Pediatric H3K27M­mutant diffuse midline glioma with vertebral metastasis: A case report and literature review.

H3K27M-mutant diffuse midline glioma (DMG) is a type of high-grade glial tumor, which occurs in the midline structure and develops mostly in children. Extraneural metastases (ENM) are exceedingly rare in patients with H3K27M-mutant DMG. A 9-year-old male patient presented with a headache, nausea and vomiting. Following magnetic resonance imaging and immunohistochemical molecular testing examination, the patient was diagnosed with H3K27M-mutant DMG and received chemoradiotherapy plus five cycles of chemotherapy with temozolomide intermittently as an adjuvant therapy. The treatment resulted in a slight reduction of the tumor volume. However, 2 months later, the patient was admitted to hospital with complaints of drooping of the mouth, and waist and back pain. Magnetic resonance imaging and positron-emission tomography-computed tomography revealed an unusual presentation with multiple vertebral metastases and craniospinal leptomeningeal dissemination. Following discussion between the members of a multidisciplinary medical team, the patient underwent one cycle of chemotherapy with cyclophosphamide, vincristine and cisplatin. However, the condition did not improve and the patient died 4 weeks after the diagnosis of ENM. The mechanisms underlying the development of these rare metastases remain unclear. The present case report provides insights into the clinical characteristics and potential metastasis mechanisms of this aggressive disease and may help to elucidate new pathways for the management of ENM.

Thermal insulation and antibacterial foam templated from bagasse nanocellulose /nisin complex stabilized Pickering emulsion.

Foam packaging with good thermal insulation and antibacterial properties is promising for cold chain delivery to strengthen food safety. This study reports a novel antibacterial foam with thermal insulation templated from bagasse nanocellulose complex particle-stabilised acrylate epoxy soybean oil (AESO) Pickering emulsions. Nanocellulose/nisin complex particles (N-CNFs) were prepared by loading positively charged nisin onto negatively charged cellulose nanofibrils via electrostatic interactions, that highly enhanced the stability of nanocellulose at the AESO/water interface and imparted the corresponding foam with good antibacterial properties. The results show that the porosity of the foam prepared with N-CNFs increased from 10.9% to 29.9% compared with that of the foam corresponding with bare nanocellulose; the thermal conductivity of the N-CNF foam decreased substantially from 0.431 W/m·K to 0.197 W/m·K. Moreover, the prepared foam exhibited good antibacterial activity, and its bacteriostatic rate against Listeria monocytogenes was 91.33%. The incorporation of antibacterial peptides into nanocellulose has enriched the study of the Pickering emulsion templating method for preparing multifunctional foam materials and is expected to broaden the application of nanocellulose in the field of food packaging.

The current management and biomarkers of immunotherapy in advanced gastric cancer.

BACKGROUND: Gastric carcinoma (GC) is the fourth most common cause of cancer-related death worldwide. Most patients are diagnosed at later stage, because of few treatment options, the prognosis is poor. In recent years, however, Immune checkpoint inhibitors(ICIs), such as anti- programmed death-1 (PD-1), anti-PD-L1, and anti-cytotoxic T lymphocyte antigen 4, have emerged as promising therapeutic agents in GC. Here, we summary the current treatment and advances of immune checkpoint inhibitors in the advanced stage of GC. METHODS: WANFANG MED ONLINE, CNKI, NCBI PUBMED and clinicaltrials.gov were used to search literature spanning from 2000 to 2021, and all literatures about "advanced gastric or gastro-oesophageal junction cancer, Immune checkpoint inhibitors, PD-1, PD-L1, Cytotoxic T lymphocyte antigen 4, immune therapy" with detailed data were included. RESULTS: Nivolumab and pembrolizumab have been recommended for the third line or subsequent therapy in advanced GC. Nivolumab plus chemotherapy has been recommended for the first line treatment in advanced GC in China. Many other ICIs have been demonstrating encouraging efficacy. PD-L1, MSI-H, Epstein Barr virus, and tumor mutational burden (TMB) status maybe potential biomarkers for response to clinical outcomes for ICIs in GC. CONCLUSION: ICIs have shown encouraging treatment efficacy and manageable safety profile in GC. Some biomarkers including PD-L1, MSI-H, EBV, and TMB status could evaluate the efficacy of ICIs in GC.

