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Simple Summary: Radiotherapy is the primary and only curative treatment for nasopharyngeal carcinoma (NPC). The adoption of intensity-modulated radiotherapy (IMRT) alone or combined with optimized chemotherapeutic strategies has improved survival rates while reducing treatment-related toxicities. However, the persistent tumor status, including residual tumor presence and early recurrence, is the predominant cause of treatment failure, associated with poorer survival outcomes. This study extracted the radiomic features from pretreatment PET images, which were used to construct a prediction model to identify patients with NPC at high risk of having persistent tumors after treatment. The model trained by the AdaBoost algorithm showed significant diagnostic performance in predicting treatment failure. This model exhibited the feasibility of assisting clinicians in identifying high-risk patients before treatment, allowing for more personalized treatment plans and improving patient outcomes. Background/Objectives: The duration of the response to radiotherapy-related treatment is a critical prognostic indicator for patients with nasopharyngeal carcinoma (NPC). Persistent tumor status, including residual tumor presence and early recurrence, is associated with poorer survival outcomes. To address this, we developed a prediction model to identify patients at a high risk of persistent tumor status prior to initiating treatment. Methods: This retrospective study included 104 patients with NPC receiving radiotherapy-related treatment who had completed a 3-year follow-up period; 29 were classified into the persistent tumor status group and 75 into the disease-free group. Radiomic features were extracted from pretreatment positron emission tomography (PET) images and used to construct a prediction model by employing machine learning algorithms. The model's diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC), whereas SHapley Additive exPlanations (SHAP) analysis was conducted to determine the contribution of individual features to the model. Results: The prediction model developed using the AdaBoost algorithm and validated through five-fold cross-validation achieved the highest AUC of 0.934. Its sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.66%, 86.67%, 72.22%, 95.59%, and 87.5%, respectively. SHAP analysis revealed that the feature of high dependence low metabolic uptake emphasis50 had the greatest impact on model predictions. Furthermore, patients classified as disease-free exhibited markedly higher overall survival rates compared with those with persistent tumor status. Conclusions: In conclusion, the proposed prediction model efficiently identified patients with NPC at a high risk of persistent tumor status by using radiomic features extracted from pretreatment PET images. [ABSTRACT FROM AUTHOR]

Objective: Immune checkpoint inhibitors (ICI) are recommended as the first‐line therapy for platinum‐refractory head and neck squamous cell carcinoma (HNSCC), a disease with a poor prognosis. However, biomarkers in this situation are rare. The objective was to identify radiomic features‐associated biomarkers to guide the prognosis and treatment opinions in the era of ICI. Methods: A total of 31 platinum‐refractory HNSCC patients were retrospectively enrolled. Of these, 65.5% (20/31) received ICI‐based therapy and 35.5% (11/31) did not. Radiomic features of the primary site at the onset of recurrent metastatic (R/M) status were extracted. Prognostic and predictive radiomic biomarkers were analysed. Results: The median overall survival from R/M status (R/M OS) was 9.6 months. Grey‐level co‐occurrence matrix‐associated texture features were the most important in identifying the patients with or without 9‐month R/M death. A radiomic risk‐stratification model was established and equally separated the patients into high‐, intermittent‐ and lower‐risk groups (1‐year R/M death rate, 100.0% vs. 70.8% vs. 27.1%, p = 0.001). Short‐run high grey‐level emphasis (SRHGE) was more suitable than programmed death ligand 1 (PD‐L1) expression in selecting whether patients received ICI‐based therapy. Conclusions: Radiomic features were effective prognostic and predictive biomarkers. Future studies are warranted. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing radiation therapy (RT) often experience anxiety, which may jeopardize the treatment success. The efficacy of music interventions in reducing anxiety remains contentious. This randomized trial aimed to evaluate the impact of music listening on anxiety symptoms in patients undergoing initial RT. Methods: First-time RT patients were randomly allocated to experimental and control groups. The Brief Symptom Rating Scale (BSRS-5), Distress Thermometer (DT), and Beck Anxiety Inventory (BAI-C) were administered pre- and post-RT. Changes in physiological anxiety symptoms were monitored over 10 consecutive days starting from the first day of RT. The experimental group received music during RT; the control group did not. The generalized linear mixed model was used to estimate the pre–post difference in the BSRS-5, DT, and BAI-C scores between the music intervention and control group. Results: This study included 50 patients each in the experimental and control groups. BSRS-5 and DT scores were significantly reduced in the experimental group post-RT (p = 0.0114 and p = 0.0023, respectively). When music listening was discontinued, these scores rebounded. While the posttest BAI-C score was significantly lower in the experimental group (p < 0.0001), the pre–post difference between the two groups was not significant (p = 0.0619). On cessation of music listening, the BAI-C score also rebounded. Conclusions: For cancer patients undergoing initial RT, music listening intervention significantly reduced anxiety symptoms measured using the BSRS-5, DT, and BAI-C scores after two weeks. Our results demonstrate the effectiveness of music listening intervention in reducing anxiety symptoms, thereby potentially improving the quality of life of cancer patients undergoing RT. [ABSTRACT FROM AUTHOR]

