Who Really Benefits from 3D-Based Planning of Brachytherapy for Cervical Cancer?

BACKGROUND: Although intracavitary radiotherapy (ICR) is essential for the radiation therapy of cervical cancer, few institutions in Korea perform 3-dimensional (3D)-based ICR. To identify patients who would benefit from 3D-based ICR, dosimetric parameters for tumor targets and organs at risk (OARs) were compared between 2-dimensional (2D)- and 3D-based ICR. METHODS: Twenty patients with locally advanced cervical cancer who underwent external beam radiation therapy (EBRT) following 3D-based ICR were retrospectively evaluated. New 2D-based plans based on the Manchester system were developed. Tumor size was measured by magnetic resonance imaging. RESULTS: The mean high risk clinical target volume (HR-CTV) D90 value was about 10% lower for 2D- than for 3D-based plans (88.4% vs. 97.7%; P = 0.068). Tumor coverage did not differ between 2D- and 3D-based plans in patients with tumors ≤ 4 cm at the time of brachytherapy, but the mean HR-CTV D90 values in patients with tumors > 4 cm were significantly higher for 3D-based plans than for 2D-based plans (96.0% vs. 78.1%; P = 0.017). Similar results were found for patients with tumors > 5 cm initially. Other dosimetric parameters for OARs were similar between 2D- and 3D-based plans, except that mean sigmoid D2cc was higher for 2D- than for 3D-based plans (67.5% vs. 58.8%; P = 0.043). CONCLUSION: These findings indicate that 3D-based ICR plans improve tumor coverage while satisfying the dose constraints for OARs. 3D-based ICR should be considered in patients with tumors > 4 cm size at the time of brachytherapy or > 5 cm initially.

Management of Endometrial Hyperplasia With a Levonorgestrel-Releasing Intrauterine System: A Korean Gynecologic-Oncology Group Study.

OBJECTIVE: The aim of the study was to evaluate the efficacy of the levonorgestrel intrauterine system (LNG-IUS) for treatment of endometrial hyperplasia (EH). METHODS: A prospective multicenter study was conducted from November 2010 to March 2014. Patients with histologically confirmed EH were treated with LNG-IUS. At 3, 6, and 9 months after LNG-IUS insertion, follow-up endometrial aspiration biopsies with the LNG-IUS in the uterus were undertaken. At the 12th month of follow-up, endometrial tissues were obtained via 2 methods: endometrial aspiration biopsy with the LNG-IUS in the uterus, followed by dilatation and curettage (D&C) after LNG-IUS removal. The primary outcome was the regression rate at 12 months after LNG-IUS insertion, and the secondary outcome was the consistency of the results between the endometrial aspiration biopsy and the D&C. RESULTS: The study population comprised 75 patients, including 37 with simple hyperplasia without atypia; 3 with atypical simple hyperplasia; 23 with complex hyperplasia without atypia, and 12 with atypical complex hyperplasia. Of these patients treated with the LNG-IUS, 38 (50.7%) were followed up at 12 months after LNG-IUS insertion. The complete regression rate at 12 months was 94.7% (36/38): 100% (6/6) of patients with atypical EH and 93.7% (30/32) with EH without atypia. In all of the cases (100%, 36/36), patients achieved complete regression within 3 months of LNG-IUS insertion. A comparison of the pathologic results from endometrial aspiration biopsy and D&C was carried out for 15 patients. In the histologic results by endometrial aspiration biopsy, 14 patients were diagnosed as "normal endometrium" and 1 as "insufficient tissue for pathologic evaluation." Among the 14 cases of normal endometrium by endometrial aspiration biopsy, 1 was diagnosed as "residual EH" by D&C, and the 1 case with insufficient tissue was diagnosed as normal endometrium by D&C. CONCLUSIONS: Levonorgestrel intrauterine system is an effective and favorable method for treatment of EH.

Van der Waals force: a dominant factor for reactivity of graphene.

