Comparison of conservative treatment versus transcatheter arterial embolisation for the treatment of spontaneously ruptured hepatocellular carcinoma

Purpose: To elucidate the prognostic factors in the spontaneous rupture of hepatocellular carcinoma (HCC) and to determine whether transcatheter arterial embolisation (TAE) is associated with better prognosis compared to conservative treatment. Material and methods: A retrospective multicentre study was conducted involving 71 patients with spontaneous rupture of HCC. A conservative treatment group (Cons T group) included 20 patients, while a transcatheter arterial embolisation group (TAE group) included 51 patients. Results: The median survival time (MST) in the Cons T group was only 16 days and the survival rate was 39% at one month, whereas the MST in the TAE group was 28 days and the one month survival rate was 63%. However, there is no statistically significant difference in the overall survival between Cons T and TAE groups (p = 0.213). Multivariable analysis identified only the presence of distant metastasis as an independent prognostic factor (p = 0.023). A subanalysis including patients without distant metastasis showed that the presence of portal vein tumour thrombosis was a significant prognostic factor (p = 0.015). Conclusions: Distant metastasis appears to be a prognostic factor in spontaneous rupture of HCC. In cases without distant metastasis, portal vein tumour thrombosis could influence the prognosis. Our data failed to prove any benefit of TAE as the primary management

Long-Term Outcome of Proton Therapy and Carbon-Ion Therapy for Large (T2a–T2bN0M0) Non–Small-Cell Lung Cancer

IntroductionAlthough many reports have shown the safety and efficacy of stereotactic body radiotherapy (SBRT) for T1N0M0 non–small-cell lung cancer (NSCLC), it is rather difficult to treat T2N0M0 NSCLC, especially T2b (>5 cm) tumor, with SBRT. Our hypothesis was that particle therapy might be superior to SBRT in T2 patients. We evaluated the clinical outcome of particle therapy for T2a/bN0M0 NSCLC staged according to the 7th edition of the International Union Against Cancer (UICC) tumor, node, metastasis classification.MethodsFrom April 2003 to December 2009, 70 histologically confirmed patients were treated with proton (n = 43) or carbon-ion (n = 27) therapy according to institutional protocols. Forty-seven patients had a T2a tumor and 23 had a T2b tumor. The total dose and fraction (fr) number were 60 (Gray equivalent) GyE/10 fr in 20 patients, 52.8 GyE/4 fr in 16, 66 GyE/10 fr in 16, 80 GyE/20 fr in 14, and other in four patients, respectively. Toxicities were scored according to the Common Terminology Criteria for Adverse Events, Version 4.0.ResultsThe median follow-up period for living patients was 51 months (range, 24–103). For all 70 patients, the 4-year overall survival, local control, and progression-free survival rates were 58% (T2a, 53%; T2b, 67%), 75% (T2a, 70%; T2b, 84%), and 46% (T2a, 43%; T2b, 52%), respectively, with no significant differences between the two groups. The 4-year regional recurrence rate was 17%. Grade 3 pulmonary toxicity was observed in only two patients.ConclusionParticle therapy is well tolerated and effective for T2a/bN0M0 NSCLC. To further improve treatment outcome, adjuvant chemotherapy seems a reasonable option, whenever possible

新たに開発された高性能紫外線照射システムによる 医療機器表面の細菌制御に関する研究

患者や医療従事者が触れる機会の多い医療機器の表面消毒は非常に重要であり、医療機器表面の汚染の度合いによっては感染の危険性を生じる。しかし、環境表面の殺菌は、清掃スタッフにより手で行われているが、拭き残しの発生や薬剤耐性菌への効果が薄いことが課題とされている。そこで、本研究においては、キセノン紫外線消毒ロボット及び消毒ポッド（LS-DP システム）を導入し、用手清拭後、紫外線照射後の２つのタイミングで各種医療機器における表面採取、培養を行い、菌コロニーの検出数から評価を行った。その結果、全ての機器において、紫外線照射後のコロニー数は清拭後に比べて有意差を持って低かった。用手清拭後に多くの菌が培養、検出され、清掃スタッフにより手で行われる清掃には物理的に清拭できない部位があり、紫外線照射を用手清拭後に行うことで消毒効果が上乗せされ、医療機器を介する院内感染の防止に有用であると示唆された

Formation and Characterization of 2D Closely Packed Arrays of Bare Gold Nanoparticles without Aggregation