Purpose: CSMed® wound dressing, a dressing with various herb extracts, was tested for its therapeutic effect in radiation dermatitis of breast and head-and-neck cancer patients. Methods: This study included 20 breast cancer patients and 10 head-and-neck cancer patients. Half of the irradiated area was covered with CSMed® and the other half was under routine treatment. The severity of radiation dermatitis was evaluated with radiation therapy oncology group (RTOG) grade throughout the treatment and the follow-up period. The RTOG grade between the dressed and undressed area were compared to illustrate the therapeutic effect of CSMed® dressing. Results: The results showed that CSMed® dressed area had significant lower RTOG score at 3–7 weeks and final record during the treatment, and 1–3 weeks during follow-up than undressed area. Conclusions: This indicated that CSMed® can delay the onset, reduce the severity, and enhance healing of radiation dermatitis. CSMed® can be used for prophylaxis and management of radiation dermatitis. [ABSTRACT FROM AUTHOR]

Understanding the three‐dimensional (3D) structure of the human skull is imperative for medical courses. However, medical students are overwhelmed by the spatial complexity of the skull. Separated polyvinyl chloride (PVC) bone models have advantages as learning tools, but they are fragile and expensive. This study aimed to reconstruct 3D‐printed skull bone models (3D‐PSBs) using polylactic acid (PLA) with anatomical characteristics for spatial recognition of the skull. Student responses to 3D‐PSB application were investigated through a questionnaire and tests to understand the requirement of these models as a learning tool. The students were randomly divided into 3D‐PSB (n = 63) and skull (n = 67) groups to analyze pre‐ and post‐test scores. Their knowledge was improved, with the gain scores of the 3D‐PSB group (50.0 ± 3.0) higher than that of the skull group (37.3 ± 5.2). Most students agreed that using 3D‐PSBs with quick response codes could improve immediate feedback on teaching (88%; 4.41 ± 0.75), while 85.9% of the students agreed that individual 3D‐PSBs clarified the structures hidden within the skull (4.41 ± 0.75). The ball drop test revealed that the mechanical strength of the cement/PLA model was significantly greater than that of the cement or PLA model. The prices of the PVC, cement, and cement/PLA models were 234, 1.9, and 10 times higher than that of the 3D‐PSB model, respectively. These findings imply that low‐cost 3D‐PSB models could revolutionize skull anatomical education by incorporating digital technologies like the QR system into the anatomical teaching repertoire. [ABSTRACT FROM AUTHOR]

Background: Ninety percent of patients receiving radiation therapy experience side effects. Busy schedules and intensive health education programs may lead to incomplete education content delivery and inaccurate patient self-care implementation. This study investigated whether multimedia health education improves the accuracy of patient self-care implementation compared with paper-based education. Methods: From March 11, 2020 to February 28, 2021, 110 patients were randomly divided into experimental and control groups, each comprising 55 participants. Paper-based materials were used along with multimedia materials. Radiology self-care awareness questionnaires were administered to both groups before the first treatment and on day 10. The differences in radiology self-care awareness between the two groups was analyzed with inferential statistics, independent t tests, categorical data, and Pearson's chi-squared test. Differences between the two groups were considered significant at a p value of < 0.05. Results: The treatment accuracy rate improved from 10.9 to 79.1% in the control group and from 24.8 to 98.5% in the experimental group, indicating an improvement in both groups. The difference was significant. These results indicate that the intervention could improve the effectiveness of self-care. Conclusions: Participants who used pretreatment multimedia health education exhibited a higher rate of having a correct understanding of treatment self-care than did the control group. These findings can inform the development of a patient-centered cancer treatment knowledge base for improved quality of care. [ABSTRACT FROM AUTHOR]

