A dosimetric comparison of two-phase adaptive intensity-modulated radiotherapy for locally advanced nasopharyngeal cancer

The purpose of this investigation was to evaluate the potential dosimetric benefits of a two-phase adaptive intensity-modulated radiotherapy (IMRT) protocol for patients with locally advanced nasopharyngeal cancer (NPC). A total of 17 patients with locally advanced NPC treated with IMRT had a second computed tomography (CT) scan after 17 fractions in order to apply and continue the treatment with an adapted plan after 20 fractions. To simulate the situation without adaptation, a hybrid plan was generated by applying the optimization parameters of the original treatment plan to the anatomy of the second CT scan. The dose–volume histograms (DVHs) and dose statistics of the hybrid plan and the adapted plan were compared. The mean volume of the ipsilateral and contralateral parotid gland decreased by 6.1 cm³ (30.5%) and 5.4 cm³ (24.3%), respectively. Compared with the hybrid plan, the adapted plan provided a higher dose to the target volumes with better homogeneity, and a lower dose to the organs at risk (OARs). The Dmin of all planning target volumes (PTVs) increased. The Dmax of the spinal cord and brainstem were lower in 94% of the patients (1.6–5.9 Gy, P < 0.001 and 2.1–9.9 Gy, P < 0.001, respectively). The D_mean of the contralateral parotid decreased in 70% of the patients (range, 0.2–4.4 Gy). We could not find a relationship between dose variability and weight loss. Our two-phase adaptive IMRT protocol improves dosimetric results in terms of target volumes and OARs in patients with locally advanced NPC.     

Clinical factors predictive of PCR positive in pandemic H1N1 2009 influenza virus infection

Please cite this paper as: Phungoen et al. (2011) Clinical factors predictive of PCR positive in pandemic H1N1 2009 influenza virus infection. Influenza and Other Respiratory Viruses 5(6), e558–e562. Objective Pandemic H1N1 2009 influenza virus (H1N1) has been spreading globally. Clinical features might be predictive and may be different among countries. Even though the PCR test is a confirmatory test for this viral infection, it is expensive and limited in most Thai health care facilities. We studied predictive factors of PCR positive in H1N1 suspected patients. Methods Consecutive patients who had influenza‐like illness less than seven days and had been tested for H1N1 by the real‐time PCR method between May and July 2009 were enrolled. Clinical data was collected and compared between those who had positive and negative PCR tests. Results There were 6494 patients had flu‐like symptoms. Of those, 166 patients were done PCR test and 75 patients (45·18%) had positive PCR test. There were four predictors for positive PCR test including history of contact with confirmed H1N1 patients, headache, body temperature, and coryza with the adjusted odds ratio (95% confidence interval) of 2·84 (1·09–7·40), 6·25 (1·42–27·49), 1·69 (1·08–2·66), and 0·31 (0·12–0·79), respectively. Conclusions Clinical factors can be both suggestive and protective factors for H1N1 infection. These factors may be helpful in clinical practice to assess the possibility of the H1N1 infection in people who are at risk; particularly in resource‐limited health care facilities.     

Different chest radiographic findings of pulmonary paragonimiasis in two endemic countries

We compared the chest radiographic findings of patients with pulmonary paragonimiasis in the Lao People's Democratic Republic (PDR) with a report from Korea. The clinical and radiological characteristics of 50 confirmed Laotian pleuropulmonary paragonimiasis patients were studied between March 2003 and June 2007. In 49 patients, the chest radiographs showed abnormal findings (98%). Pulmonary parenchymal abnormalities were found in all 49 patients, whereas pleural effusion was only found in 11 patients (22%). The three most common intraparenchymal findings were multiple small cysts (90%), irregular linear densities (68%), and nodular opacities (40%). The numbers of patients who had these three findings were significantly different from the Korean report (P < 0.001). In conclusion, radiographic findings of pulmonary paragonimiasis may vary among countries.     

Bioactive Compounds from Carissa spinarum

In our continuing efforts to find new antiherpetic agents from plants, an extract prepared from the stems of Carissa spinarum L. was found to possess appreciable activity against herpes simplex viruses (HSV I and II). A chemical study of this plant was then initiated, and this led to the isolation of 12 compounds, including a coumarin, two cardiac glycosides and nine lignans. These isolated compounds were evaluated for several biological activities, including antiherpetic, cytotoxic, antioxidant and antibacterial effects. The cardiac glycoside evomonoside was found to be the only antiherpetic principle, showing moderate activity against herpes simplex virus types I and II in the inactivation method. The lignans (?)‐carinol, (?)‐carissanol and (?)‐nortrachelogenin exhibited cytotoxicity against breast (MCF7) and lung (A549) cancer cells. Moderate anti‐DPPH free radical activity was observed for all the lignans. None of the isolates showed antibacterial activity. Copyright © 2012 John Wiley & Sons, Ltd.     

Any heart failure treatments associated with worsening renal function in patients admitted due to acute heart failure?

BackgroundWorsening renal function (WRF) occurs in approximately 25% of acute heart failure patients, and both baseline characteristics and heart failure treatment may increase the risk of WRF. This study aimed to evaluate additional risk factors for WRF in acute heart failure, particularly those related to heart failure treatment.MethodsThis was a retrospective, observational, analytical study. The inclusion criteria were age 18 years or over, hospital admission due to acute heart failure, and having undergone at least two serum creatinine tests during admission. The eligible patients were classified into two groups: WRF and non-WRF. Predictors for WRF (including treatment parameters) were determined using logistic regression analysis.ResultsDuring the study period, there were 301 eligible patients who met the study criteria. Of those, 82 (27.24%) had WRF. There were two independent factors associated with WRF occurrence: baseline diastolic blood pressure and beta blocker treatment, with adjusted odds ratios (95% confidence interval) of 1.060 (1.008, 1.114) and 0.064 (0.006, 0.634), respectively. The Hosmer-Lemeshow Chi square for the final model was 6.11 (p = .634).  ConclusionsAfter examining several heart failure treatments and baseline factors, we found that beta blocker treatment results improvement in kidney function.     

