Preliminary results of primary chemotherapy in retinoblastoma

Transcranial duplex real time sonography (TCCS) is a non-invasive imaging modality that allows repetitive examinations of central nervous system vascular and parenchymal anatomy; a broad spectrum of cerebral pathology may be disclosed: vascular changes include ischemic and hemorrhagic stroke, arteriosclerotic vascular degeneration, arteno-venous malformations and aneurysms, as well as neoplastic and degenerative parenchymal disorders. Imaging was performed with a duplex ultrasound system, employing a 2.25 resp. 2.0 MHz phased-array transducer. Imaging was achieved through the acoustic bone window of the temporal bone and through the foramen magnum. For three-dimensional image reconstruction a mechanical position sensor and online video grabbing was applied. To evaluate the potential of a transpulmonary stable ultrasound contrast enhancing agent we used galactose-based SH U 508 A (Levovist, Schering, Berlin) with 1 to 6 i.v. injections per patient in a phase 2/3 clinical protocol. The signal to noise ratio is significantly improved; the Doppler signal intensity is increased by approx. 25 dB. Levovist was well tolerated and no adverse events occurred, approx. 30% of patients had a sensation of heat and slight pain at the injection site during and shortly after the injection. With the increase in signal intensity, the complete circle of Willis, the peripheral arterial branches, the vertebro-basilar system and the basal venous system may be depicted. In addition, tumour parenchyma vascularisation may be detected, as well as improved delineation of arteriovenous malformations and aneurysms. Three dimensional image reconstruction may represent a novel option in contrast enhanced transcranial duplex imaging including additional information about 3D structure and continuity.     

Topical mitomycin C chemotherapy for conjunctival melanoma and PAM with atypia

Increasing parental participation in their child's health and health care is an important process by which the health care system can effectively address and service the needs of its patients. Clinicians need to have an appreciation of parental understanding, beliefs, and expectations. This paper reviews the recent literature regarding parental needs, concerns, decision-making strategies, and expectations for their children's health and health care.     

Combining cyclosporin with chemotherapy controls intraocular retinoblastoma without requiring radiation

Chemotherapy without radiation has not controlled most intraocular retinoblastoma, perhaps because of the common high expression of multidrug resistance P-glycoprotein that we found in retinoblastoma. Cyclosporin blocks P-glycoprotein-induced efflux of vincristine and teniposide in vitro, and possibly modulates responses to carboplatin. To avoid eye irradiation in bilateral retinoblastoma patients with RB1 germline mutations, which incurs a high second malignancy rate, we added cyclosporin A to a vincristine-teniposide-carboplatin protocol and consolidated chemotherapy responses with focal therapy. We scored patients requiring irradiation, enucleation, or focal ablation of central vision as failures. In 21 study patients, the overall relapse-free rate at a median follow-up of 3.3 years was 76%, with a rate of 92% for newly diagnosed and 50% for previously treated, relapsed retinoblastoma. Our results for the most unfavorable tumors with vitreous seeds (86% at 3.5 years) are better than published success rates of irradiation for similar tumors, or irradiation with the same chemotherapy without cyclosporin (45% at 2. 6 years). These results also exceeded our historic success rate with similar chemotherapy without cyclosporin, focal therapy, and/or radiation in 19 equivalently poor-risk patients (relapse-free rate 37% at a median follow-up of 5.6 years, P = 0.032), 16 of whom were previously untreated (relapse-free rate also 37%, P = 0.012). A better outcome occurred with higher cyclosporin blood levels and projected tissue exposure. Cyclosporin did not enhance the usual chemotoxicity. This clinical study suggests that cyclosporin improves the long-term response of retinoblastoma to chemotherapy, possibly by more than one mechanism.     

Stage differences in the dependencies of topic initiation and topic following behavior.

