Interinstitutional variations in planning for stereotactic body radiation therapy for lung cancer

PURPOSE: The aim of this study was to assess interinstitutional variations in planning for stereotactic body radiation therapy (SBRT) for lung cancer before the start of the Japan Clinical Oncology Group (JCOG) 0403 trial. METHODS AND MATERIALS: Eleven institutions created virtual plans for four cases of solitary lung cancer. The created plans should satisfy the target definitions and the dose constraints for the JCOG 0403 protocol. RESULTS: FOCUS/XiO (CMS) was used in six institutions, Eclipse (Varian) in 3, Cadplan (Varian) in one, and Pinnacle3 (Philips/ADAC) in one. Dose calculation algorithms of Clarkson with effective path length correction and superposition were used in FOCUS/XiO; pencil beam convolution with Batho power law correction was used in Eclipse and Cadplan; and collapsed cone convolution superposition was used in Pinnacle3. For the target volumes, the overall coefficient of variation was 16.6%, and the interinstitutional variations were not significant. For maximal dose, minimal dose, D95, and the homogeneity index of the planning target volume, the interinstitutional variations were significant. The dose calculation algorithm was a significant factor in these variations. No violation of the dose constraints for the protocol was observed. CONCLUSION: There can be notable interinstitutional variations in planning for SBRT, including both interobserver variations in the estimate of target volumes as well as dose calculation effects related to the use of different dose calculation algorithms.     

Overestimation of corneal endothelial cell density by automated method in glaucomatous eyes with impaired corneal endothelial cells

International Ophthalmology - To determine between-method differences in corneal endothelial cell parameters using center and automated methods of non-contact specular microscopy (CellCheck...     

Vascular endothelial cell injury induced by Bothrops jararaca venom; non-significance of hemorrhagic metalloproteinase.

To examine the effect of Bothrops jararaca venom and its major hemorrhagic metalloproteinase, jararafibrase I (JF I), on vascular endothelial cells, B. jararaca crude venom and JF I were infused intravenously into rabbits. The degree of endothelial cell injury was estimated from the plasma level of soluble thrombomodulin (TM). The fibrinogen level, prothrombin time (PT), JF I antigen level and macroglobulin activity of the plasma were also measured. The TM level was not increased even by a large quantity of JF I, while the crude venom caused an increase in TM level suggesting the occurrence of endothelial cell injury. No alterations of fibrinogen level and PT were noted with a high amount of JF I, and no systemic bleeding was observed. Macroglobulin, which is the main inhibitor of metalloproteinase in rabbit plasma, was not significantly reduced despite a high dose of JF I. The elevation of TM level in the rabbit plasma after infusion of crude venom was totally suppressed by pretreatment with heparin. These findings suggest that the endothelial cell injury caused by B. jararaca venom is not due to the hemorrhagic metalloproteinase but to the coagulating factors in the venom. Plasma macroglobulin appears to be efficient enough to neutralize the circulating hemorrhagic metalloproteinases inoculated by B. jararaca.     

Envisioning the inner body during the edo period in Japan: <Emphasis Type="Italic">inshoku yojo kagami</Emphasis> (rules of dietary life) and <Emphasis Type="Italic">boji yojo kagami</Emphasis> (rules of sexual life)

There are two ukiyoe, Japanese woodblock prints, that were produced around 1850 and give a good picture of the images of the insides of the human body that were widely accepted among the common people in the Edo period. The Inshoku yojo kagami (Rules of Dietary Life) shows a man drinking sake. The Boji yojo kagami (Rules of Sexual Life) shows a woman, apparently a courtesan. The purpose of the two ukiyoe was to educate viewers about the functions of the principal inner organs in the traditional East Asian concept of the body and to admonish them against excessive eating, drinking and sexual intercourse. The contrivance of the two ukiyoe lies in their fusion of two formats. One is the format of a see-through body displaying the internal organs. The other is that of explaining the functions of the various internal organs in the form of familiar scenes from the living space of cities and households. Miniature sketches can be seen in the prints of people at work, performing the tasks believed to be that of each organ. However, the scheme of the two ukiyoe was not an innovation of the author of the ukioye. Already in the kibyoshi (Yellow Cover booklets), the scheme of likening the interior of the body to a living space had been adopted. After entering the 18th century, Chinese medical knowledge and anatomical drawings became available. As sex manuals, Yellow Cover booklets, and ukiyoe publications, incorporated and disseminated the newly acquired medical knowledge and the medical concept of the body gradually became the common sense view among people in the street.     

