Improvement in quality of life in patients with nasopharyngeal carcinoma treated with non-invasive extracorporeal radiofrequency in combination with chemoradiotherapy

Abstract

Purpose: To improve the quality of life (QOL) of patients with nasopharyngeal carcinoma (NPC) after chemoradiotherapy (CRT), it is necessary to find an effective method to reduce the toxic side-effects of CRT.

Materials and methods: Between June 2007 and June 2010, 83 previously untreated patients with NPC were randomized to receive CRT either with or without non-invasive extracorporeal radiofrequency (ERF). All the patients underwent radiation, and weekly chemotherapy of paclitaxel 135–175 mg/m² and cisplatin 60–90 mg/m². In addition, the patients in the treatment group also underwent non-invasive ERF on a radiofrequency machine at 13.56 MHz for 1 hour at 41–43°C. After the completion of treatment, evaluation was carried out to determine the survival rate, disease-free survival time, and QOL. QOL was analyzed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35) every 6 months during the three-year period.

Results: After completion of the treatments, the 36-month survival rate was 0.730 in the treatment group and 0.535 in the reference group (p = 0.041); the average disease-free survival time was 48 months in the treatment group and only 37.5 months in the reference group (p = 0.048). In the post- treatment questionnaires, several NPC-specific (pain, swallowing, speech, social eating, opening mouth, dry mouth, sticky saliva) QOL domains were better preserved with CRT + ERF compared to CRT at different time-points.

Conclusions: The combination treatment of ERF with CRT can prolong the survival rate and disease-free survival time and improve the QOL for patients with NPC.     

Changes in brain size with treatment in patients with hyper- or hypothyroidism

BACKGROUND AND PURPOSE: Although neuropsychological symptoms and signs are common in thyroid disease, their organic substrate is unknown. We performed brain MR imaging in patients with hyperthyroidism or hypothyroidism before and after treatment and correlated the results with hormonal markers. METHODS. Eight patients with hyperthyroid disease and three with hypothyroid disease underwent imaging within 1-2 days of a thyroid hormone testing. Images were registered, and brain and ventricular sizes were measured by using a semiautomated contour and thresholding technique. Changes in brain and ventricular volume were correlated with serum levels of total thyroxine (T(4)), unbound triiodothyronine (free T(3)), and thyroid-stimulating hormone (TSH) before and after treatment. RESULTS. With treatment, brain size decreased by 6,329-31,183 mm(3) in the hyperthyroid group and increased by 2,599-48,825 mm(3) in the hypothyroid group. Conversely, with treatment, ventricular size increased by 325-6,279 mm(3) in the hyperthyroid group and decreased by 760-2,376 mm(3) in the hypothyroid group. There was a highly significant correlation between reduction in brain size and reduction in T(4), as well as between the increase in ventricular size and reduction in T(4). There was a significant correlation between reduction in ventricular size and reduction in free T(3). There were highly significant correlations between reduced levels of TSH and increase in brain size, as well as between increased levels of TSH and increase in ventricular size. CONCLUSION. In thyroid disease, the size of the brain and ventricles significantly change after treatment, and these changes are correlated with T(4), free T(3), and TSH levels. The mechanism of these changes is uncertain, but it may involve osmolyte regulation, the sodium and water balance, and alterations in cerebral hemodynamics.     

Orbital phlebography in patients with Tolosa-Hunt's syndrome in comparison with normal subjects

