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1.  Clinical results of proton beam therapy for advanced neuroblastoma 
Purpose
To evaluate the efficacy of proton beam therapy (PBT) for pediatric patients with advanced neuroblastoma.
Methods
PBT was conducted at 21 sites in 14 patients with neuroblastoma from 1984 to 2010. Most patients were difficult to treat with photon radiotherapy. Two and 6 patients were classified into stages 3 and 4, respectively, and 6 patients had recurrent disease. Seven of the 8 patients who received PBT as the initial treatment were classified as the high risk group. Twelve patients had gross residual disease before PBT and 2 had undergone intraoperative radiotherapy before PBT. Five patients received PBT for multiple sites, including remote metastases. Photon radiotherapy was used in combination with PBT for 3 patients. The PBT doses ranged from 19.8 to 45.5 GyE (median: 30.6 GyE).
Results
Seven patients are alive with no evidence of disease, 1 is alive with disease progression, and 6 died due to the tumor. Recurrence in the treatment field was not observed and the 3-year locoregional control rate was 82%. Severe acute radiotoxicity was not observed, but 1 patient had narrowing of the aorta and asymptomatic vertebral compression fracture at 28 years after PBT, and hair loss was prolonged in one patient.
Conclusion
PBT may be a better alternative to photon radiotherapy for children with advanced neuroblastoma, and may be conducted safely for patients with neuroblastoma that is difficult to manage using photon beams.
doi:10.1186/1748-717X-8-142
PMCID: PMC3693889  PMID: 23758770
Neuroblastoma; Proton therapy; Radiotherapy; Late toxicity; Pediatrics
2.  Luminophore Application Study of Polymer-Ceramic Pressure-Sensitive Paint 
Sensors (Basel, Switzerland)  2013;13(6):7053-7064.
A polymer-ceramic pressure-sensitive paint (PC-PSP) is a fast responding and sprayable PSP which has been applied for capturing global unsteady flows. The luminophore application process is studied to enhance the characterization of the PC-PSP. A dipping deposition method is used to apply a luminophore on a polymer-ceramic coating. The method selects a solvent by its polarity index. The characterization includes the signal level, pressure sensitivity, temperature dependency, and response time. It is found that the luminophore application process affects the steady-state characterizations, such as the signal level, pressure sensitivity, and temperature dependency. A range of change for each characterization, which is based on the minimum quantity, is a factor of 4.7, 9, and 3.8, respectively. A response time on the order of ten microseconds is shown. The application process is not a dominant factor for changing the response time, which is within the uncertainty of the thickness variation. Comparisons of the effects on the luminophore application process and the polymer content are made to discuss the PC-PSP characterization results.
doi:10.3390/s130607053
PMCID: PMC3715269  PMID: 23760088
pressure-sensitive paint; polymer ceramic; luminophore application
3.  The miR-221/222 cluster, miR-10b and miR-92a are highly upregulated in metastatic minimally invasive follicular thyroid carcinoma 
International Journal of Oncology  2013;42(6):1858-1868.
Minimally invasive follicular thyroid carcinoma (MI-FTC) is characterized by limited capsular and/or vascular invasion with good long-term outcomes. However, some cases of MI-FTC show a poor prognosis because of severe distant metastasis (i.e., metastatic MI-FTC). Nonetheless, no method has been established for predicting the prognosis of MI-FTC. This study was conducted to identify novel prognostic factors for metastatic MI-FTC by the use of microRNA (miRNA). Thirty-four patients with MI-FTC were categorized into two groups: the metastatic group, M(+) (n=12) and the non-metastatic group, M(−) (n=22). In the M(+) group, distant metastasis was recognized after the initial operation established the diagnosis of MI-FTC. In the M(−) group, no distant metastasis was recognized postoperatively for ≥10 years. Using laser micro-dissection followed by quantitative real-time PCR and PCR arrays, we performed a comprehensive expression profiling of 667 miRNAs in formalin-fixed, paraffin-embedded samples from the initial MI-FTC operation. Furthermore, we assessed the potential use of miRNAs as novel biomarkers for the metastatic potential of MI-FTC by logistic regression analysis. Comprehensive quantitative analysis of miRNA expression in MI-FTC samples revealed that the miR-221/222 cluster (i.e., miR-221, miR-222 and miR-222*), miR-10b and miR-92a were significantly upregulated in the M(+) group compared with the M(−) group. Interestingly, the expression levels of these miRNAs were also shown to be upregulated in widely invasive FTC (WI-FTC; n=13) that has distant metastasis and worse prognosis, indicating a close similarity in the miRNA expression between metastatic MI-FTC and WI-FTC. Logistic regression analysis revealed that miR-10b made a significant contribution to prognosis (OR 19.759, 95% CI 1.433–272.355, p= 0.026). Our findings suggest that miR-10b is a potential prognostic factor for evaluating the metastatic potential of MI-FTC at an initial operation stage.