The aim is to investigate the effect of lotus (Nelumbo nucifera Gaertn.) seedpod extract (LSE) on acetaminophen (APAP)-induced hepatotoxicity. LSE is rich in polyphenols and has potent antioxidant capacity. APAP is a commonly used analgesic, while APAP overdose is the main reason for drug toxicity in the liver. Until now, there has been no in vitro test of LSE in drug-induced hepatotoxicity responses. LSEs were used to evaluate the effect on APAP-induced cytotoxicity, ROS level, apoptotic rate, and molecule mechanisms. The co-treatment of APAP and LSEs elevated the survival rate and decreased intracellular ROS levels on HepG2 cells. LSEs treatment could significantly reduce APAP-induced HepG2 apoptosis assessed by DAPI and Annexin V/PI. The further molecule mechanisms indicated that LSEs decreased Fas/FasL binding and reduced Bax and tBid to restore mitochondrial structure and subsequently suppress downstream apoptosis cascade activation. These declines in COX-2, NF-κB, and iNOS levels were observed in co-treatment APAP and LSEs, which indicated that LSEs could ameliorate APAP-induced inflammation. LSE protected APAP-induced apoptosis by preventing extrinsic, intrinsic, and JNK-mediated pathways. In addition, the restoration of mitochondria and inflammatory suppression in LSEs treatments indicated that LSEs could decrease oxidative stress induced by toxic APAP. Therefore, LSE could be a novel therapeutic option for an antidote against overdose of APAP. [ABSTRACT FROM AUTHOR]

Featured Application: The Taguchi methodology can effectively optimize brain gray/white matter CT image quality by finite combinations of five parameters with an auxiliary slit gauge and solid water plates. The methodology can be applied in other medical facilities in similar scenarios and the slit gauge solidifies the image quality via a quantified calculation instead of a manual judgement. Injuries due to traffic accidents have been significant causes of death in Taiwan and traffic accidents have been most common in recent years. Brain computed tomography (CT) examinations can improve imaging quality and increase the value of an imaging diagnosis. The image quality of the brain gray/white matter was optimized using the Taguchi design with an indigenous polymethylmethacrylate (PMMA) slit gauge to imitate the adult brain and solid water phantoms. The two gauges without coating contrast media were located inside the center of a plate to simulate the brain and scanned to obtain images for further analysis. Five major parameters—CT slice thickness, milliampere-seconds, current voltage, filter type, and field of view—were optimized. Analysis of variance was used to determine individual interactions among all control parameters. The optimal experimental acquisition/settings were: slice thickness 2.5 mm, 300 mAs, 140 kVp, smooth filter, and FOV 200 mm2. Signal-to-noise was improved by 106% (p < 0.001) over a routine examination. The effective dose (HE) is approximately 1.33 mSv. Further clinical verification and the image quality of the ACR 464 head phantom is also discussed. [ABSTRACT FROM AUTHOR]

Patients with oral cavity squamous cell carcinoma (OCSCC) who develop distant metastasis (DM) face poor outcomes, and effective prediction models of DM are rare. A total of 595 patients with OCSCC were retrospectively enrolled in this study. Because pathological N staging significantly influences the development and mechanisms of DM, the patients were divided into nodal-negative (pN−) and -positive (pN+) groups. Clinical outcomes, prognoses, and prediction models were analyzed separately for both groups. Overall, 8.9% (53/595) of these patients developed DM. Among the DM cases, 84.9% (45/53) of them developed DM within the first 3 years. The median overall survival, locoregional recurrence-free survival, time until DM development, and postmetastatic survival were 19.8, 12.7, 14.6, and 4.1 months, respectively. Distinguishing patients who only developed locoregional recurrence from those with DM according to locoregional conditions was difficult. Age, surgical margin, and early locoregional recurrence were predictors of DM that were independent of time until DM in the pN− group; the lymphocyte-to-monocyte ratio, presence of lymphovascular invasion, and early locoregional recurrence in the pN+ group were determined. If one point was scored for each factor, then two scoring systems were used to classify the patients into low- (score = 0), intermittent- (score = 1), or high- (score = 2 or 3) risk for the pN− and pN+ groups. According to this scoring system, the 3-year DM rates for the low, intermittent, and high risk subgroups were 0.0%, 5.9%, and 17.8% for the pN− group and 7.1%, 44.9%, and 82.5% for the pN+ group, respectively. These systems also effectively predicted DM, and the areas under the curve predicted DM occurring within the first 3 years were 0.744 and 0.820 for the pN− and pN+ groups, respectively. In conclusion, effective scoring models were established for predicting DM. [ABSTRACT FROM AUTHOR]

