Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial

Publication date: Available online 31 January 2018
Source:Journal of Bodywork and Movement Therapies
Author(s): Fahimeh Kamali, Mehdi Zamanlou, Ali Ghanbari, Abbass Alipour, Soha Bervis
BackgroundManual therapy and exercise therapy are two common treatments for low back pain. Although their effects have been discussed in several studies, the superiority of one over the other for patients with sacroiliac joint dysfunction is still unclear.ObjectivesThe aim of this study was to compare the effects of manipulation (M) and stabilization exercises (S) in patients with subacute or chronic sacroiliac joint dysfunction.MethodsThe participants in this randomized controlled trial study were patients with subacute or chronic sacroiliac joint dysfunction for more than 4 weeks and less than 1 year. A total of 40 patients were randomized with a minimization method to the M (n = 20) or S (n = 20) group; 15 patients in each group received treatment. The treatment program lasted 2 week in group M and 4 weeks in group S. Pain and the Oswestry Disability Index (ODI) were recorded before and immediately after the treatment period.ResultsBoth groups showed significant improvement in assessed pain and ODI (P < 0.05). There were no statistically significant differences between groups in post-intervention assessed pain or ODI (P > 0.05).ConclusionsDespite the improvements seen after both manipulation and stabilization exercise therapies in patients with sacroiliac joint dysfunction, there was no significant between-group difference in the treatment effects. This result suggests that neither manual therapy nor stabilization exercise therapy is superior for treating subacute or chronic sacroiliac joint dysfunction.



http://ift.tt/2DRxDNg

The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial

Publication date: Available online 31 January 2018
Source:Journal of Bodywork and Movement Therapies
Author(s): Maryam Tarameshlu, Leila Ghelichi, Amir Reza Azimi, Noureddin Nakhostin Ansari, Ahmad Reza Khatoonabadi
BackgroundDysphagia is common following Multiple Sclerosis (MS) and is associated with significant morbidity and mortality. The current rehabilitation program to swallowing therapy is Traditional Dysphagia Therapy (TDT), but there is a dearth of evidence about its effectiveness in MS patients.ObjectivesThis study was aimed to determine the effects of the TDT on the swallowing function in MS patients with dysphagia.MethodsA pilot double blind randomized clinical trial was carried out on 20 patients with MS. Patients were randomly divided into experimental group (TDT) comprising sensorimotor exercises and swallowing maneuvers, and Usual Care (UC) comprising diet prescription and postural changes. Patients in both groups received treatments for 6 weeks, 18 treatment sessions, 3 times per week, every other day. The Mann Assessment of Swallowing Ability (MASA) was the main outcome measure. The swallowing ability was assessed before treatment (T0), after the end of 9th session (T1), after the end of 18th session (T2), and after 6 weeks follow-up (T3). Penetration–Aspiration Scale (PAS) and Pharyngeal Residue Rating Scale (PRRS) as secondary outcome measures were applied at T0 and T2.ResultsBoth groups had improved regarding MASA, PAS and PRRS scores over the time (P < 0.001). The improvements achieved in all outcomes were significantly greater in the TDT group than those of the UC group. The Main effect of the Time × Group interaction was significant for MASA score (P < 0.001). The large effect sizes were found for MASA score in both the TDT (d = 3.91) and the UC (d = 1.11) groups.ConclusionsThis pilot randomized controlled trial showed that the TDT significantly improved the swallowing function of the MS patients with dysphagia.



http://ift.tt/2EsIe2j

Dry needling versus friction massage to treat tension type headache: A randomized clinical trial