Glucocorticoid-induced leucine zipper protects noise-induced apoptosis in cochlear cells by inhibiting endoplasmic reticulum stress in rats.

Endoplasmic reticulum (ER) stress-mediated apoptosis has been reported to be involved in the noise-induced hearing loss (NIHL). Glucocorticoid-induced leucine zipper (GILZ) protein has been reported to have different regulatory effects on apoptosis according to cell types. However, whether GILZ regulates apoptosis in cochlear cells is unclear. Our study aimed to investigate the mechanism by which GILZ protected ER stress-mediated cochlear apoptosis induced by noise exposure. In our trials, forty-eight male Spraque-Dawley rats were randomized into the noise, OE-GILZ-rLV + noise (ON), shRNA-GILZ-rLV + noise (SN), and control group. Rats in noise and control groups were pre-treated by administration of Blank-rLV. Before and on days 1, 4, 14 after noise exposure, auditory brainstem response (ABR) and cochlear apoptosis were detected. Changes in GILZ, GRP78, CHOP, Bcl-xL, Bax, and cleaved caspase-3 levels were investigated. Noise exposure increased ABR threshold shifts and cochlear apoptosis in parallel with downregulation of Bcl-xL and upregulation of GRP78, CHOP, Bax and cleaved caspase-3. GILZ overexpression significantly reduced ABR threshold shifts and apoptotic cochlear cells owing to noise exposure. GILZ overexpression in the cochlea further increased GRP78 elevation, decreased expression of CHOP, Bax and cleaved caspase-3, and increased expression of Bcl-xL. GILZ silencing demonstrated the opposite effect on these effects. GILZ protects cochlea from ER stress-mediated apoptosis induced by noise exposure through reduction of CHOP and regulation of ER stress-associated apoptotic proteins.

A glimpse into the psychological status of E.N.T inpatients in China: A cross-sectional survey of three hospitals in different regions.

OBJECTIVE: To determine whether E.N.T inpatients have a higher prevalence of mental illness than the general population and whether certain diseases are more likely to be associated with mental illness than other diseases. METHODS: This cross-sectional survey was conducted in the E.N.T departments of three hospitals in different cities in China. The psychological status of all consecutive adult inpatients was assessed within 1-2 days following hospital admission using the Symptom Checklist-90 (SCL-90), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). Inpatients from the general surgery and pneumology departments at the same hospital were enrolled and surveyed as control groups. RESULTS: The 439 patients enrolled in the final analysis accounted for 88.0% of all E.N.T inpatients during the study period. Of these patients, 16.4% were in an anxious state and 79.5% were in a depressive state. The overall anxiety (41.7 ± 9.7) and depression (55.9 ± 29.2) scores were much higher than Chinese norm (29.8 ± 10.0 and 33.5 ± 8.6, respectively), and significant differences were observed (t = 20.89, P < 0.01 and t = 13.12, P < 0.01, respectively). Although 18.7% of the E.N.T patients were psychiatric distress, these patients scored lower on the SCL-90 than the Chinese norm. Furthermore, the patients in the E.N.T department had a higher prevalence of anxiety and depression than those in the general surgery department but a similar prevalence to those in the respiratory department. CONCLUSION: Psychological distress, particularly anxiety and depression, are widespread in patients with otolaryngological diseases. Therefore, the identification and treatment of co-occurring psychiatric disorders in this high risk and clinically challenging group of patients are urgent in China.

Efficacy of intratympanic corticosteroid, intravenous batroxobin and combined treatment for sudden sensorineural hearing loss with type-2 diabetes.

BACKGROUND: Intratympanic corticosteroid (IC), intravenous batroxobin (IB) as the treatment for sudden sensorineural hearing loss (SSNHL) has been reported. However, the data on combination therapy (CT) was scarce. OBJECTIVE: The aim of this retrospective study was to compare the efficacy of IC, IB, and CT in the treatment of SSNHL with diabetes. MATERIAL AND METHODS: A total of 212 SSNHL patients with diabetes, who were initially treated within 14 days of onset of disease, were divided into three groups by treatment modality. The hearing recovery was evaluated by the results of pure-tone test after completion of treatment. The prognostic factors, including age, severity of initial hearing loss, duration to onset of treatment, and audiometric curve type, were further compared. RESULTS: There was a significant difference in hearing recovery by the treatment (p < .05). Recovery rates in the CT group were significantly higher in patients with early treatment than with delayed treatment (p = .021). However, duration and recovery rate was not significantly correlated in IC and IB group (p > .05). In patients recieving early treatment, the recovery rate in CT group was significantly higher than that in IC (p = .013) and IB group (p = .029). Regardless of treatment, the recovery rates were higher in patients with flat and ascending audiograms (p < .05). CONCLUSIONS AND SIGNIFICANCE: Patients receiving combined therapy, especially in the early stage of SSNHL, could achieve significantly superior recovery in the treatment of SSNHL with diabetes, compared with those using IC or IB alone.

