Stereotactic body radiotherapy for Stage I lung cancer with chronic obstructive pulmonary disease: special reference to survival and radiation-induced pneumonitis

This retrospective study aimed to evaluate radiation-induced pneumonitis (RIP) and a related condition that we define in this report—prolonged minimal RIP (pmRIP)—after stereotactic body radiotherapy (SBRT) for Stage I primary lung cancer in patients with chronic obstructive pulmonary disease (COPD). We assessed 136 Stage I lung cancer patients with COPD who underwent SBRT. Airflow limitation on spirometry was classified into four Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades, with minor modifications: GOLD 1 (mild), GOLD 2 (moderate), GOLD 3 (severe) and GOLD 4 (very severe). On this basis, we defined two subgroups: COPD-free (COPD −) and COPD-positive (COPD +). There was no significant difference in overall survival or cause-specific–survival between these groups. Of the 136 patients, 44 (32%) had pmRIP. Multivariate analysis showed that COPD and the Brinkman index were statistically significant risk factors for the development of pmRIP. COPD and the Brinkman index were predictive factors for pmRIP, although our findings also indicate that SBRT can be tolerated in early lung cancer patients with COPD.     

糖尿病肾病临床研究述评

本文从中医病名、病因病机、诊断标准、临床分期、疗效评定、辨证论治、临床科研七个方面对糖尿病肾病的研究进行了述评。指出：糖尿病肾病的中医病名、诊断、分期及疗效评定标准亟待统一；立足于临床实际，参考现代医学有关认识，应用ＤＭＥ方法，开展糖尿病肾病临床和实验研究，深入探讨其病因病机和证治规律，在中医基本理论指导下，大胆创新，是提高临床疗效的关键；分期辨证论治较为符合疾病的发展规律，便于寻找防治糖尿病肾病的有效方法。     

大肠癌临床分期相关蛋白的蛋白质组学研究

目的：筛选与大肠癌临床分期相关的蛋白，为大肠癌分子分期和预后预测提供依据。方法：将不同临床分期大肠癌组织蛋白进行二维凝胶电泳，选择部分差异表达蛋白进行MALDI-TOF质谱分析和生物信息学分析以鉴定差异表达蛋白;免疫组织化学方法验证筛选结果。结果： 建立了不同临床分期大肠癌组织的二维凝胶电泳图谱，其中Ⅰ，Ⅱ，Ⅲ，Ⅳ大肠癌组织平均蛋白质点数分别为970±41,980±32,1010±43,1240±34;以Ⅰ期大肠癌为参照，Ⅱ期大肠癌差异表达蛋白有52.00±12，Ⅲ期大肠癌差异表达蛋白42.00±11，Ⅳ期大肠癌差异表达蛋白72.00±15，通过进行质谱分析和生物信息学查询，鉴定30个显著差异表达的蛋白点，其中Ⅱ，Ⅲ，Ⅳ均上调的有3种蛋白：AnnexinⅡ,AnnexinⅣ,热休克蛋白27(HSP27)。而仅在Ⅳ期中上调蛋白有1种蛋白,即肝脂肪酸结合蛋白（LFABP)。AnnexinⅡ和肝型脂肪酸结合蛋白表达的免疫组化检测结果与蛋白质筛选结果基本一致。结论：不同临床分期的大肠癌中存在着差异表达蛋白，这些蛋白可能作为大肠癌分子分期和预后的标志物。     

Scalp topography of the spontaneous K-complex and of delta-waves in human sleep

Objective: Together with spindles, K-complexes are well known hallmarks of stage 2 sleep (S2). However, little is known about their topographical distribution in comparison to delta-waves and to K-complexes superimposed by spindles. Patients and methods: In this study, the topographical distribution of spontaneous K-complexes and delta-waves in S2 and delta-waves in stage 4 sleep (S4) in 10 healthy young adults (aged 20 to 35 years, 7 female) was investigated. K-complexes with and without spindles in S2, delta-waves with and without spindles in S2, and delta-waves in S4 distributed all over the night were visually selected. EEG power maps and statistical parametric maps were calculated. Results: Absolute delta power of S2 K-complexes appeared to be significantly higher than of S2 delta-waves and delta power of S4 delta-waves was higher than of S2 delta-waves. In K-complexes and delta-waves, power was found to be highest over medio-frontal regions in the delta frequency band (0.5 - 4.0 Hz) with a second maximum occipitally in delta-waves, no matter whether superimposed by a spindle or not. Conclusion: K-complexes and delta-waves in S2 differ in topographical distribution. Even though in S2 delta-waves have less power, they have a similar topographical distribution in S2 and S4, supporting the hypothesis that delta-waves in S2 further develop towards delta-waves in slow wave sleep. The delta frequency components of K-complexes and delta-waves are unaffected by spindles.     