Background: The routine radiation therapy treatment planning does not include secondary radiation and peripheral doses resulting from radiotherapy exposure in patients with nasopharyngeal carcinoma (NPC) undergoing Volumetric Modulated Arc Therapy (VMAT) using an linear accelerator (linac) of Axesse (Elekta 2538).Objective: VMAT has a better dose conformity of the tumor and is also operated by adjusting the shapes of mulileaf collimator. However, such treatment is potentially important to improve the accuracy of estimated health risks.Methods: This study aimed to evaluate the equivalent dose of organ or tissue (DT) and effective dose (E) for normal organs using the Alderson Rando phantom as an equivalent of the human body. Thermoluminescent dosimeters (TLD-100H) were calibrated by 6 MV X-ray originated by the linac. A total of 252 TLDs were used. These TLDs were inserted into phantom organ or tissue which closely approximated to these places.Results: The thyroid dose (D푡ℎ푦) had the highest dose, 1840 ± 202 mSv/treatment. The E of the Rando was 7.11 ± 0.61 mSv/treatment, as estimated using ICRP 103. The skin doses (D푠푘푖푛) varied significantly outside the treatment field and decreased as the distance from the treatment field increased.Conclusions: This study can be referred to practical guidance regarding radiation protections of the public. [ABSTRACT FROM AUTHOR]

Background: According to statistics of the Ministry of Health and Welfare in 2017, the second leading cause of death in Taiwan was lung cancer.Objective: Routine treatment planning does not consider photoneutron dose equivalent (PNDE) of patient induced secondary radiation resulting from primary exposure of lung cancer. However, such treatment is potentially important for improving estimates of health risks.Methods: This study used 10, 30, 50, 70, and 90 kg of polymethylmethacrylate (PMMA) phantoms as patient to measure PNDE varying anatomical area during lung cancer of intensity modulated radiotherapy (IMRT) treatment. Paired thermoluminescent dosimeters (TLD-600 and 700) were calibrated using university reactor neutrons. TLDs were inserted into phantom which was closely corresponded of the represented tissues or organs.Results: Neutron doses (ND) of organ or tissue (N⁢DT) were determined in these phantoms using paired TLDs approach. The risks of incurring fatal secondary malignancies, maximum statistical and total errors were estimated. Evaluated PNDE ranged from 0.80 ± 0.12 to 0.56 ± 0.08 mSv/Gy for these phantoms.Conclusion: The estimated N⁢DT decreased with increasing distance that is from the central axis. Evaluated PNDE and N⁢D푠푘푖푛 for these phantoms were discussed. This investigation also identified secondary risks associated with PNDE relating to radiation protection. [ABSTRACT FROM AUTHOR]

Early progression, defined as a disease-free interval (DFI) of less than 6 months after completion of adjuvant platinum-based chemoradiotherapy (CRT), leads to poor outcomes in locally advanced oral cavity squamous cell carcinoma (OCSCC). However, appropriate biomarkers for predicting early progression remain unknown. In this study, 346 patients with OCSCC, who underwent curative surgical resection and platinum-based adjuvant CRT at the Taipei Veterans General Hospital (202 patients, training cohort) and Chung Shan Medical University Hospital (144 patients, validation cohort) were enrolled. The clinical–pathological variables were compared using the χ2 test. Cox proportional-hazards analyses were performed for DFIs. Survival was estimated using the Kaplan–Meier method and log-rank tests, and a scoring system for predicting early progression was established. One-fifth (20.5%, 71/346) of all patients experienced progression within 6 months. Each of the independent factors for the DFI in the training cohort, including pT3-4, extracapsular spread, and perineural invasion, were assigned a score of one point to establish a scoring system. The 6-month DFIs of the low-risk (score 0–1), intermediate-risk (score 2), and high-risk (score 3) groups were 97.8%, 78.7%, and 35.7% and 88.2%, 77.6%, and 42.1% in the training and validation cohorts, respectively. If the cutoff level was ≥2 or <2, the sensitivity/specificity/area under the curve for the training and validation cohorts were 94.4%/56.1%/0.837, and 73.3%/56.6%/0.703, respectively. The established scoring system effectively predicted early progression after adjuvant CRT for locally advanced OCSCC. [ABSTRACT FROM AUTHOR]