Treatment of high-grade gliomas using escalating doses of hypofractionated simultaneous integrated boost-intensity-modulated radiation therapy in combination with temozolomide: A modified Phase I clinical trial.

BACKGROUND: Recent studies have shown that hypofractionated simultaneous integrated boost-intensity-modulated radiation therapy (SIB-IMRT) provided certain survival benefits over other fractionation methods for high-grade gliomas. However, the best hypofractionation mode and its efficacy have not been confirmed. The purpose of this study was to investigate the maximum tolerated dose (MTD) of hypofractionated SIB-IMRT with stepwise escalating doses combined with temozolomide (TMZ) for treating malignant gliomas. METHODS: The patients received concurrent postoperative radiotherapy and chemotherapy. SIB-IMRT was adopted to increase the dose both in the surgical cavity and residual tumor (planning target volume 1). The dose at each fraction was gradually increased from 2.8 Gy/f (total of 20 times), with an escalating dose interval of 0.4 Gy. The planning target volume 2 involved the 2 cm region around surgical cavity, and residual tumor remained unchanged, with 2.5 Gy each time and a total of 50 Gy/20f. TMZ was administered with a dose of 75 mg/m2/day during radiotherapy. Adjuvant TMZ was given at 150-200 mg/m2/day for 5 days every 28 days. A total of 16 patients were enrolled. RESULTS: Three patients exhibited dose-limiting toxicity (DLT), two cases reported Grade 3 headache in the 3.6 Gy/f and 4 Gy/f dose groups, and one patient developed persistent seizures attacks in the 4 Gy/f dose group. Therefore, 4 Gy/f was considered the DLT and the lower dose level of 3.6 Gy/f was regarded as the MTD in the study, with tolerable adverse reactions. The median overall survival (OS) and median progression-free survival (PFS) in this study were 19 and 16 months, respectively. The 1- and 2-year OS and PFS were 86.7%, 31.0% and 73.7%, 26.7%, respectively. CONCLUSIONS: It showed that the treatment of high-grade gliomas with hypofractionated SIB-IMRT combined with TMZ had an MTD of 3.6 Gy/f (72 Gy/20f). In addition, the results preliminarily showed improved survival.

The Development of a Triaxial Cutting Force Sensor Based on a MEMS Strain Gauge.

Cutting force measurement is a quintessential task for status monitoring during machining. In the past, a number of cutting force sensors have been developed, each featuring a different set of performance advantages. In a pursuit to improve the measuring sensitivity and reduce the cross-interference error, in this paper we propose a triaxial cutting force sensor based on a commercial micro-electro-mechanical system (MEMS) strain gauge. An elastic-sensitive element comprised of two mutual-perpendicular octagonal rings is designed for triaxial cutting force measurement, and a decoupling matrix is derived from static calibration to reduce cross-interference. It can be concluded from static calibration that the sensor's sensitivity is 0.32 mV/N, 0.32 mV/N, and 0.05 mV/N in triaxial directions, and the proposed decoupling matrix is able to reduce cross-interference error to 0.14%, 0.25%, and 4.42%. Dynamic cutting force measurement shows that the cutting force sensor can reflect the variation of cutting status very well, it is qualified to measure triaxial cutting forces in practical applications.

The role of NRAGE subcellular location and epithelial-mesenchymal transition on radiation resistance of esophageal carcinoma cell.

