UNWANTED RADIATION EXPOSURE TO RADIOSENSITIVE ORGANS DURING HAND CT.

This study aimed to investigate unwanted radiation exposure of radiosensitive organs during computed tomography (CT) scans of the hand. Furthermore, we investigated the effectiveness of a shield in reducing unwanted radiation exposure. In a prospective observational study, the patients were randomized to receive a shield during the hand CT scan. Two group of patients were further randomized to undergo multi-detector CT (MDCT) or cone-beam CT (CBCT). The radiation dose was measured in the target point and the nearest skin surface of radiosensitive organs by attached the thermoluminescent dosemeter chips. When shielding was performed, the radiation doses had decreased significantly with a mean of 79% (65-91%) in the MDCT group and 88.6% (85-93%) in the CBCT group. In the non-shielded group, the radiation doses to the radiosensitive organs decreased inversely with increasing distance, which means that the closer the target point is, the more unwanted radiation exposure increases. It is important to keep radiosensitive organs as far as possible from the target point during CT scan. In particular, it is necessary to shield the radiosensitive organs closer to the target point. Level of Evidence: Level II, Prospective observational study.

Mast cell degranulation and vascular endothelial growth factor expression in mouse skin following ionizing irradiation.

The present study aimed to identify the mechanisms underlying the increase in vascular permeability in mouse skin following irradiation. The left ears of C3H mice were subjected to 2 and 15 Gy of radiation in a single exposure. At 24 h after irradiation, the ears were excised and tissue sections were stained with toluidine blue to assess mast cell degranulation. Vascular endothelial growth factor (VEGF) expression was assessed via immunohistochemistry and western blotting. Approximately 5% (3%-14%) (mean [95% CI]) of mast cells in the skin of control mice were degranulated; moreover, at 24 h after 2 Gy irradiation, this value increased to approximately 20% (17%-28%). Mast cell degranulation by 15 Gy irradiation (32% [24%-40%]) was greater than that by 2 Gy irradiation. Significant differences were observed in mast cell degranulation among the control, 2 Gy and 15 Gy groups (p = 0.012). Furthermore, VEGF-positive reactions were observed in the cytoplasm of scattered fibroblasts in the dermis. In immunohistochemistry tests, VEGF expression at 24 h after irradiation increased slightly in the 2 Gy group compared to that in the control group, whereas no difference in VEGF expression was observed in the 15 Gy group compared to that in the control group. Expression of VEGF in western blots was consistent with that in immunohistochemistry. In conclusion, mast cell degranulation was increased in mouse skin at 24 h after irradiation in a dose-dependent manner. In contrast, VEGF expression was slightly increased following only low-dose (2 Gy) irradiation.

Three-dimensional dose reconstruction-based pretreatment dosimetric verification in volumetric modulated arc therapy for prostate cancer.

PURPOSE: We performed three-dimensional (3D) dose reconstruction-based pretreatment verification to evaluate gamma analysis acceptance criteria in volumetric modulated arc therapy (VMAT) for prostate cancer. MATERIALS AND METHODS: Pretreatment verification for 28 VMAT plans for prostate cancer was performed using the COMPASS system with a dolphin detector. The 3D reconstructed dose distribution of the treatment planning system calculation (TC) was compared with that of COMPASS independent calculation (CC) and COMPASS reconstruction from the dolphin detector measurement (CR). Gamma results (gamma failure rate and average gamma value [GFR and γAvg]) and dose-volume histogram (DVH) deviations, 98%, 2% and mean dose-volume difference (DD98%, DD2% and DDmean), were evaluated. Gamma analyses were performed with two acceptance criteria, 2%/2 mm and 3%/3 mm. RESULTS: The GFR in 2%/2 mm criteria were less than 8%, and those in 3%/3 mm criteria were less than 1% for all structures in comparisons between TC, CC, and CR. In the comparison between TC and CR, GFR and γAvg in 2%/2 mm criteria were significantly higher than those in 3%/3 mm criteria. The DVH deviations were within 2%, except for DDmean (%) for rectum and bladder. CONCLUSIONS: The 3%/3 mm criteria were not strict enough to identify any discrepancies between planned and measured doses, and DVH deviations were less than 2% in most parameters. Therefore, gamma criteria of 2%/2 mm and DVH related parameters could be a useful tool for pretreatment verification for VMAT in prostate cancer.