The World Health Organization regards betel quid (BQ) as a human carcinogen. The current study analyzes whether the BQ cues can elicit activity in the chewers' craving-related brain areas. We adopted a cue-reactivity paradigm to examine the changes in the brain activities. The urge intensity was also included to examine whether it can moderate the brain areas stimulated by BQ cues. Sixteen male BQ chewers and 16 healthy male controls were recruited and analyzed. Four types of cues were adopted: BQ cues, matched food cues, visual control cues, and resting crosshair cued. The most direct and important comparison was between the brain activities elicited by the BQ cues versus those by the food cues. Furthermore, to test the current urge intensity effect, we compared BQ chewers with a strong urge versus those with a weak urge. All of the three-dimension anatomical and multi-slice task-based functional images were acquired using 3 T MRI. We found that (1) the BQ chewers and the healthy controls had similar brain activation patterns when comparing any two cue types, (2) the high-urge (not the low-urge) chewers showed craving-related activations (e.g., anterior cingulate cortex, medial orbitofrontal gyrus, and superior frontal gyrus) in the critical BQ cues vs. the food cue comparisons. (3) The high-urge chewers had larger contrast activations (BQ - Food) in many craving-related brain areas than low-urge chewers did (e.g., frontal gyrus). The urge states endorsed by the chewers can moderate the neural responses to BQ cues. Multisensory cues should be considered to elicit more intense and consistent cravings. [ABSTRACT FROM AUTHOR]

The effective dose (HE) and organ or tissue equivalent dose (HT) for use in brain computed tomography (CT) examinations with various body weights were evaluated. Thermoluminescent dosimeters (TLD-100H) were inserted into Rando and five anthropomorphic phantoms. These phantoms were made of polymethylmethacrylate (PMMA), according to the specifications of ICRU 48, with masses from 10 to 90 kg. Brain CT examinations were conducted, scanning the maxillae from the external auditory meatus to the parietal bone using a 128-slice multi-detector CT (MDCT) scanner. To reduce errors, three independent trials were conducted. Calculated HE,TLD, based on the weighting factor recommended by ICRP 103, was 1.72 ± 0.28 mSv, which slightly exceeds the HE,DLP of 1.70 mSv, that was calculated from the dose–length product (DLP) of the Rando phantom. This experiment yielded HE,TLD values of ICRP 103 from the highest 1.85 ± 0.28 (90 kg) to the lowest 1.47 ± 0.22 (10 kg) mSv. HE,TLD (mSv) = 5.45×10−3 W(kg) + 1.361, with an R 2 of 0.87667. Using the DLP protocol, HE,DLP was estimated from CTDIvol that was recorded directly from the console display of the CT unit and multiplied by the conversion coefficient (k) recommended by the ICRP 103. Finally, the experimental results obtained herein are compared with those in the literature. Physicians should choose and adjust protocols to prevent the exposure of patients to unnecessary radiation, satisfying the as low as reasonably achievable (ALARA) principle. These findings will be valuable to patients, physicians, radiologists and the public. [ABSTRACT FROM AUTHOR]

Endotoxin lipopolysaccharide (LPS) plays an important role in the acceleration of hepatic inflammation. Natural medicinal plants that can prevent inflammation by targeting LPS have potential therapeutic clinical application. The aim of the study is to examine the anti-inflammatory effects of lotus seedpod extract (LSE), used as a traditional Chinese herbal medicine with hemostasis function and for eliminating bruise, on the LPS-induced hepatic inflammation and its underlying molecular mechanisms in vitro and in vivo. In vitro, LSE and its purified compound (-)-epigallocatechin (EGC) dose-dependently inhibited the expressions of pro-inflammatory cytokines and mediators, including tumor necrosis factor (TNF)- α , interleukin (IL)-6, cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS), without affecting cell viability in LPS-stimulated human hepatoma cell line HepG2. Molecular studies showed the anti-LPS effect of HLP or EGC might be mediated via downregulation of Toll-like receptor 4. (TLR4)-mediated both NF- κ B and p38 signaling, as demonstrated by the usage of pyrrolidine dithiocarbamate (PDTC), a specific NF- κ B inhibitor. In vivo, LPS-induced hepatic inflammation was significantly ameliorated in LSE-fed mice as gauged by dose-dependent inhibition of serum levels of biochemical markers of liver damage, the changes of hepatic lobular architecture and the secretion of pro-inflammatory mediators, as well as induction of anti-oxidant enzymes. As a result, our data presented the first evidence of EGC-enriched LSE as an anti-inflammatory agent in LPS-stimulated HepG2 cells and mice, and these findings may open interesting perspectives to the strategy in treatment for hepatic inflammation. [ABSTRACT FROM AUTHOR]

