Antioxidative and Antiplatelet Effects of Aqueous Inflorescence Piper Betle Extract

Piper betle, belonging to the Piperaceae family, is a tropical plant, and its leaf and inflorescence are popularly consumed by betel quid (BQ) chewers in Taiwan and many other South and Southeast Asian countries. However, little is known about the biochemical properties of inflorescence Piper betle (IPB) toward reactive oxygen species (ROS) and platelet functions. In the present work, aqueous IPB extract was shown to be a scavenger of H(2)O(2), superoxide radical , and hydroxyl radical with a 50 % inhibitory concentration ( IC(50)) of about 80, 28, and 73 microg/mL, respectively. IPB extract also prevented the hydroxyl radical induced PUC 18 plasmid DNA breaks at concentrations higher than 40 microg/ mL. Since ROS are crucial for platelet aggregation, we further found that IPB extract also inhibited the arachidonic acid (AA) induced and collagen- induced platelet aggregation, with an IC(50) of 207 and 335 microg/mL, respectively. IPB extract also inhibited the AA-, collagen-( >100 microg/ mL of IPB), and thrombin (>250 microg/mL of IPB) -induced thromboxane B(2) (TXB(2)) production by more than 90%. However, IPB extract showed little effect on thrombin- induced aggregation. These results indicated that aqueous components of IPB are potential ROS scavengers and may prevent the platelet aggregation possibly via scavenging ROS or inhibition of TXB(2) production

A ten year experience in total body irradiation in BMT patients

　Total body irradiation is the popular treatment of lymphopoietic malignancies and preparation for bone marrow transplantation. Hyperfractionated radiation regimen was to deliver a total dose of 1200 cGy in 8 fractions, 3 fractions a day for 2.5 days. One HVL (half value layer ) alloy lung shield is being used to minimize pulmonary toxicity. Acute toxic effects included reversible gastroenteritis, mucositis, and myelosuppression. Delayed toxic effects include interstitial pneumonitis, cataract formation and GVHD. Interstitial pneumonitis is one of the major causes of morbidity and mortality after bone marrow transplantation. Pulmonary toxicity occurred in 26 ( 56.5% ) cases and 16 of them died from IP In 15 infected cases, 5 were classified as IP with infectious agent of cytomegalovirus. The other cases without infectious agent were classified as idiopathic IP ( IIP ), which occurred in 23.9% of the TBI patients

Tangent-based volumetric modulated arc therapy for advanced left breast cancer

Abstract Purpose To introduce the benefits of tangent-based volumetric modulated arc therapy (TVMAT), an innovative radiotherapy planning technique, compared with traditional volumetric modulated arc therapy (VMAT) for advanced left breast cancer needing nodal irradiation. Materials and methods Twenty-three patients with advanced left breast cancer who had received modified radical mastectomy (MRM) and needed adjuvant radiotherapy including nodal irradiation were assessed. Among 23 radiotherapy treatment plans, 17 plans were designed by using TVMAT technique and 6 plans were designed by using traditional VMAT. The main difference of TVMAT from VMAT was that the area of avoidance sector within specific degrees of angle that had no monitor unit (MU) delivery was used in the arc planning, including a total of 5 sectors in 5 partial arcs. The dosimetries of planning target volume (PTV), right breast, bilateral lungs, and heart between TVMAT and VMAT were compared. Results The conformity index (CI) and homogeneity index (HI) of PTV between two groups were statistically equivalent (CI: 0.98 ± 0.02 and 0.98 ± 0.03, P = 0.431; HI: 0.12 ± 0.03 and 0.11 ± 0.05, P = 0.177), which indicated that the treatment efficacy of the plans regarding TVMAT was compatible with VMAT. However, all neighboring organs at risk (OAR) showed a great percentage of reduction in mean doses (right breast: 53.1%, right lung: 37.7%, left lung: 8.8%, heart: 21.2%) and low dose parameters (V10: right breast: 72.3%, right lung: 86.1%, left lung: 12.5%, heart: 25.1%; V5: right breast: 56.5%, right lung: 28.3%, left lung: 12.7%, heart: 18.2%) by using TVMAT. Conclusion TVMAT greatly decreases the radiation doses delivered to the OAR with maintained therapeutic efficacy. It is highly recommended for treating breast cancer, especially for difficult cases with left side disease needing nodal irradiation

Quantitative analysis of respiration-induced motion of each liver segment with helical computed tomography and 4-dimensional computed tomography

