Quality of life (QOL) assessment of MIP (mitomycin, ifosfamide and cisplatin) chemotherapy in advanced non-small cell lung cancers (NSCLC)

BACKGROUND: Quality of life (QOL) assessment has emerged to measure and quantify the balance between treatment benefit and toxicity, and has a value in predicting response and overall survival in cancer patients. METHODS: From July 1995 to February 1997, 38 symptomatic patients with advanced non-small cell lung cancer (NSCLC) were treated with MIP chemotherapy (mitomycin 6 mg/m2, ifosfamide 3000 mg/m2 and cisplatin 50 mg/m2 on day 1 every 3 weeks). Patients were assessed for QOL including physical well-being, general symptoms and lung cancer-specific symptoms, as well as objective response. RESULTS: The overall response rate was 38.9% (14/36, all were partial response) and the median duration of response was 3.5 months [95% confidence interval (CI) 2.0-4.0]. The median duration of overall survival was 7 months (95% CI 5.9-8.5). The overall improvement of QOL was 58.3% with 21 patients feeling better on treatment. The toxicity of chemotherapy was mild, mainly nausea/vomiting and minimal alopecia. Using multiple clinical predictors of survival (age, histology, stage, performance status), only change of QOL emerged significantly (P = 0.0007). CONCLUSIONS: MIP had an endurable response and low toxicity profile, and provided good QOL. Integral QOL data in our study provided the strong prediction of survival in advanced NSCLC. Further experienced QOL study will provide greatly enhanced outcome data in clinical trials.      

海南粗榧新碱衍生物HH07A对体外L1210细胞的杀伤作用

体外培养的小鼠L1210细胞被HH07A2μg·ml^-1作用24h后,与对照组细胞相比,其细胞数不再增长,有丝分裂数及集落形成率下降,细胞形态及细胞周期动力学均发生一定的变化。且HH07A大剂量短期作用抑制Ll210细胞集落形成的效率高于低剂量持续作用。     

阿魏酸钠对花生四烯酸代谢的影响

利用放射薄层方法测定兔血小板花生四烯酸代谢产物TXB₂,PGE₂和PGF_2α。用放射免疫法测定兔血小板TXB₂及主动脉6-keto-PGF_1α。阿魏酸钠(SF,0.1～3.2 mmol/L),抑制¹⁴C-花生四烯酸转化为TXB₂,呈剂量效应关系,IC₅₀为0.762 mmol/L。SF在较高浓度(0.8～3.2mmol/L)时亦抑制PGE₂,PGF_2α的生成。用放免法观察到,SF对血小板TXB₂和动脉壁6-keto-PGF_1α的生成均有抑制作用,对TXB₂的作用较强。结果提示,SF可抑制兔血小板和动脉壁环氧酶活性。     

在实践中提高对保健护理的认识

保健护理是护理实践的中心内容,是授权护理的前提,也是许多护理学理论研究的焦点。学生在学习中必须撑握人类躯体、心理和精神等方面的知识,但是仅有这些知识,却不了解保健护理的核心内容部分是远远不够的。尽管有许多书面材料提到保健护理是整体护理不可分割的部分,但要教育学生承认护理中的关护行为。并形成概念将保健护理作为专家护理实践的基础,仍具有挑战性。在社区医疗保健活动中,给注册护士-护理学士学位(RN-BSN)学生布置一项任务,给她们提供认识保健护理行为和交流范例的机会。按照要求,每个学生必须在“保健护理日志”中记录自己…     

Analgesic effects of JCM-16021 on neonatal maternal separation-induced visceral pain in rats

AIM:To investigate the pharmacological effect of JCM-16021,a Chinese herbal formula,and its underlying mechanisms.METHODS:JCM-16021 is composed of seven herbal plant materials.All raw materials of the formula were examined according to the quality control criteria listed in the Chinese Pharmacopeia(2005).In a neonatal maternal separation(NMS)model,male SpragueDawley rats were submitted to daily maternal separation from postnatal day 2 to day 14,or no specific handling(NH).Starting from postnatal day 60,rats...     