I examined the topic initiation/topic following sequence data from the beginning, middle, and late stages of 16 counseling dyads (a successful and less successful dyad from each of eight counselors). I hypothesized that the beginning, middle, and end of successful counseling would demonstrate different patterns of dependency in the sequence data. Client and counselor topic initiation and topic following behavior was examined by using loglinear analysis to see the extent to which they varied because of the previous behavior of the other participant (interchain dependency), their own previous behavior (intrachain dependency), outcome (determined by a composite of client and counselor evaluations), and stage. Although high interchain dependencies were present for all the clients and counselors, significant variation was related to stage and outcome. Further, both clients and counselors in successful dyads demonstrated significant increases of intrachain dependency in the end stage, but no similar increases were found for either clients or counselors in the less successful dyads. These results are discussed with respect to relationship formation and development, differences in client and counselor role, and implications for future studies on interaction sequences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of costs for infusion versus bolus chemotherapy administration--Part two. Use of charges versus reimbursement for cost basis

BACKGROUND: The costs of infusion versus bolus administration of chemotherapy has been a point of controversy as has been the method of quantitating the cost. The present study analyzes the reimbursement for chemotherapy administration by infusion compared with bolus delivery based on reimbursement and relates this to cost based on projected charges and actual charges in a private practice setting. METHODS: Actual reimbursement records were retrieved for selected patients receiving infusion or bolus administration of specific chemotherapy regimens for three tumors: colon carcinoma, breast carcinoma, and lymphoma. All services were included except for radiology and hospitalization. Medicare reimbursement represented 90% of the treatment cycles analyzed. RESULTS: Actual reimbursement per month for each infusion regimen was as follows: colon carcinoma, $528 (5-fluorouracil [5-FU]); breast carcinoma, $621 (doxorubicin and cyclophosphamide [AC]) and $685 (cyclophosphamide, methotrexate, and fluorouracil [CMF]); and lymphoma, $603 (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP]). Actual reimbursement per month for a bolus regimen was colon carcinoma, $393 (5-FU + leucovorin); breast carcinoma, $991 (AC) or $453 (CMF); and lymphoma, $749 (CHOP). Actual reimbursement represents 21-36% of actual charges. Projected charges based on the model system are generally less than the actual charges. CONCLUSIONS: The cost of chemotherapy as defined by reimbursement are substantially less than actual charges and are also less than projected costs based on charges. Data comparing bolus versus infusion reimbursement costs for colon carcinoma, breast carcinoma, and lymphoma indicate that differences between reimbursement for bolus and infusion administration are not substantial.     

Topical therapy for psoriasis

The role of collateral flow was evaluated in a pharmacological stress test [a combination of low-dose dobutamine (DOB) and a vasodilator] as a predictor of wall motion reversibility at rest after percutaneous transluminal coronary angioplasty (PTCA) using ultrafast computed tomography (UFCT). Segments with wall motion abnormalities before PTCA were divided into two groups; ie, either with or without collateral flow. Patients were scanned at rest for baseline and again after 5 min of intravenous administration of 4 micrograms/kg per min of DOB after nitroglycerin (0.3 mg sublingually) or isosorbide dinitrate (2.5 mg bolus intravenous injection). Three months after PTCA, patients were scanned again and wall motion was compared with the previous findings. In collateral-dependent segments, the sensitivity of the pharmacological stress test as a predictor of wall motion reversibility was 87.5% and the specificity was 83.3%. In collateral-independent segments, the sensitivity was only 41.7%, while the specificity was 95.2%. Our findings demonstrate that the pharmacological stress test we used satisfactorily predicted wall motion reversibility in collateral-dependent segments, but tended to underestimate wall motion reversibility in collateral-independent segments. Therefore, collateral flow may be an important factor in accurately predicting wall motion reversibility by this pharmacological stress test.     

Topic overviews and processing of topic structure.

In 3 experiments, the authors investigated the information included in a topic overview that is accessed during reading. In each experiment, participants read on a computer, 3 expository passages that discussed 6 topics related to a common theme. The type of information found in the overview was manipulated. In all experiments, the presence of topic but not order information (i.e., order of topic appearance) led to faster topic sentence reading times regardless of whether participants read to glean general information from the passage or to attend specifically to the topic structure. Analyses of reading times on sentences indicating a shift in topic revealed that information about global passage structure was also encoded from the overview even in the absence of specific topic structure information. The General Discussion focuses on the type of information readers encoded from overviews as well as mechanisms by which overview information may be accessed during reading. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Topical corticosteroids for mycosis fungoides. Experience in 79 patients

Lupin is toxic because of its alkaloid content, sparteine and lupanine in particular. Although the pharmacological properties of sparteine are well known those of lupanine have not been much studied. This paper reports procedures for extraction, purification and crystallization of lupanine, and methods for the preparation of an extract for injection of Lupinus mutabilis Sweet, and for the determination of the acute toxicity and maximum non-lethal dose (DL0) of lupanine, sparteine and lupin extract in the mouse. The three substances were tested on the central nervous system (CNS) for locomotor activity, for interaction with specific drugs used for treatment of the CNS (the stimulant drugs amphetamine and pentetrazol and the depressant drugs pentobarbital and chlorpromazine) and for analgesic activity. The results indicate that lupanine and lupin extract are less toxic than sparteine and that at the doses studied the three products have a weak sedative effect on the CNS.     