Publication date: Available online 31 January 2018
Source:Journal of Bodywork and Movement Therapies
Author(s): Fahimeh Kamali, Marzieh Mohamadi, Leila Fakheri, Fatemeh Mohammadnejad
Tension type headache (TTH), the most common type of headache, is known to be associated with myofascial pain syndrome and the existence of myofascial trigger points. There are several treatment options for myofascial trigger points. In this study we compared the effectiveness of dry needling and friction massage to treat patients with TTH.A convenience sample of 44 patients with TTH participated in this randomized clinical trial. The frequency and intensity of headache, pressure pain threshold at the trigger point site, and cervical range of motion were recorded. Then the participants were randomly assigned to one of two treatment groups for dry needling or friction massage, delivered in 3 sessions during 1 week. The participants were evaluated 48 h after the last treatment session. Analysis of covariance, paired t-test and Wilcoxon's test were used for statistical analysis.The results showed that both treatment methods significantly reduced headache frequency and intensity, and increased pain threshold at the trigger points. However, neither treatment had any effect on cervical range of motion except for extension, which increased in the dry needling group. Between-group comparisons showed that dry needling increased pain threshold significantly more than friction massage. There were no significant differences between groups in any other outcome variables.Dry needling and friction massage were equally effective in improving symptoms in patients with TTH. The decreases in frequency and intensity of headache were similar after both dry needing and friction massage.



http://ift.tt/2DSjY8y

Evaluating the effect of rain on the fate of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) accumulated in polluted trees in Amman, Jordan

Abstract

Open combustion of solid waste is one of the main sources of the emission of dioxin and dioxin-like compounds (DLCs). Ambient dioxin will eventually undergo depositions on soils and tree leaves. Pine trees have shown an ability to store dioxin in their needles allowing biomonitoring of dioxin atmospheric concentrations. Infiltration can transport dioxin to greater depths into the ground, on one hand, while vaporization can allow dioxin to return back to the atmosphere on the other. Several studies evaluated the migration of dioxin between two compartments; however, few studies have attempted to understand the fate of non-conservative PCDDs and PCDFs in an unsteady state system of more than two mediums. This study focused on the transportation of dioxin between polluted trees and the underlying soil through the effect of rain water. For approximately 10 years, pine trees in this study have been exposed to emissions generated by the open combustion of municipal solid waste (MSW) from a fixed location. Soil samples located further from the point source had generally lower dioxin concentrations. Dioxin concentrations were correlated to distance from the source using least square regression. Soil samples below contaminated trees had dioxin concentrations 10–35% greater than the calculated measurements for the same spots using the regression model. By detecting these spikes in concentrations, it was possible to identify pools of dioxin found directly under the contaminated trees—indicating a rinsing effect of rain water on the stored dioxin on the trees' needles.

http://ift.tt/2FxI9d0

Unexpected potential protective associations between outdoor air pollution and cataracts

Abstract

Air pollution is one of the biggest public health issues, and the eye is continuously exposed to multiple outdoor air pollution. However, to date, no large-scale study has assessed the relationship between air pollutants and cataracts. We investigated associations between outdoor air pollution and cataracts in the Korean population. A population-based cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey, including 18,622 adults more than 40 years of age. The presence of cataracts and their subtypes were evaluated by ophthalmologists. Air pollution data (levels of particulate matter, ozone, nitrogen dioxide, and sulfur dioxide) for the 2 years prior to the ocular examinations were collected from national monitoring stations. The associations of multiple air pollutants with cataracts were assessed by multivariate logistic regression analyses. Sociodemographic factors and previously known risk factors for cataracts were controlled as covariates (model 1 included sociodemographic factors, sun exposure, and behavioral factors, while model 2 further included clinical factors). Higher ozone concentrations were protectively associated with overall cataract which included all subtypes [single pollutant model: 0.003 ppm increase—model 1 (OR 0.89, p = 0.014), model 2 (OR 0.87, p = 0.011); multi-pollutant model: 0.003 ppm increase—model 1 (OR 0.80, p = 0.002), model 2 (OR 0.87, p = 0.002)]. Especially, higher ozone concentrations showed deeply protective association with nuclear cataract subtype [0.003 ppm increase—single pollutant model: model 2 (OR 0.84, p = 0.006), multi-pollutant model: model 2 (OR 0.73, p < 0.001)]. Higher tropospheric ozone concentrations showed protective associations with overall cataract and nuclear cataract subtype in the Korean population.