Multi-institutional analysis of T3 subtypes and adjuvant radiotherapy effects in resected T3N0 non-small cell lung cancer patients.

PURPOSE: We evaluated the prognostic significance of T3 subtypes and the role of adjuvant radiotherapy in patients with resected the American Joint Committee on Cancer stage IIB T3N0M0 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: T3N0 NSCLC patients who underwent resection from January 1990 to October 2009 (n = 102) were enrolled and categorized into 6 subgroups according to the extent of invasion: parietal pleura chest wall invasion, mediastinal pleural invasion, diaphragm invasion, separated tumor nodules in the same lobe, endobronchial tumor <2 cm distal to the carina, and tumor-associated collapse. RESULTS: The median overall survival (OS) and disease-free survival (DFS) were 55.3 months and 51.2 months, respectively. In postoperative T3N0M0 patients, the tumor size was a significant prognostic factor for survival (OS, p = 0.035 and DFS, p = 0.035, respectively). Patients with endobronchial tumors within 2 cm of the carina also showed better OS and DFS than those in the other T3 subtypes (p = 0.018 and p = 0.016, respectively). However, adjuvant radiotherapy did not cause any improvement in survival (OS, p = 0.518 and DFS, p = 0.463, respectively). Only patients with mediastinal pleural invasion (n = 25) demonstrated improved OS and DFS after adjuvant radiotherapy (n = 18) (p = 0.012 and p = 0.040, respectively). CONCLUSION: The T3N0 NSCLC subtype that showed the most favorable prognosis is the one with endobronchial tumors within 2 cm of the carina. Adjuvant radiotherapy is not effective in improving survival outcome in resected T3N0 NSCLC.

The role of autophagy induced by pemetrexed in lung adenocarcinoma cells.

Autophagy is known as an important regulatory mediator for cell survival or death and its important role in cancer. Pemetrexed (PTX) has been used in chemotherapy for lung cancer. However, the underlying molecular mechanisms have not been fully clarified. To investigate the role of autophagy induced by PTX in A549 cells, we performed MTT assay, acridine orange staining, western blotting, Annexin V/PI by using the 3-MA autophagy inhibitor. PTX induced autophagy after 48 h treatment in A549 cells. Furthermore, PTX showed acidic vesicular organelles (AVOs) and expressed LC3-II in A549 cells. The induction of autophagy by PTX was inhibited by 3-MA which was confirmed by reduced AVOs. When the autophagy was inhibited, Annexin V was increased. In addition, PARP cleavage was increased as shown by western blotting. Taken together, PTX induced autophagy in A549 cells and these cellular events possibly cause the apoptotic and/or necrotic cell death of A549 cells.

Autophagy induction by low-dose cisplatin: the role of p53 in autophagy.

The majority of chemotherapy treatments for lung cancer use cisplatin; however, its use is limited as it has several side-effects. Autophagy (or type II cell death) is an important mechanism by which programmed cell death occurs. The purpose of this study was to determine whether low-dose cisplatin treatment induces autophagy in lung cancer cells. We also examined whether autophagy inhibition results in p53-mediated apoptosis. NCI-H460 (wild-type p53) and NCI-H1299 (null-type p53) cells were treated with 5 or 20 µM cisplatin for 12, 24 or 48 h. An MTT assay was performed to measure the cell viability following cisplatin treatment. To detect cisplatin-induced autophagy, cell morphology (autophagic vacuole) and LC3 localization were examined. The outcome of autophagy inhibition was determined using 3-methyladenine (3-MA) to detect Annexin V (+), propidium iodide (PI) (-) and acridine orange (+) cells by FACS analysis. To determine whether cisplatin induced autophagy, we examined the role of p53 as a cell survival regulator in autophagy. Low-doses of cisplatin (5 µM) induced cell death and this was augmented by 3-MA in both cell lines. Autophagic vacuoles and cytoplasmic LC3 formation was more evident in H460 cells than in H1299 cells. The induction of autophagy by low-dose cisplatin was increased by 2-fold in H460 compared to H1299 cells. However, the tests for apoptosis showed no difference between the 2 cell lines. Following 3-MA pretreatment, cisplatin-induced autophagy was found to be markedly reduced (a 3-fold reduction) in wild-type p53 compared to null-type p53 cells. However, cisplatin-induced apoptosis increased in wild-type p53 compared to null-type p53 cells. Autophagy induction and apoptotic shift after autophagy inhibition may be mediated by p53 activation in lung cancer cells treated with low-dose cisplatin.