Health profile of middle-aged women: The Women's Health in the Lund Area (WHILA) study

BACKGROUND: Middle-aged women experience various health-related problems. The aim of this study was to evaluate the impacts of menopause status and hormone intervention on women's health. METHODS: In an ongoing, population-based study, 4943 women, born 1935 to 1945 and living in the Lund area of Southern Sweden, were included in this analysis. They completed a generic questionnaire pertaining to socio-demographic background and current health-related symptoms. Among the cohort, 9% of women were pre-menopausal (PM), 52% were post-menopausal without hormone replacement therapy (PMO) and 39% were current hormone replacement therapy users (PMT). RESULTS: Hot flushes and vaginal dryness were strongly related to menopausal status. The prevalence of somatic symptoms worsened progressively from the groups of PM to PMO to PMT. The most abundant complaints were headache and muscle-skeletal-joint problems. A total of 85% of women experienced psychological problems. Contrary to our expectation, a poorer profile of psychological health was found in the PMT group when compared with the PMO group. CONCLUSIONS: The high prevalence of symptoms in middle-aged women could be attributed to age, hormonal influence as well as personality.     

Mechanisms of microvascular response to laser pulses

"Selective photothermolysis" is widely used for treating vascular lesions. In order to understand mechanisms of response, we investigated fast events during pulsed laser treatment of microvessels. A high-speed (2000 fps) CCD camera and microscope were used to image hamster cheek pouch microvessels during and after 532 nm and 1064 nm laser pulse exposures. Pulse duration and fluence were varied systematically (1-50 ms, 0-600 J per cm2). Threshold fluences for fast events were determined. On a millisecond time-scale, a specific series of fast events occur, which are wavelength, fluence, irradiance, and pulse duration dependent. In order of increasing fluence we observed: blood coagulation, vasoconstriction, thread-like appearance of the treated vascular segment, vessel disappearance, intravascular cavitation, bubble formation, vessel wall rupture and hemorrhage, and shrinkage of perivascular tissue. With increasing pulse duration, the threshold fluences for coagulation, vessel disappearance, and cavitation increase, and cavitation becomes less violent, conforming to the vessel lumen. Intravascular cavitation did not always rupture the vessel wall, and is not the mechanism for immediate vessel disappearance, a desired endpoint for treating vascular lesions. The apparent mechanism for immediate vessel disappearance is contraction of intravascular blood and perivascular collagen after thermal denaturation. This study suggests that detecting fast events in humans, in real time, may provide useful feedback signals for "smarter" laser devices.     

An unusual complication from esthetic injection of liquid silicone into the forehead

PURPOSE: To report a case of migration of liquid silicone into the upper eyelid. DESIGN: Interventional case report. METHODS: A 32-year-old woman had an injection of liquid silicone into the subcutaneous tissue of the forehead. She developed a cystic mass in the upper eyelid 2 days postinjection. An excisional biopsy was performed. RESULTS: The mass lay in the Müller's muscle, and its base adhered to the tarsus. The mass ruptured during dissection, revealing a yellowish turbid fluid. Histopathologic findings showed lipogranulomatous reaction. CONCLUSIONS: Liquid silicone injection to the forehead may promote formation of a cystic mass in the upper eyelid.     

Flavonoids and stilbenoids with COX-1 and COX-2 inhibitory activity from Dracaena loureiri

Fom the stem wood of Dracaena loureiri, a new homoisoflavanone named loureiriol (1) and eight known flavonoid and stilbenoid derivatives, including 5,7-dihydroxy-3-(4-hydroxybenzyl)-4-chromanone (2), 4,4'-dihydroxy-2,6-dimethoxydihydrochalcone (3), 2,4'-dihydroxy-4,6-dimethoxydihydrochalcone (4), 4'-hydroxy-2,4,6-trimethoxydihydrochalcone (5), 4,6,4'-trihydroxy-2-methoxydihydrochalcone (6), 4,3',5'-trihydroxystilbene (7), 4,3'-dihydroxy-5'-methoxystilbene (8) and 4-hydroxy-3',5'-dimethoxystilbene (9) were isolated. These compounds were evaluated for their inhibitory activity against the enzymes cyclooxygenase-1 and cyclooxygenase-2. Potent but non-selective activity was found for the stilbenoids 7-9 (IC(50) 1.29 - 4.92 microM) whereas weak or no activity was observed for the flavonoids 1-6.     

A new phenanthrene dimer from Dendrobium palpebrae

A new phenanthrene dimer, namely dendropalpebrone (1), was isolated from the whole plant of Dendrobium palpebre, along with nine known compounds (2–10). All of the isolates were evaluated for their hydroxyl radical scavenging effects using a deoxyribose assay. Dendroflorin (10) showed an appreciable activity, and therefore was selected for further studied in RAW264.7 cells. Compound 10 significantly decreased ROS in H₂O₂-stimulated RAW264.7 cells in a dose-dependent manner, and improved activity of SOD, GPx, and CAT enzymes.