Abstract Background To analyze the respiratory-induced motion of each liver segment using helical computed tomography (helical CT) and 4-dimensional computed tomography (4DCT), and to establish the individual segment expansion margin of internal target volume (ITV) to facilitate target delineation of tumors in different liver segments. Methods Twenty patients who received radiotherapy with CT-simulation scanning of the whole liver in both helical CT and 10-phase-gated 4DCT were investigated, including 2 patients with esophagus cancer, 4 with lung cancer, 10 with breast cancer, 2 with liver cancer, 1 with thymoma, and 1 with gastric diffuse large B-cell lymphoma (DLBCL). For each patient, 9 representative points were drawn on the helical CT images of liver segments 1, 2, 3, 4a, 4b, 5, 6, 7, and 8, respectively, and adaptively deformed to 2 phases of the 4DCT images at the end of inspiration (phase 0 CT) and expiration (phase 50 CT) in the treatment planning system. Using the amplitude of each point between phase 0 CT and phase 50 CT, we established quantitative data for the respiration-induced motion of each liver segment in 3-dimensional directions. Moreover, using the amplitude between the original helical CT and both 4DCT images, we rendered the individual segment expansion margin of ITV for hepatic target delineation to cover more than 95% of each tumor. Results The average amplitude (mean ± standard deviation) was 0.6 ± 3.0 mm in the left-right (LR) direction, 2.3 ± 2.4 mm in the anterior-posterior (AP) direction, and 5.7 ± 3.4 mm in the superior-inferior (SI) direction, respectively. All of the segments moved posteriorly and superiorly during expiration. Segment 7 had the largest amplitude in the SI direction, at 8.6 ± 3.4 mm. Otherwise, the segments over the lateral side, including segments 2, 3, 6, and 7, had greater excursion in the SI direction compared to the medial segments. To cover more than 95% of each tumor, the required expansion margin of ITV in the LR, AP, and SI directions were at least 2.5 mm, 2.5 mm, and 5.0 mm on average, respectively, with variations between different segments. Conclusions The greatest excursion occurred in liver segment 7, followed by the segments over the lateral side in the SI direction. The individual segment expansion margin of ITV is required to delineate targets for each segment and direction

3M Cavilon No-Sting Barrier Film or topical corticosteroid (mometasone furoate) for protection against radiation dermatitis: A clinical trial

Background/PurposeEvidence on the prevention of radiation dermatitis is lacking. The aim of this study was to investigate the effect of 3M Cavilon No Sting Barrier Film and topical corticosteroids on irradiated skin.MethodsThirty-nine postoperative breast cancer patients were randomized into three groups for intraindividual comparison (skin to be irradiated was divided into 2 parts): (1) 3M No Sting Barrier Film versus no treatment; (2) corticosteroid versus no treatment; and (3) corticosteroid versus 3M No Sting Barrier Film. The primary end points monitored were the time to first occurrence of grade 1 pruritus, pain score of 3 and grade 2 radiation dermatitis. The secondary end points studied were the incidence of grade 3 radiation dermatitis and total pain scores. Data analysis was done using the SPSS software version 10.ResultsSkin given the 3M barrier film experienced a later occurrence of pruritus compared to both corticosteroids and untreated, although this was statistically insignificant. Corticosteroids delayed the time to occurrence of grade 2 dermatitis compared to both untreated skin and 3M barrier film, (mean day of onset = corticosteroid: 52 vs. untreated: 43, p = 0.092; corticosteroid: 53.4 vs. 3M barrier film: 44.5, p = 0.002, t test). Skin given corticosteroids had the lowest incidence of grade 3 dermatitis among all three conditions, although the differences were statistically insignificant. No statistically significant differences were noted in total pain scores.ConclusionThe 3M barrier film may be helpful against dermatitis associated pruritus. Corticosteroids may delay the time of onset of severe skin reactions and also reduce the incidence of severe radiation dermatitis

Dosimetric analysis of tangent-based volumetric modulated arc therapy with deep inspiration breath-hold technique for left breast cancer patients

Abstract Background Tangent-based intensity modulated radiation therapy (TIMRT) is a common adjuvant radiotherapy strategy for breast cancer patients. This study compared the dosimetric characteristics of tangent-based volumetric modulated arc therapy (TVMAT) and TIMRT for left breast cancer patients during deep inspiration breath-hold (DIBH) and free breathing (FB) techniques. Methods Fourteen patients with left breast cancer after breast-conserving surgery were included. The first arc started at 331.8–353.6 degrees and stopped at 281.8–315.0 degrees. The third arc started at 123.2–149.1 degrees and stopped at 88.0–96.0 degrees. The second and fourth arcs were reverse arcs of first and third arcs. DIBH-TIMRT inversing plans were generated using opposing tangential fields. Wilcoxon signed rank test and Spearman correlation were used to examine the significance of dose difference. Results Compared with FB-TVMAT, the mean heart dose of DIBH-TVMAT plans was reduced from 7.9 Gy to 3.2 Gy (p < 0.001). The average left lung volume receiving 30 Gy or more (V30Gy) was reduced from 12.9 to 5.7% (p < 0.001). DIBH-TVAMT plans resulted in a lower mean dose to the contralateral breast and lung (2 Gy and 0.7 Gy vs 3.4 Gy and 1.5 Gy, respectively) as compared to FB-TVMAT plans. Compared with DIBH-TIMRT, the average left lung V30Gy of DIBH-TVMAT plans was reduced from 8.5 to 5.7% (p = 0.031). As for low-dose areas, exposure of the left lung, right breast, heart and right lung volume with 10 Gy or more was not significantly different between the IMRT- and VMAT-plans. Conclusions DIBH-TVMAT for left breast cancer treatment retains treatment plan quality similar to the DIBH-IMRT technique without compromising dose restrictions to the heart, right breast and right lung. DIBH-TVMAT increased left lung protection but still had higher V5Gy to right breast and substantially higher V5Gy to heart. For left breast cancer patients receiving treatment with the DIBH technique, DIBH-TVMAT provides better treatment quality and is a safe and feasible treatment strategy