BACKGROUND: Neurotrophin receptor-interacting MAGE homolog (NRAGE) has been considered as a tumor suppressor. In the previous study, we established human esophageal carcinoma resistance cell line TE13R120 and found the difference of NRAGE expression between TE13 and TE13R120 cells by gene microarray. Herein, we further discuss the possible molecular mechanism of NRAGE on participating the radiation sensitivity of esophageal carcinoma cells. MATERIALS AND METHODS: We used colony formation assay to measure the surviving fraction and relevant radiobiological parameters. NRAGE expression was estimated by immunofluorescence and Western blot. Tumor growth factor-ß (TGF-ß) was used for inducing epithelial-mesenchymal transition (EMT) in TE13 cells to detect the relationship between NRAGE and EMT; the capacity of cell migration was also assessed by wound healing assay. RESULTS: TE13R120 cells were showed significantly radioresistance compared with TE13. The D0, Dq, and N value of TE13R120 were all higher than those of TE13 (2.499, 1.991, and 2.219 vs. 2.242, 0.854, and 1.645), as well as SF2 (0.734 vs. 0.538). Results of immunofluorescences showed that NRAGE was mainly expressed in the nucleus of TE13R120 cells, but in TE13 cells, it was mainly in cytoplasm. In addition, EMT phenotype was observed in TE13R120 cells and TGF-ß-induced EMT in TE13 cells, E-cadherin expression was decreased, but vimentin was upregulated. Furthermore, TE13 cells have a rising tendency in NRAGE nucleus expression after treatment with TGF-ß. Results of wound healing assay showed that the cell migration of TE13R120 and TGF-ß-induced EMT in TE13 cells were remarkably enhanced. CONCLUSIONS: Our results indicate that NRAGE subcellular localization is related to radiation resistance of esophageal carcinoma cell and EMT may be involved in NRAGE subcellular location.

Relation Between Crystal Structure and Electrochemical Performance of LiNi1/3ZnxCo1/3-xMn1/3O2 (0.000 ≤ x ≤ 0.133).

LiNi1/3ZnxCo1/3-xMn1/3O2 (0.000 ≤ x ≤ 0.133) hollow microspheres are synthesized using MnO2 hollow microspheres both as a self-template and Mn source. These hollow microspheres, ~4 µm in diameter, are composed of approximately 300 nm basic nanoparticles. The XRD patterns of LiNi1/3ZnxCo1/3-xMn1/3O2 were analyzed by the RIETAN-FP program, and the obtained samples have a layered α-NaFeO2 structure. Electrochemical performances of the samples were carried out between 2.5 V and 4.5 V. The behavior of the lattice parameters is consistent with Cycling performance and rate performance change with increase of x. Compared with the others, the sample of x = 0.133 exhibits a relatively superior electrochemical performance. The specific capacity of x = 0.133 was increased by 10.7% than no-doped. In addition, the cyclic voltammograms curves of the second cycle show no significant alteration compared with the first cycle and the electrochemical impedance of zinc doping sample showed smaller transfer resistance than the no-doping sample.

Identification of novel NRAGE involved in the radioresistance of esophageal cancer cells.

Radiotherapy (RT) is one main method for the treatment of esophageal squamous cell carcinoma (ESCC), and the radioresistance is the predominant cause of patients with local recurrence. The previous results of gene microarray and subsequent verification showed that NRAGE might be involved in radiation resistance of ESCC cells. In this study, we reestablished human esophageal carcinoma radioresistant cell lines TE13R120 and ECA109R60 with gradient dose irradiation as previously reported, respectively. NRAGE expression was high in TE13R120 and ECA109R60 cells and was correlative with ionizing radiation (IR) resistance in clinic. However, the radiosensitivity of TE13R120 cells had a remarkable increase detected by colony formation assays after siRNA against NRAGE (siNRG) transfection into TE13R120 cells. Compared with TE13 cells, an increasing number of TE13R120 cells with NRAGE overexpression in S phase and a lower ratio in G2/M were observed by flow cytometry method (FCM). Intriguingly, the above changes were partially reversed in TE13R120 cells treated with siNRG. More importantly, the ectopic subcellular localization of NRAGE mediated nuclear translocation of ß-catenin which may be one reason of IR resistance of esophageal carcinoma cell. These data indicate that NRAGE extremely may be a pivotal factor involved in Wnt/ß-catenin signal pathway, mediating nuclear translocation of ß-catenin and then facilitating the formation of radioresistance of ESCC.

Can upper airway surgery for OSA protect against cardiovascular sequelae via effects on coagulation?

