The Application of Number Needed to Treat (NNT) to Clinical Problems in Radiotherapy

The goals of this report are: 1) to review the number needed to treat (NNT) concept, which, although well established in many sectors of medicine, is still relatively new to the radiotherapy community; 2) to discuss several clinical radiotherapy examples illustrating the inherent advantages of the NNT approach; and 3) to discuss potential future roles of the NNT concept within radiotherapy.     

Potassium permanganate resistant amyloid in fine-needle aspirate of the liver

A case of primary amyloidosis, initially detected by fine-needle aspiration of the liver, is reported here. Amorphous acellular metachromatic material was seen extracellularly in between the hepatocytic cords compressing them. This material showed typical apple-green birefringence under crossed bipolars after alkaline Congo-red staining proved its amyloid nature. It was resistant to potassium permanganate pretreatment, indicating it to be of the AL type. © 1994 Wiley-Liss, Inc.     

Cardiovascular risk in parents of children with extreme lipoprotein cholesterol levels: the Bogalusa Heart Study

Fasting serum lipids, lipoprotein cholesterol, and other cardiovascular disease risk factors were examined in 321 natural parents of children with low and/or high levels of beta- and pre-beta-lipoprotein cholesterol. Parents of children from low pre-beta-lipoprotein groups had elevated alpha- and lower pre-beta-lipoprotein cholesterol levels. Parents whose children had high beta-lipoprotein cholesterol levels also had high serum total and beta-lipoprotein cholesterol levels. Parents of children with high levels of both beta- and pre-beta-lipoprotein cholesterol had a high prevalence of both abnormal risk factor levels, as well as clinical evidence of early coronary artery disease (before age 50 years). These observations show that parents of children with high beta- and/or pre-beta-lipoprotein cholesterol levels have greatly enhanced risk for cardiovascular disease, and children mirror their parents' lipoprotein cholesterol levels. These observations emphasize the need for cardiovascular risk evaluation early in life, especially in high-risk families.     

Arterial wall injury and proteoglycan changes in atherosclerosis

The concept of injury as a mechanism leading to atherosclerosis has been fostered by numerous studies of initiating factors and by observation of the response of cardiovascular connective tissue, ie, cellular and extracellular matrix components. Carbohydrate-protein macromolecules of the extracellular matrix are a complex group of biologically important substances that play a crucial role in mesenchymal tissue repair following injury, a process needed to maintain arterial wall integrity. Of particular interest are the proteoglycans that enter into a variety of roles, from that of inhibiting atherosclerosis and helping to maintain fibrillar structures to that of taking part in lipid deposition in the development of atherosclerosis.     

Prevalence and geographic distribution of Hepatitis C Virus genotypes in Indian patient cohort

Viral hepatitis represents a major global health problem with 170 million Hepatitis C Virus (HCV) carriers worldwide, and 12–13 million HCV carriers in India. HCV genotypes are of clinical significance in indicating drug responsiveness and prognosis of the patient. The HCV genotypes are of epidemiologic significance as well, as they are indicative of transmission route of infection and have not been extensively studied in the Indian context. In the current study, HCV genotyping was examined in 2118 patients from different geographic regions of India. HCV was detected by PCR amplification of 5′ UTR and core-envelope1 regions, followed by genotyping using nucleotide sequencing and analysis with NCBI tool (http://www.ncbi.nlm.nih.gov/projects/genotyping/formpage.cgi). HCV genotype distribution in the 2118 Indian patients demonstrated prevalence of HCV3 (3a/3b primarily) in 62% and HCV1 (1a/1b primarily) in 31% patients. The predominance of HCV3 was significant in northern (p = 0.01) and eastern (p = 0.008) regions of India. HCV types 2, 4, 5, and 6 were detected in 0.05–4.5% of the patient group. Thus, our studies demonstrate HCV genotype prevalence in the cohort group in different regions of India.     

The nonspecific symptom screening method. Detection of nonpsychotic morbidity based on nonspecific symptoms

Detection of nonpsychotic morbidity in primary care patients presenting with nonspecific and somatic symptoms has been difficult because of several factors related to the patients, primary care clinicians, and working conditions of the over-crowded clinic. The available standardized screening questionnaires do not overcome many of these difficulties when used for routine clinical purposes. A screening method based only on nonspecific symptoms, which could be easily incorporated into the routine initial clinical work-up of a patient, was developed in this study and has been found to have good validity and reliability for screening nonpsychotic morbidity. The method of construction of the screen and its clinical applicability and limitations are discussed.     

Relation of body fat distribution to hyperinsulinemia in children and adolescents: the Bogalusa Heart Study

The relation of body fat distribution to plasma levels of glucose and insulin during an oral glucose tolerance test was examined in 355 Black and White school-age children. Both central and peripheral fat were similarly related to fasting, 30-min, and 1-h glucose. Unlike peripheral fat, central body fat was more strongly related to the 1-h insulin response (r = 0.35 vs 0.26); this association remained significant for central fat independent of peripheral fat (r = 0.18). The strong relation of central fat to insulin response was noted in both races and sexes but not in either sexually immature or relatively thin children. These findings indicate that, even in early life, a central body fat pattern relates positively to insulin response to glucose load. Thus, knowledge of body fat localization may help identify persons most susceptible to hyperinsulinemia in early life.     

Psychoactive drugs, pineal gland and affective disorders

The possibility of pineal gland involvement as a part of "neuroendocrine dysfunction" in some of the psychiatric diseases has received special attention in recent years. The discovery of a cascade of receptors and the action of many psychoactive drugs on pineal gland supports the concept that the pineal gland can be considered as a suitable model system for assessing the action of psychotropic drugs. Psychotropic drugs, particularly antidepressants both tricyclics and monoamine oxidase inhibitors when administered either to animals or to patients suffering from depressive illness affects the pineal gland function and melatonin concentration. This raises the possibility that the beneficial effects of these drugs may relate to their ability to alter the pineal gland function and melatonin secretion. The occurrence of seasonal affective disorders and their response to bright light treatment implicate, melatonin as a "bio-chemical marker" for these disease states. In view of these facts it can be suggested that pineal gland does play an important role in the etiology of mental diseases, especially affective disorders.