Reactivity control of graphene is an important issue because chemical functionalization can modulate graphene's unique mechanical, optical, and electronic properties. Using systematic optical studies, we demonstrate that van der Waals interaction is the dominant factor for the chemical reactivity of graphene on two-dimensional (2D) heterostructures. A significant enhancement in the chemical stability of graphene is achieved by replacing the common SiO2 substrate with 2D crystals such as an additional graphene layer, WS2, MoS2, or h-BN. Our theoretical and experimental results show that its origin is a strong van der Waals interaction between the graphene layer and the 2D substrate. This results in a high resistive force on graphene toward geometric lattice deformation. We also demonstrate that the chemical reactivity of graphene can be controlled by the relative lattice orientation with respect to the substrates and thus can be used for a wide range of applications including hydrogen storage.

Nanometer thick elastic graphene engine.

Significant progress has been made in the construction and theoretical understanding of molecular motors because of their potential use. Here, we have demonstrated fabrication of a simple but powerful 1 nm thick graphene engine. The engine comprises a high elastic membrane-piston made of graphene and weakly chemisorbed ClF3 molecules as the high power volume changeable actuator, while a 532 nm LASER acts as the ignition plug. Rapid volume expansion of the ClF3 molecules leads to graphene blisters. The size of the blister is controllable by changing the ignition parameters. The estimated internal pressure per expansion cycle of the engine is about ∼10(6) Pa. The graphene engine presented here shows exceptional reliability, showing no degradation after 10,000 cycles.

Successful treatment of recurrent focal segmental glomerulosclerosis with a low dose rituximab in a kidney transplant recipient.

Recurrence of focal segmental glomerulosclerosis (FSGS) is a major therapeutic challenge in kidney transplantation (KT). Although intensive plasmapheresis and high-dose rituximab have been introduced to treat recurrent FSGS, the most effective dosage and regimen of rituximab have not been determined. Herein we reported the first case of successful treatment of recurrent FSGS with a low-dose rituximab. The patient showed marked proteinuria (3.5 g/d) and oliguria 2 d after KT. Two courses of plasmapheresis and immunoglobulin were applied to the patient, however, nephrotic range proteinuria persisted and creatinine level increased to 3.56 mg/dL. Five months post-transplant, the patient received injection with only one dose of rituximab 100 mg, without further plasmapheresis, which resulted in immediate reduction of serum creatinine and full remission of proteinuria during the following 18 months. This case suggested that recurrent FSGS, which frequently relapses after plasmapheresis, could be treated successfully with a low-dose rituximab even without plasmapheresis.

Engineering a Hierarchy of Disorder: A New Route to Synthesize High-Performance 3D Nanoporous All-Carbon Materials*.

A new nanoporous amorphous carbon (NAC) structure that achieves both ultrahigh strength and high electrical conductivity, which are usually incompatible in porous materials is reported. By using modified spark plasma sintering, three amorphous carbon phases with different atomic bonding configurations are created. The composite consisted of an amorphous sp2-carbon matrix mixed with amorphous sp3-carbon and amorphous graphitic motif. NAC structure has an isotropic electrical conductivity of up to 12 000 S m-1, Young's modulus of up to ≈5 GPa, and Vickers hardness of over 900 MPa. These properties are superior to those of existing conductive nanoporous materials. Direct investigation of the multiscale structure of this material through transmission electron microscopy, electron energy loss spectroscopy, and machine learning-based electron tomography revealed that the origin of the remarkable material properties is the well-organized sp2/sp3 amorphous carbon phases with a core-shell-like architecture, where the sp3-rich carbon forms a resilient core surrounded by a conductive sp2-rich layer. This research not only introduces novel materials with exceptional properties but also opens new opportunities for exploring amorphous structures and designing high-performance materials.

Field emission properties of a graphene/polymer composite.

Thin graphene/polymer sheet composites were fabricated using easily soluble expanded graphite (ESEG), and their field emission (FE) parameters were examined. Due to the high dispersability of ESEG, a stable graphene suspension was prepared by ultrasonication in toluene without the need for a surfactant. The suspension consisted of exfoliated graphene sheets with a thickness of 1 - 2 nm. Using a calendering process, the solution was further shear mixed with ethyl cellulose to obtain a well-dispersed graphene/polymer composite. The composite was screen printed onto a conducing substrate to fabricate the FE cathode layers. The FE measurements were taken in a diode configuration at an applied electrostatic field and inter-electrode distance of 1.7 to 6 V/microm and approximately 200 microm, respectively. The threshold turn-on-field was approximately 3.5 V/microm at a current density of approximately 10 microA/cm2 with a corresponding mean field enhancement factor of 1350 +/- 50. Emission occurred mainly from the edges and bends of the graphene layers. The luminescence uniformity of the composite cathode layers was examined using a phosphor-coated anode.