Topical NSAIDs for musculoskeletal conditions. A review of the literature

In recent years a growing number of topical nonsteroidal anti-inflammatory drugs (NSAIDs) have become available. This has been prompted in large part by the high incidence of serious gastrointestinal adverse events associated with the use of systemic NSAIDs, and the premise that minimisation of plasma concentrations of active drug may result in fewer systemic adverse effects. Evidence in humans and animals with topical NSAIDs demonstrates lower plasma concentrations than with systemically administered drugs, while those in soft tissues are still of a magnitude considered consistent with exerting an anti-inflammatory effect. In joints, however, the evidence is less strong, and there is still dispute whether in this case the drug reaches the joint predominantly via the transcutaneous or systemic route. There has been a sufficient number of studies of soft tissue conditions to demonstrate the superiority of topical NSAIDs over placebo and to suggest equivalent efficacy in comparison with some oral NSAIDs. For arthropathies, however, the literature is more sparse. Although several studies claim a benefit for topical NSAIDs against placebo, the results are less conclusive and further study is required. Trials of topical agents against intra-articular corticosteroids and rubefacients are either lacking or inconclusive. The adverse event profile of topical agents is reasonable: minor cutaneous effects occur in up to 2% of patients but tend to be self-limiting. Gastrointestinal events appear from the existing literature to be infrequent and minor, although long term studies are required. Bronchospasm and renal impairment have been reported and may be more frequent in patients who have experienced these effects with oral agents. The initial costs of topical agents tend to be higher than those of oral agents but a cost-effectiveness analysis suggests an overall benefit: this issue requires further clarification.     

Counselor's empathy level and client topic changes.

Tested the hypothesis that client-introduced topic changes follow a reduction in counselor's level of empathy. Empathy ratings were made by 2 experienced judges for 27 counselor statements made prior to topic change and for 27 randomly selected counselor statements. These ratings were compared with the average empathy rating for the counseling interview. In 22 of the 27 statements made prior to topic change, the empathy rating was lower than the interview average. This was true for only 13 of the 27 randomly selected statements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integration of topic and subordinate information during reading.

Four experiments examined how readers integrate subordinate information with relevant context as they read. Ss read texts a sentence at a time with occasional interruptions lasting 30 sec. Following a distractor task, they resumed reading after being reminded of the topic sentence of the last paragraph they read (topic cue condition), being reminded of the last sentence they had read (local cue condition), or receiving no reminder of what they had been reading (no cue condition). Reading times on the 1st sentence following interruption were faster in the topic and local cue conditions than in the no cue condition (1) when the topic and local cues supplied missing referents for the target sentences, (2) when the target sentences were written to be understood as independent statements, and (3) whether the target sentences were embedded in short or long texts. Results are interpreted as demonstrating that readers integrate subordinate information with relevant topics, as well as with the immediate local context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of signaling topic structure on text recall.

Two experiments studied effects of signaling devices (headings, overviews, and summaries) on text memory. In Exp 1, Ss read a text with or without signals, then recalled the topics of the text. Signaling produced better memory for the topics and their organization. In Exp 2, Ss recalled the content of the text they read, and recalls were scored for the number of accurately recalled ideas. Signals produced recalls that were better organized by text topics. Signals also influenced the distribution of recall of ideas: Ss remembered more topics but recalled less about each accessed topic if the text they read contained signals than if it did not. The results are interpreted as supporting a model in which signals influence readers' representations of a text's topic structure, which, in turn, is used to guide the recall of text content. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multimodality treatment for retinoblastoma in children