Orbital phlebography has been reported to be pathologic in some patients with Tolosa-Hunt's syndrome (recurrent painful ophthalmoplegia). A systematic study of the phlebographic findings in Tolosa-Hunt's syndrome in comparison with a normal material seems not to have been performed. In this investigation, orbital phlebography was performed in 19 patients with Tolosa-Hunt's syndrome and in a reference group of 23 persons without the disease. In 13 of 19 patients (68%) with Tolosa-Hunt's syndrome, the phlebography was pathologic (narrowing or occlusion of particularly the third segment of the superior ophthalmic vein, partial occlusion of the cavernous sinus). Orbital phlebography was normal in all but one of the subjects in the reference group. The medical history of this subject in retrospect revealed symptoms other than painful ophthalmoplegia commonly found in patients with Tolosa-Hunt's syndrome, suggesting that he suffered from a variant of the disease causing the syndrome. In one patient with recurrent painful ophthalmoplegia a biopsy from an eye muscle showed venous vasculitis, probably indicating the basic pathology behind the phlebographic changes in patients with Tolosa-Hunt's syndrome.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Dynamic equinus with hindfoot valgus in children with hemiplegia

In children with hemiplegia, it is important to distinguish between equinus with hindfoot varus (equinovarus) or valgus (equinovalgus). Premature onset of medial gastrocnemius (GM) EMG in individuals with equinus is well documented. Premature onset of Peroneus longus (PL) EMG has been described in neurologically impaired adults with equinovalgus, but not in children. Our aim was to record the onset of PL and GM activity on the hemiplegic side of children with equinovalgus deformity. Fifteen children GMFCS 1 (3.8 yrs ± 2) with hemiplegia had a goniometric assessment of passive ankle range of motion and assessment of ankle function from video and surface EMG recording during gait. The clinical and video observations were used to determine the equinovalgus, as defined by Wren, at initial contact (IC). The premature onset of muscle activity was normalised as a swing (SW) percentage prior to IC of the following stance (ST). A paired T-test compared the onset of muscle activity between PL and GM. The ankle passive dorsiflexion was 13° ± 12° (hemiplegic side) versus 18° ± 10° (non-involved side) (p<0.05). For the non-involved limb, the onset of GM activity was at 14% of the gait cycle (midstance), the onset of PL activity was at 19% (p<0.05). For the hemiplegic limb with equinovalgus, there was a premature onset activity of PL (-24%) and GM(-8%) (p<0.001). On the non involved side, the onset of PL activity occurred, as in adults, after the onset of GM activity, during ST. On the hemiplegic side, there was no triceps surae contracture and the onset of PL activity occurred prior to the onset of GM activity, during terminal SW. This study confirmed the overactivity of PL in hemiplegic children with equinovalgus.     

Metrizamide compared with metrizoate in cardioangiography in high-risk patients with coronary artery disease

In a double-blind, randomized, two-group study of 99 'high-risk' patients mainly with coronary artery disease, the non-ionic contrast medium, Amipaque (metrizamide), was compared with the ionic medium, Isopaque Coronar (meglumine-Na-Ca-metrizoate) in cinecardioangiography. In evaluating the influence of the contrast media on the left ventricular end diastolic pressure (LVEDP), the material was divided into 2 groups, 55 patients with a basal LVEDP of 15 mmHg or less and 44 with an LVEDP above this level. In the former group LVEDP increased significantly after injection of the contrast medium into the left ventricle, but significantly less (p = 0.006) after Amipaque than after Isopaque Coronar. In the patients with a basal LVEDP above 15 mmHg, no significant change occurred in LVEDP after left ventriculography with any of the 2 contrast media. No serious complications occurred.     

Radiochemotherapy in Combination with Regional Hyperthermia in Preirradiated Patients with Recurrent Rectal Cancer