Assessing the Efficacy of the Early Rehabilitation Pathway in Combination with Morita Therapy after Hip and Knee Arthroplasty.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective methods for the treatment of end-stage osteoarthritis. Furthermore, rehabilitation training and psychological interventions play significant roles in the recovery of hip and knee joint function after THA and TKA. A total of 46 patients who received hip replacement and knee replacement are equally divided into two groups, with the control group being prescribed routine rehabilitation intervention and the observation group prescribed an early rehabilitation pathway with Morita therapy intervention. According to the results, the observation group displayed a significantly decreased incidence of deep venous thrombosis, while simultaneously reducing the recovery time of lower limb function (P < 0.05), including straight leg raising time, walking time, and vertical knee flexion time. In addition, the treatment program demonstrates a significant ability to improve the joint function score, pain score, quality of life score, and range of motion score (P < 0.05). Moreover, serum D-dimer, fibrin degradation products (FDP), and femoral vein blood flow peak also are significantly reduced (P < 0.05). Therefore, we have determined that an early rehabilitation pathway combined with Morita therapy can effectively reduce stress pain, improve the recovery process of joint motor function, and reduce the incidence of thrombosis. However, an increased sample size would facilitate the confirmation of the safety and efficacy of the program. In addition, the overall financial expenditure and feasibility of the treatment need to be considered.

Proteomic analysis reveals an elevated expression of heat shock protein 27 in preeclamptic placentas.

AIM: The purpose of this study was to identify the placental proteins that are associated with preeclampsia by performing proteomic analysis. METHODS: To identify the proteins associated with preeclampsia, we performed two-dimensional electrophoresis (2-DE), followed by silver staining. The overexpressed proteins were identified by performing matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS), followed by peptide mass fingerprinting, a protein database search and Western blot analysis. Immunohistochemical staining was performed to determine the localization of the overexpressed Hsp27. RESULTS: By use of 2-DE and MALDI-TOF-MS analysis, twelve differentially expressed proteins were identified, of which four proteins were upregulated and eight proteins were downregulated. One of the upregulated spots was identified as Hsp27. Immunohistochemical analysis showed that Hsp27 was mainly located in the trophoblasts. The Western blot analysis showed that the expression of Hsp27 in the tissues of the preeclampsia placenta was significantly increased. CONCLUSIONS: Our study confirmed that four proteins are upregulated and eight proteins are downregulated in preeclampsia. These differentially expressed proteins include signal transduction protein and molecular chaperon protein, in which Hsp27 is upregulated. We suggest that the increased expression level of Hsp27 might be correlated with the pathophysiology of preeclampsia.

Failure of uterine artery embolization for controlling postpartum hemorrhage.

AIM: We evaluated the efficacy of uterine artery embolization (UAE) for controlling postpartum hemorrhage (PPH). MATERIALS AND METHODS: Between January 2008 and December 2009, 23 women with intractable PPH underwent UAE. Specific diagnoses included uterine atony (n = 10), placenta accreta (n = 8), puerperal hematoma (n = 2) and placental polyp (n = 3). RESULTS: Of 10 patients with uterine atony, treatment with UAE failed in two women with severe vasoconstriction. One patient developed lumbosacral plexopathy. All eight patients with placenta accreta were treated successfully with the placement of multiple sutures in the placental bed and UAE. Two of the three women with placental polyps were treated successfully with UAE and packing of the uterus. CONCLUSIONS: Embolization should follow resuscitation for vascular collapse. In the case of an adherent placenta, embolization is more effective with the placement of multiple sutures in the placental bed or compression of the placental bed.

Three-dimensional CuO nanobundles consisted of nanorods: hydrothermal synthesis, characterization, and formation mechanism.

