Effect of intra-arterial cisplatin and 1,3-bis(2chloroethyl)-1-nitrosourea (BCNU) dosage on radiographic response and regional toxicity in malignant glioma patients: proposal of a new method of intra-arterial dosage calculation

Summary The frequency of both neurologic toxicity and therapeutic response due to intra-arterial (IA) chemotherapy is decreased by dose reduction. A method to individualize IA drug dosage is needed to provide each patient with the safest, most effective dose. Most trials of IA chemotherapy for malignant glioma have used body surface area (BSA) to calculate dosage; but brain size and arterial distribution do not correlate well with BSA. Fixed doses of cisplatin and BCNU were used in combination to perform 35 IA infusions in 20 malignant gliomas patients. Doses modified by the number of major intracranial vessels supplied by the infused artery were used in 34 infusions in 19 patients. Patients receiving 150 to 200 mg CP and 300 mg BCNU had an incidence of neurologic deficit of 5.6% if 3 vessels were supplied by the infused artery compared to 42% for those with only 2 vessels. This crude dose modification maintained efficacy while reducing neurologic toxicity. Further refinement is possible using well established intra-arterial pharmacokinetic principles. Intra-arterial dosing based on volume flow at the site of infusion would yield a more reproducible exposure of the infused capillary bed to a drug than methods currently in use. More consistent drug exposure should reduce toxicity due to over dosing and treatment failure due to under dosing. Address for offprints: 1151 N. State St., Suite 504, Jackson, MS 39202-2407, USA     

Characteristics of tetrahydrocannabinol (THC)-produced discrimination in rats

Rats were trained in a T-shaped maze to discriminate the effects produced by i.p. injections of tetrahydrocannabinol (THC) and the no-drug state (state-dependency, StD). Several doses of both ⁸-THC (range: 0.75–5.0 mg/kg) and ⁹-THC (range: 0.75–10.0 mg/kg) were used in order to compare the number of sessions required by the animals until reaching criterion performance. An additional group of rats had to discriminate pentobarbital sodium (20.0 mg/kg) from the no-drug state.Results: THC discrimination was proportional to dose i.e., animals that had to differentiate high doses of THC from no drug acquired the T-maize task faster than animals trained with the lower doses of THC. Acquisition data further suggest that ⁸-THC is somewhat less potent than the ⁹-isomer. ⁹-THC (10.0 mg/kg) produces strong StD, as defined by Overton (1971), since both this group and the barbiturate group reached the criterion within the first 10 training sessions. Time and dose testings suggest that stimulus properties of drugs vary in a quantitative way and that the calculated ED₅₀ values are mainly determined by the training dose used. It was found that the higher the training dose used the higher was the corresponding ED₅₀ value. Hashish smoke can maintain drug responding among THC-trained rats. A lowered content of brain catecholamines and/or serotonin, induced by AMPT (150 mg/kg) and PCPA (310–350 mg/kg), did not lessen ⁹-THC (2.5 mg/kg) discrimination.Portions of the results were presented at the Fourth Scandinavian Meeting on Physiology and Behavior, Oslo May 22–24, 1975.     

Cortical activation during retrieval of arithmetical facts and actual calculation: a functional magnetic resonance imaging study

By using functional magnetic resonance imaging (fMRI), the neural substrates involved in mental recitation of the single-digit multiplication table and serial subtraction were studied. The former depends mostly on well-learned arithmetical facts, while the latter requires arithmetic processing. Activation during each task was compared with that in a number counting control. During the recitation of single-digit multiplication, the activated regions included the area lying along the left intraparietal sulcus, the premotor and supplementary motor areas, and the posterior portion of the left inferior frontal gyrus. The areas activated during serial subtraction included these areas as well as the bilateral prefrontal and right parietal areas. From the results obtained during retrieval of the multiplication table in this study and previous studies, it was concluded that semantic memory of the multiplication table is stored in the area lying along the intraparietal sulcus and that the frontal areas play an executive role in utilizing the semantic memory of arithmetical facts. It was assumed that the arithmetical facts requiring actual calculation are also stored in the same region. The additional activation during serial subtraction compared with the activation during retrieval of the multiplication table is probably due to the processes of actual calculation. These processes include proper alignment of digits, which may have caused the right parietal activation, and maintaining digits needed for the mental serial subtractions, which may have caused the bilateral prefrontal activation.     

乳腺癌术后大分割短疗程放射治疗的临床研究

目的研究乳腺癌术后大分割放射治疗的疗效、疗程、副反应以及替代常规放射治疗的可能性.方法60例乳腺癌术后需放射治疗病例被随机均分至大分割放射治疗组(HOFRT组)和常规放射治疗组(CRT组).两组病例根据TNM分期、腋淋巴结转移数等设内乳野、锁腋野、胸壁野,采用6MV X线、电子线照射;HOFRT组的胸壁野照射采用切线对穿野照射.HOFRT组第1、3天为5.0 Gy/次,第15、17天为6.5 Gy/次.共DT23 Gy,4分次,17 d完成.CRT组2.0～2.5 Gy/次,共DT45～50Gy,20～25分次,4～5周完成.HOFRT组10例和CRT组9例腋窝后野加量10～15Gy,5～7分次,5～7 d完成.HOFRT和CRT组的总疗程分别为3.1～3.4、4.7～6.0周.结果HOFRT、CRT组的5年总生存率分别为65.8%、76.9%;Ⅲ期5年生存率分别为59.8%、80.0%(P＞0.05);局部复发率分别为10.7%、7.4%(P＞0.05).HOFRT组的局部复发、生存率等与CRT组相似.HOFRT组放射治疗晚期损伤导致的患侧上肢淋巴水肿、活动受限分别为8、6例,与CRT组相似(CRT为14、7例,P＞0.05).HOFRT组急性2～3级放射性皮肤损伤显著低于CRT组(313),明显减少由于急性损伤延长放射治疗疗程.结论大分割放射治疗是一种短疗程、安全、有效的乳腺癌术后放射治疗方案,局部复发、生存率和疗后晚期并发症与常规放射治疗无差异,具有替代常规放射治疗的可能性.     