doi:10.3892/ijo.2013.1879
PMCID: PMC3699596  PMID: 23563786
microRNA; minimally invasive follicular thyroid carcinoma; thyroid surgery; metastasis; prognostic factor
4.  Prognosis was not deteriorated by multiple primary cancers in esophageal cancer patients treated by radiotherapy 
Journal of Radiation Research  2013;54(4):706-711.
Esophageal cancer patients are often associated with multiple primary cancers (MPC). The aim of this study is to evaluate the effect of MPC on prognosis in esophageal cancer patients treated by radiotherapy. Between 2001 and 2008, esophageal cancer patients treated by definitive radiotherapy at Gunma Cancer Center were retrospectively reviewed. Exclusion criteria were preoperative or postoperative radiotherapy, palliative radiotherapy, follow-up of <6 months, radiation dose of <50 Gy and no information on MPC. We analyzed 167 esophageal cancer patients and 56 (33.5%) were associated with MPC. Gastric cancer was the most frequent tumor (38.2%), followed by head and neck cancer (26.5%). Median follow-up time was 31.5 months (range 6.1–87.3 months). Patients with MPC included more stage I/II esophageal cancer than those without MPC (66.1% vs. 36.9%, P < 0.01). The 5-year overall survival rate for esophageal cancer with MPC was relatively better than those without MPC (46.1% vs. 26.7%), although the difference did not reach statistical significance in univariate analysis (P = 0.09). Stage I/II esophageal cancer patients had a significantly better overall survival than stage III/IV patients (P < 0.01). Among esophageal cancer patients with MPC, there was no difference in overall survival between antecedent and synchronous cancer (P = 0.59). Our study indicated that the prognosis of esophageal cancer patients treated by radiotherapy was primarily determined by the clinical stage itself, but not the presence of MPC.
doi:10.1093/jrr/rrt002
PMCID: PMC3709673  PMID: 23381956
esophageal cancer; radiotherapy; multiple primary cancers; synchronous cancer;  antecedent cancer
5.  A seven-year disease-free survivor of malignant pleural mesothelioma treated with hyperthermia and chemotherapy: a case report 
Introduction
Malignant pleural mesothelioma was once a rare finding but its incidence is increasing worldwide, most likely because of widespread exposure to asbestos. Although complete surgical resection is considered the only curative treatment, the results of surgery have shown a median survival time of only one year. In inoperable cases, chemotherapy, radiotherapy, and a combination of both have been considered as palliative therapy. Therefore, outcomes for inoperable cases have been poor. Here, we report the case of a long-term survivor treated with hyperthermia and chemotherapy.
Case presentation
A 61-year-old Japanese man with a performance status of 1 due to chest pain was referred to our hospital. He had a history of asbestos exposure for approximately five years. A computed tomography scan showed diffuse extensive right pleural thickening with small nodular lesions, and video-assisted thoracoscopy revealed tumor invasion of the ipsilateral chest wall muscles. The histopathologic findings were consistent with a diagnosis of malignant pleural mesothelioma (sarcomatoid type). The tumor was diagnosed as being stage cT3N0M0. Our patient refused any invasive therapies including surgery and radiotherapy, and was therefore treated with hyperthermia and systemic chemotherapy with agents such as cisplatin and irinotecan. He underwent three hyperthermia sessions and a single course of chemotherapy without any severe complications. One month after treatment, a follow-up computed tomography scan showed no definitive abnormality in the thoracic space. Our patient has subsequently survived without any evident disease for more than seven years.