Novel monoclinic CuO nanobundles, 0.8-1 microm in size, were synthesized at 130 degrees C in the presence of sodium dodecyl benzenesulfonate (SDBS) by a simple hydrothermal method. Each nanobundle was comprised of many nanorods with one ends growing together to form a center and another ends radiating laterally from this center. The length and the diameter of these assembled nanorods are in the range of 200-300 nm and about 20-30 nm, respectively. HRTEM and SAED results indicated that the CuO nanorods grow along the [010] direction. An investigation of the hydrothermal process revealed that the reaction time, temperature and surfactant play important roles in the formation of the resultant CuO nanostructures. Isolated CuO nanorods were obtained when the temperature was increased to 190 degrees C, and CuO microflowers composed of many nanosheets were produced at 130 degrees C when cetyltrimethylammonium bromide (CTAB) was employed instead of SDBS. The possible mechanism for the formation of these CuO nanostructures was discussed simply on the basis of the experimental results.

Metallic copper nanostructures synthesized by a facile hydrothermal method.

A facile hydrothermal route has been developed for the synthesis of nearly spherical copper nanoparticles, copper nanocubes and ribbon-like network nanostructures. The as-prepared copper nanostructures were characterized by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), transmission electron microscopy (TEM), high-resolution TEM (HRTEM), and UV-vis spectrum analysis. These copper products were fabricated in the presence of surfactant sodium dodecyl benzenesulfonate (SDBS) acting not only as stabilizer but also as size and shape controller via hydrothermal reduction process. HRTEM revealed that the surface of the copper nanostructures was packed with a thin layer of impurities such as oxide combined surfactant or amorphous surfactant. The influence of surfactant concentration and temperature on the resultant copper nanostructures was investigated in details. UV-vis spectra indicated that strong red shift existed for the copper ribbon-like network nanostructures due to the novel morphology as well as the presence of impurities on the surface.

Proton and Li-Ion Permeation through Graphene with Eight-Atom-Ring Defects.

Defect-free graphene is impermeable to gases and liquids but highly permeable to thermal protons. Atomic-scale defects such as vacancies, grain boundaries, and Stone-Wales defects are predicted to enhance graphene's proton permeability and may even allow small ions through, whereas larger species such as gas molecules should remain blocked. These expectations have so far remained untested in experiment. Here, we show that atomically thin carbon films with a high density of atomic-scale defects continue blocking all molecular transport, but their proton permeability becomes ∼1000 times higher than that of defect-free graphene. Lithium ions can also permeate through such disordered graphene. The enhanced proton and ion permeability is attributed to a high density of eight-carbon-atom rings. The latter pose approximately twice lower energy barriers for incoming protons compared to that of the six-atom rings of graphene and a relatively low barrier of ∼0.6 eV for Li ions. Our findings suggest that disordered graphene could be of interest as membranes and protective barriers in various Li-ion and hydrogen technologies.

One-step exfoliation synthesis of easily soluble graphite and transparent conducting graphene sheets.

Easily soluble expanded graphite is synthesized in a one-step exfoliation process that can be used for the lowcost mass production of graphene for various applications because of the simplicity and speed of the process. The graphene obtained is sufficiently expanded to be dispersed in aqueous solutions with an ordinary surfactant and in organic solvents.

A role of HNO3 on transparent conducting film with single-walled carbon nanotubes.

There is some controversy regarding the effects of HNO3 on films of single-walled carbon nanotubes (SWCNTs). In this study we examined the change in sheet resistance of an HNO3-modified SWCNT film after different drying times at 85 degrees C using various analytical techniques. The shift and suppression in the Raman spectra, bleaching of the transition peaks related to van Hove singularities and a shift in the original peak in the C 1s XPS spectra provided evidence for p-type doping. A decrease in sheet resistance was also observed in the SWCNTs films due to the removal of residual N-methylpyrrolidone solvent on the surface and bundle of SWCNTs. These results suggest that p-type doping has a larger effect on the sheet resistance than the removal of residual N-methylpyrrolidone by an HNO3 treatment.

Increased interaction between heat shock protein 27 and mitogen-activated protein kinase (p38 and extracellular signal-regulated kinase) in pre-eclamptic placentas.