http://ift.tt/2Fz5sDc

Muscle activity and kinetics of lower limbs during walking in pronated feet individuals with and without low back pain

Publication date: Available online 31 January 2018
Source:Journal of Electromyography and Kinesiology
Author(s): Nader Farahpour, AmirAli Jafarnezhadgero, Paul Allard, Mahdi Majlesi
The objectives of this study were to investigate whether excessive feet pronation alters the joints' kinematics, kinetics and the activity of involved muscles during gait in low back pain patients. Methods: The lower limb joints' motion, moment and power, as well as the activity of involved muscles during walking were measured in a control group, and two experimental groups including a group with excessive feet pronation only, and another group of low back pain patients with excessive feet pronation. Results: In both experimental groups, ankle inversion, knee flexion and internal rotation, hip internal rotation, plantar flexors' moment, hip flexors' moment, and peak positive ankle power were lower than those in control group (p<0.05). Besides, in patients, higher activity of gastrocnemius medialis, gluteus medius, erector spinae, and internal oblique muscles, and lower negative power at the ankle and peak positive power at the knee were observed (p < 0.05). In conclusion, pronated feet with low back pain was associated with less ankle inversion and knee flexion, higher knee and hip internal rotation, higher muscle activity, less energy absorption at the ankle, and reduced positive power at the knee. This study reveals that strengthening of the muscles especially knee extensors are of great importance in low back pain patients with feet pronation.



http://ift.tt/2GBxlvM

The Effects of Pressure Biofeedback Training on Infraspinatus Muscle Activity and Muscle Thickness

Publication date: Available online 31 January 2018
Source:Journal of Electromyography and Kinesiology
Author(s): Il-young Yu, Yeon-ki Choo, Moon-hwan Kim, Jae-seop Oh
The aim of this study was to investigate muscle activity in the infraspinatus and posterior deltoid and infraspinatus muscle thickness during a prone external rotation (PER) exercise using pressure biofeedback. Fifteen healthy men participated in this study, performing PER exercise with pressure biofeedback under four conditions (comfortable, 2 mm Hg, 4 mm Hg, and 8 mm Hg). Surface electromyography (EMG) was used to monitor infraspinatus and posterior deltoid muscle activity, and ultrasonography was used to collect infraspinatus muscle thickness data. Infraspinatus activity and muscle thickness were greatest at 2 mm Hg pressure feedback, and both measures were significantly different from those under other pressure feedback conditions (p < 0.05). In contrast, posterior deltoid activity was lower at 2 mm Hg. However, there was no significant difference between any of the four pressure feedback conditions. These findings suggest that PER exercise with pressure biofeedback, particularly at 2 mm Hg, is effective in selectively activating the infraspinatus muscle.



http://ift.tt/2s2iXJV

A prospective study of the safety and efficacy of liver stereotactic body radiotherapy in patients with and without prior liver-directed therapy

