Impaired disengagement from threatening cues of impending pain in a crossmodal cueing paradigm.

This paper reports an experimental investigation of attentional engagement to and disengagement from cues of impending pain. Pain-free volunteers performed a cueing task in which they were instructed to detect somatosensory and tone targets. Target stimuli were preceded by visual cues informing participants of the modality of the impending stimuli. Participants were randomly assigned to a pain group (n = 54) or to a control group (n = 53). Somatosensory targets consisted of painful electrocutaneous stimuli in the pain group and non-painful vibrotactile targets in the control group. Analyses revealed a similar amount of attentional engagement to both cues signalling somatosensory targets, irrespective of their threat value. However, participants had significantly more difficulty in disengaging attention from a threatening cue of impending pain compared to a cue signalling the non-painful vibrotactile target. Our findings provide further evidence that pain cues demand attention, particularly resulting in impaired disengagement.     

The magnetic resonance detected intraprostatic lesion in prostate cancer: planning and delivery of intensity-modulated radiotherapy.

BACKGROUND AND PURPOSE: Local relapse after radiotherapy for prostate cancer mostly originates at the original tumor location. Dose escalation reduces local relapse rates. It may be of benefit to focus the highest dose to the intraprostatic lesion (GTVMRI) using intensity-modulated radiotherapy (IMRT). Therefore, the visualization of the GTVMRI and its inclusion into computer optimization is mandatory. MATERIALS AND METHODS: Fifteen patients with prostatic adenocarcinoma were referred for IMRT. All these patients had a palpable lesion on digital rectal examination (DRE) and/or a PSA >10.0 ng/ml. A T2-weighted MR examination of the prostate was performed in order to detect a GTV(MRI) and correlate the location of the GTV(MRI) with the site of the tumour-containing cylinder (biopsy). Two IMRT plans were compared: a plan without the inclusion of the GTV(MRI) (IMRT-CONV) versus a plan including the GTV(MRI) into the plan optimization (IMRT-GTV(MRI)). For comparison, both physical and biological endpoints of the GTV(MRI), CTV, PTV and rectum were taken into account. After the finalization of the planning study, the IMRT-GTV(MRI) plans were clinically delivered using step-and-shoot IMRT. Acute gastro-intestinal (GI) and genito-urinary (GU) toxicity were recorded. RESULTS: In all cases, the location of the GTV(MRI) corresponded with the site of the tumor containing biopsy cylinder. The mean and median distance of the GTV(MRI) to the anterior rectal wall was 3 and 2mm, respectively (range: 0-12 mm). For the GTV(MRI), its inclusion in the optimization led to a significant increase of all physical endpoints (P<0.01), without compromising the dose to the CTV, PTV and rectum. Mean GTV(MRI) dose was 78.3 Gy (IMRT-GTV(MRI)) versus 76.9 Gy (IMRT-CONV) (P<0.00001). All IMRT treatments were successfully delivered within 6 min. We did not observe grade 3 acute GI toxicity. One patient developed grade 3 GU toxicity (nocturia), that disappeared after administration of medication. Grade 2 GI and GU toxicity was observed in, respectively, four and six patients. CONCLUSION: Using T2-weighted MR, the visualization of an intraprostatic lesion is feasible. The inclusion of the GTV(MRI) into planning optimization leads to a modest increase in dose, without compromising the dose to the CTV, PTV and organs at risk. The clinical delivery of these plans runs without problems. Acute toxicity is mild.     

Dynamics of neovascularization in normal tissue

Neovascularization of normal tissue was investigated by observing tissue grown in a transparent rabbit ear chamber. Stereological principles, applied to photomicrographs of the tissue, quantified vascular characteristics such as surface area, volume, and length per cubic millimeter of tissue. Mathematical models were developed to simulate growth of the microvasculature. The model developed here possesses, at least from a qualitative point of view, two important properties of observable growth kinetics: cell debris, mostly dead red blood cells and platelets, is required for the neovascularization to begin, and vessel density exhibits a maximum before reaching the steady-state value.     

Interaction of left ventricular relaxation and filling during early diastole in human subjects

Seventeen patients with coronary artery disease were studied with cineangiography and simultaneous tip manometry at resting heart rate and submaximal tachycardia induced by atrial pacing. During early diastole, defined as the interval from the opening of the mitral valve to the point of minimal left ventricular pressure, 20 percent of total ventricular filling took place at resting heart rate, but 62 percent occurred during tachycardia. Minimal pressure was significantly correlated with the time constant of pressure decay during the isovolumic phase (r = 0.75 at resting heart rate and r = 0.81 during tachycardia). The measured minimal pressure could be predicted by extrapolating the exponential decay of ventricular isovolumic pressure to the time of occurrence of the minimal pressure, which occurred on average 2.7 time constants from the peak negative rate of change of pressure. At resting heart rate the time constant of relaxation was inversely correlated with ventricular inflow volume (r = ?0.64) and inflow rate (r = ?0.72). It is concluded that left ventricular relaxation has a relevant role in early diastolic pressure-volume relations and increases during tachycardia.     

