Prospective study of the short-term adverse effects of gamma knife radiosurgery

Purpose of this study is to determine the types, incidence, and severity of acute complications of intracranial stereotactic radiosurgery (SRS), specifically Gamma Knife (GK). Patients who had never had previous SRS were eligible for this prospective IRB-approved study. The questionnaire used applicable questions from CTCAE v.3.0, the Brief Pain Questionnaire (Short Form), Brief Fatigue Inventory, and the Tinnitus Handicap Inventory. Questionnaires were obtained prior to Gamma Knife (GK), 1 week, 1 month, and 2 months to assess complications. Seventy-six eligible patients (median age of 62 years) had complete data and were analyzed. Diagnoses included: 26 (34%) with brain metastases, 15 (20%) with trigeminal neuralgia, 12 (16%) with schwannoma, 10 (13%) with meningioma, 7 (9%) with arteriovenous malformation, 3 (4%) with pituitary adenoma, and 3 (4%) with other. At 1 week, 24% developed minimal scalp numbness (p =?0.0004 baseline compared to 1 week). Only 13% had minimal scalp numbness at 1 month and 2% at 2 months (both p?5?NS compared to baseline). There was no difference in scalp tingling between baseline and the various time points. Thirteen percent developed pin site pain at 1 week with a median intensity level of 2 out of 10. By one month, only 3% had pin site pain with a median intensity level of 3 out of 10. Four percent developed pin-site infection at 1 week and none at 1 and 2 months. There was no significant difference in nausea from baseline at 1 week, but there was worsening nausea at 1 month (p =?0.0114). By 1 month, 10% reported new local hair loss. 23%, 16%, and 15% complained of new/worsening fatigue at 1 week, 1 month, and 2 months, respectively, but 40% reported fatigue at baseline. Balance improved following SRS over all time periods (for all comparisons, p 相似文献   

Investigating communication in cancer consultations: what can be learned from doctor and patient accounts of their experience?

This study investigated how doctors and patients diagnosed with advanced incurable cancer experienced the disclosure of bad news. The intention was to gain contrasting perspectives of the processes involved in oncology consultations. Sixteen doctors and 16 patients from a cancer centre in the UK participated in the study. A series of consultations were observed and audio recorded, and the perspectives of doctors, patients and relatives were investigated through semi‐structured interviews. Participants were invited to describe how they experienced and felt about the disclosure of information over a period of time following a specific consultation. Analysis was based on a constant comparative method. This research suggests that patients control what they do or do not do with information to meet their own needs and objectives, but doctors do not necessarily appreciate this. Doctors do not always prepare patients for what is happening to them in an active open awareness context, and this can be stressful for some patients. The results indicate that communication is not just about one person making decisions. They also indicate that in many cases more success could be gained from finding out how patients prefer to manage and control the exchange of bad news, at different points, through their care pathway.     

Stereotactic radiosurgical treatment of brain metastases in older patients

BACKGROUND: This study was designed to evaluate the therapeutic effect of stereotactic radiosurgery (SRS) in patients aged > or =75 years who presented with brain metastasis. METHODS: The authors analyzed the data from 44 consecutive patients treated with SRS for > or =1 brain metastasis. The median age at the time of treatment for brain metastases was 79.3 years (range, 75 years-86 years), and the median Karnofsky performance status was 80 (range, 50-100). At the time of SRS, 31 patients were treated for a single metastasis, and the remaining 13 patients were treated for > or =2 lesions (n = 74 lesions). The median tumor volume was 1.2 cm(3) (range, 0.007 cm(3)-22.5 cm(3)). The median maximal and marginal doses were 36 grays (Gy) (range, 18.8 Gy-48.2 Gy) and 20 Gy (range, 10 Gy-24 Gy), respectively. RESULTS: Median survival was 7.3 +/- 1.65 months (range, 1.6 months-38.9 months) from the time of diagnosis of brain metastasis. Median survival of the patients with a single brain metastasis (10.1 +/- 1.92 months) was longer than that of the patients with > or =2 metastases (6.6 +/- 1.28 months) (P <.02). A single lesion was found to be an independent favorable prognostic factor (P +/- = +/- .017; odds ratio, 2.385 [95% confidence interval, 1.167-4.874]) in univariate and multivariate analysis. Patients with nonsmall cell lung cancer fared worse than patients with other tumor types (survival of 6.5 +/- 0.70 months vs 10.1 +/- 2.33 months [P<.05]). CONCLUSIONS: SRS for patients aged > or =75 years with brain metastases is an effective and safe treatment modality that appears to improve survival, with outcomes that compare favorably with those reported for younger patients in an appropriately selected population.     

Platelet storage pool deficiency in pigs

We report a new bleeding disease--storage pool deficiency (SPD) of platelets--in pigs from the Mayo swine colony of homozygous von Willebrand's disease (vWD) and of heterozygous carriers of vWD. Levels of factor VIII, von Willebrand factor antigen (vWF:Ag), and ristocetin cofactor (RCof) were similar in the vWD carriers and SPD pigs. The latter pigs, however, had bleeding times of 15 minutes or more and were severe bleeders, in contrast to clinically normal vWD carriers. Platelet aggregation in response to collagen was reduced in most SPD pigs. Total platelet content of ADP, ATP, and serotonin was less than that of normal pigs. While the initial uptake of 14C-labeled serotonin into platelets was similar in SPD and normal pigs, retention of serotonin was reduced in platelets of SPD pigs. Transmission electron microscopy showed a large decrease of dense bodies in the platelets of SPD pigs. These findings support a diagnosis of SPD. Genetic analyses suggest an autosomal recessive mode of inheritance. A breeding program is under way to produce pigs affected only at the SPD gene, thus allowing further characterization of SPD and SPD-carrier pigs.     

