Survival outcome of cervical cancer patients treated by image-guided brachytherapy: a ‘real world’ single center experience in Thailand from 2008 to 2018

The objective of our study was to evaluate the survival outcome of cervical cancer patients treated using image-guided brachytherapy (IGBT). From 2008 to 2018, 341 patients with cervical cancer were treated by radical radiotherapy. IGBT (by computed tomography [CT] or transabdominal ultrasound [TAUS]) was used to treat all of these patients. The characteristic data and patient status after treatment were recorded. All data were evaluated for survival outcome analysis. From a total of 341 patients, 295 patients were analyzed and 46 patients were excluded due to data missing in the survival outcomes. At the median follow-up time of 48 months (IQR 30–80 months), The 4-year local control, progression-free survival and overall survival rates were 89.5%, 74.9% and 69.1%, respectively. For overall survival, the size (> 5 cm), pathology (non-SCCA), stage (stage III–IV by FIGO 2009), lymph node (LN) (presented) and overall treatment time (OTT) (> 56 days) showed statistical significance in univariate analysis while non-SCCA pathology, advanced stage, presented LN and longer OTT showed statistical significance in multivariate analysis. In conclusion, our analysis reports a 4-year overall survival rate of 69.1%. Non-SCCA pathology, advanced stage disease, LN presence and longer OTT showed worse prognostic factors in multivariate analysis.     

Activation of group I metabotropic glutamate receptors leads to brain-derived neurotrophic factor expression in rat C6 cells

Brain-derived neurotrophic factor (BDNF), which mediates neuronal growth, neuroprotection and synaptic modulation, is expressed in neurons and glial cells. The present study investigated the expression of BDNF in response to the activation of group I metabotropic glutamate receptors (mGluRs) by (S)-3,5-Dihydroxyphenylglycine (DHPG) in rat C6 glioma cells. The increase in BDNF mRNA in DHPG-stimulated cells, which peaked by 12 h after DHPG exposure, was attenuated by the mGluR5 inhibitor MPEP, but not by the mGluR1 inhibitor CPCCOEt. DHPG-induced BDNF mRNA expression reduced in cultures pretreated with protein kinase C (PKC) inhibitor, GFX, but not with calcium/calmodulin kinase II (CaMKII) inhibitor, KN-93. Immunostaining revealed high BDNF expression in cytoplasm of C6 cells after 48 h of incubation with 1 μM DHPG, but this was lower in MPEP-pretreated cells. These results indicate that activation of group I mGluRs induces BDNF mRNA and protein expression via mGluR5 subtype and PKC-dependent signaling pathway in C6 glioma cells.     

Cadaveric study of the anatomical reference points for proximal humeral plate positioning

Background

Complications following locking plate fixation in proximal humeral fractures often related to malposition plates and inadequate screw fixation. However, literature did not define the best anatomical reference point for plate positioning. We conducted a study to assess the occurrence of subacromial impingement and screw perforation with two anatomical reference points for proximal humeral plate positioning.

Method

Sixty shoulders of 30 cadavers were dissected, and proximal humeral locking plate was placed in two different levels in the coronal plane of the upper tip of plate: (1) the proximal portion of bicipital groove group and (2) the most prominent of lesser tuberosity group. Subacromial impingement during passive forward elevation and screw perforation were assessed in relation to the plate positioning.

Results

No subacromial impingement during passive motion contacted to the plate in both groups. The calcar screw perforation rate was significantly lower in the proximal portion of the bicipital groove group (2 of 60 specimens, 3.33%) than the most prominent of lesser tuberosity group (52 of 60 specimens, 86.67%). The most proximal screws of the plate were no humeral head perforation in all specimens.

Conclusion

Our study would suggest that two anatomical reference points could be used to be the landmark to avoid the subacromial impingement and the most proximal screw perforation. However, the placement of the locking plate using the proximal portion of bicipital groove reference is better for calcar screw insertion.