: Among the 17 patients, 6 (35.3%) died and 9 (52.9%) had poor functional outcome. Regarding the functional outcome, the mean hematoma volume to tumor volume ratio (HTVR) was 8.5 ± 3.9% in the favorable outcome group and 42.3 ± 27.8% in the poor outcome group (p = 0.001). For the survival outcome, the mean HTVR was 15.7 ± 16.1% in the living group and 46.0 ± 31.5% in the deceased group (p = 0.016). The cutoff point of the receiver operating characteristics curve for HTVR to predict death and poor functional outcome was 19.27% and 16.8%, respectively. CONCLUSION: Our study demonstrated that patients with larger HTVR had significantly worse functional and survival outcomes than those with smaller HTVR. We suggest that early and aggressive treatment for PIGCTs in patients with large HTVR can improve their long-term prognosis.

How Cryptococcus interacts with the blood-brain barrier.

Cryptococcus demonstrates predilection for invasion of the brain, but the mechanism by which Cryptococcus crosses the blood-brain barrier (BBB) to cause brain invasion is largely unknown. In order for Cryptococcus to cross the BBB, there must be a way to either cross human brain microvascular endothelial cells, which are the main constitute of the BBB, or go in between tight junctions. Recent evidence of human brain microvascular endothelial cell responses to transcellular brain invasions includes membrane rearrangements, intracellular signaling pathways and cytoskeletal activations. Several Cryptococcal genes related to the traversal of BBB have been identified, including CPS1, ITR1a, ITR3c, PLB1, MPR1, FNX1 and RUB1. In addition, Cryptococcus neoformans-derived microvesicles may contribute to cryptococcal brain invasion. Paracellularly, Cryptococcus may traverse across BBB using either routes utilizing plasmin, ammonia or macrophages in a Trojan horse mechanism.

Modulation of Sonic hedgehog signaling and WW domain containing oxidoreductase WOX1 expression enhances radiosensitivity of human glioblastoma cells.

WW domain containing oxidoreductase, designated WWOX, FOR or WOX1, is a known pro-apoptotic factor when ectopically expressed in various types of cancer cells, including glioblastoma multiforme (GBM). The activation of sonic hedgehog (Shh) signaling, especially paracrine Shh secretion in response to radiation, is associated with impairing the effective irradiation of cancer cells. Here, we examined the role of Shh signaling and WOX1 overexpression in the radiosensitivity of human GBM cells. Our results showed that ionizing irradiation (IR) increased the cytoplasmic Shh and nuclear Gli-1 content in GBM U373MG and U87MG cells. GBM cells with exogenous Shh treatment exhibited similar results. Pretreatment with Shh peptides protected U373MG and U87MG cells against IR in a dose-dependent manner. Cyclopamine, a Hedgehog/Smoothened (SMO) inhibitor, reversed the protective effect of Shh in U87MG cells. Cyclopamine increased Shh plus IR-induced H2AX, a marker of DNA double-strand breaks, in these cells. To verify the role of Shh signaling in the radiosensitivity of GBM cells, we tested the effect of the Gli family zinc finger 1 (Gli-1) inhibitor zerumbone and found that it could sensitize GBM cells to IR. We next examined the role of WOX1 in radiosensitivity. Overexpression of WOX1 enhanced the radiosensitivity of U87MG (possessing wild type p53 or WTp53) but not U373MG (harboring mutant p53 or MTp53) cells. Pretreatment with Shh peptides protected both WOX1-overexpressed U373MG and U87MG cells against IR and increased the cytoplasmic Shh and nuclear Gli-1 content. Zerumbone enhanced the radiosensitivity of WOX1-overexpressed U373MG and U87MG cells. In conclusion, overexpression of WOX1 preferentially sensitized human GBM cells possessing wild type p53 to radiation therapy. Blocking of Shh signaling may enhance radiosensitivity independently of the expression of p53 and WOX1. The crosstalk between Shh signaling and WOX1 expression in human glioblastoma warrants further investigation.

Long-term survival analysis of nasopharyngeal carcinoma by plasma Epstein-Barr virus DNA levels.

BACKGROUND: The objective of this study was to confirm the relation between plasma Epstein-Barr virus (EBV) DNA (pEBV DNA) load and treatment outcomes after long-term follow-up in patients with nasopharyngeal carcinoma (NPC). METHODS: In total, 210 patients with NPC were enrolled, including 99 previously reported patients and 111 new patients. They prospectively received treatment with induction chemotherapy plus radiotherapy and were followed for at least 6 years. In these patients, pEBV DNA levels were measured before treatment and 1 week after treatment. The plasma viral load was correlated with treatment outcomes in the group of new patients and in the entire group. RESULTS: By using previously defined pEBV DNA cutoff values (1500 copies/mL pretreatment and 0 copies/mL post-treatment), there was a significant correlation between the pEBV DNA value and relapse-free survival, overall survival, and subsequent relapse rates in the new, independent patient cohort. Outcome analyses for the entire group revealed a higher relapse rate (45.6% vs 21.5% [P = .0037] or 76.7% vs 26.1% [P < .0001]), a worse relapse-free survival rate (56.5% vs 79.3% [P < .0001] or 23.3% vs 75.6% [P < .0001]), and poorer overall survival (59.2% vs 86% [P = .0003] or 33.3% vs 79.4% [P < .0001]) in patients who had high pretreatment or persistently detectable post-treatment pEBV DNA levels, respectively, versus their respective counterparts. Multivariate Cox analysis also confirmed these results. CONCLUSIONS: In this expanded study, the prognostic significance of pEBV DNA was confirmed using predefined cutoff values in an independent patient group, and pEBV DNA was identified as an independent prognostic marker for NPC.