Publication date: Available online 30 January 2018
Source:Radiotherapy and Oncology
Author(s): Dominic H. Moon, Andrew Z. Wang, Joel E. Tepper
Background and purposeTo evaluate the safety and efficacy of liver stereotactic body radiotherapy (SBRT), and examine potential factors impacting outcomes including prior liver-directed therapy.Materials and methodsPatients with ECOG 0–1, Child-Pugh Class A or B, and primary hepatocellular carcinoma (HCC) or liver metastases unsuitable for surgical resection or ablation were eligible for a prospective single arm trial. SBRT was delivered with a CyberKnife system to 45 Gy in 3 fractions with a predetermined dose de-escalation scheme. Adverse events, local control, and survival were assessed.ResultsA total of 30 patients were enrolled. Eleven patients (37%) had HCC and 19 (63%) patients had liver metastases. Fourteen patients (47%) had prior liver-directed therapies including nine with liver resection, seven with trans-arterial chemoembolization, and six with radiofrequency ablation. Cumulative grade 2 and 3 acute toxicity occurred in 47% and 7% of patients, respectively. Similar rates of ≥grade 2 acute toxicity were observed between patients who had prior liver-directed treatments and those who did not. At a median follow-up of 12.7 months, 1-year local control and overall survival were 81% and 62%, respectively. Prior liver-directed therapy did not affect local control or survival.ConclusionsLiver SBRT is a safe and effective treatment even in the setting of prior liver-directed surgical and ablative therapies.



http://ift.tt/2ErJNNO

Development and validation of an MRI-based model to predict response to chemoradiotherapy for rectal cancer

Publication date: Available online 31 January 2018
Source:Radiotherapy and Oncology
Author(s): Philippe Bulens, Alice Couwenberg, Karin Haustermans, Annelies Debucquoy, Vincent Vandecaveye, Marielle Philippens, Mu Zhou, Olivier Gevaert, Martijn Intven
Background and purposeTo safely implement organ preserving treatment strategies for patients with rectal cancer, well-considered selection of patients with favourable response is needed. In this study, we develop and validate an MRI-based response predicting model.MethodsA multivariate model using T2-volumetric and DWI parameters before and 6 weeks after chemoradiation (CRT) was developed using a cohort of 85 rectal cancer patients and validated in an external cohort of 55 patients that underwent preoperative CRT.ResultsTwenty-two patients (26%) achieved ypT0-1N0 response in the development cohort versus 13 patients (24%) in the validation cohort. Two T2-volumetric parameters (ΔVolume% and Sphere_post) and two DWI parameters (ADC_avg_post and ADCratio_avg) were retained in a model predicting (near-)complete response (ypT0-1N0). In the development cohort, this model had a good predictive performance (AUC = 0.89; 95% CI 0.80–0.98). Validation of the model in an external cohort resulted in a similar performance (AUC = 0.88 95% CI 0.79–0.98).ConclusionAn MRI-based prediction model of (near-)complete pathological response following CRT in rectal cancer patients, shows a high predictive performance in an external validation cohort. The clinically relevant features in the model make it an interesting tool for implementation of organ-preserving strategies in rectal cancer.



http://ift.tt/2DQQfwZ

Palliative radiotherapy for locally advanced non-metastatic head and neck cancer: A survey of UK national practice

Publication date: Available online 30 January 2018
Source:Radiotherapy and Oncology
Author(s): Muhammad Shahid Iqbal, Charles Kelly, Josef Kovarik, Bojidar Goranov, Ghazia Shaikh, David Morgan, Werner Dobrowsky, Vinidh Paleri




http://ift.tt/2DTk9kg

Clinical significance of soluble programmed cell death ligand-1 (sPD-L1) in hepatocellular carcinoma patients treated with radiotherapy

Publication date: Available online 30 January 2018
Source:Radiotherapy and Oncology
Author(s): Hyun Ju Kim, Sangjoon Park, Kyoung-Jin Kim, Jinsil Seong
PurposeTo investigate the clinical implications of the soluble programmed cell death-ligand 1 (sPD-L1) level in hepatocellular carcinoma (HCC) patients treated with radiotherapy (RT).Materials/methodsHCC patients treated with RT between June 2011 and March 2015 were prospectively recruited and sPD-L1 levels were measured using an enzyme-linked immunosorbent assay. Blood samples were obtained at the RT start, RT end, and 1-month follow-up. The associations of the sPD-L1 level with the clinical features and outcomes were analyzed.ResultsFifty-three patients with HCC were included. Thirty-four patients received conventional fractionated RT with hepatic arterial infusional chemotherapy, while 19 patients received stereotactic body radiotherapy (SBRT). The initial sPD-L1 level was significantly associated with stage, tumor size, portal vein tumor thrombosis, and venous invasion. The overall-survival was significantly poorer in patients with a higher level of initial sPD-L1 (≥1.315 pg/mL). A higher level of sPD-L1 at 1 month (≥12.9 pg/mL) was significantly related to early lung metastasis. The sPD-L1 level was significantly increased after RT and the change pattern of sPD-L1 was different between two RT schemes.ConclusionsThe level of sPD-L1 was associated with tumor aggressiveness and outcomes, suggesting its role as a possible predictive biomarker. The increases in sPD-L1 after RT suggests that combined treatment with RT and immune checkpoint inhibitors may be a promising therapeutic strategy in HCC.