AIMS: Heat shock protein 27 (Hsp27) is a well-known stress response protein that is characterized by its phosphorylative capacity. Hsp27 becomes phosphorylated in response to various stimuli through interaction with several different kinases. The purpose of this study was to evaluate the interaction between Hsp27 and mitogen-activated protein kinase (MAPK) (p38, extracellular signal-regulated kinase [ERK], and c-Jun N-terminal kinase) in the human placenta derived from patients with pre-eclampsia. METHODS: Western blot analysis was used to examine the levels of expression of Hsp27 and MAPK (p38, ERK, and c-Jun N-terminal kinase). Immunoprecipitation analysis was used to determine the interaction between Hsp27 and MAPK (p38 and ERK). RESULTS: Western blotting analysis and immunohistochemistry showed that the expression of Hsp27 and p-Hsp27 in the placental tissues of the pre-eclampsia group were significantly higher than that in the normal pregnancy group. Immunoprecipitation analysis showed that the interaction between Hsp27 and MAPK (p38 and ERK) was significantly increased in the pre-eclamptic placenta tissues. CONCLUSION: The interaction between Hsp27 and MAPK was increased, suggesting that phosphorylation of Hsp27 might be induced by p38 and ERK in placentas from patients with pre-eclampsia.

Analysis of vitamin D-binding protein (VDBP) gene polymorphisms in Korean women with and without endometriosis.

OBJECTIVE: Vitamin D-binding protein (VDBP) mediates various biological processes in humans. The goal of this study was to investigate whether VDBP gene polymorphisms could predispose Korean women to endometriosis. METHODS: We prospectively enrolled women with endometriosis (n = 16) and healthy controls (n = 16). Total serum 25-hydroxyl vitamin D (25(OH)D) concentrations were measured using an Elecsys vitamin D total kit. Levels of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using a vitamin D BP Quantikine ELISA kit. DNA was extracted using a DNeasy blood & tissue kit. Two singlenucleotide polymorphisms (SNPs; rs4588 and rs7041) in GC, the gene that codes for VDBP, were analyzed using a TaqMan SNP genotyping assay kit. The functional variant of VDBP was determined based on the results of the two SNPs. RESULTS: Gravidity and parity were significantly lower in the endometriosis patients than in the control group, but serum CA-125 levels and the erythrocyte sedimentation rate were significantly higher. Total serum 25(OH)D levels in the endometriosis patients were significantly lower than in the control group. However, serum bioavailable 25(OH)D, free 25(OH)D, and VDBP levels did not differ significantly between the endometriosis and control groups. The genotypes and allele frequencies of GC were similar in both groups. CONCLUSION: Korean women with endometriosis had lower total serum 25(OH)D concentrations than controls. Neither serum VDBP concentrations nor polymorphisms in the gene coding for VDBP were associated with endometriosis. Further studies are needed to investigate the pathophysiology and clinical implications of 25(OH)D and VDBP in endometriosis.

Differences in 25-hydroxy vitamin D and vitamin D-binding protein concentrations according to the severity of endometriosis.

OBJECTIVE: To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease. METHODS: Women with mild endometriosis (n = 9) and advanced endometriosis (n = 7), as well as healthy controls (n = 16), were enrolled in this observational study. Serum total 25(OH)D concentrations were analyzed using the Elecsys vitamin D total kit with the Cobas e602 module. Concentrations of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using the Human Vitamin D BP Quantikine ELISA kit. Variables were tested for normality and homoscedasticity using the Shapiro-Wilk test and Leven F test, respectively. Correlation analysis was used to identify the variables related to total 25(OH)D and VDBP levels. To assess the effects of total 25(OH)D and VDBP levels in the three groups, multivariate generalized additive modeling (GAM) was performed. RESULTS: Gravidity and parity were significantly different across the three groups. Erythrocyte sedimentation rate (ESR) and CA-125 levels increased as a function of endometriosis severity, respectively (p= 0.051, p= 0.004). The correlation analysis showed that total 25(OH)D levels were positively correlated with gravidity (r = 0.59, p< 0.001) and parity (r = 0.51, p< 0.003). Multivariate GAM showed no significant relationship of total 25(OH)D levels with EMT severity after adjusting for gravidity and ESR. However, the coefficient of total 25(OH)D levels with gravidity was significant (1.87; 95% confidence interval, 0.12-3.63; p= 0.040). CONCLUSION: These results indicate that vitamin D and VDBP levels were not associated with the severity of endometriosis.