BACKGROUND AND PURPOSE: Encouraging results of phase II studies combining chemotherapy with radiotherapy have been published. In this study, the results of a multimodal salvage therapy including radiochemotherapy (RCT) and regional hyperthermia (RHT) in preirradiated patients with recurrent rectal cancer are reported. PATIENTS AND METHODS: All patients enrolled had received previous pelvic irradiation (median dose 50.4 Gy). The median time interval between prior radiotherapy and the onset of local recurrence was 34 months. The combined treatment consisted of reirradiation with a median dose of 39.6 Gy (30.0-45.0 Gy), delivered in fractions of 1.8 Gy/day. 5-fluorouracil was given as continuous infusion 350 mg/m(2)/day five times weekly, and RHT (BSD-2000 system) was applied twice a week within 1 h after radiotherapy. The primary endpoint was local progression-free survival (LPFS); secondary endpoints were overall survival, symptom control, and toxicity. RESULTS: 24 patients (median age 59 years) with a previously irradiated locally recurrent adenocarcinoma of the rectum were enrolled. The median LPFS was 15 months (95% confidence interval 12-18 months] with a median follow-up of 27 months (16-37 months). The overall 1-year and 3-year survival rates were 87% and 30%, respectively. Pain was the main symptom in 17 patients. Release of pain was achieved in 12/17 patients (70%). No grade 3 or 4 hematologic or skin toxicity occurred. Grade 3 gastrointestinal acute toxicity was observed in 12.5% of the patients. Paratumoral thermometry revealed a homogeneous distribution of temperatures. CONCLUSION: RCT combined with RHT is an efficient salvage therapy showing high efficacy with acceptable toxicity and can be recommended as treatment option for this unfavorable group of preirradiated patients with local recurrence of rectal cancer.     

Correlation of iron in the hippocampus with MMSE in patients with Alzheimer's disease

Purpose

To investigate the brain iron deposits in patients with Alzheimer's disease (AD) and healthy age‐matched controls using phase imaging.

Materials and Methods

Twenty‐six AD patients and 24 healthy controls were recruited. A three‐dimensional high‐resolution, gradient‐echo sequence was used to acquire phase data in the coronal plane. A high‐pass filter was used to remove the phase variation caused by field inhomogeneity. The regions evaluated included the bilateral putamen, globus pallidus, and the head and body of the hippocampus.

Results

Significantly lower phase values in both the basal ganglion and hippocampus were revealed in the AD group compared to the normal controls (P < 0.05). The phase value in the right side of the head of the hippocampus had a moderate positive correlation with the MMSE score (r= 0.603, P = 0.000) and a negative correlation with the duration of the disease (r = ?0.677, P = 0.013). Using ?0.0972 radians as an optimal cutoff value, the sensitivity and specificity for differentiation between AD and normal controls reached 95.8 and 80.8%, respectively.

Conclusion

Phase imaging proved to be a useful method for the differentiation between normal controls and AD patients. An investigation of the excessive accumulation of iron in the hippocampus may help us better understand the pathologic process and neuropsychological dysfunction of AD disease. J. Magn. Reson. Imaging 2009;29:793–798. © 2009 Wiley‐Liss, Inc.

     

Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma

The purpose of this study was to assess the quality of biliary duct visualization using Gd-EOB-DTPA-enhanced magnetic resonance cholangiography (EOB-MRC) in patients with liver cirrhosis. Forty adult patients with liver cirrhosis (cirrhosis group) and 20 adult individuals with normal liver parenchyma (control group) underwent EOB-MRC using T1-weighted GRE imaging up to 180 min after Gd-EOB-DTPA administration. Two observers assessed the visualization of each biliary structure and the overall anatomical visualization of the biliary tree. Child-Pugh, MELD score and laboratory findings were compared. The grade of visualization for each evaluated biliary structure was statistically different in the two groups (P = 0.004 to <0.001). The overall EOB-MRC quality was rated as sufficient for anatomical visualization of the biliary tree in all individuals of the control group 20 min after Gd-EOB-DTPA application, but in only 16/40 patients (40%) of the cirrhosis group within 30 min after application. Analysis of the ROC curves revealed that the cut-off values, for non-sufficient visualization of the biliary tree 20 min after Gd-EOB-DTPA application, were MELD scores > or =11 and total serum bilirubin levels > or =30 micromol/l. Consecutively, EOB-MRC in patients with liver cirrhosis resulted in a decreased or even non-visualization of the biliary tree in a substantial percentage of patients.     