Conclusions
The combination of hyperthermia and chemotherapy may be a novel and safe therapeutic option for malignant pleural mesothelioma, and can be considered for patients ineligible for radical treatment. Further clinical studies of the combination of hyperthermia and chemotherapy are needed to confirm the effects of this treatment on malignant pleural mesothelioma.
doi:10.1186/1752-1947-6-427
PMCID: PMC3541074  PMID: 23272646
Chemotherapy; Hyperthermia; Long-term survivor; Malignant pleural mesothelioma
6.  Risk factors for rectal bleeding associated with I-125 brachytherapy for prostate cancer 
Journal of Radiation Research  2012;53(6):923-929.
The purpose of this study was to determine the risk factors for rectal bleeding after prostate brachytherapy. Between April 2005 and September 2009, 89 patients with T1c-2cN0M0 prostate cancer were treated with permanent I-125 seed implantation alone. The prostate prescription dose was 145 Gy, and the grade of rectal bleeding was scored according to the Common Terminology Criteria for Adverse Events version 4.0. Post-treatment planning was performed with fusion images of computerized tomography and magnetic resonance imaging 4–5 weeks after brachytherapy. Patient characteristics and dosimetric parameters were evaluated to determine risk factors for bleeding. The calculated parameters included the rectal volume in cubic centimeters that received >50–200% of the prescribed dose (RV50–200) and the minimal doses received by 1–30% of the rectal volume (RD1–30). The median follow-up time was 42 months (ranging 18–73 months). Grade 1 rectal bleeding occurred in 24 (27.0%) patients, but no Grade 2 or severe bleeding was observed. Usage of anticoagulants had a significant correlation with the occurrence of bleeding (P = 0.007). The RV100–150 and RD1–10 were significantly higher in patients with rectal bleeding than in those without bleeding. The RV100 was identified as a possible threshold value; the 3-year rectal bleeding rate in patients with an RV100 > 1.0 cm3 was 36%, whereas that with an RV100 ≤ 1.0 cm3 was 14% (P < 0.05). Although no Grade 2 morbidity developed in this study, the RV100 should be kept below 1.0 cm3, especially in additional dose-escalated brachytherapy.
doi:10.1093/jrr/rrs059
PMCID: PMC3483856  PMID: 22859567
prostate cancer; brachytherapy; rectal bleeding; dose-volume-histogram; anticoagulant
7.  Long-term results of curative intraluminal high dose rate brachytherapy for endobronchial carcinoma 
Background
The treatment strategy of central lung tumors is not established. Intraluminal brachytherapy (ILBT) is widely used for palliative treatment of endobronchial tumors, however, it is also a promising option for curative treatment with limited data. This study evaluates the results after ILBT for endobronchial carcinoma.
Method
Sixteen-endobronchial carcinoma of 13 patients treated with ILBT in curative intent for 2000 to 2008 were retrospectively reviewed. ILBT using high dose rate 192 iridium thin wire system was performed with 5 Gy/fraction at mucosal surface. The patient age ranged from 57 to 82 years old with median 75 years old. The 16 lesions consisted of 13 central endobronchial cancers including 7 roentgenographically occult lung cancers and 3 of tracheal cancers. Of them, 10 lesions were treated with ILBT of median 20 Gy combined with external beam radiation therapy of median 45 Gy and 6 lesions were treated with ILBT alone of median 25 Gy.
Results
Median follow-up time was 32.5 months. Two-year survival rate and local control rate were 92.3% and 86.2%, respectively. Local recurrences were observed in 2 lesions. Three patients died due to lung cancer (1 patient) and intercurrent disease (2 patients). Complications greater than grade 2 were not observed except for one grade 3 dyspnea.
Conclusions
ILBT combined with or without EBRT might be a curative treatment option in inoperable endobronchial carcinoma patients with tolerable complication.
doi:10.1186/1748-717X-7-112
PMCID: PMC3411402  PMID: 22824158
Lung cancer; Radiation therapy; High dose rate; Intraluminal brachytherapy; Curative intent
8.  Characterization and Optimization of Polymer-Ceramic Pressure-Sensitive Paint by Controlling Polymer Content 
Sensors (Basel, Switzerland)  2011;11(7):6967-6977.