Rationale: Betel quid (BQ) is a common addictive substance in many Asian countries. However, few studies have focused on the influences of BQ on the brain. It remains unclear how BQ can affect structural brain abnormalities in BQ chewers. Objectives: We aimed to use generalized q-sampling imaging (GQI) to evaluate the impact of the neurological structure of white matter caused by BQ. Methods: The study population comprised 16 BQ chewers, 15 tobacco and alcohol controls, and 17 healthy controls. We used GQI with voxel-based statistical analysis (VBA) to evaluate structural brain and connectivity abnormalities in the BQ chewers compared to the tobacco and alcohol controls and the healthy controls. Graph theoretical analysis (GTA) and network-based statistical (NBS) analysis were also performed to identify the structural network differences among the three groups. Results: Using GQI, we found increases in diffusion anisotropy in the right anterior cingulate cortex (ACC), the midbrain, the bilateral angular gyrus, the right superior temporal gyrus (rSTG), the bilateral superior occipital gyrus, the left middle occipital gyrus, the bilateral superior and inferior parietal lobule, and the bilateral postcentral and precentral gyrus in the BQ chewers when compared to the tobacco and alcohol controls and the healthy controls. In GTA and NBS analyses, we found more connections in connectivity among the BQ chewers, particularly in the bilateral anterior cingulum. Conclusions: Our results provided further evidence indicating that BQ chewing may lead to brain structure and connectivity changes in BQ chewers. [ABSTRACT FROM AUTHOR]

Purpose: The effective dose (HE) and organ or tissue equivalent dose (HT) of a Rando phantom undergoing two brain computed tomography (CT) examination protocols were evaluated using thermoluminescent dosimeters (TLD-100H) and dose length product (DLP) methods. Materials and methods: TLDs were inserted into the correlated positions of an organ or tissue of Rando phantom, such as thyroid, brain, and salivary gland, using (A) axial scan: scanning the maxillae ranging from external auditory meatus to the parietal bone, and (B) helical scan: scanning from the mandible to the parietal bone. CT examinations were performed on a Philips computer tomography (Brilliance CT) at Lukang Christian Hospital. TLDs were measured using a Harshaw 3500 TLD reader. The HT of organ and tissue during the two protocols was discussed. Results and conclusion: HE were calculated using ICRP 60 and 103 at 2.67 ± 0.18 and 1.89 ± 0.23 mSv based on an axial scan, and 4.70 ± 0.38 and 4.39 ± 0.37 mSv based on a helical scan, respectively. In the DLP method, HE was estimated from CTDIvol that was recorded directly from the console display of the CT unit and then calculated using AAPM 96. Finally, experimental results are compared with those in literature. Radiologists should choose and adjust protocols to prevent unnecessary radiation to patients and satisfying the as low as reasonably achievable (ALARA) principle. These findings will be valuable to patients, physicians, radiologists, and the public. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between antidepressant prescription and breast cancer.Methods: The National Health Research Institute in Taiwan provided a database of 1 000 000 random subjects for this study. We identified 14 737 new antidepressant female users who were more than 15 years old during 1999-2005 with at least 10 prescriptions and one year exposure to an antidepressant. These were matched 1:1 by age and residence to non-antidepressant users from the same database to compare the risk of breast cancer.Results: In a model adjusted by age, residence, insurance amount, and depressive disorder, antidepressant prescription was not associated with breast cancer risk. This held true for both selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressants.Conclusions: There was no evidence for an association between antidepressant prescription and the risk of breast cancer. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the occurrences of post-irradiation chronic suppurative otitis media (CSOM), otitis media with effusion (OME), chronic rhinosinusitis (CRS), and their interrelationship in nasopharyngeal carcinoma (NPC) patients treated by intensity-modulated radiotherapy (IMRT). A retrospective review of medical records and magnetic resonance imaging for NPC patients across a 5-year follow-up was conducted. Rhinosinusitis was diagnosed and staged by Lund-Mackay system. A total of 102 patients were enrolled in the study. On the 5th year following IMRT, 8 patients (7.8 %), 30 patients (29.4 %), and 17 patients (16.7 %) suffered from IMRT-induced CSOM, post-irradiation OME, and CRS, respectively. Analysis by logistic regression showed a lack of association between the occurrence of post-irradiation OME and CRS ( P = 0.06). These observations indicated that the modern radiotherapy technique exhibits capability in decreasing the incidences of CSOM and CRS comparing to the data of traditional radiotherapy. But post-irradiation OME was still encountered in more than one-quarter of long-term survivors of NPC. Of note, rhinosinusitis in NPC survivors does not predispose to the development of post-irradiation OME, suggesting nasal irrigation might be unnecessary for the management of OME following radiotherapy. [ABSTRACT FROM AUTHOR]