Plasma EBV DNA clearance rate as a novel prognostic marker for metastatic/recurrent nasopharyngeal carcinoma.

PURPOSE: To investigate the prognostic effect of the concentrations and clearance rates of plasma EBV DNA in metastatic/recurrent nasopharyngeal carcinoma (NPC). EXPERIMENTAL DESIGN: Thirty relapsed and four previously nontreated metastatic NPC patients were treated according to the consensus guidelines of the head and neck cancer team in our hospital (i.v. chemotherapy first, followed by local irradiation boost and oral maintenance chemotherapy where applicable). Multiple plasma samples were collected during the first month of chemotherapy. Circulating EBV DNA concentrations were measured by a real-time quantitative PCR. The half-life values (t(1/2)) of plasma EBV DNA clearance were calculated. The associations between clinical outcome and plasma EBV DNA assays were analyzed. RESULTS: Tumor response evaluated after 12 weeks of treatment showed 14 complete responses (41.2%), 12 partial responses (35.3%), 7 stable diseases (20.6%), and 1 progression disease (2.9%). The plasma EBV DNA concentrations have no significant effects on outcome prediction. The t(1/2) of plasma EBV DNA clearance ranged from 1.85 to 28.29 days (median, 3.99). Patients with a short t(1/2) of plasma EBV DNA clearance have significantly higher complete response rate and overall survival than those with long t(1/2). Multivariate analysis revealed a significant effect of the t(1/2) of plasma EBV DNA clearance on survival. CONCLUSIONS: The clearance rates of plasma EBV DNA during the first month of chemotherapy can predict tumor response and patient survival. Early change of chemotherapy regimen may be considered for patients with slow plasma EBV DNA clearance rate.

Factors affecting the concentrations of PM10 in central Taiwan.

In this study, the synoptic weather types that have high probability and low probability of producing PM10 episode are referred to as HPE and LPE, respectively. Multiple linear regressions analysis showed that NO2 was the most important contributor (35.61%) to the concentrations of PM10 for HPE weather. For LPE weather, the season factor had the greatest contribution (48.11%) to the concentrations of PM10. Using the correlation coefficients between the concentrations of PM10 and SO2 or NO2 on HPE and LPE to calculate the increase of PM10 from LPE to HPE, we found that the increase of PM10 owing to the increase of SO2 and NO2 from LPE to HPE was 12.93microg/m3 which was about 51% of the total amount of PM10 increased from LPE to HPE. Results of factor analysis showed that the first component could be attributed to the result of local pollution especially for the weather patterns of types P3 and P6, while the secondary component for the weather patterns of types P1 and P4 can be attributed to the long-range transport of SO2 pollutants from China.

Immune response against grouper nervous necrosis virus by vaccination of virus-like particles.

The grouper is a high-value fish in the seafood market. Grouper nervous necrosis virus (GNNV) causes mass mortality, near 100% in larvae and juveniles, which has great economic impact on the aquaculture of the marine fish. Since vaccination is one of the best methods against viral diseases, grouper Epinephelus lanceolatus was injected with virus-like particles (VLPs) of GNNV at different dosages and injection frequencies. The anti-sera of vaccinated fish were analyzed with antigen-capture ELISA to quantify immunization titer. The antibody titers in the vaccinated fish increased remarkably within 4 weeks, during which time the antibody was definitely capable to neutralize the native virus. With one shot of 10-250 microg VLPs, the stimulated antibody titer reached a steady saturation level in 1 month, among which the titers by one shot of 100 and 250 microg VLPs were 13% higher than by 10 microg. Two shots of 10 and 100 microg VLPs increased to maximum titer, which was 29% higher than one shot, whereas two shots of 250 microg VLPs and four shots of 100 microg VLPs dramatically downgraded the titers by -23% and -44%, respectively. These results imply that the overdose effects occurred in total dosages higher than 200 microg VLPs. The experiments of VLP vaccine with adjuvant revealed that the adjuvant is not required for increasing the efficacy of the VLP vaccine. Immunization with the VLPs can also stimulate fish to produce high antibody titer for more than 5 months, which can be correlated to long-term protection. When VLPs are used as vaccine agent, a dosage at 1 microg/g of fish body weight is enough to stimulate a full-scale immune response.

Variations of nitrate and sulfate in the atmosphere on days of high and low particulate matters.

Particulate matters with aerodynamic diameter less than 10 microm (PM10) were collected with high-volume samplers for four periods of consecutive samplings. Each period included a high PM10 (defined as PM10 > or = 110 microg/m3) episode. The concentrations of all ionic species of high PM10 day (HPD) samples were higher than those of low PM10 (defined as PM10 < 110microg/m3) d (LPD) samples. Using the ionic concentrations of HPD samples at each station divided by those of LPD samples at respective stations, the results showed that NO3- increased most from LPD to HPD among the eight ionic species examined. A high mean value (3.15) of NO3-/elemental carbon (EC) ratio of HPD divided by that of LPD indicates that concentration variations due to chemical formation and nonchemical factors apparently were higher than those of the concentration variations due to nonchemical factors alone. The NO3-/SO4(2-) ratio of HPD divided by that of LPD ranged from 1.62 to 3.92 for the four periods. The results indicate that more nitrate than sulfate had formed during high PM10 episodes. Multiple linear regression analysis showed that the percentage of NH4+ associated with nitrate and sulfate decreased and the percentage that could be explained by Ca2+ and Na+ increased on HPD. The reactions of HNO3 and H2SO4 with sea salt particles and with aqueous carbonates on soil particles during HPD were considered the main causes leading to these variations.