A pressure-sensitive paint (PSP) with fast response characteristics that can be sprayed on a test article is studied. This PSP consists of a polymer for spraying and a porous particle for providing the fast response. We controlled the polymer content (%) from 10 to 90% to study its effects on PSP characteristics: the signal level, pressure sensitivity, temperature dependency, and time response. The signal level and temperature dependency shows a peak in the polymer content around 50 to 70%. The pressure sensitivity was fairly constant in the range between 0.8 and 0.9 %/kPa. The time response is improved by lowering the polymer content. The variation of the time response is shown to be on the order of milliseconds to ten seconds. A weight coefficient is introduced to optimize the resultant PSPs. By setting the weight coefficient, we can optimize the PSP for sensing purposes.
doi:10.3390/s110706967
PMCID: PMC3231655  PMID: 22163996
pressure-sensitive paint; polymer ceramic; optimization
9.  Full-range imaging of eye accommodation by high-speed long-depth range optical frequency domain imaging 
Biomedical Optics Express  2010;1(5):1491-1501.
We describe a high-speed long-depth range optical frequency domain imaging (OFDI) system employing a long-coherence length tunable source and demonstrate dynamic full-range imaging of the anterior segment of the eye including from the cornea surface to the posterior capsule of the crystalline lens with a depth range of 12 mm without removing complex conjugate image ambiguity. The tunable source spanned from 1260 to 1360 nm with an average output power of 15.8 mW. The fast A-scan rate of 20,000 per second provided dynamic OFDI and dependence of the whole anterior segment change on time following abrupt relaxation from the accommodated to the relaxed status, which was measured for a healthy eye and that with an intraocular lens.
doi:10.1364/BOE.1.001491
PMCID: PMC3018118  PMID: 21258564
(170.4500) Optical coherence tomography; (170.3880) Medical and biological imaging; (170.4470) Ophthalmology
10.  New approach for the glaucoma detection with pupil perimetry 
Objective:
To calculate the pattern deviation for identifying abnormal points of pupil perimetry, and also to evaluate the grayscale display for distinguishing glaucomatous pupil field loss (abnormal test points) from normal pupil field (normal test points).
Methods:
Fourteen patients ranging in age from 51 to 80 years, who had normal-tension glaucoma (6 eyes) and primary open-angle glaucoma (8 eyes) were tested. Pupil perimetry (Kowa & Hamamatsu, Japan) was used to objectively measure the visual field. Also, to obtain a subjective visual field, the analysis was performed with a Humphrey Field Analyzer (30-2, Full threshold program, Carl Zeiss Meditec, Dublin). Of the 76 test points, the 22 surrounding points and the 3 points corresponding to the blind spot are excluded; and among the remaining 51 points, the 85th percentile value of pupil perimetry was calculated. The abnormal and normal test points were recorded, and the amount of positive or negative deviation of each test point from the normal median value for the corresponding test points was determined. We also used this technique to identify the value for distinguishing glaucomatous pupil field loss from the normal pupil field.
Results:
This study could be improved by calculating the sensitivity and specificity of a certain cut-off value between the normative data and the glaucoma patients. The value for identifying both abnormal and normal test points was a negative deviation of −4. Based on these results, pupil perimetry gray scales were determined: white (< −3), 25% gray (from −4 to −8), 50% gray (from −9 to −13), 75% gray (from −14 to −18) and black (> −19). Glaucomatous pupil field losses were generally distinguished from the normal pupil field by use of a gray scale.
Conclusion:
Our studies demonstrated that, when a deviation of > −4 was regarded as an abnormal value, the detection of pupil perimetry exhibited improvement in glaucoma patients.
PMCID: PMC2909891  PMID: 20668724
pupil perimetry; percentage pupil constriction; glaucoma; pattern deviation; gray scale
11.  Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture 
European Spine Journal  2008;18(Suppl 2):206-209.