CONCLUSION: Upper airway surgery is associated with salutary effects on the blood coagulation characteristics of OSA patients, a benefit that may be protective against cardiac and cerebrovascular morbidity and mortality. OBJECTIVE: Increased blood coagulation is an important factor linking OSA and cardiovascular complications. Surgery is an important method to treat OSA, but the effect of surgery on blood coagulation in OSA patients is unknown. METHODS: the authors performed a prospective clinical trial of adult OSA patients who underwent surgery from 2012-2014. Pre-operative and post-operative blood coagulation parameters and polysomnography (PSG) results were compared. RESULT: There were 61 subjects. The total rate of success in curing OSA was 11.5%. The rate of response after surgery was 40.8%. Overall, the Apnea-Hypopnea Index (AHI) improved after surgery (from 39.8 3 ± 24.49 to 25.9 7 ± 18.53, p < 0.01). After surgery, serum platelet counts (PLT) decreased (from 242.5 ± 52.6 to 230.9 ± 40.7, p=0.01), and Fibrinogen (FIB) levels declined (from 262.5 ± 52.5 to 247.3 ± 44.4, p = 0.02). Other blood coagulation parameters also improved: prothrombin time (PT) (from 10.6 2 ± 0.62 to 10.8 6 ± 0.70, p=0.01), activated partial thromboplastin time (APTT) (from 26.9 8 ± 4.94 to 27.7 8 ± 3.02, p = 0.06), and Thrombin time (TT) (from 19.5 3 ± 0.84 to 20.1 1 ± 1.31, p < 0.01).

The complete mitochondrial genome of Eurynorhynchus pygmeus (Charadriiformes: Scolopacidae).

The complete mitochondrial DNA genome of spoon-billed sandpiper Eurynorhynchus pygmeus was determined by using the polymerase chain reaction method and the phylogenetic tree including 15 species of Charadriiformes were reconstructed to validate our samples in this study. The circular mitogenome (16,707 bp in length) contains 13 protein-coding genes, 2 rRNA genes (12S rRNA and 16S rRNA), 22 tRNA genes and a control region. The content of four kinds of bases of the complete mitochondrial DNA is 31.29% for A, 24.85% for T, 13.84% for G and 30.02% for C, respectively.

The complete mitochondrial genome of Recurvirostra avosetta (Charadriiformes: Recurvirostridea).

The complete mitochondrial genome of Recurvirostra avosetta (Charadriiformes: Recurvirostridea) is a circular DNA with 16,897 bp in length, which contained 13 protein-coding genes, 2 ribosomal RNAs, 22 transfer RNAs, and a control region. The overall base compositions of the complete mtDNA are A (31.72%), T (23.59%), G (13.56%), and C (31.13%). The non-coding regions include a control region (1333 bp) and a few intergenic spacers (range from 17 to 90). The phylogentic trees were also reconstructed to validate the samples.

The complete mitochondrial genome of Terek sandpiper, Xenus cinereus (Charadriiformes: Scolopacidae).

The complete mitochondrial DNA genome of Terek sandpiper, Xenus cinereus, was detected by using polymerase chain reaction method and DNASTAR software package. The circular mitogenome (16,817 bp in length) contains 13 protein-coding genes, 2 rRNA genes (12S ribosomal RNA and 16S ribosomal RNA), 22 tRNA genes and a control region. The content of four kinds of bases of the complete mitochondrial DNA is 30.7% for A, 24.9% for T, 30.2% for C and 14.3% for G, respectively. To validate our data, 12 published complete mitochondrial genomes of Charadriiformes along with the genome of Terek sandpiper were used to construct the phylogenetic tree.

Does airway surgery lower serum lipid levels in obstructive sleep apnea patients? A retrospective case review.