Background. Sinus mucosa abnormalities on image studies, which is the major diagnostic measure for sinusitis, were investigated in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT). Methods. A retrospective review of the MRIs for patients with NPC was conducted. Sinus mucosa abnormalities were staged by the Lund–Mackay system. Results. A total of 94 patients were enrolled in this study. The rate and severity of sinus abnormalities were highest on the third postradiotherapy month (p < .005, t test). There was no significant increase in the incidence of abnormalities on the fifth postradiotherapy year (t test). The anterior ethmoid and maxillary sinuses were the most affected sinuses before and after radiotherapy (p < .005, chi-square test). Conclusion. Our data showed that the anterior ethmoid and maxillary sinuses were the most vulnerable sinuses for therapeutic toxicity after IMRT in patients with NPC. In the long run, however, the application of IMRT does not significantly increase the incidence of sinus toxicities. [ABSTRACT FROM AUTHOR]

Andrographolide (Andro), a diterpenoid lactone isolated from a traditional herbal medicine Andrographis paniculata, has been shown to suppress the growth and invasion of human colorectal carcinoma (CRC) Lovo cells, and trigger apoptosis in vitro. The potential of Andro as a chemotherapeutic agent in CRC was evaluated by investigating its cytotoxic effects as a single agent or in coadministration with cisplatin (CDDP). Andro potentiated the cytotoxic effect of CDDP in Lovo cells through apoptosis. The molecular mechanism for these favorable cellular response was further investigated by analyzing the apoptotic profiles, protein levels, and mRNA expression patterns of several key genes after treatments of Andro or/and CDDP. Molecular results indicated that the effect of Andro alone might be mediated via both intrinsic and extrinsic apoptotic pathways in Lovo cells. The addition of Andro to CDDP induced synergistic apoptosis, which could be corroborated to the changes in protein and mRNA levels of Bax and Bcl-2, and the increased Fas/FasL association in these cells, resulting in increased release of cytochrome c, and activation of caspases. Pretreatment of Nok-1 monoclonal antibody, a Fas signaling inhibitor, or Bax inhibitor peptide V5 repressed the Andro-induced cleavage of procaspase and the sensitization to CDDP-induced apoptosis. Finally, the combination therapy of Andro with CDDP was evidenced by its synergistic inhibition on the growth of Lovo cells in xenograft tumor studies. The results indicate that Andro, in combination with chemotherapeutics, is likely to represent a potential therapeutic strategy for CRC. [ABSTRACT FROM PUBLISHER]