Electron microscopic study of cat meninges

The intervascular portions of the encephalic dura mater, arachnoid membrane and pia mater were studied with special reference to their spatial relationships. The cell types were analyzed at electron microscopic level. An outer dural layer, composed of typically elongated fibroblasts and large intercellular spaces was identified. The middle dural layer was composed of collagenous connective tissue matrix together with some fibrocytes scattered in it. The inner dural layer showed epithelium-like arranged cells with light cytoplasm and long processes. The electron-dense band, measuring about 20 nm in width, located between dura mater and arachnoid was not so prominent as in the previously investigated experimental animals. The intercellular contacts among the cells of the outer arachnoid layer included maculae and zonulae adherentes and gap junctions mainly, while the tight junctions observed were quite rare. Following the arachnoid trabecular layer, an inner arachnoid layer could be hardly demonstrated. The pial cells were differentiated into 2 distinct layers, bordering the narrow and discontinuous pial space.     

Experimental Studies on Facial Nerve Regeneration

Insufficient recovery after injury of a peripheral motor nerve is due to (1) inappropriate pathfinding as a result of axonal regrowth to inappropriate targets, (2) excessive collateral axonal branching at the lesion site, and (3) polyinnervation of the neuromuscular junctions (NMJs). The rat facial nerve model is often used because of its simple and reliable readout to measure recovery of function (vibrissal whisking). Over the last decades scientists have concentrated their efforts to combat mostly NMJ polyinnervation, because it turned out to be very difficult to reduce collateral axonal branching and impossible to navigate thousands of axons toward the original fascicles. In the past, several groups of scientists concentrated their efforts to reduce the activity-dependent polyinnervation of NMJs by electrical stimulation of the muscles (square 0.1 msec pulses at 5 Hz). The results showed no recovery of functions and a severe reduction in the number of innervated NMJs to approximately one fifth of those observed in intact animals. More recent experiments, however, have shown that motor recovery improved significantly following mechanical stimulation of the denervated facial muscles (vibrissal and orbicularis oculi) and that restored functions could invariably be linked to reduced polyinnervation at the NMJ while the number of innervated NMJ remained the same. These results suggest that clinically feasible and effective therapies could be developed and tested in the near future. Anat Rec, 302:1287–1303, 2019. © 2019 Wiley Periodicals, Inc.     

Antibacterial effect of TiO2:Cu:Ag thin coatings on Pseudomonas strain measured by microbiological and ATP assays

The aim of this study is to investigate the antimicrobial properties of nanocomposite thin TiO₂:Cu:Ag films on Pseudomonas putida as a natural isolate and an opportunistic pathogen. Several different methods were used to compare the antibacterial effect of thin TiO₂:Cu:Ag layers obtained by radiofrequency magnetron sputter deposition against P. putida: optical density of the bacterial suspension, most probable number of survived cells, dehydrogenase activity inhibition, scanning electron microscopy images, atomic flame absorption spectroscopy, and adenosine triphosphate (ATP) luminescent assay. Optical density measurements and most probable plate count were in agreement and showed a strong bactericidal effect of the as‐deposited and only bacteriostatic effect of the annealed coatings with the same metal content on tested bacteria. As the metal quantity in the medium rises during the first hour of the experiment, it could be suggested that this is the main reason for cell death. ATP‐luminescent assay showed up to 18‐fold reduction of the signal. It was compared with other microbiological and biochemical assays to prove the strong antibacterial effect of nanocomposite thin TiO₂:Cu:Ag coatings with the possibilities of medical applications. Protection of medical devices against infections is a significant current challenge raised by an increasing number of medical devices‐associated infections and microbial resistance to conventional antibiotic and multidrug treatments. Deposition of antimicrobial coatings is one of the current approaches to mitigate the problem.     

Classification and Clinical Management of Retrograde Peri-implantitis Associated with Apical Periodontitis: A Proposed Classification System and Case Report

Biological complications involving dental implants include peri-implant diseases such as peri-implant mucositis and peri-implantitis. The latter presents with progressive bone loss from the alveolar crest in a coronal apical direction. However, a separate disease entity termed retrograde peri-implantitis (RPI), which presents with progressive bone loss at the periapex of the implant, also exists and may be of particular interest to endodontists because it typically presents with periapical pathology of both the implant and adjacent tooth or at a site that previously housed an endodontically treated tooth. The reported prevalence of retrograde peri-implantitis is 0.26%, which is much lower than the prevalence of marginal peri-implantitis; however, its incidence increases to 7.8% when teeth adjacent to the implant exhibit an endodontic infection. It is positively correlated with a shorter distance between the implant and the adjacent tooth and a shorter time elapsed from the endodontically treated adjacent tooth to implant placement. This case report describes a patient diagnosed with an RPI lesion (RPI) associated with an adjacent endodontically treated tooth with a persistent periapical radiolucent lesion. The diagnosis, possible etiology, and management of the RPI lesion is thoroughly reported including follow-up visits showing complete resolution after subsequent periodontal and endodontic therapy. Endodontic evaluation of teeth adjacent to the implant site should be performed for primary prevention of RPI. Proper classification of RPI will aid in determining the course of treatment; class 1 and 2 cases require endodontic therapy of the involved teeth for healing to occur.