Exosomal transfer of tumor-associated macrophage-derived miR-21 confers cisplatin resistance in gastric cancer cells

Cisplatin-based chemotherapy is frequently used to treat advanced gastric cancer (GC). However, the resistance often occurs with the mechanisms being not well understood. Recently, emerging evidence indicates ...

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Distinct activity of the bone-targeted gallium compound KP46 against osteosarcoma cells - synergism with autophagy inhibition

Osteosarcoma is the most frequent primary malignant bone tumor. Although survival has distinctly increased due to neoadjuvant chemotherapy in the past, patients with metastatic disease and poor response to che...

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Comparison of topical ropivacaine with and without ketamine on post-surgical pain in children undergoing tonsillectomy: a randomized controlled double-blind study

Abstract

Purpose

Tonsillectomy in pediatric patients may cause severe postoperative pain. Topical local anesthetics are an easy and safe way to control post-tonsillectomy pain, but there is no benefit during the early postoperative stage. Topical ketamine shows a good effect on early stage postoperative pain. We compared the effect of topical ropivacaine with and without ketamine on post-tonsillectomy pain.

Methods

Patients aged 3–7 years undergoing tonsillectomy were selected to participate in the study. Our study was performed in a randomized, placebo-controlled, double-blind manner. Patients were randomly assigned to one of two groups using computer-generated random numbers. The researchers who assessed the pain score, the caregivers, and the patient were blinded to group assignment. One group received topical ropivacaine with saline (RS group) and the other group received topical ropivacaine with 20 mg ketamine (RK group) on the tonsillar bed. Pain scores using the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at 15 min and 30 min, and at 1, 2, 4, 8, 16 and 24 h were recorded. Rescue analgesic requirement and complications were also recorded.

Results

A total of 66 patients were randomly assigned to the RS group (n = 33) and the RK group (n = 33). The mCHEOPS scores were significantly lower in the RK group at 15 min (P = 0.046). The mCHEOPS scores of the two groups decreased with time, but there was no intergroup interaction. The RS group received more analgesics until 1 h after surgery and the RK group received more analgesics during 1–24 h after surgery. There were no differences in adverse outcomes.

Conclusions

Topical ropivacaine with ketamine can reduce immediate postoperative pain and analgesic requirement better than ropivacaine alone.

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Hepato-bronchial fistula secondary to perforated sigmoid diverticulitis: a case report

Patients with diverticulitis are predisposed to hepatic abscesses via seeding through the portal circulation. Hepatic abscesses are well-documented sequelae of diverticulitis, however instances of progression ...

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Pre-existing chronic interstitial pneumonia is a poor prognostic factor of Goodpasture’s syndrome: a case report and review of the literature

Goodpasture's syndrome is a rare disease that is characterized by rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage.

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Platypnea-orthodeoxia syndrome in the right lateral decubitus position: a case report

Platypnea-orthodeoxia syndrome is a rare syndrome characterized by dyspnea and hypoxia when the patient is sitting or standing. Here we report a case of platypnea-orthodeoxia syndrome caused by a right hemidia...

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Intensity Modulated Radiation Therapy with Pulsed Reduced Dose Rate as a Re-irradiation Strategy for Recurrent Central Nervous System Tumors: An Institutional Series and Literature Review

Publication date: Available online 12 April 2017
Source:Practical Radiation Oncology
Author(s): Erin S. Murphy, Kevin Rogacki, Andrew Godley, Peng Qi, Chandana Reddy, Manmeet Ahluwalia, David Peereboom, Glen Stevens, Jennifer S. Yu, John H. Suh, Sam T. Chao
BackgroundPulsed reduced dose rate (PRDR) is a re-irradiation technique that potentially overcomes volume and dose limitations in the setting of previous radiotherapy for recurrent central nervous system tumors. Intensity modulated radiation therapy (IMRT) has not yet been reported as a PRDR delivery technique. We reviewed our IMRT PRDR outcomes and toxicity and reviewed the literature of available PRDR series for CNS re-irradiation.Material/MethodsA total of 24 patients with recurrent brain tumors received PRDR re-irradiation between 8/2012 and 12/2014. Twenty-two patients were planned with IMRT. Linear accelerators delivered an effective dose rate of 0.0667Gy/min. Data collected included number of prior interventions, diagnosis, tumor grade, radiotherapy dose and fractionation, normal tissue dose, radiotherapy planning parameters, time to progression, overall survival and adverse events.ResultsThe median time to PRDR from completion of initial radiotherapy was 47.8months (R: 11–389.1months). The median PRDR dose was 54Gy (R: 38–60Gy). The mean planning target volume was 369.1 +/− 177.9cm³. The median PFS and 6month PFS after PRDR treatment was 3.1months and 31%, respectively. The median OS and 6month OS after PRDR treatment was 8.7months and 71%, respectively. 50% of patients had ≥4 chemotherapy regimens prior to PRDR. Toxicity was similar to initial treatment including no cases of radiation necrosis.ConclusionIMRT PRDR re-irradiation is a feasible and appropriate treatment strategy for large volume recurrent CNS tumors resulting in acceptable overall survival with reasonable toxicity in our patients who were heavily pretreated. Prospective studies are necessary to determine the optimal timing of PRDR re-irradiation, the role of concurrent systemic agents, and the ideal patient population who would receive the maximal benefit from this treatment approach.SummaryIntensity modulated radiation therapy (IMRT) has not yet been reported as a pulsed reduced dose rate (PRDR) delivery technique for recurrent brain tumors and may allow for safe and comprehensive re-irradiation for large volume tumors. We reviewed our IMRT PRDR outcomes and toxicity and reviewed the literature of available PRDR series for recurrent central nervous system tumors. We conclude that IMRT PRDR re-irradiation is a feasible and appropriate treatment strategy for large volume recurrent brain tumors resulting in acceptable overall survival with reasonable toxicity in our patients who were heavily pretreated.



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