Recombinant human epidermal growth factor accelerates the proliferation of irradiated human fibroblasts and keratinocytes in vitro and in vivo.

Irradiation causes the impaired proliferation of cells lining mucosal membranes. Epidermal growth factor (EGF) facilitates proliferation of various skin cells; however, the wound healing effects of EGF on radiation-damaged cells is less well known. To evaluate the effects of recombinant human EGF (rhEGF) on the proliferation of cells following irradiation, we tested two types of fibroblast cell lines and one keratinocyte cell line. The viable cell numbers were significantly increased by rhEGF treatment for 24 h immediately after 8 Gy of irradiation. The most effective dose of rhEGF was 10 nM in all cell lines used in this study. The percentage of BrdU-labeled cells was also significantly increased by rhEGF treatment. To evaluate the effects of rhEGF on radiation-induced oral mucosal damage in BALB/c mice, we systematically injected 1 mg/kg/day EGF for three days after 17 Gy of irradiation. Administered rhEGF ameliorated radiation-induced mucosal damage in vivo. rhEGF significantly increased the epithelial cell layer thickness and the proliferation of basal layer cells as detected by Ki-67 staining. Our results suggest that rhEGF can be a therapeutic treatment for radiation-induced wounds by stimulating the proliferation of fibroblasts and keratinocytes following irradiation.

Recombinant human epidermal growth factor accelerates recovery of mouse small intestinal mucosa after radiation damage.

PURPOSE: To determine whether systemically administered recombinant human epidermal growth factor (rhEGF) accelerates the recovery of mouse small intestinal mucosa after irradiation. METHODS AND MATERIALS: A mouse mucosal damage model was established by administering radiation to male BALB/c mice with a single dose of 15 Gy applied to the abdomen. After irradiation, rhEGF was administered subcutaneously at various doses (0.04, 0.2, 1.0, and 5.0 mg/kg/day) eight times at 2- to 3-day intervals. The evaluation methods included histologic changes of small intestinal mucosa, change in body weight, frequency of diarrhea, and survival rate. RESULTS: The recovery of small intestinal mucosa after irradiation was significantly improved in the mice treated with a high dose of rhEGF. In the mice that underwent irradiation without rhEGF treatment, intestinal mucosal ulceration, mucosal layer damage, and severe inflammation occurred. The regeneration of villi was noticeable in mice treated with more than 0.2 mg/kg rhEGF, and the villi recovered fully in mice given more than 1 mg/kg rhEGF. The frequency of diarrhea persisting for more than 3 days was significantly greater in the radiation control group than in the rhEGF-treated groups. CONCLUSIONS: Systemic administration of rhEGF accelerates recovery from mucosal damage induced by irradiation. We suggest that rhEGF treatment shows promise for the reduction of small intestinal damage after irradiation.

Effects of nutritional supplement with herbal extract on bone mineral density and height in prepubescent children - a preliminary study.

The aim of this study was to investigate the efficacy of a nutritional supplement with herbal extracts on height and on the bone mineral density (BMD) development of prepubescent children who were in the 25th percentile of standard height of their age. All children were administered a supplement for 6 months, with height and BMD measured. The supplement increased significantly the height and BMD, compared with the baseline in both boys and girls. The annual growth rate was higher than the standard rate. These preliminary data indicate that supplements enhanced the rate of BMD and height development, although this result must be replicated in a large population-based study and placebo-controlled trials to confirm the conclusions.

Effects of multifunctional fabrics on cardiac autonomic tone and psychological state.

Heart rate variability was compared in 20 subjects wearing multifunctionalfabric (experimental sessions) and cotton (control sessions) clothing. Anxiety, depression, fatigue, and stress levels were lower and emotional levels were higher during the experimental sessions than in the control sessions. Multifunctional fabrics reduced the low-frequency/high-frequency power ratio of heart rate variability. These results support the hypothesis that multifunctional fabrics increase cardiac parasympathetic tone. In addition, subjects had lower heart rates during the experimental sessions compared with controls, suggesting a stabilizing effect on the autonomic nervous system. In conclusion, multifunctional fabrics may act to stabilize both the autonomic nervous system and psychological state.

Effects of a Korean traditional herbal remedy on psychoneuroendocrine responses to examination stress in medical students: a randomized placebo-controlled trial.