http://ift.tt/2Es5nBN

Review of the patient positioning reproducibility in head-and-neck radiotherapy using Statistical Process Control

Publication date: Available online 31 January 2018
Source:Radiotherapy and Oncology
Author(s): Sarah J. Moore, Patries M. Herst, Robert J.W. Louwe
Background and purposeA remarkable improvement in patient positioning was observed after the implementation of various process changes aiming to increase the consistency of patient positioning throughout the radiotherapy treatment chain. However, no tool was available to describe these changes over time in a standardised way. This study reports on the feasibility of Statistical Process Control (SPC) to highlight changes in patient positioning accuracy and facilitate correlation of these changes with the underlying process changes.Materials and methodsMetrics were designed to quantify the systematic and random patient deformation as input for the SPC charts. These metrics were based on data obtained from multiple local ROI matches for 191 patients who were treated for head-and-neck cancer during the period 2011–2016.ResultsSPC highlighted a significant improvement in patient positioning that coincided with multiple intentional process changes. The observed improvements could be described as a combination of a reduction in outliers and a systematic improvement in the patient positioning accuracy of all patients.ConclusionSPC is able to track changes in the reproducibility of patient positioning in head-and-neck radiation oncology, and distinguish between systematic and random process changes. Identification of process changes underlying these trends requires additional statistical analysis and seems only possible when the changes do not overlap in time.



http://ift.tt/2EtRBii

Biological hydrogen peroxide detection with aryl boronate and benzil BODIPY-based fluorescent probes

Publication date: Available online 31 January 2018
Source:Sensors and Actuators B: Chemical
Author(s): Malcolm S. Purdey, Hanna J. McLennan, Melanie L. Sutton-McDowall, Daniel W. Drumm, Xiaozhou Zhang, Patrick K. Capon, Sabrina Heng, Jeremy G. Thompson, Andrew D. Abell
The detection of hydrogen peroxide (H2O2) using fluorescent probes is critical to the study of oxidative stress in biological environments. Two important sensing architectures for detecting H2O2, aryl boronates and benzils, are compared here using novel boron-dipyrromethene (BODIPY) fluorescent probes. The aryl boronate PeroxyBODIPY-1 (PB1) and benzil-based nitrobenzoylBODIPY (NbzB) were synthesised from a common BODIPY intermediate in order to compare sensitivity and selectivity to H2O2. The aryl boronate PB1 gives the highest change in fluorescence on reaction with H2O2 while the benzil NbzB exhibits exclusive selectivity for H2O2 over other reactive oxygen species (ROS). Both proved to be cell-permeable, with PB1 being able to detect H2O2 in denuded bovine oocytes. The strengths of these aryl boronate and benzil probes can now be exploited concurrently to elucidate biological mechanisms of H2O2 production and oxidative stress.



http://ift.tt/2E3JLy1

Influence of surface composition on the colloidal stability of ultra-small detonation nanodiamonds in biological media