BACKGROUND: Obstructive sleep apnea (OSA) is tightly linked to increased cardiovascular disease. Surgery is an important method to treat OSA, but its effect on serum lipid levels in OSA patients is unknown. We aimed to evaluate the effect of upper airway surgery on lipid profiles. MATERIAL AND METHODS: We performed a retrospective review of 113 adult patients with OSA who underwent surgery (nasal or uvulopalatopharyngoplasty [UPPP]) at a major, urban, academic hospital in Beijing from 2012 to 2013 who had preoperative and postoperative serum lipid profiles. RESULTS: Serum TC (4.86±0.74 to 4.69±0.71) and LP(a) (median 18.50 to 10.90) all decreased significantly post-operatively (P<0.01, 0.01, respectively), with no changes in serum HDL, LDL, or TG (P>0.05, all). For UPPP patients (n=51), serum TC, HDL and LP(a) improved (P=0.01, 0.01,<0.01, respectively). For nasal patients (n=62), only the serum LP(a) decreased (P<0.01). In patients with normal serum lipids at baseline, only serum LP(a) decreased (P<0.01). In contrast, in patients with isolated hypertriglyceridemia, the serum HDL, TG and LP(a) showed significant improvements (P=0.02, 0.03, <0.01, respectively). In patients with isolated hypercholesterolemia, the serum LP(a) decreased significantly (P=0.01), with a similar trend for serum TC (P=0.06). In patients with mixed hyperlipidemia, the serum TC and LDL also decreased (P=0.02, 0.03, respectively). CONCLUSIONS: Surgery may improve blood lipid levels in patients with OSA, especially in patients with preoperative dyslipidemia, potentially yielding a major benefit in metabolism and cardiovascular sequelae. Prospective studies should examine this potential metabolic effect of airway surgery for OSA.

Phase II clinical trial of whole-brain irradiation plus three-dimensional conformal boost with concurrent topotecan for brain metastases from lung cancer.

BACKGROUND: Patients with brain metastases from lung cancer have poor prognoses and short survival time, and they are often excluded from clinical trials. Whole-cranial irradiation is considered to be the standard treatment, but its efficacy is not satisfactory. The purpose of this phase II clinical trial was to evaluate the preliminary efficacy and safety of the treatment of whole-brain irradiation plus three-dimensional conformal boost combined with concurrent topotecan for the patients with brain metastases from lung cancer. METHODS: Patients with brain metastasis from lung cancer received concurrent chemotherapy and radiotherapy: conventional fractionated whole-brain irradiation, 2 fields/time, 1 fraction/day, 2 Gy/fraction, 5 times/week, and DT 40 Gy/20 fractions; for the patients with ≤ 3 lesions with diameter ≥ 2 cm, a three-dimensional (3-D) conformal localised boost was given to increase the dosage to 56-60 Gy; and during radiotherapy, concurrent chemotherapy with topotecan was given (the chemoradiotherapy group, CRT). The patients with brain metastasis from lung cancer during the same period who received radiotherapy only were selected as the controls (the radiotherapy-alone group, RT). RESULTS: From March 2009 to March 2012, both 38 patients were enrolled into two groups. The median progression-free survival(PFS) time , the 1- and 2-year PFS rates of CRT group and RT group were 6 months, 42.8%, 21.6% and 3 months, 11.6%, 8.7% (χ2 = 6.02, p = 0.014), respectively. The 1- and 2-year intracranial lesion control rates of CRT and RT were 75.9% , 65.2% and 41.6% , 31.2% (χ2 = 3.892, p = 0.049), respectively. The 1- and 2-year overall survival rates (OS) of CRT and RT were 50.8% , 37.9% and 40.4% , 16.5% (χ2 = 1.811, p = 0.178), respectively. The major side effects were myelosuppression and digestive toxicities, but no differences were observed between the two groups. CONCLUSION: Compared with radiotherapy alone, whole-brain irradiation plus 3-D conformal boost irradiation and concurrent topotecan chemotherapy significantly improved the PFS rate and the intracranial lesion control rate of patients with brain metastases from lung cancer, and no significant increases in side effects were observed. Based on these results, this treatment method is recommended for phase III clinical trial.

[Clinical observation of isolated congenital anosmia].

OBJECTIVE: To introduce 8 patients with isolated congenital anosmia and to discuss the clinical manifestations, imaging characteristics and family characteristics of this rarely seen disorder. METHODS: Eight patients with isolated congenital anosmia treated between April 2007 and April 2012 were reviewed retrospectively. There were 4 males and 4 females. A detailed medical history collection, physical examination, nasal endoscopy, T&T and Sniffin'Sticks subjective olfactory function tests, olfactory event-related potentials sinonasal computed tomography scan and sex hormones level monitoring were performed in all patients. Seven cases underwent magnetic resonance image of olfactory pathway examination. RESULTS: All patients were anosmia without evidence of other defects. ENT physical examination, nasal endoscopy and computed tomography scan were normal except 4 cases with obvious nasal septum deviation, 2 cases with concha bullosa. Subjective olfactory test indicated all of them were anosmia. Olfactory event-related potentials were obtained in only 1 patient. Magnetic resonance imaging revealed the smaller or atrophy olfactory bulb and olfactory tract in five cases, the absence of olfactory bulbs and tracts in two case. A female patient did not have MRI examination because of wearing IUDs. Detection of 8 patients of sex hormones were normal. Family characteristics: 3 patients showed family inheritance pattern. CONCLUSIONS: The diagnosis of isolated congenital anosmia should be based on chief complaint, medical history, physical examination, olfactory test, nasal endoscopy, olfactory testing, olfactory imaging and olfactory event-related potentials. Magnetic resonance image of olfactory pathway and olfactory event-related potentials have important value for the diagnosis. More attention should be paid to the genetic susceptibility of the family.