The aim of this study was to investigate the efficacy of Ondamtanggamibang, a Korean traditional herbal remedy, as a treatment of stress-related psychophysiological variables in healthy medical students experiencing examination stress. Forty volunteers were randomly assigned to either an herbal remedy group (n = 20) or a placebo control group (n = 20). After treatment, systolic blood pressure and plasma concentrations of norepinephrine and cortisol concentrations decreased significantly in the herbal remedy group. The herbal remedy group also exhibited beneficial changes in psychological variables such as anxiety, depression, stress and emotional state. These results suggest that a Korean traditional herbal remedy may reduce systolic blood pressure and catecholamine levels, possibly by stabilizing the sympathetic nervous system. This herbal remedy also reduced the negative psychological symptoms, stress and heightened the emotional state experienced by medical students during examinations.

External Qi therapy to treat symptoms of Agent Orange Sequelae in Korean combat veterans of the Vietnam War.

We investigated the efficacy of Qi therapy as a non-pharmacological treatment for various symptoms presented by Korean combat veterans of the Vietnam War with Agent Orange Sequelae. Nine subjects volunteered to receive 30 minutes of Qi therapy, twice per day for 7 days. There was marked improvement in 89% of the patients with impaired physical activity, 86% of those with psychological disorder, 78% of those with heavy drug use, and 67% of those with fatigue, indigestion and high blood glucose levels. This data suggests that Qi therapy combined with conventional treatment has positive effects in reducing and managing the pain, psychosomatic disorders, and substance abuse in patients with Agent Orange Sequelae. We cannot completely discount the possible influence of the placebo effect, and more objective, clinical measures are needed to study the long-term effects of Qi therapy.

Endocrine and immune effects of Qi-training.

Psychoneuroimmunological approaches have shown that Qi-training influences the holistic health state in men. We found that Qi-training increased the plasma level of growth hormone (GH) and insulin-like growth factor (IGF)-I. In addition, the respiratory function and adhesion capacity of neutrophil was increased after Qi-training. In an in vitro analysis, GH primed and increased the respiratory function and adhesion of neutrophils through tyrosin kinase passway. Taken together, in vivo and in vitro data suggest that the beneficial effects of Qi-training on immunological functions are mediated via neuroendocrine responses.

Effect of multi-functional fabric on sleep stages and growth hormone levels during sleep.

Nine young girls participated in cross-over sessions, sleeping with either multi-functional fabric (experimental session) or cotton (control session). The relative duration of slow-wave sleep (SWS) was 1.89-fold higher in the experimental session than in the control session. The peak growth hormone (GH) secretion in the experimental session was more than 2.4-fold higher than during the control session (p <.001). The quality of sleep during the experimental session was significantly better than in the control session (p <.01). These results suggest that multi-functional fabric wear is effective in inducing deep sleep, increasing GH, and improving the quality of sleep.

Survey of the use of complementary and alternative medicine among Korean diabetes mellitus patients.

PURPOSE: This study was designed to measure the prevalence of complementary and alternative medicine (CAM) use among Korean diabetes mellitus (DM) patients. METHODS: A 23-question survey on DM was used and included questions on demographic information (7), clinical information (7) and the utilisation of CAM (9). RESULTS: Of 223 respondents, 145 (65%) had taken CAM products, while 78 (35%) had not. At the suggestion of family members and relatives, 43.5% of the respondents started taking CAM products. A total of 57.9% of the users felt that it was effective, 30.3% considered that it regulated the blood glucose level and 27.6% felt it was effective in achieving psychological relaxation. Of 93 CAM materials used by respondents, 63.7% were various types of plants, 21.6% were animal material and 14.7% were a mixture of both. The majority of DM patients (81.2%) were trying a new type of CAM, and one third of all patients were trying to start using a new type of CAM after consulting with their physicians. CONCLUSIONS: Doctors should recognise that complementary medicines are widely used by diabetic patients and should appreciate that these medicines can cause adverse effects. Doctors should therefore be prepared to question patients to determine what non-conventional medicines they are using.

Hydrodynamic analysis of waveforms induced by vibrational stimuli at meridian and non-meridian points.