Hypofractionated stereotactic radiotherapy with and without transarterial chemoembolization for small hepatocellular carcinoma not eligible for other ablation therapies: Preliminary results for efficacy and toxicity

Aim: To investigate the efficacy and toxicity of hypofractionated stereotactic radiotherapy for the treatment of patients presenting with hepatocellular carcinoma (HCC) in a single institutional setting. Methods: Sixteen patients who presented with solitary HCC, including two patients with a tumor thrombus of the portal veins, were treated with stereotactic radiotherapy with or without transarterial chemoembolization. The criteria for stereotactic radiotherapy were existence of technical difficulties for other ablation therapies, inoperable disease or refusal to undergo surgery, tumor staged as Grade A or B according to the Child-Pugh classification, and solitary tumor distant from the gastrointestinal tract and kidney with a tumor volume <100 cm(3). In 14 of 16 patients, a total dose of 35- 50 Gy was delivered in 5-7 fractions over 5-9 days. Results: At the end of a mean follow-up of 612 days (median 611 days; range 244-994 days), all patients were alive. Eight of 16 patients had complete responses and seven others were judged as stable with lipiodol accumulation. In one patient, local recurrence developed after 489 days. Intrahepatic recurrences developed outside the treated volume in six patients and no extrahepatic metastases developed during follow-up. No serious treatment-related toxic manifestations developed. Conclusions: Stereotactic radiotherapy for HCC with or without transarterial chemoembolization is feasible therapy and provides good local control with a short treatment period. Stereotactic radiotherapy may be of clinical benefit in patients who are inoperable or for whom there are difficulties in other ablation therapies.     

Effect of preintervention remodeling type on subsequent coronary artery behavior after directional atherectomy

To evaluate the influence of preintervention remodeling on subsequent vessel behavior after directional coronary atherectomy (DCA) under intravascular ultrasound (IVUS) guidance, serial (before and after DCA and at 6-month follow-up) IVUS data were analyzed for 246 lesions that were classified into 2 categories: positive remodeling (PR) in 77 lesions versus intermediate or negative remodeling in 169 lesions. Although the 2 groups had similar baseline characteristics, IVUS data showed that the PR group had a greater acute lumen area (LA) gain without an increased late LA loss, resulting in a greater net (acute plus late) LA gain and follow-up LA. This suggests that IVUS-guided DCA may neutralize the negative impact of preintervention PR on late vessel patency.     

Comparison of surgical outcome using the prediction scoring system of E-PASS for thoracic surgery.

OBJECTIVE: The purpose of this study was to determine if our predictive scoring system, E-PASS, can estimate the surgical outcome. METHODS: We conducted a multicenter cohort study for 3 years in four national hospitals. A consecutive series of 731 patients who underwent elective thoracic operations were analyzed. The preoperative risk score (PRS) and the comprehensive risk score (CRS) of the E-PASS were determined preoperatively and immediately after the operation, respectively. The cost of the surgical admission and the severity of the postoperative complications were recorded at the time of discharge. RESULTS: The CRS significantly correlated with the severity of the postoperative complications (rs = 0.728, P < 0.0001) and the charge (rs = 0.530, P< 0.0001). When the estimated/real morbidity ratio (MR) among the hospitals was compared, it varied from 0.16 to 0.59. A significant increase in the cost was observed according to the CRS. CONCLUSION: The E-PASS scoring system may be useful for standardizing the patient population and surgical severity to compare the surgical outcome.