Uniform 2D arrays of metal nanoparticles (NPs) have received significant attention in the field of molecular sensing using localized surface plasmon resonance. Generally, metal NPs bear organic surface-modifying molecules to prevent aggregation and form 2D metal NP arrays. However, surface-modifying molecules negatively affect molecular sensing. Previously, we developed a technique for forming a 2D bare metal NP array, denoted the sandwich (SW) technique. However, the formation mechanism of these 2D metal NP arrays remains unknown and therefore the experimental conditions of the SW technique are not optimized. Here, we observed the formation of a 2D Au NP (d: 60 nm) array using the SW technique with an optical microscope. Moderate drying conditions of the colloidal droplets sandwiched between two parallel substrates were necessary for forming 2D Au NP arrays. We then optimized the drying conditions and obtained a 2D Au NP array. This array was uniform, and the Au NPs were arranged at distances of 4.5 nm with hexagonal periodicity, without aggregation. Further, the 2D Au NP arrays exhibited excellent spot-to-spot reproducibility in surface-enhanced Raman scattering

Compatibility of the repairable-conditionally repairable, multi-target and linear-quadratic models in converting hypofractionated radiation doses to single doses

We investigated the applicability of the repairable-conditionally repairable (RCR) model and the multi-target (MT) model to dose conversion in high-dose-per-fraction radiotherapy in comparison with the linear-quadratic (LQ) model. Cell survival data of V79 and EMT6 single cells receiving single doses of 2-12 Gy or 2 or 3 fractions of 4 or 5 Gy each, and that of V79 spheroids receiving single doses of 5-26 Gy or 2-5 fractions of 5-12 Gy, were analyzed. Single and fractionated doses to actually reduce cell survival to the same level were determined by a colony assay. Single doses used in the experiments and surviving fractions at the doses were substituted into equations of the RCR, MT and LQ models in the calculation software Mathematica, and each parameter coefficient was computed. Thereafter, using the coefficients and the three models, equivalent single doses for the hypofractionated doses were calculated. They were then compared with actually-determined equivalent single doses for the hypofractionated doses. The equivalent single doses calculated using the RCR, MT and LQ models tended to be lower than the actually determined equivalent single doses. The LQ model seemed to fit relatively well at doses of 5 Gy or less. At 6 Gy or higher doses, the RCR and MT models seemed to be more reliable than the LQ model. In hypofractionated stereotactic radiotherapy, the LQ model should not be used, and conversion models incorporating the concept of the RCR or MT models, such as the generalized linear-quadratic models, appear to be more suitable

Single Nucleotide Polymorphisms Associated with Risk of Adverse Skin Reactions to Radiation in Patients Undergoing Breast-conserving Therapy: Single-institution Analysis

Purpose/Objective(s)In a previous study involving 9 institutions, 8 single nucleotide polymorphism (SNP) markers in 6 loci of genome were found to be associated with risks of early adverse skin reaction to radiation following breast-conserving surgery. In the present study, the SNPs for these loci were reanalyzed in patients, including new cases, treated and followed at a single institution with a uniform policy, in order to confirm the significance of previously reported polymorphisms. Association with adverse skin reaction within 6 months after radiation was also analyzed. An area under a receiver operating characteristic curve (AUC-ROC) analysis was newly applied in this study.\nMaterials/MethodsWith informed consent, DNA samples from 115 patients undergoing prophylactic radiation after breast-conserving surgery were obtained for SNP analysis. All patients received 50 Gy in 2-Gy daily fractions by tangential irradiation with or without an electron boost of 10 Gy in 5 fractions. Using the National Cancer Institute-Common Toxicity Criteria scoring system version 2, the patients were grouped according to adverse skin reactions within 3 months after starting radiotherapy (grade ≤ 1, n = 74; grade = 2, n = 41) as well as those within 6 months (grade 0, n = 61; grade 1, n = 52). Eight SNPs from the 6 loci were analyzed for assessment of associations between groups. A risk score of a patient was calculated according to a total number of risk genotype(s) (an increased risk genotype = 1 and a reduced risk genotype = -1). The sensitivity and specificity of the markers were evaluated using an AUC-ROC analysis.\nResultsEach genotype of the PTTG1 rs3811999 CC, the RAD9A rs917570 CC, and the RAD9A rs2286620 TT showed association with an increased risk (P = 0.024, 0.040, and 0.017, respectively), while the REV3L rs190246 GG/GT and rs240962 GG/GT genotypes were associated with a reduced risk of adverse skin reaction within 3 months (P = 0.0059 and 0.049, respectively). After applying Bonferroni correction, only the rs190246 GG/GT genotype was considered to remain statistically significant (Pcorrected = 0.047). When combined effects of the 3 increased-risk genotypes and the 2 reduced-risk genotypes were examined by the AUC-ROC method, the AUC value of the model reached 0.72. No association was observed between the analyzed SNPs and adverse skin reaction within 6 months.\nConclusionsThis single-institution analysis confirmed the significance of combined effects of the SNPs on PTTG1, RAD9A, and REV3L genes in determining early adverse skin reaction. These SNPs were, however, not associated with reaction within 6 months, suggesting that they are not related to recovery of skin damage between 3 and 6 months after radiation