Real-world data on patterns and outcomes of radiation therapy for brain metastases in a population-based cohort of lung cancer patients in Victoria

Introduction

We evaluated real-world data on the patterns and outcomes of radiotherapy (RT) for brain metastases (BM) in a population-based cohort of patients with lung cancer (LC) in Victoria.

Methods

The Victorian Radiotherapy Minimum Data set (VRMDS) and the Victorian Cancer Registry (VCR) were linked to identify patients with LC who underwent RT for BM between 2013 and 2016. We determined: (i) proportion of patients treated with stereotactic radiosurgery (SRS); (ii) overall survival (OS); and (iii) 30-day mortality (30M) following RT for BM.

Results

Of the 1001 patients included in the study, 193 (19%) had SRS. There was no significant increase in SRS use over time – from 18% in 2013 to 21% in 2016 (P-trend = 0.8). In multivariate analyses, increased age (P = 0.03) and treatment in regional centres (P < 0.001) were independently associated with lower likelihood of SRS treatment. The median OS following RT for BM was 3.6 months. Patients who had SRS had better OS than those who did not have SRS (median OS 8.9 months vs. 3 months, P < 0.01). SRS use, age, sex and year of treatment were independently associated with OS in multivariate analyses. A total of 184 (18%) patients died within 30 days of RT for BM, and the proportion was higher in older (P = 0.001) and male patients (P = 0.004).

Conclusion

One-in-five LC patients who received RT for BM had SRS. The improved OS with SRS is likely confounded by patient selection. It is important to reduce 30M by better selecting patients who may not benefit from RT for BM.     

A novel and non-invasive approach utilising nasal washings for the detection of nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is an epithelial cancer of the nasopharynx which is highly associated with Epstein–Barr virus (EBV). Worldwide, most of the top 20 countries with the highest incidence and mortality rates of NPC are low- and middle-income countries. Many studies had demonstrated that EBV could be detected in the tissue, serum and plasma of NPC patients. In this study, we explored the potential of assays based on non-invasive nasal washings (NW) as a diagnostic and prognostic tool for NPC. A total of 128 patients were evaluated for NW EBV DNA loads and a subset of these samples were also tested for 27 EBV and human miRNAs shortlisted from literature. EBV DNA and seven miRNAs showed area under the receiver operating characteristic curve (AUC) values of more than 0.7, suggestive of their potential utility to detect NPC. Logistic regression analyses suggested that combination of two NW assays that test for EBNA-1 and hsa-miR-21 had the best performance in detecting NPC. The trend of NW EBV DNA load matched with clinical outcome of 71.4% (10 out of 14) NPC patients being followed-up. In summary, the non-invasive NW testing panel may be particularly useful for NPC screening in remote areas where healthcare facilities and otolaryngologists are lacking, and may encourage frequent testing of individuals in the high risk groups who are reluctant to have their blood tested. However, further validation in an independent cohort is required to strengthen the utility of this testing panel as a non-invasive detection tool for NPC.     

胶囊内镜在不明原因消化道出血中的诊断价值

目的:探讨胶囊内镜在不明原因消化道出血中的诊断价值。方法:对20例不明原因消化道出血患者行胶囊内镜检查的临床资料进行回顾性分析。结果:肠道血管畸形5例,小肠克罗恩病4例,小肠间质瘤4例,小肠溃疡1例,回肠非特异性炎1例,病变检出率为75%(15/20)。部分患者经手术病理证实。结论:胶囊内镜安全、无创,对不明原因消化道出血具有较高的诊断价值,在有条件的医院,可推广应用。     

Structure of the human sensorimotor system. I: Morphology and cytoarchitecture of the central sulcus

We have studied the morphology of the central sulcus and the cytoarchitecture of the primary sensorimotor cortex in 20 human brains obtained at autopsy. Although the surface appearance of the central sulcus varies greatly from brain to brain (and between hemispheres of individual brains), its deep structure is remarkably consistent. The fundus of the central sulcus is divided into medial and lateral limbs by a complex junction midway between the sagittal and Sylvian fissures. Based on functional imaging studies, this junction appears to be a structural hallmark of the sensorimotor representation of the distal upper extremity. We also identified and measured area 4 (primary motor cortex) and area 3 (primary somatic sensory cortex) in Nissl-stained sections cut orthogonal to the course of the central sulcus. Although the positions of the cytoarchitectonic boundaries in the paracentral lobule showed considerable interindividual variation, the locations of the borders of areas 4 and 3 along the course of the sulcus were similar among the 40 hemispheres examined. In addition to describing more thoroughly this portion of the human cerebral cortex, these observations provide a basis for evaluating lateral symmetry of the human primary sensorimotor cortex.      

Psychologic morbidities prior to loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia

The objective of this study was to assess and compare anxiety and distress in patients undergoing colposcopic examinations and loop electrosurgical excision procedure (LEEP). Patients seen for evaluation of cervical intraepithelial neoplasia (CIN) and LEEP were recruited. All patients received further teaching with respect to their abnormality right after the colposcopic evaluation by nursing staff. The Hospital anxiety and Depression Scale (HADS) and the Psychosocial Effects of Abnormal Pap Smears (PEAPS) questionnaires were used to measure and compare distress between the two groups. Linear regression models were built to identify significant predictive variables for psychologic morbidities. Twenty-one colposcopy and 20 LEEP patients participated in this study. No significant demographic differences were noted. Eighty-one percent of patients having colposcopy and 65% of those undergoing LEEP can be classified as having significant anxiety and depression based on the HADS questionnaire. Patients undergoing LEEP scored significantly better than colposcopy patients on the mean total PEAPS score and on the self-belief/cancer concern and effects on sexual relationship dimension scores. Significant psychologic morbidities exist in patients diagnosed with CIN. Face-to-face individualized education and support after colposcopy can decrease patients' distress at subsequent treatment visits.     

