Potential improvement of tumor control probability by induction chemotherapy for advanced nasopharyngeal carcinoma

PURPOSE: To assess the reduction of tumor bulk and improvement of tumor control probability (TCP) by using induction chemotherapy for advanced nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: From February to December 2005, 20 patients with Stage III-IVB NPC were treated with induction-concurrent chemotherapy and intensity-modulated radiotherapy with accelerated fractionation. Combination of cisplatin and 5-fluorouracil was used in the induction phase and single agent Cisplatin in the concurrent phase. All patients were irradiated at 2Gy per fraction, 6 daily fractions per week, to a total dose of 70Gy. RESULTS: Nineteen (95%) patients completed all 3 cycles of induction chemotherapy and 90% had 2 cycles of concurrent chemotherapy. Induction chemotherapy achieved significant down-staging of T-category in 35% of patients (p=0.016) and reduction of gross tumor volume (GTV_P) from 55.6 to 22.9cc (mean 61.4%, p<0.001). Although the mean radiation dose did not show any substantial change, the volume within GTV_P that failed to reach 70Gy was reduced from 10.2% to 3.8% (p=0.017). The estimated local TCP increased from 0.83 to 0.89 (p=0.002). CONCLUSIONS: Induction chemotherapy using cisplatin-5-fluorouracil could significantly reduce tumor bulk leading to potential improvement in tumor control.     

Osteochondritis dissecans in Perthes' disease Report of 7 cases

We report 7 cases of osteochondritis dissecans following Perthes' disease in 363 hips, i.e., an incidence of 2 percent. Six of the 7 cases belonged to Salter group B (Catterall Groups III-IV), indicating a higher incidence in hips with a worse prognosis. Six cases were asymptomatic and did not require treatment; in 3 of these, there was spontaneous radiographic healing of the lesion.     

Stress levels of adrenaline amplify the blood pressure response to sympathetic stimulation

The possibility that sympathetic pressor responses are modulated by adrenaline-mediated facilitation of neuronal noradrenaline release was explored in 17 subjects with borderline hypertension. Infusion of adrenaline, which raised plasma adrenaline by a factor of 8 to 9, augmented the rise in systolic and diastolic arterial pressure induced by standardized cold pressor and isometric exercise tests. The heart rate response to these tests was not affected. When a low dose of propranolol was given on top of the adrenaline infusion before the cold pressor test, the blood pressure response to cold exposure was not different from the response observed when the test was performed during saline infusion. Plasma noradrenaline was higher during adrenaline infusion then during saline infusion, both before and after the cold pressor and isometric exercise tests, and the effect of adrenaline on plasma noradrenaline was antagonized by propranolol. These observations are consistent with the hypothesis that stress levels of circulating adrenaline may amplify sympathetic pressor responses by facilitation of the release of transmitter noradrenaline.     

Nuclear receptor BgFTZ-F1 regulates molting and the timing of ecdysteroid production during nymphal development in the hemimetabolous insect Blattella germanica

Postembryonic development of holometabolous and hemimetabolous insects occurs through successive molts triggered by 20-hydroxyecdysone (20E). The molecular action of 20E has been extensively studied in holometabolous insects, but data on hemimetabolous are scarce. We have demonstrated that during the nymphal development of the hemimetabolous insect Blattella germanica, 20E binds to the heterodimeric receptor formed by the nuclear receptors BgEcR-A and BgRXR activating a cascade of gene expression, including the nuclear receptors BgE75 and BgHR3. Herein, we report the characterization of BgFTZ-F1, another nuclear hormone receptor involved in 20E action. BgFTZ-F1 is activated at the end of each instar, and RNAi has demonstrated that BgHR3 is needed for BgFTZ-F1 activation, and that BgFTZ-F1 has critical functions of during the last nymphal instar. Nymphs with silenced BgFTZ-F1 cannot ecdyse, arrest development, and show structures of ectodermal origin duplicated. BgFTZ-F1 also controls the timing of the ecdysteroid molting pulse.     

阿莫西林/舒巴坦与其它4种抗菌药物的体外抗菌活性比较

目的比较研究阿莫西林/舒巴坦(amoxicllin/sulbactam)与阿莫西林/克拉维酸钾、阿莫西林钠、头胞噻肟、氨苄西林/舒巴坦四种抗菌药物的体外抗菌活性.方法对121株临床分离菌株,经VITEK重新鉴定后采用琼脂平板二倍稀释法测定最低抑菌浓度(MIC).结果阿莫西林/舒巴坦对G+球菌的6敏感率为90.91%,明显高于阿莫西林和头胞噻肟,而对G-杆菌中肺炎克雷伯菌、嗜血杆菌属的敏感率分别为83.3%和100%,与阿莫西林/克拉维酸,氨苄西林/舒巴坦和头胞噻肟相近,明显高于阿莫西林.阿莫西林/舒巴坦对大多数临床常见菌显示了较高的抗菌活性,尤其是对产酶菌的抗菌活性显著高于阿莫西林.结论阿莫西林/舒巴坦是一对产酶菌有效的复合制剂.     