A comprehensive programme was developed for the treatment of uni- and bilateral retinoblastoma in children with due regard to the disease stage by the TNM system. The use of the current sources of teletherapy and cyclic polychemotherapy expanded indications for organ-saving therapy at most common stages. Treatment by the program was performed in 202 patients, including 125 children with unilateral damage and 77 with bilateral damage. An attempt made treat 140 (75%) children at the first stage. More than 70% of cases were diagnosed as having disease stage T3 in one or two stage, while such patients underwent ocular enucleation. A complete or partial (more than 50%) tumor regression without signs of its progression for 2 years or more was achieved in 62% of cases. At the first stage of therapy, conservative therapy insignificantly affected the children's longevity in uncomplicated cases, which is particularly important in bilateral involvement, while this preserved the organ of vision in more than half the patients (62%). Five-year survival was 92 and 82% in unilateral retinoblastoma surgically treated and untreated, 83 and 84%, respectively. Adequate multimodality treatment brought about low incidence rates of recurrence and metastasis (10%) in conservative therapy and 7.7% among all patients.     

Multidrug resistance protein (MRP) expression in retinoblastoma correlates with the rare failure of chemotherapy despite cyclosporine for reversal of P-glycoprotein

Failure of chemotherapy associated with expression of the multidrug resistance protein p170 frequently occurs in retinoblastoma (RB). Despite using cyclosporine, which inhibits p170 and improves our chemotherapy results, rare failures occur. In nonmetastatic primarily enucleated RBs, we show expression of p170 in 3 of 18 samples and expression of multidrug resistance protein (MRP), the second protein associated with resistance to chemotherapy, in 1 of 18 samples. All three RBs that failed chemotherapy without cyclosporine expressed MRP with p170. All three RBs that were enucleated immediately when chemotherapy failed despite the addition of cyclosporine expressed only MRP. One RB enucleated 2 years after failing chemotherapy with cyclosporine, despite radiation and salvage chemotherapy, expressed both p170 and MRP. Two metastatic RBs that expressed both p170 and MRP at diagnosis and at recurrence failed chemotherapy without cyclosporine, whereas one metastatic RB that expressed neither protein was cured by chemotherapy without cyclosporine. MRP may result in failure of chemotherapy despite the elimination of p170-expressing clones by cyclosporine.     

History of retinoblastoma

The author presents a brief account on the development of knowledge regarding the clinical picture, diagnosis, dynamics of the disease, surgical and conservative therapy of the most serious intraocular malignity of child age. He emphasizes the contribution made by different authors, starting in 1597 when Pawius published the first account of an autopsy of a child affected with the tumour. He emphasizes the biological importance, the affection of the optic nerve by the tumour, the vital importance of early enucleation, the importance of distant resection of the optic nerve during removal of the eye and the importance and contribution of conservative treatment for the vital perspective of affected children.     

Empathy: An unneglected topic in psychological research.

Answers K. B. Clark's (see record 1980-09677-001) argument that empathy has been neglected as a topic by stating that empathy has not been neglected, nor have the fundamental problems that Clark identified. Clark's assumption that empathy leads to prosocial or helping behavior is critiqued in terms of recent research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Topical treatments for photoaged skin. Separating the reality from the hype

Most patients have committed the usual folly of recreational sunbathing in childhood, and in adulthood they notice the manifestations in the mirror. Increasingly, they are seeking professional advice regarding the growing stream of products that promise to improve their photoaged skin. Physicians need to be informed about the great range and complexity of products available, if for no other reason than to steer patients clear of traveling-medicine-show products. A better reason is to be able to provide guidance on proper use of formulations that have proven benefit.     

一种面向网络长文本的话题检测方法

提出了一种面向网络长文本的话题检测方法.针对文本表示的高维稀疏性和忽略潜在语义的问题,提出了Word2vec&LDA（latent dirichlet allocation）的文本表示方法.将LDA提取的文本特征词隐含主题和Word2vec映射的特征词向量进行加权融合既能够进行降维的作用又可以较为完整的表示出文本信息.针对传统话题发现方法对长文本输入顺序敏感问题,提出了基于文本聚类的Single-Pass&HAC（hierarchical agglomerative clustering）的话题发现方法,在引入时间窗口和凝聚式层次聚类的基础上对于文本的输入顺序具有了更强的鲁棒性,同时提高了聚类的精度和效率.为了评估所提出方法的有效性,本文从某大学社交平台收集了来自真实世界的多源数据集,并基于此进行了大量的实验.实验结果证明,本文提出的方法相对于现有的方法,如VSM（state vector space model）、Single-Pass等拥有更好的效果,话题检测的精度提高了10%~20%.