论僵蚕的不良反应

僵蚕的不良反应有过敏反应、腹胀不良反应，有出血倾向者和肝昏迷患者应慎用。古代文献中有僵蚕的“恶”、“忌”等论述，应根据病情选择适宜剂量。     

Dose-Volume Histograms for bladder and rectum

: A careful examination of the foundation upon which the concept of the Dose-Volume Histogram (DVH) is built, and the implications of this set of parameters on the clinical application and interpretation of the DVH concept has not been conducted since the introduction of DVHs as a tool for the quantitative evaluation of treatment plans. The purpose of the work presented herein is to illustrate problems with current methods of implementing and interpreting DVHs when applied to hollow anatomic structures such as the bladder and rectum.

: A typical treatment plan for external beam irradiation of a patient with prostate cancer was chosen to provide a data set from which DVH curves for both the bladder and rectum were calculated. The two organs share the property of being shells with contents that are of no clinical importance. DVHs for both organs were computed using a solid model and using a shell model. Typical treatment plans for prostate cancer were used to generate DVH curves for both models. The Normal Tissue Complication Probability (NTCP) for these organs is discussed in this context.

: For an eight-field conformal treatment plan of the prostate, a bladder DVH curve generated using the shell model is higher than the corresponding curve generated using the solid model. The shell model also has a higher NTCP. A six-field conformal treatment plan slo results in a higher DVH curve for the shell model. A treatment plan consisting of bilateral 120-degree arcs, results in a higher DVH curve for the shell model, as well as a higher NTCP.

: The DVH concept currently used in evaluation of treatment plans is problematic because current practices of defining exactly what constitutes “bladder” and “rectum.” Commonly used methods of tracing the bladder and rectum imply use of a solid structure model for DVHs. In reality, these organs are shells and the critical structure associated with NTCP is obviously and indisputably the shell, as opposed to its contents. Treatment planning algorithms for DVH computation should thus be modified to utilize the shell model for these organs.     

不同电针刺激频率对脑卒中患者脑血流灌注和脑功能的影响

目的:寻找治疗脑卒中的适宜电针刺激频率.方法:47例脑卒中患者电针头皮运动区,根据其频率分为2 Hz、2/15 Hz、100 Hz组,应用单光子发射型计算机断层(SPECT)观察3组患者电针前和电针中脑血流灌注和脑功能的变化.结果:三种不同的电针刺激频率均能改善脑卒中患者的局部脑血流灌注和脑细胞功能活动,2/15 Hz和100 Hz组较2 Hz组为强.结论:在刺激强度固定的条件下,2/15 Hz、100 Hz的刺激频率治疗脑卒中疗效较好.     

Airborne Infection with Bacillus anthracis��from Mills to Mail

The lack of identified exposures in 2 of the 11 cases of bioterrorism-related inhalation anthrax in 2001 raised uncertainty about the infectious dose and transmission of Bacillus anthracis. We used the Wells-Riley mathematical model of airborne infection to estimate 1) the exposure concentrations in postal facilities where cases of inhalation anthrax occurred and 2) the risk for infection in various hypothetical scenarios of exposure to B. anthracis aerosolized from contaminated mail in residential settings. These models suggest that a small number of cases of inhalation anthrax can be expected when large numbers of persons are exposed to low concentrations of B. anthracis. The risk for inhalation anthrax is determined not only by bacillary virulence factors but also by infectious aerosol production and removal rates and by host factors.     

Bolus Calculators

Matching meal insulin to carbohydrate intake, blood glucose, and activity level is recommended in type 1 diabetes management. Calculating an appropriate insulin bolus size several times per day is, however, challenging and resource demanding. Accordingly, there is a need for bolus calculators to support patients in insulin treatment decisions. Currently, bolus calculators are available integrated in insulin pumps, as stand-alone devices and in the form of software applications that can be downloaded to, for example, smartphones. Functionality and complexity of bolus calculators vary greatly, and the few handfuls of published bolus calculator studies are heterogeneous with regard to study design, intervention, duration, and outcome measures. Furthermore, many factors unrelated to the specific device affect outcomes from bolus calculator use and therefore bolus calculator study comparisons should be conducted cautiously. Despite these reservations, there seems to be increasing evidence that bolus calculators may improve glycemic control and treatment satisfaction in patients who use the devices actively and as intended.     

超算中心及其在医学信息计算分析中的应用

在医疗卫生数据迅猛增长的背景下，首先介绍了国内超算中心的基本情况和建设现状；然后结合临床脑电信号（EEG）研究工作的实际情况，从超算中心的使用流程，计算分析的程序设计和优化，任务交付和结果获取，以及计算结果和速度的分析对比，详细阐述了基于超算中心的医学信息分析研究的步骤与方法。研究对于应用超算中心来支持医学大数据分析，同时对推广超级计算在医学领域的应用有重要意义。