免疫吸附抗介质治疗内毒素休克的实验研究

目的观察应用免疫吸附的方法特异性清除循环肿瘤坏死因子－α（ＴＮＦ－α）对内毒素休克的影响。方法利用新西兰白兔内毒素休克模型，研究经抗ＴＮＦ－α单克隆抗体亲和免疫吸附柱血液灌流对平均动脉压、血浆ＴＮＦ－α活性、肝肾功能及存活率的影响。结果免疫吸附治疗后，血浆ＴＮＦ－α水平迅速下降，低血压状态明显改善，延缓和显著减轻了肝肾功能损害及心肌、细胞膜和溶酶体损伤的发生，实验动物存活率明显提高。结论免疫吸附特异性清除循环ＴＮＦ－α可能是一条治疗内毒素休克的新的有效途径。     

Factors associated with walking activity in adults with cerebral palsy

BackgroundThis prospective study used instrumented gait analysis, patient-reported outcomes, and portable accelerometers to examine walking activity in adults with cerebral palsy (CP).Research questionThis study aimed to provide objective data and evaluate factors associated with walking activity in adults with CP.MethodsParticipants with CP (ages 25–45 years) completed instrumented gait analysis and patient-reported outcomes, including the Patient Reported Outcome Measurement Information System (PROMIS) and Satisfaction with Life Score (SWLS), and wore a StepWatch for 8 days. Average strides per day, stratified by Gross Motor Function Classification System (GMFCS), were compared with nondisabled adults ages 30–39 years utilizing Welch’s t-tests with Bonferroni corrections. Correlation coefficients and stepwise multiple linear regression analyses examined relationships between walking activity and GMFCS, gait deviation index (GDI), gait velocity, PROMIS physical function, SWLS, body mass index (BMI), and employment.ResultsParticipants included 109 adults with CP, ages 29 ± 4 years, classified at GMFCS levels I/II (73 %) and III/IV (27 %). Compared with nondisabled adults, daily stride count was significantly lower in both groups of adults with CP (p < 0.00025), with a progressive decline according to GMFCS level. Walking activity correlated with PROMIS physical function (r = .42), GDI (r = .48), and gait velocity (r = .58). Association for employment was lower (r = 0.27) but significant, while age, SWLS, and BMI were not individually correlated with walking activity. Stepwise, multiple linear regression modeled with Akaike information criterion explained 40.9 % of the observed variability in walking activity in this cohort of adults with CP.SignificancePhysical function, as classified by GMFCS or measured by PROMIS and self-selected walking velocity, has the strongest association with and is the most significant predictor of walking activity in adults with CP. After accounting for physical function, a small amount of the variation in walking activity can be explained by GDI, employment, and age.     

Ultrasound elastography in patients with rectal cancer treated with chemoradiation

Objective

The current literature has described several predictive markers in rectal cancer patients treated with chemoradiation, but so far none of them have been validated for clinical use. The purpose of the present study was to compare quantitative elastography based on ultrasound measurements in the course of chemoradiation with tumor response based on T stage classification and the Mandard tumor regression grading (TRG).

Materials and methods

We prospectively examined 31 patients with rectal cancer planned for high dose radiochemotherapy. The tumor and the mesorectal fat elasticity were measured using the Acoustic Radiation Force Impulse to generate information on the mechanical properties of the tissue. The objective quantitative elastography shear wave velocity was compared to the T stage classification and TRG.

Results

The baseline mean tumor elasticity was 3.13 m/s. Two and six weeks after the start of chemoradiation the velocities were 2.17 m/s and 2.11 m/s, respectively. The difference between baseline velocity and velocities during the treatment course was statistically significant, (p < 0.0001). Patients with tumor confined to the rectal wall at histopathology (ypT1-2) had a mean elasticity measurement after two weeks of treatment of 1.95 m/s, whereas tumors invading the mesorectal fat (ypT3-4) had a velocity of 2.47 m/s, (p < 0.05). The mean elasticity tended to be lower (1.99 m/s) after two weeks in patients with TRG 1–2 responses in contrast to 2.24 m/s in those with TRG 3–4.

Conclusion

Ultrasound elastography after two weeks of chemoradiation seems to hold early predictive information to the pathological T stage.     