Meridian theory is an important part of traditional Chinese medicine (TCM). Although acupuncture has been accepted in many countries, the nature of the meridian theory and the principles of acupuncture are still unclear in the modern scientific view. The purpose of this study was to determine the differences in wave propagation of mechanical vibrations (optimal stimulator frequency of 40 Hz) through the pericardium meridian [EH-4 (Chieh-Men) and EH-5 (Chien-Shih)] and adjacent control regions in 20 subjects using hydrodynamic analysis. The mean transfer speed was significantly lower in the meridian (4 m/s) than in the adjacent control region (8.5 m/s, P < 0.001). There were also significant differences between the meridian and control points in the attenuation rate (P < 0.001) and peak amplitude (P < 0.001). In conclusion, these results imply that the substance of the meridian differs from that of the adjacent control regions.

Effects of Qi-training (Qigong) on forearm blood gas concentrations.

Using an ABA' design, the authors investigated the effects of Qi-training on blood gas concentrations with a 20 min control rest period (A), 1 h of Qi-training (B), and a 20-min rest period (A'). The blood partial pressures of oxygen (PO2) and carbon dioxide (PCO2), and oxygen content, oxygen saturation, and pH were significantly altered. The mean PO2 value increased significantly during Qi-training by 14 mmHg (about 24%, p < .01) compared with control A. During Qi-training, the mean decrease in PCO2 was 3 mmHg (about 10%). These results suggest that the practical application of Qi-training may exert a positive regulatory function on physiological status.

Retrospective survey on therapeutic efficacy of Qigong in Korea.

Qigong is a complementary intervention for preventing and curing disease, and protecting and improving health through regulation of body and mind. Recently, we have been studying the psychoneuroimmunological effects of Qigong on the promotion of health. However, there are not many studies on the therapeutic efficacy of Qigong on various symptoms in Korea, hence the need to survey the clinical efficacy of Qigong. To evaluate the impact of Qigong in health care we categorized its effectiveness on the basis of ten years of subjects' memoranda. Among the 768 subjects, the motivation for doing Qigong was mostly to attend to health problems (81.5%), and males were more likely to use Qigong than females. The most improved symptoms were associated with psychological and musculoskeletal problems. Furthermore 66.9% of subjects reported improvements of perceived physical health and 40.3% of perceived psychological health. Other symptoms reduced by Qigong were pain (43.1%), fatigue (22.1%), and insomnia (8.7%). Wound healing was also surveyed (n = 332), and 84% of respondents reported improvement in recovery time, 66.6% reported reduced inflammation after Qigong and 50.3% reported no scarring as compared to before. In addition, 59.9% of respondents reported an increase in resistance to the common cold after four months of Qigong. The limitation of the study is that it is a retrospective survey on the basis of trainees' experiences of Qigong. Although this may constitute a potential bias, the study despite its limitations does provide precious empirical evidence of the effectiveness of Qigong.

Qigong reduced blood pressure and catecholamine levels of patients with essential hypertension.

This study was designed to investigate the efficacy of Qigong as a non-pharmacological treatment of hypertension and evaluate the contribution of Qigong in the blood pressure (BP) reduction of essential hypertension patients. Fifty-eight patients volunteered to participate in this study and were randomly divided into either a Qigong group (n = 29), or a wait list control group (n = 29). In response to 10 weeks of Qigong, systolic blood pressure (SBP), diastolic blood pressure (DBP), and rate pressure product (RPP) were decreased significantly. There was a significant reduction of norepinephrine, epinephrine, cortisol, and stress level by the Qigong. These results suggest that Qigong may reduce BP and catecholamines via stabilizing the sympathetic nervous system. Therefore, Qigong is an effective nonpharmacological modality to reduce BP in essential hypertensive patients.

Effects of in vitro and in vivo Qi-therapy on neutrophil superoxide generation in healthy male subjects.

The present study investigated the effects of in vitro and in vivo Korean ChunSoo Qi-Energy Healing on neutrophil superoxide generation. Neutrophil superoxide generation was measured by a chemiluminescence assay. Superoxide generation was significantly increased in vitro by emitted Qi-therapy (QT) of 60-second duration and 150-second duration compared to control (1.59-fold for 60 seconds, p < 0.05; 1.50-fold for 150 seconds, p < 0.05). Neutrophil superoxide generation increased significantly immediately after 5 minutes of QT in vivo (1.42-fold, p < 0.05). These results show that QT in vivo and in vitro has an acute stimulatory effect on neutrophil superoxide generation. This study provides direct scientific support that Qi as such may positively affect human innate immunity.