Objectives/Hypothesis Postirradiation otitis media with effusion (OME) is a common adverse otologic effect in nasopharyngeal carcinoma (NPC) patients treated by radiotherapy. The purpose of this study was to determine the long-term incidence of postirradiation OME in NPC patients following intensity-modulated radiotherapy (IMRT) and to evaluate the potential factors associated with the development of this otologic complication. Study Design Retrospective observational study. Methods A retrospective review of NPC patients treated by IMRT between January 2002 and June 2008 was conducted. Otologic complications were regularly evaluated during follow-up. Presence of OME was detected by findings of otoscopic exam, pure-tone audiometry, impedance audiometry, and tympanocentesis. Incidence of postirradiation OME and relevant factors were analyzed. Results A total of 105 patients (210 ears) were enrolled in the study. There were 34 patients (32.4%) with unilateral or bilateral postirradiation OME 3 years or more following radiotherapy. There was no correlation between the complication and the stage of primary tumor. The presence of pretreatment OME, however, was significantly associated with the development of postirradiation OME. Although there was no significant relationship between the radiation dose and post-treatment OME, the link with radiation toxicity was demonstrated by the finding that 28% of postirradiation OME developed in the ears contralateral to the side of primary nasopharyngeal tumor. Conclusions Postirradiation OME remains a common late toxicity in NPC patients treated by modern radiotherapy. Pretreatment injuries by the tumor and radiation-induced damages to the eustachian tube both play a major role in the development of the otologic complication. Level of Evidence Level of Evidence: 3b (nonconsecutive cohort study). Laryngoscope, 123:2148-2153, 2013 [ABSTRACT FROM AUTHOR]

Leukopenia and immunity impairment usually occur during cancer therapy. Citronellol, an oil soluble compound derived from the geranium, has anticancer and antiinflammatory properties, as well as promoting wound healing. Ganoderma lucidum, Codonopsis pilosula and Angelicae sinensis are traditional Chinese herbs, all of which have proven immunomodulatory functions in laboratory-based research. This randomized, double-blind, placebo-controlled study examined whether the Chinese medicinal herb complex (CCMH; a mixture of citronellol and extracts of G. lucidum, C. pilosula and A. sinensis) improves the immune cell counts of cancer patients receiving chemotherapy and/or radiotherapy. A total of 105 cancer patients receiving chemotherapy or radiotherapy were enrolled. The quantities of immune cells in the blood of the subjects were determined before and after 6 weeks of cancer treatment, with either CCMH or a placebo. CCMH significantly reduced the depletion of leukocytes (14.2% compared with 28.2%) and neutrophils (11.0% compared with 29.1%). Analysis of the lymphocyte phenotype revealed that the patients receiving the placebo had reduced CD4 lymphocytes and natural killer (NK) cells than the CCMH-treated patients. Treatment with CCMH for patients receiving chemotherapy and/or radiotherapy may improve their immune function, improving their ability to fight off the cancer, as well as any secondary infections that could compromise their treatment and their health. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common cancer for women in Taiwan and post-lumpectomy radiotherapy is one of the therapeutic strategies for this malignancy. Although the 10-year overall survival of breast cancer patients is greatly improved by radiotherapy, the locoregional recurrence is around 10% and triple negative breast cancers (TNBCs) are at a high risk for relapse. The aim of this paper is to understand the mechanisms of radioresistance in breast cancers which may facilitate the development of new treatments in sensitizing breast cancer toward radiation therapy. Tribbles homolog 3 (TRIB3) is a pseudokinase protein and known to function as a protein scaffold within cells. It has been reported that higher TRIB3 expression is a poor prognostic factor in breast cancer patients with radiotherapy. In this study, we investigate the involvement of TRIB3 in the radiation response of TNBC cells. We first found that the expression of TRIB3 and the activation of Notch1, as well as Notch1 target genes, increased in two radioresistant TNBC cells. Knockdown of TRIB3 in radioresistant MDA-MB-231 TNBC cells decreased Notch1 activation, as well as the CD24-CD44+ cancer stem cell population, and sensitized cells toward radiation treatment. The inhibitory effects of TRIB3 knockdown in self-renewal or radioresistance could be reversed by forced expression of the Notch intracellular domain. We also observed an inhibition in cell growth and accumulated cells in the G0/G1 phase in radioresistant MDA-MB-231 cells after knockdown of TRIB3. With immunoprecipitation and mass spectrometry analysis, we found that, BCL2-associated transcription factor 1 (BCLAF1), BCL2 interacting protein 1 (BNIP1), or DEAD-box helicase 5 (DDX5) were the possible TRIB3 interacting proteins and immunoprecipitation data also confirmed that these proteins interacted with TRIB3 in radioresistant MDA-MB-231 cells. In conclusion, the expression of TRIB3 in radioresistant TNBC cells participated in Notch1 activation and targeted TRIB3 expression may be a strategy to sensitize TNBC cells toward radiation therapy. [ABSTRACT FROM AUTHOR]