Total lymphoid irradiation preceding bone marrow transplantation for chronic myeloid leukaemia

Between August 1985 and October 1987 we treated 35 patients with chronic myeloid leukaemia (CML) by high dose chemotherapy, total body irradiation (TBI) (1000 or 1200 cGy, n = 31) and total lymphoid irradiation (TLI) (800 or 600 cGy, n = 35) preceding allogeneic bone marrow transplantation (BMT). Both TBI and TLI were given at 200 cGy/fraction. Twenty-three patients had HLA-identical sibling donors, nine patients had HLA-matched but unrelated donors, and three partially HLA-mismatched donors. Twenty-two patients received T-cell depleted marrow. The addition of TLI to the standard protocol did not add greatly to the toxicity. Four patients had recurrent leukaemia before engraftment was evaluable. The other 31 patients engrafted and no graft failed. Twenty-two patients survive at a median time from transplant of 305 days (range 81-586 days). Fourteen have no evidence of disease; eight have or had only cytogenetic evidence of leukaemia. We conclude that the addition of TLI to pretransplant immunosuppression increases the probability of reliable engraftment in patients receiving T-cell depleted marrow. This benefit is not associated with significantly increased toxicity.     

Effect of medial arch-heel support in inserts on reducing ankle eversion: a biomechanics study

Background  

Excessive pronation (or eversion) at ankle joint in heel-toe running correlated with lower extremity overuse injuries. Orthotics and inserts are often prescribed to limit the pronation range to tackle the problem. Previous studies revealed that the effect is product-specific. This study investigated the effect of medial arch-heel support in inserts on reducing ankle eversion in standing, walking and running.     

A study on the prevalence of hepatitis B surface antigen among Chinese adult males in Singapore

A study was conducted in Singapore on 8829 Chinese men aged 35 years or more to determine whether the prevalence of hepatitis B surface antigen (HBsAg) positivity is associated with the source from which the subjects were recruited, or with occupation as an indicator of socioeconomic status. The HBsAg prevalence rates were significantly different (p less than 0.0001) among the five source groups: 8.3% in healthy blood donors, 7.8 in other healthy subjects, 9.2 in non-hepatic outpatients, 10.3 in hospital non-hepatic patients who were not gravely ill, and 11.2 in hospital non-hepatic patients who were gravely ill. After statistical adjustment by multiple logistic regression for age and occupation, the odds ratio (using 'other healthy subjects' as the reference group) ranged from 0.98 (95% CL = 0.65-1.47) for healthy blood donors to 1.42 (95% CL = 0.95-2.12) for hospital non-hepatic patients who were gravely ill. The HBsAg prevalence rates were also significantly different (p less than 0.0001) among occupations: 8.5% in professional, technical and administrative personnel, 9.7 in clerical, sales and services personnel, 10.3 in agricultural and factory workers and unskilled labourers, and 10.5 among the unemployed and retired. After statistical adjustment for age and source groups, the odds ratio (using professional, technical and administrative subjects as the reference group) ranged from 1.07 (95% CL = 0.99-1.17) for the unemployed and retired subjects, to 1.19 (95% CL = 0.93-1.53) for agricultural and factory workers and unskilled labourers.     

Potential improvement of tumor control probability by induction chemotherapy for advanced nasopharyngeal carcinoma

PURPOSE: To assess the reduction of tumor bulk and improvement of tumor control probability (TCP) by using induction chemotherapy for advanced nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: From February to December 2005, 20 patients with Stage III-IVB NPC were treated with induction-concurrent chemotherapy and intensity-modulated radiotherapy with accelerated fractionation. Combination of cisplatin and 5-fluorouracil was used in the induction phase and single agent Cisplatin in the concurrent phase. All patients were irradiated at 2Gy per fraction, 6 daily fractions per week, to a total dose of 70Gy. RESULTS: Nineteen (95%) patients completed all 3 cycles of induction chemotherapy and 90% had 2 cycles of concurrent chemotherapy. Induction chemotherapy achieved significant down-staging of T-category in 35% of patients (p=0.016) and reduction of gross tumor volume (GTV_P) from 55.6 to 22.9cc (mean 61.4%, p<0.001). Although the mean radiation dose did not show any substantial change, the volume within GTV_P that failed to reach 70Gy was reduced from 10.2% to 3.8% (p=0.017). The estimated local TCP increased from 0.83 to 0.89 (p=0.002). CONCLUSIONS: Induction chemotherapy using cisplatin-5-fluorouracil could significantly reduce tumor bulk leading to potential improvement in tumor control.     