Publication date: Available online 31 January 2018
Source:Diamond and Related Materials
Author(s): Carlo Bradac, Ishan Das Rastogi, Nicole M. Cordina, Alfonso Garcia-Bennett, Louise J. Brown
Fluorescent nanodiamonds (NDs) are strong contenders as bio-labels for life science imaging, diagnostics and therapeutics. Ultimately, for their use in biomedical applications, their size should ideally be <10 nm. Yet, even more critical for their specificity and efficient uptake in cellular systems, is their resilience to aggregation, which is dictated by their colloidal stability in complex, physiological environments. To this end, we characterize small detonation NDs (~5 nm) by examining their surface chemical profiles and stability in solutions of varying ionic strength and pH. Using dynamic light scattering measurements, we demonstrate that small monodisperse ND particles with chemically homogeneous and negatively charged surface profiles are more stable than positive particles under a broad range of simulated biological environments. We show that the colloidal stability of small clusters of both positive and negative detonation NDs is improved by functionalization with bovine serum albumin. Based on these analyses, we propose and describe strategies for enhancing the overall colloidal stability of detonation NDs and their resilience to aggregation. Our findings provide a practical framework towards the reduction in size of the bio-conjugates employed to probe complex biological systems, and the advancement of bio-imaging techniques with minimal perturbation of the molecular trafficking in cellular and organelle systems.

Graphical abstract

http://ift.tt/2FyQRaU

Inorganic nanoparticles: a potential cancer therapy for human welfare

Publication date: Available online 31 January 2018
Source:International Journal of Pharmaceutics
Author(s): Arivalagan Pugazhendhi, Thomas Nesakumar Jebakumar Immanuel Edison, Indira Karuppusamy, Brindhadevi Kathirvel
Cancer is an abnormal condition leading to uncontrolled cell division which causes damage to the body tissues. Around 100 types of cancer are studied so far namely breast cancer, lung cancer, skin cancer, prostate cancer, colon cancer and lymphoma. Major cancer therapies include chemotherapy, surgery and radiations but their major drawbacks are non-specifically distributed antitumor agents, uneven delivery of drug concentration to the tumour and low monitoring. Nanoparticles (NPs) are the newly trending field of nanomedicine implied in cancer therapy. The structural characteristics of NPs makes them excellent mode for targeting and penetrating the abnormal cell growth caused by cancer. They can potentially enter the abnormal cells causing DNA damage and determine the defects in the genes. Apart from targeting cancer cells they also aid in drug delivery, imaging of abnormal cells, release and monitoring of therapeutic agents against cancer. The present review deals with the inorganic NPs mediated pharmacotherapy, potential strategies for developing drug delivery system, evaluate the merits and demerits of traditional chemotherapy and nanotheraphy for significantly improving the treatment of cancers.

Graphical abstract

http://ift.tt/2E5shRW

A novel method for the preparation of fluorescent C60 poly(amino acid) composites and their biological imaging

Publication date: Available online 31 January 2018
Source:Journal of Colloid and Interface Science
Author(s): Dazhuang Xu, Meiying Liu, Qiang Huang, Junyu Chen, Hongye Huang, Fengjie Deng, Jianwen Tian, Yuanqing Wen, Xiaoyong Zhang, Yen Wei
Recently, fullerene (C60) and its derivatives have been widely explored for many applications owing to their enriched physical and chemical properties. Specifically, the synthesis and biomedical applications of fluorescent C60 have been extensively investigated previously. However, the preparation of polymer-functionalized fluorescent C60 has not been reported thus far. In this study, water-dispersible fluorescent C60 polymer composites were successfully synthesized through the combination of the thiol-ene click reaction and subsequent ring-opening polymerization. First, 2-aminoethanethiol was introduced on the surface of C60 by the thiol-ene click reaction. The surface of amino group-functionalized C60 (C60-NH2) was further modified with poly(amino acid)s via ring-open polymerization of GluEG N-carboxyanhydrides (NCAs). The morphology, functional groups, optical properties and biocompatibility were examined by a number of characterization equipment and assays in detail. We demonstrated that the resultant fluorescent C60 poly(amino acid) (C60-GluEG) composites have a small size (about 5 nm), high water dispersibility, intense fluorescence and high photostability. Cell viability results implied that the C60-GluEG composites possess low cytotoxicity. Moreover, these C60-GluEG composites can easily penetrate into live cells, indicating their great potential for biological imaging applications.