双氯芬酸钠透明质酸钠滴眼液治疗急性变态反应性结膜炎评价

目的 评价0.1%双氯芬酸钠透明质酸钠滴眼液辅助治疗急性变态反应性结膜炎的有效性及安全性的临床评价.方法 对90例(180只眼)急性变态反应性结膜炎患者.包括季节性与常年性变态反应性结膜炎,随机分成三组.A组:对照一组,单用0.05%依美斯汀滴眼液;B组:对照二组,0.05%依美斯汀滴眼液联合0.1%普拉洛芬滴眼液;C组:试验组0.05%依美斯汀滴眼液联合0.1%双氯芬酸钠透明质酸钠滴眼液,三组每种用药均为每日3次.分别于治疗前与治疗后1d、4d、7d、14d随访,评估眼痒、流泪、畏光、异物感等症状与睑结膜乳头和滤泡、分泌物、结膜充血、结膜水肿、角膜缘改变、角膜上皮改变、球周组织水肿等体征,评价有效率及治愈率,并观察用药后眼部不适及副反应.结果 三组患者的一般情况、治疗前症状与体征评分差异均无统计学意义(P＞0.05).A组、B组与C组的治疗有效率在治疗后第1天分别为6.7%、56.7%与60.0%,第4天分别为20.0%、100.0%与96.7%,第7天分别为53.3%、100.0%与100.0%,第14天分别为73.3%、100.0%与100.0%.治疗第14天治愈率分别为10.0%、73.3%与63.3%.两两比较各随访时间点的有效率与治愈率,A组与B组的组间差异均具有统计学意义(P均＝0.000),A组与C组组间的差异均具有统计学意义(P均=0.000),而B组与C组在治疗后各随访时间点的有效率与治愈率相当,差异无统计学意义(P=0.918、0.147、0.058、0.0405＞0.05).各试验组未见用药后的眼部不适及副反应.结论 非甾体类消炎药能快速、有效缓解急性变态反应性结膜炎的症状与体征,其中,0.1%双氯芬酸钠透明质酸钠滴眼液与同类进口滴眼液的疗效相当,是一种有效、安全又经济的变态反应性结膜炎的辅助治疗药物.     

Incorporation of thioamide linkages into a growing peptide under SPPS conditions improved by salt effects

Amino acid methyl dithioesters may be coupled in the presence of DMAP and salts to a growing peptide chain on a polymeric resin with high coupling yields and low racemization. © Munksgaard 1995.     

外源核苷酸对肉鸡生产性能的影响

研究了天然日粮中补充外源核苷酸对肉仔鸡胃肠道等消化器官及生产性能的影响 .0～ 14日龄爱维因肉仔鸡按体重随机分成 4组 ,每组 4个重复 ,分别饲喂玉米豆饼无鱼粉基础日粮 ( 1组 ) ,基础日粮中添加 0 .0 5%核酸 ( 2组 )、0 .1%核酸 ( 3组 )以及基础日粮中含 2 %鱼粉 ( 4组 ) .结果表明 ,第 2 ,3,4组的肉仔鸡 14日龄生长速度比对照组提高 14%～ 17% ,饲料利用率提高 4 %～6% .2、3组鸡 4日龄十二指肠质量、3组鸡空肠质量、胰腺质量显著高于对照组 (P <0 .0 5) ;7日龄小肠粘膜的蛋白酶活性也极显著高于对照组 (P <0 .0 1) .研究表明 ,日粮中添加外源核苷酸对提高肉仔鸡生长速度、胃肠道、胰脏质量、肠粘膜蛋白酶活性均有重要的影响 .     

Sleep complaints and sleep disordered breathing in hemodialysis patients.

BACKGROUND: The objective of the study was to determine the prevalence of sleep complaints and of sleep disordered breathing (SDB) in hemodialysis patients not selected for sleep complaints and to determine the effect of hemodialysis on SDB. The feasibility of home recording of sleep related respiration in these patients was also studied. METHODS: The patients completed a questionnaire and parameters of SDB were examined in the home setting on nights following dialysis and nights following no dialysis with the Edentrace II Recording System. RESULTS: Six (46%) of 13 patients had sleep complaints. Symptoms suggestive for sleep apnea syndrome were found in four (31%) of these 13 patients. In three (75%) of these four patients SDB was found. Sleep related respiration was monitored in 15 patients. Registrations satisfactory for interpretation were obtained in all patients. SDB was observed in five (33%) of these 15 patients. There were no significant differences in parameters of SDB between nights following dialysis and nights following no dialysis. CONCLUSIONS: Home recording of sleep related respiration in hemodialysis patients is feasible. Sleep complaints and SDB are common in these patients. No clinically significant differences in SDB were found between nights following dialysis and nights following no dialysis.     

Efficacy and cost-effectiveness of a physiotherapy program for chronic rotator cuff pathology: A protocol for a randomised,double-blind,placebo-controlled trial

Background  

Chronic rotator cuff pathology (CRCP) is a common shoulder condition causing pain and disability. Physiotherapy is often the first line of management for CRCP yet there is little conclusive evidence to support or refute its effectiveness and no formal evaluation of its cost-effectiveness.