Early (Stage A) prostatic cancer

Summary This study was performed in order to elucidate some of the problems of incidence, morphology and natural history concerned with Stage A prostatic cancer or prostatic microcarcinoma (PMC).The prostates of 100 patients, treated by subtotal prostatectomy for benign prostatic hyperplasia (BPH), were studied by comparing both routine and step-section techniques. The incidence of PMC was 41% by the former and 86% by the latter technique. Assessment of the size of PMC, as measured by the sum of the two main diameters, resulted in three groups: A₁, A₂, A₃. The last of these may represent a frankly malignant condition, judged by size and the histological appearance. Radical prostatectomy is strongly suggested as appropriate therapy for this group.Supported in part by a Grant from the Ministry of Education (art. 286 T.U., 1977/78)     

The Recuperative Effects of REM Sleep and Stage 4 Sleep on Human Performance After Complete Sleep Loss: Experiment 1

Twelve young (17–21 yrs) male Navy recruits volunteered for a sleep loss study. After 4 baseline days, the Ss were completely deprived of sleep for 2 days and nights. Next followed an experimental phase of 2 days and nights after which all Ss received 2 nights of uninterrupted sleep. During the experimental phase, the 4 Ss in the REM-deprived group were aroused whenever they showed signs of REM sleep. The 4 Ss of the stage 4-deprived group were aroused whenever they showed signs of entering stage 4 sleep, and the 4 Ss of the Control group had uninterrupted sleep. All tests (speed and accuracy of addition, speed and accuracy of self-paced vigilance, errors of omission in experimenter paced vigilance, immediate recall of word lists, and mood) showed significant impairment after the first night of complete sleep loss. But during the experimental (sleep-stage-deprivation) and recovery phases, all three groups showed equal rates of recovery. Depriving the S of stage REM or stage 4 during recovery sleep does not affect the recuperation rate. Frequent arousals (50–100 per night) also do not impair recovery. The amount of sleep is probably more important than the kind of sleep.     

Outcome of combination chemotherapy in extensive stage small-cell lung cancer: Any treatment related progress?

During the past two decades many different treatment regimens of combination chemotherapy have been applied in extensive stage small-cell lung cancer (SCLC). This study was carried out to identify whether these modifications have resulted in an improved overall survival for extensive stage during the past two decades. In total, 1111 patients with extensive stage SCLC were included in six consecutive randomised trials in our setting from 1973 until 1992. Of these, 526 patients treated in the early period (1973–1981) were compared with 585 patients treated in the late period (1981–1992) with respect to pretreatment prognostic factors, staging, treatment and outcome. No change in the distribution of prognostic factors was detected and the frequency of patients with extensive stage was equal in the two periods, and no difference in overall response rates and survival was observed (P=0.49). Median survival in the two periods was 208 days and 215 days, respectively. No stage migration or treatment-related improved outcome was observed in extensive disease. We suggest restricting aggressive treatment to patients with favorable prognosis and long-term survival as a realistic aim.     

第一产程异常胎心监护图形与新生儿结局的关系

目的　探讨第一产程异常胎心监护图形与新生儿结局的关系。方法　回顾分析 2 0 0 2年 8月至 2 0 0 3年 6月在我院足月单胎头位分娩产妇 ,第一产程中胎心率 (FHR)异常图形 2 1 7例 (观察组 )和FHR正常图形的2 6 9例 (对照组 )的临床资料。结果　第一产程异常FHR图形的发生率为 4 4 7% ,常见类型为轻度变异减速(6 4 5 % )、基线变异减弱 (2 1 6 % )和轻度心动过速 (1 2 0 % )。晚期减速、基线变异减弱和重度变异减速是导致新生儿窒息的危险因素。观察组羊水过少 (5 1 % )、脐带缠绕 (2 2 6 % )、羊水粪染 (1 0 6 % )、新生儿窒息 (6 5 % )、新生儿转入NICU(1 0 1 % )的发生率和剖宫产率 (31 8% )明显高于对照组 (P <0 0 5 )。结论　第一产程异常FHR图形的发生率较高 ,其中晚期减速、基线变异减弱、重度变异减速与新生儿窒息的发生相关 ,其他图形可在严密监护下继续试产     

Treatment development: Can we find a better way?

The present paper argues that traditional approaches to treatment development, including a technological approach, a stage model, and existing inductive approaches such as functional analysis are inadequate in various ways. Treatment developing needs to focus more on theoretical development, practicality, and the fit with clients and practitioners. We argue that progress requires greater philosophical clarity, and steps to ensure a connection between philosophy of science assumptions and an analytic agenda which fits naturally with applied psychology. Theoretical progress requires distinguishing between clinical and basic models and harmonizing their relationship, and more focus on the manipulable context of action. Applied psychology needs to join in a common cause with basic psychology in domains of mutual interest, and develop basic analyses and mid-level terms that can be both scientifically progressive and clinically useful. Issues of practicality, capacity for dissemination, and public health impact need to be considered at the beginning and throughout treatment development. Issues of effectiveness, change processes, mediation, moderation, training, active components, and similar issues should be part of the evaluation system from the beginning. It is time to create a more coherent approach to treatment innovation.