Three-dimensional dynamic magnetic resonance angiography for the evaluation of radiosurgically treated cerebral arteriovenous malformations

We assessed the value of three-dimensional (3D) dynamic magnetic resonance angiography (MRA) for the follow-up of patients with radiosurgically treated cerebral arteriovenous malformations (AVMs). Fifty-four patients with cerebral AVMs treated by radiosurgery (RS) were monitored using conventional catheter angiography (CCA) and 3D dynamic MRA with sensitivity encoding based on the parallel imaging. Cerebral AVM was qualitatively classified by two radiologists into one of five categories in terms of residual nidus size and persistence of early draining vein (I, >6 cm; II, 3–6 cm; III, <3 cm; IV, isolated early draining vein; V, complete obliteration). 3D MRA findings showed a good agreement with CCA in 40 cases (κ=0.62). Of 23 nidus detected on CCA, 3D dynamic MRA showed 14 residual nidus. Of 28 occluded nidus on 3D dynamic MRA, 22 nidus were occluded on CCA. The sensitivity and specificity of 3D dynamic MRA for the detection of residual AVM were 81% and 100%. 3D dynamic MRA after RS may therefore be useful in association with MRI and can be repeated as long as opacification of the nidus or early venous drainage persists, one CCA remaining indispensable to affirm the complete occlusion at the end of follow-up.     

WEB-DL Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Short- and Midterm Results in a European Study

BACKGROUND AND PURPOSE:Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms, but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data in patients treated with WEB-DL.MATERIALS AND METHODS:Twelve European neurointerventional centers participated in the study. Clinical data and pre- and postoperative short- and midterm images were collected. An experienced interventional neuroradiologist independently analyzed the images. Aneurysm occlusion was classified into 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant.RESULTS:Forty-five patients (34 women and 11 men) 35–74 years of age (mean, 56.3 ± 9.6 years) with 45 aneurysms treated with the WEB device were included. Aneurysm locations were the middle cerebral artery in 26 patients, the posterior circulation in 13 patients, the anterior communicating artery in 5 patients, and the internal carotid artery terminus in 1 patient. Forty-two aneurysms were unruptured. Good clinical outcome (mRS < 2) was observed in 93.3% of patients at the last follow-up. Adequate occlusion (complete occlusion, opacification of the proximal recess, or neck remnant) was observed in 30/37 patients (81.1%) in short-term follow-up (median, 6 months) and in 26/29 patients (89.7%) in midterm follow-up (median, 13 months). Worsening of the aneurysm occlusion was observed in 2/28 patients (7.1%) at midterm follow-up.CONCLUSIONS:The results suggest that the WEB endovascular treatment of wide-neck bifurcation aneurysms offers stable occlusion in a class of aneurysms that are historically unstable. Additionally, our data show that opacification of the WEB recess can be delineated from true neck or aneurysm remnants.