Factors associated with physical activity in Canadian adults with diabetes

INTRODUCTION: The purpose of this study was to identify key demographic and health factors associated with physical activity (PA) participation in adults with type 1 or type 2 diabetes. METHODS: Participants were adults > or = 18 yr of age living in the province of Alberta, Canada who were previously diagnosed with type 1 (N = 697) or type 2 (N = 1614) diabetes. Individuals were recruited from the Canadian Diabetes Association (Alberta) registry and through a random digit-dialing protocol. Multiple and logistic regression models were employed to identify demographic and health factors related to PA levels, of which many to date have not been examined in this population. Analyses were conducted separately for type 1 and type 2 groups. RESULTS: Of those with type 1 and type 2 diabetes, 63.7 and 71.9%, respectively, were not achieving recommended PA levels. For those with type 1, higher PA levels were associated with a younger age, being single, higher income, lower level of perceived disability, and not smoking. For the type 2 group, a younger age, male gender, higher education, higher income, lower body mass index, and lower level of perceived disability were associated with higher PA levels. CONCLUSIONS: Many of our results for both diabetes types are consistent with findings from other limited research in this domain. Contrary to previous research, however, a significant negative relationship was reported between body mass index and PA for the type 2 group. In addition, perceived disability was negatively associated with PA, which, to date, has not been reported in the literature with type 2 individuals. Research and practice related to physical activity promotion for this population should take into account specific demographic and health factors associated with PA.     

Acute pancreatitis in patients with hemorrhagic fever with renal syndrome

The objective of this study was to determine the prevalence and clinical significance of acute pancreatitis in patients in whom hemorrhagic fever with renal syndrome (HFRS) has been diagnosed. We retrospectively reviewed all patients with a diagnosis of HFRS at our institution from 1994 to 1998. The review included medical records, laboratory results, radiologic examinations, and one autopsy report. From 1994 to 1998, 13 patients received diagnoses of HFRS that were confirmed by serology. In 9 patients (69%), serum amylase, serum lipase, or both were assessed during hospitalization. Seven (78%) of the 9 patients had pancreatitis. Four (57%) of these 7 patients with HFRS and pancreatitis had associated pulmonary edema, and 1 patient had rhabdomyolysis. In our small retrospective case series, acute pancreatitis in patients with HFRS was much more common than previously recognized. Patients with HFRS and pancreatitis had increased morbidity. However, the treatment for the associated pancreatitis was conservative.     

Mechanical thrombectomy with snare in patients with acute ischemic stroke

Introduction We evaluated the efficacy and safety of thrombus extraction using a microsnare in patients with acute ischemic stroke (AIS). Methods This was a prospective, observational, cohort study in which consecutive patients with AIS (<6 hours of ischemia for anterior circulation and <24 hours for posterior circulation) who had been previously excluded from intravenous tissue plasminogen activator (tPA) thrombolysis were included and followed-up for 3 months. Mechanical embolectomy with a microsnare of 2–4 mm was undertaken as the first treatment. Low-dose intraarterial thrombolysis or angioplasty was used if needed. TIMI grade and modified Rankin stroke scale (mRSS) score were used to evaluate vessel recanalization and clinical efficacy, respectively. Results Nine patients (mean age 55 years, range 17–69 years) were included. Their basal mean NIHSS score was 16 (range 12–24). In seven out of the nine patients (77.8%) the clot was removed, giving a TIMI grade of 3 in four patients and TIMI grade 2 in three patients. Occlusion sites were: middle cerebral artery (four), basilar artery (two) and anterior cerebral artery plus middle cerebral artery (one). The mean time for recanalization from the start of the procedure was 50 min (range 50–75 min). At 3 months, the mRSS score was 0 in two patients and 3–4 in three patients (two patients died). Conclusion According to our results, the microsnare is a safe procedure for mechanical thrombectomy with a good recanalization rate. Further studies are required to determine the role of the microsnare in the treatment of AIS.