Graphical abstract

http://ift.tt/2FA32Ep

Diamond, Carbon Nanotubes and Graphene for Biomedical Applications

Publication date: 2018
Source:Reference Module in Biomedical Sciences
Author(s): Aaqil Rifai, Elena Pirogova, Kate Fox
Carbon based materials are becoming more prevalent in biomedical applications. In particular, materials like diamond, carbon nanotubes and graphene are widely used across medicine in applications such as electrodes, tissue engineering, optics, biomedical engineering, medical implants, medical devices, and sensors. In this reference module, we focus on broad applications where diamond, carbon nanotubes and graphene are preferably utilized for their beneficial properties describing in depth the key advantages of their selection and the future advances that may be offered.



http://ift.tt/2FviAcv

Patient Reported Sexual Aid Utilization and Efficacy following Radiation Therapy for Localized Prostate Cancer

Publication date: Available online 31 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Robert T. Dess, Theresa P. Devasia, Nima Aghdam, William C. Jackson, Payal D. Soni, Clayton P. Smith, Amyre L. Mitchell, Simeng Suy, Daniel A. Hamstra, Shruti Jolly, Paul L. Nguyen, Felix Y. Feng, Matthew J. Schipper, Ted A. Skolarus, David C. Miller, Daniela A. Wittmann, Sean P. Collins, Daniel E. Spratt
PurposeErectile dysfunction is common after treatment for localized prostate cancer. Longitudinal data regarding medication and device practice patterns and efficacy in men treated are lacking. Herein, we report sexual health related quality of life (HRQOL) outcomes and utilization and efficacy of sexual aids in a contemporary cohort.Materials and MethodsBetween 2008-2013, 471 consecutive men with localized prostate cancer were treated on two institutional protocols (NCTXXXXXXXX, NCTXXXXXXXX) or on a prospective institutional registry with patient-reported HRQOL. All patients were treated with ultra-hypofractionated radiotherapy. Erectile function (EF) was defined as "firm enough for intercourse" with or without aids per EPIC-26 (n=222 at baseline); results apply to this cohort unless specifically noted. Sexual aid utilization and efficacy was patient-reported. Multivariable-analysis of EF was performed.ResultsMedian follow-up was 60 months, median age was 67, and 70% had intermediate- or high-risk disease per NCCN. At 24 and 60 months, questionnaire response rates were 86% and 67%, and EF was retained in 53% and 41%, respectively. Baseline sexual aid utilization was 37% (n=82) and was associated with lower 24-month EF preservation on multivariable-analysis (adjusted-odds-ratio: 0.49 95%CI 0.26-0.92). By 60 months, 70% of men had tried aids. Of those who found aids helpful at baseline, 84-89% reported continued benefit at 24-60 months. Among aid-naïve patients, efficacy was 80% with first-time use within 12 months and 70% >12 months post-radiotherapy (p=0.02). Among men who developed erectile dysfunction, but found sexual aids helpful, 25% were not current users at 60 months.ConclusionsOne third of men utilized sexual aids at baseline, which doubled by 5-years post-radiotherapy. Self-reported efficacy was high, and sustained. Despite significant declines in EF, a number of men reported helpfulness of aids, but were not active users. Future study is required to understand drivers of aid utilization to optimize post-treatment sexual function.