A modified Phase I trial of radiation dose escalation in 3D conformal radiation therapy with concurrent vinorelbine and carboplatin chemotherapy for non-small-cell lung cancer.

The Radiation Therapy Oncology Group reported a maximum tolerated dose of 74 Gy for patients with non-small cell lung cancer (NSCLC); however, it was unclear whether this dose could be safely administered to Asian patients due to differences in their physique compared to Western patients. We therefore conducted a modified Phase I trial to determine whether 70 Gy could be safely delivered to Chinese patients with NSCLC undergoing 3D-conformal radiation therapy (3D-CRT) with concurrent chemotherapy. Previously untreated NSCLC patients received 3D-CRT (2 Gy/day, 5 fractions per week). Three dose levels were examined: 62, 66 and 70 Gy. Two cycles of concurrent chemotherapy (vinorelbine and carboplatin) were started on the first day of radiation therapy. Dose-limiting toxicity (DLT) was defined as severe or life-threatening side effects that altered the continued implementation of chemoradiotherapy. Among the 19 patients recruited in this study, most of the haematologic and non-haematologic toxicities were mild to moderate and clinically manageable. Only one patient, in the 70 Gy cohort, experienced a DLT of Grade 3 radiation-induced pneumonia. The overall response rate was 77.8% (14/18). The median progression-free survival (PFS) was 12 months, and the 1-year PFS was 37.6%. Our results support both the feasibility of incorporating 3D-CRT with concurrent vinorelbine and carboplatin and a dose escalation to 70 Gy for Chinese patients with NSCLC, based on the acceptable toxicity and encouraging overall response and survival rates. A further evaluation of this regimen in a prospective Phase II trial is ongoing.

Phase II trial of capecitabine combined with docetaxel in previously treated patients with non-small cell lung cancer: A randomized controlled study.

Docetaxel alone has been confirmed to be beneficial to patients with advanced previously treated non-small cell lung cancer (NSCLC). However, the duration and survival time is short. The study of two-agent combination regimens has important clinical significance. We conducted this randomized controlled phase II trial to comparatively evaluate the efficacy and side effects of capecitabine combined with docetaxel in previously treated patients with NSCLC. Patients with previously treated NSCLC who failed first-line chemotherapy were randomized into two groups; one received capecitabine combined with docetaxel (XT group) and the other received docetaxel alone (T group). Patients in the XT group received chemotherapy as follows: capecitabine 625 mg/m(2), p.o. bid, days 5-18; and docetaxel 30 mg/m(2), days 1 and 8, while patients in the T group received docetaxel 35 mg/m(2) on days 1 and 8. The primary endpoint was time to progression (TTP), and secondary endpoints were overall survival (OS), response rate (RR) and disease control rate (DCR). Forty-eight patients were recruited (23 in the XT group and 25 in the T group). TTP, median survival time (MST) and 1-year OS rate in the XT group and the T group were 7 months, 12 months, 47.6% and 3 months, 12 months, 39.6%, respectively. The TTP in the XT group was significantly longer compared to that in the T group (χ(2)=4.763, p=0.029). The RR and DCR in the XT group and T group were 13.0% (3/23), 78.3% (18/23) and 12.0% (3/25), 76% (19/25), respectively. The difference was not significant (p>0.05). The major side effects observed in the two groups were neutropenia, fatigue and nausea, and toxicities were mild to modest. No severe cases of hand-foot syndrome were observed in the XT group. In conclusion, compared with docetaxel alone, capecitabine combined with docetaxel for patients with previously treated NSCLC achieved a significantly longer TTP and this regimen was well tolerated. The relatively high median TTP, 1-year OS rate and DCR encourage further evaluation of this regimen in a randomized phase III trial.