Investigation of auditory dysfunction in Leber hereditary optic neuropathy

Purpose: To investigate the possibility of auditory dysfunction in patients with Leber hereditary optic neuropathy (LHON). Methods: We prospectively recruited 10 affected patients from the north‐east of England harbouring one of the three primary mitochondrial LHON mutations (3460G>A n = 3, 11778G>A n = 5 and 14484T>C n = 2). A detailed auditory history was taken and they were asked to complete a validated hearing questionnaire. Each patient then underwent a comprehensive topographic neuroauditory assessment to evaluate both middle‐ and inner‐ear functions and the integrity of the brainstem auditory pathways. Results: We found no evidence of cochlear nerve dysfunction or abnormalities of the central brainstem auditory pathways in our LHON cohort and five patients had completely normal hearing tests. The remainder had mild conductive hearing loss from childhood ear infections and/or high‐frequency sensorineural hearing loss from previous noise injury. Conclusion: Although further studies are required to confirm our findings, auditory dysfunction as a result of a primary LHON mutation is probably uncommon.     

Radionuclide contents in building materials used in Hong Kong

The radionuclide contents of conventional natural raw building materials, coal ash and slag, and finished building products have been determined using gamma-ray spectrometry. Results of brick measurements in their original geometry and in crushed form are compared. The radioactive concentrations in cement and sand, mostly imported from China, are among the lowest measured. However, due to the high radioactivity of aggregates, composed of granite mainly extracted locally, the mean Ra equivalent activity of concrete is high compared with that in some countries. The radioactivity levels of coal ash and slag in Hong Kong are about the average values in other countries. The incorporation of coal ash and slag in ordinary concrete does not alter the radioactivity significantly.     

性传播疾病混合感染的回顾性研究

目的分析性传播疾病（ＳＴＤｓ）的混合感染情况。方法统计１９９５～１９９８年性病门诊患者的检测资料。结果①淋病所占比率逐年下降，由沙眼衣原体和解脲支原体感染导致的非淋菌性尿道炎增高；②混合感染病例增多，以２种病原体合并感染居多；③４年平均混合感染率为１７５％，以淋球菌合并支原体最高（５２％）；④年度混合感染率从１０４％增高至２１２％。结论性传播疾病的混合感染率逐年增高，且已占相当大的比率（１７５％），应引起医务工作者的重视。     

七氟烷通过ERK1／2／Nrf2信号通路诱导HO-1基因表达抑制神经元凋亡

目的：研究七氟烷（Sevoflurane）诱导神经元血红素氧合酶－1（HO－1）基因表达的信号转导通路，探讨七氟烷脑保护机制。 方法：将培养7d的新生Wistar大鼠海马神元随机分为5组：正常培养组（C组）、氧糖剥夺组（D组）、2％七氟烷＋氧糖剥压组（S1组）、4％七氟烷＋氧糖剥压组（S2组）、4％七氟烷＋U-012＋4％七氟烷＋氧糖剥压组（U组）。C组和S2组神经元分别给予2％或4％七氟烷预处理60min后同D组处理。U组在神经元给予4％七氟烷处理同时在培养液中加入U－0126使其终浓度为10μmol/L后同S2组处理。收集神经元进行HO－1－mRNA和ERK1/2、Nrf2、AP-1和HO－1蛋白表达的检测，检测神经元的存活率和凋亡率。 结果：与C组比较，D组神经无HO－1蛋白表达增加（P〈0.05）,ERK1/2,Nrf2和AP-1蛋白表达增加（P〈0.05），神经元存活率降低、凋亡率增加（P〈0.01）.与D组比较，S1组神经元HO－1－mRNA和HO-1蛋白表达增加（P〈0.01）,ERK1/2和Nrf2蛋白表达增加（P〈0.01）,AP－1蛋白表达变化不明显（P〉0.05），经元存活率长高、凋亡率降低（P〈0.01）.与S2组比较，U组神经元HO-1－mRNA和HO－1蛋白表达降低（P〈0.01）,ERK1/2和Nrf2蛋白表达降低（P〈0.01），AP-1蛋白表达表达变化不明显（P〉0.05）,神经元存活率降低、凋亡率增加（P〈0.01）. 结论：Sevoflurane通过ERK1/2/Nrf2信号通路诱导神经元HO-1-mRNA表达，抑制氧糖剥夺神经元的凋亡。     

Detection and prevention of medication misadventures in general practice.

BACKGROUND: Adverse drug events are leading categories of iatrogenic patient injury. Development of preventive strategies for general practice setting depends on effective detection of events. OBJECTIVE: The aim of the study is to compare the strengths and weaknesses of voluntary reporting, chart review and patient survey in measuring medication misadventures in general practice and to analyze the events by severity and preventability, drug groups and patients' and doctors' characteristics, for the formulation of preventive strategies. METHOD: In the 2-month study period, we applied voluntary report, chart review and patient survey to collect data related to medication misadventures and compared their detection rate. RESULTS: The chart review demonstrated the highest yield for detecting overall medication misadventures (2.03% medication orders), followed by patient survey (1.46% medication orders) and voluntary reporting (0.52% medication orders). Chart review and patient survey were better than voluntary reporting in uncovering preventable adverse drug events. However, voluntary reporting was pivotal in capturing sentinel events. Beta-blocker, diuretic, angiotensin-converting enzyme inhibitor, aspirin and non-steroidal anti-inflammatory drugs had caused 82.0% of all adverse drug events. These events were more common with advanced age of patients, greater number of consultation problems and prescribed drug items. Additional resources implicated were minimal. CONCLUSION: We suggested a complementary approach using chart review and voluntary reporting in measuring and monitoring medication misadventures in general practice. Close monitoring of the events was necessary for older patients, multiple medical problems and poly-pharmacy and for patients using beta-blocker, diuretic, angiotensin-converting enzyme inhibitor, aspirin or non-steroidal anti-inflammatory drugs on a long-term basis.