Teaser

Among a prospectively followed cohort of 471 men treated with radiation therapy for prostate cancer, we demonstrate that sexual aid use is common at baseline, increases with time, and is helpful to many. However, a substantial number of men reported benefit, but were not currently using aids, and future study is required to optimize post-treatment sexual function.


http://ift.tt/2EtTBXW

Appraisal of late radiation-induced oral microvascular changes at the patient-side

Publication date: Available online 31 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Renée Helmers, Nina F. Straat, Arash Navran, Tim A.P. Nai Chung Tong, David N. Teguh, Robert A. van Hulst, Jan de Lange, Dan M.J. Milstein
ObjectivesLate radiation-induced tissue toxicity in the head and neck (HN) region is associated with ulceration and osteoradionecrosis as a result of a detrimental effect on the underlying tissue microvasculature. The aim of this investigation was to determine the clinical feasibility of examining and measuring late irradiation changes in the oral microcirculation of HN cancer patients using the novel CytoCam video microscope system.Materials and methodsIn 30 HN cancer patients and 30 age-matched controls, bilateral video images were recorded noninvasively of the oral microcirculation of the buccal mucosa and mandibular gingiva. Tissue perfusion parameters such as functional capillary density (FCD), buccal blood vessel diameter (Øbv), and microcirculatory flow index (MFI) were analyzed.ResultsNo difference was observed for mean buccal mucosa FCD in irradiated vs. healthy tissue, whereas a lower mean gingival FCD in irradiated vs. healthy tissue was observed (34±17 cpll/mm² vs. 68±19 cpll/mm²; p<0.001). A significant difference in mean buccal Øbv of 16±3 μm was measured compared to 14±1 μm in control buccal mucosa (p<0.001). No significant difference in MFI was observed between the two groups.ConclusionQuantifying oral microcirculatory injury associated with late irradiation effects using the CytoCam was feasible in HN cancer patients. Results indicate that marked differences in tissue-specific microcirculatory measurements of angioarchitecture, diminished capillary density, and extensively dilated blood vessel diameters are associated with late irradiation effects in HN cancer patients.

Teaser

Late irradiation microvascular effects in oral mucosa can easily be measured at the patient sideAnatomic differences in angioarchitecture and angiomorphology highlight pathologies Decreased capillary density in mandibular gingiva is associated with late radiation-induced microvascular effects Oral mucosal perfusion and microangiopathies occur differently in different tissues


http://ift.tt/2DQVjRK

Machine Learning on a Genome-Wide Association Study to Predict Late Genitourinary Toxicity Following Prostate Radiotherapy

Publication date: Available online 31 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Sangkyu Lee, Sarah Kerns, Harry Ostrer, Barry Rosenstein, Joseph O. Deasy, Jung Hun Oh
PurposeLate genitourinary (GU) toxicity after radiotherapy limits the quality of life of prostate cancer survivors, but efforts to explain GU toxicity using patient/dose information remain unsuccessful. We aimed to identify patients with higher congenital GU toxicity risk by identifying and integrating patterns in genome-wide single nucleotide polymorphisms (SNPs).Materials and MethodsWe applied a pre-conditioned random forest regression (PRFR) method for predicting risk from the genome-wide data to combine the effects of multiple SNPs and overcome statistical power limitations of single-SNP analysis. We studied a cohort of 324 prostate cancer patients who were self-assessed for four urinary symptoms at 2 years after radiotherapy using the International Prostate Symptom Score.ResultsThe predictive accuracy of the methodology varied across symptoms. Only for the weak stream endpoint, it achieved a significant area under the curve of 0.70 (95% confidence interval: 0.54 – 0.86, p = 0.01) on hold-out validation data that outperformed competing methods. Gene ontology analysis highlighted key biological processes, such as neurogenesis and ion transport, from the genes known to be important for urinary tract functions.ConclusionWe applied machine learning methods and bioinformatics tools to genome-wide data to predict and explain GU toxicity. Our approach enabled designing a more powerful predictive model and finding plausible biomarkers and biological processes associated with GU toxicity.



http://ift.tt/2EszzwN