Retinoic acid inhibits junctional communication between animal cells

Retinoic acid inhibits junctional communication between a varietyof vertebrate cell types in culture. It reduces the intercellulartransfer of ³H-nucleotides between Syrian hamster kidney fibroblasts(BHK 21/13), Chinese hamster lung fibro-blasts (V79), rat liverepithelial cells (BRL), Swiss mouse embryo fibroblasts (3T3),rainbow trout gonadal fibroblasts (RTG2) and Xenopus embryofibroblasts (Xen). It also reduces metabolic cooperation betweenhypoxanthine-guanine phosphoribosyl transferase deficient mutantand wild-type BHK cells. The inhibition is rapid (intercellulartransfer of iontophoretically injected Lucifer Yellow CH betweenBRL cells is completely blocked after the cells have been exposedto 10^–4 M retinoic acid for 5 min), and is fully reversedwhen the drug is removed. Based on these results and the observationthat the amount of gap junctional protein isolated from cellsgrown in the presence of retinoic acid for 1 h is the same andafter 24 h is increased (1.3- to 3.1-fold) compared with theamount isolated from untreated cells, we suggest that the inhibitoryeffect is mediated by the reversible closure of junctional channels.     

Electronic Screening Improves Efficiency in Clinical Trial Recruitment

This study evaluated the performance of an electronic screening (E-screening) method and used it to recruit patients for the NIH sponsored ACCORD trial. Out of the 193 E-screened patients, 125 met the age criterion (“age ≥ 40”). For all of these 125 patients, the performance of E-screening was compared with investigator review. E-screening achieved a negative predictive accuracy of 100% (95% CI: 98-100%), a positive predictive accuracy of 13% (95% CI: 6-13%), a sensitivity of 100% (95% CI: 45-100%), and a specificity of 84% (95% CI: 82-84%). The method maximized the use of a patient database query (i.e., excluded ineligible patients with a 100% accuracy and automatically assembled patient information to facilitate manual review of only patients who were classified as “potentially eligible” by E-screening) and significantly reduced the screening burden associated with the ACCORD trial.     

Are Doppler-detected venous emboli during cesarean section air emboli?

The incidence of venous emboli during cesarean section was studied using simultaneous precordial ultrasonic Doppler monitoring and two-dimensional echocardiography. Forty-nine patients receiving either general or continuous epidural anesthesia in the horizontal position were monitored with both Doppler monitoring and echocardiography. There was excellent correlation between the embolic events detected by Doppler monitoring and by echocardiography (kappa value = 1). The incidence of venous emboli was 29% (14/49). The venous emboli detected by Doppler monitoring were indeed air emboli, not amniotic fluid or thromboemboli, as illustrated by their echocardiographic appearance.     

胸腔镜胸膜剥除术加综合性治疗恶性胸水的疗效分析

目的：探讨胸腔镜胸膜剥除术加综合性治疗恶性胸水的临床疗效。方法：应用电视胸腔镜技术施行21例恶性胸水的胸膜剥除术，术中用顺铂20mg加注射用水200ml冲洗胸腔，术后再辅以局部2－3周期和全身4个周期化疗的综合性治疗21例肺内、外肿瘤并恶性胸水病人。治疗完成后，参考WHO近期疗效评价标准和生存质量KPS评分标准进行评价。结果：随访率100％，胸水完全缓解率为90．5％，有效率100％。自觉症状均得到明显改善，治疗后KPS评分较治疗前均提高20分以上，有显著性差异，P＜0．05。生存期超过6个月以上20例。结论：胸腔镜胸膜剥除术辅以术后的局部和全身化疗的综合性治疗模式可有效地提高恶性胸水病人的生活质量和延长生存时间。