Retroperitoneal Adrenalectomy: Open or Endoscopic?

p < 0.0001) than the open approach but was associated with less blood loss (20 vs. 125 ml, p < 0.0001). Endoscopic adrenalectomy caused less pain postoperatively ( p = 0.0005) and was associated with fewer complications ( p = 0.035). The hospital stay was shorter after endoscopic adrenalectomy than after open adrenalectomy ( p < 0.0001). In conclusion, we advocate endoscopic retroperitoneal adrenalectomy in patients with small adrenal tumors.     

Instabilität des oberen Sprunggelenkes im Sport

Zusammenfassung Die chronische Instabilit?t des oberen Sprunggelenkes (OSG) ist eine h?ufige Entit?t im Sport. Das Risiko, eine Distorsion des OSG zu erleiden, h?ngt von intrinsischen (Rückfu?-Stellung, Laxit?t, Kraft, neuromuskul?re Reaktion u. a.) sowie extrinsischen Faktoren (Schuhwerk, Sportart, Aufw?rmen u. a.) ab. Die chronische OSG-Instabilit?t wird in eine laterale, mediale und kombinierte Rotationsinstabilit?t unterteilt. Zur korrekten Therapie geh?rt auch die Behandlung der Begleitverletzungen, damit eine rasche Rückkehr zum Sport wieder m?glich ist. Grunds?tzlich gilt prim?r eine konservative Therapie, da ein mechanisches Defizit mit Training der neuromuskul?ren Kontrolle ausgeglichen werden kann. Sollte dennoch eine symptomatische chronische OSG-Instabilit?t vorliegen, ist eine anatomische Bandrekonstruktion indiziert. Dies ist entscheidend, um Verletzungspausen kurz zu halten und die Progredienz von der chronischen Instabilit?t zur OSG-Arthrose zu verhindern.      

Respiratory immunotoxicity: An in vitro assessment

As yet, in vitro assessment of the immunotoxic potency of respiratory agents is not possible. The complexity of the endpoint and the respiratory tract, and the limited availability of well-documented respiratory agents are the main reasons.

The evidence that epithelial cells (ECs) are triggered by compounds to express in vitro surface proteins and soluble mediators, has stimulated their use for developing tests for respiratory immunotoxicity. A variety of airway ECs and EC-lines have been assessed, but the available information seems to point at human alveolar cells (e.g., A549) as the most convenient cell type. EC-based test formats with various degrees of complexity have been assessed. Sofar, promising results were obtained using a 3D model using the human A549 lung cell line. Dendritic cells (DCs) have been subjected to intensive research. However, currently available tests are not well suited to discern among the potency of sensitizers. Potential explanations include the lack of standardised protocols for the generation of DCs, no good standards for estimating the quality of in vitro derived DC-cultures, and limited dynamics of the currently used end-points. Alveolar macrophages (AMs) have sofar received less attention. This may proof unjustified as macrophages may link innate responses to adaptive immunity.

The observation that ECs, DCs and AMs affect each other, suggests that test formats are required combining at least two of these cell types if ranking of compounds according to their sensitising potency is the aim. In addition, the capacity of compounds to cross a cellular membrane is an important property of an immunotoxic compound, which can be assessed only in 3D reconstituted human tissue models. While promising data have been reported for the skin, immunocompetent 3D reconstituted human lung remains to be evaluated for respiratory immunotoxicity. Obviously, the success of any of these simplified test (as compared to the complexity of the immune response) is highly dependent on the availability of early stage biomarkers (expressed at mucosal barrier level) that are predictive for relevant immunotoxicity mechanisms occurring down-stream of the immune response. As yet, such biomarkers are not yet available.     

Exposure to lead by the oral and the pulmonary routes of children living in the vicinity of a primary lead smelter

Yearly from 1974 to 1978, a medical survey was carried out among 11-year-old children attending schools situated less than 1 and 2.5 km from a lead smelter. Age-matched control children from a rural and urban area were examined at the same time. The blood lead levels (PbB) of the children living in the smelter area (mainly those attending schools located less than 1 km from the smelter) were higher than those of rural and urban children. The mean PbB levels were usually lower in girls than in boys, especially in the smelter area. Despite a slightly decreasing trend in the annual mean airborne lead concentration at less than 1 km (mean PbA: from 3.8 μg/m³ in 1974 to 2.3 μg/m³ in 1978) the PbB levels there did not improve, whereas 2.5 km from the plant a significant tendency to normalization of PbB became apparent. Therefore, in the third survey, the medical examination was combined with an environmental study which demonstrated that lead in school-playground dust and in air strongly correlated. Lead on the children's hands (PbH) was also significantly related to lead in air or lead in dust. Less than 1 km from the factory boys and girls had on the average 436 and 244 μg Pb/hand, respectively, vs 17.0 and 11.4 μg Pb/hand for rural boys and girls, respectively. Partial correlations between PbB, PbA, and PbH indicated that in the smelter area the quantitative contribution of PbA to the children's PbB is negligible compared to that of PbH. Thus, the control of airborne lead around the lead smelter is not sufficient to prevent excessive exposure of children to environmental lead. In view of the importance of lead transfer from dust and dirt via hands to the gastrointestinal tract remedial actions should be directed simultaneously against the atmospheric emission of lead by the smelter and against the lead particulates deposited on soil, dust, and dirt.