A case of bilateral pedicle stress fracture of L4 in a patient with osteoporotic compression fracture of L5 and without a history of major trauma or surgery is reported, and the literature is reviewed. Bilateral pedicle fracture is a rare entity and few cases have been reported in the literature. All reported cases had some underlying causative factors like previous spine surgery or stress related activities. To the best of the authors’ knowledge, only one case of bilateral pedicle stress fracture without a history of trauma, previous spine surgery, or stress-related activities has been reported. A 77-year-old woman presented with severe low back pain and radiating pain in the right leg that was exacerbated after standing and walking. Plain radiograph showed pathological fracture at L5 level. Magnetic resonance imaging (MRI) revealed the compression of dural sac at L5 level. CT scan taken 3 months after admission revealed bilateral pedicle fractures through L4. The patient was treated with decompressive laminectomies of L4, followed by posterior spinal fusion with rigid pedicle screw fixation and autogenous bone graft mixed with hydroxyapatite. The patient achieved pain relief and returned to normal activity. Stress fracture of the pedicle within the proximal vertebra of an osteoporotic compression fracture of lumbar spine is an uncommon entity. It may, however, be an additional source of symptoms in patients with osteoporosis who present with further back pain. Surgeons caring for this group of patients should be aware of this condition.
doi:10.1007/s00586-008-0816-5
PMCID: PMC2899572  PMID: 19005693
Pedicle fracture; Stress fracture; Osteoporosis; Low back pain; Lumbar spine
12.  Global Oxygen Detection in Water Using Luminescent Probe on Anodized Aluminum 
Sensors (Basel, Switzerland)  2009;9(6):4151-4163.
We have developed anodized-aluminum pressure-sensitive paint (AA-PSP) as a global oxygen sensor in water. Platinum (II) meso-tetra(pentafluorophenyl)porphine is selected as a luminophore based on a dipping deposition study. The developed AA-PSP is characterized using water calibration setup by controlling dissolved oxygen concentration. It is shown that AA-PSP yields 4.0% change in luminescence per 1 mg/L of oxygen concentration at 23°C. Other characteristics, such as temperature dependency, photo-degradation, and physical stability, are discussed in this paper. This AA-PSP is used to demonstrate its capability of global oxygen detection in water using the impingement of oxygen rich water (20 mg/L). Even though the difference in water is only the concentration of oxygen, we can obtain global oxygen information of the jet impingement using a fast frame rate camera. Oxygen maps as well as cross-sectional distributions are shown every 0.1 s.
doi:10.3390/s90604151
PMCID: PMC3291903  PMID: 22408518
global measurement; optical technique; dissolved oxygen; anodized aluminum; pressure-sensitive paint
13.  Truncated Surface Protective Antigen (SpaA) of Erysipelothrix rhusiopathiae Serotype 1a Elicits Protection against Challenge with Serotypes 1a and 2b in Pigs 
Infection and Immunity  1999;67(9):4376-4382.
Erysipelothrix rhusiopathiae is a causal agent of swine erysipelas, which is of economic importance in the swine industry by virtue of causing acute septicemia, chronic arthritis, and endocarditis. However, little is known about the genetic properties of its protective antigens. Recently, a surface protective antigen (SpaA) gene was identified from serotype 2 in a mouse model. We cloned spaA from virulent strain Fujisawa (serotype 1a) and determined that the N-terminal 342 amino acids without C-terminal repeats of 20 amino acids have the ability to elicit protection in mice. Fusions of 342 amino acids of Fujisawa SpaA and histidine hexamer (HisSpa1.0) protected pigs against challenge with both serotype 1 and serotype 2, the most important serotypes in the swine industry. Pigs immunized with HisSpa1.0 reacted well with both HisSpa1.0 and intact SpaA by enzyme-linked immunosorbent assay and immunoblotting. Serum collected at the time of challenge from a pig immunized with HisSpa1.0 markedly enhanced the in vitro phagocytic and killing activity of pig neutrophils against the bacteria. DNA sequences of protective regions of spaA genes from five strains of serotypes 1 and 2 were almost identical. The full DNA sequences also seemed to be conserved among strains of all 12 serotype reference strains harboring the spaA gene by restriction fragment length polymorphism analysis of PCR products. These results indicates that SpaA is a common protective antigen of serotypes 1 and 2 of E. rhusiopathiae in swine and will be a useful tool for development of new types of vaccines and diagnostic tools for effective control of the disease.
PMCID: PMC96755  PMID: 10456877

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