Endovascular treatment is now the first-line approach for both ruptured and unruptured aneurysms.^1–4 However, the limitations of standard coiling have contributed to the development of new endovascular approaches, including balloon-assisted coiling, stent-assisted coiling, flow diversion, and flow disruption.⁵The WEB (Sequent Medical, Aliso Viejo, California) is an intrasaccular device designed to disrupt the intra-aneurysmal flow at the level of the neck.^6–9 Several devices are now available in the WEB family: WEB-DL and the more recently introduced WEB-SL and WEB-SLS. Initial experience with the WEB-DL has shown the clinical utility of this device in wide-neck bifurcation aneurysms with high technical success and low acute morbidity and mortality.^7–9 Also, the initial WEB-DL literature suggests good efficacy, with a high percentage of adequate occlusion (complete occlusion or neck remnant) in the postoperative period and in short-term follow-up. In the largest series, a significant number of neck remnants were observed at follow-up (56.7%).⁹ This was due, in part, to the shape of the WEB-DL. The proximal surface of the WEB-DL is not flat but has a recess, which is concave from the direction of the parent artery. The WEB-DL and its recess conform to the aneurysm on the basis of the physician''s WEB-DL size choice. For example, the physician may choose to minimize the WEB-DL parent vessel protrusion by allowing the recess to form within the aneurysm sac; however, this contributes to the appearance of a neck remnant, though this remnant is located centrally and proximally relative to the WEB-DL. Alternatively, with a different WEB-DL size choice, the recess can be removed and the proximal portion of the WEB-DL resides in the neck/parent vessel interface as a flow divider.Aneurysm coil recanalization is an important issue in endovascular therapy, with approximately 20% of coiled aneurysms recanalized and 10% retreated.¹⁰ As previously shown, wide-neck aneurysms are highly prone to recanalization.¹¹The goal of this retrospective, multicenter, European study was to analyze the midterm clinical outcome, short- (3–8 months) and midterm (≥9 months) anatomic results after WEB-DL aneurysm treatment, and the stability of the treatment as well as the rate of retreatment. A point of particular interest was to determine whether the opacification of the proximal recess was stable with time or was a feature promoting aneurysm recanalization.     

Usefulness of MR imaging for the assessment of nonophthalmic paraclinoid aneurysms

BACKGROUND AND PURPOSE: The neuroradiologic location of asymptomatic paraclinoid aneurysms is decisive for patient management. In a preliminary study, we designed a paraclinoid MR protocol (PMP) including high-resolution T2-weighted images in 2 orthogonal planes to define the inferior limit of the distal dural ring plane that represents the borderline between the intradural and extradural internal carotid artery. In this clinical study, we compared this protocol with digital subtraction angiography (DSA) for the location of paraclinoid aneurysms.Materials and METHODS: During a 3-year period, we performed PMP and conventional angiograms in 14 consecutive patients with 17 asymptomatic paraclinoid aneurysms. Ophthalmic (superior) aneurysms were excluded. Two independent observers reviewed MR imaging data, and a third experienced neuroradiologist analyzed the conventional angiograms. MR imaging and conventional angiograms were independently analyzed, and interpretations obtained with each technique were compared.RESULTS: PMP allowed correct visualization of the aneurysms in all patients. No significant differences (P >.05) were found between the DSA and PMP for the measurement of the aneurysmal neck or sac. Interobserver agreement was good. MR imaging was discordant with conventional angiography regarding the position around the cavernous sinus of the aneurysmal neck and sac in 5 cases. PMP images were helpful for treatment decisions in 4 cases.CONCLUSION: PMP is an interesting tool that might be used in association with conventional angiography for the assessment of paraclinoid aneurysms.

Paraclinoid aneurysms (PA) represent only 5% to 11% of asymptomatic intracranial aneurysms.^1–5 The main goal of the treatment is to prevent subarachnoid hemorrhage (SAH) from aneurysmal rupture, which is associated to high rates of morbidity and mortality.⁶ Asymptomatic extradural (intracavernous) aneurysms are at lower risk of subarachnoid hemorrhage than transitional or intradural aneurysms (1.4% of SAH and exceptional cataclysmic epistaxis).⁷ However, they can result in mass effect (cranial neuropathies), carotid cavernous fistulas, or distal embolization when partly fusiform. Conversely, the rupture of an intradural (supracavernous) aneurysm is life threatening. The precise location of PA on both sides of the roof of the cavernous sinus is of great importance for patient management. The distal dural ring is the anatomic limit between the intracavernous and supracavernous internal carotid artery (ICA). Unfortunately, the distal dural ring is not easily identifiable because of its small size. We developed a paraclinoid MR protocol (PMP), which allows us to estimate the position of the distal dural ring plane. This protocol was validated previously with use of correlations between a cadaveric model and MR imaging.^8,9 Our study compares the PMP with digital subtraction angiography (DSA) in clinical conditions.