Modern brachytherapy: current state and future prospects

This article reviews the current trends and future developments in brachytherapy. Established techniques including interstitial and high-dose rate brachytherapy are discussed with particular reference to lung, oesophageal, cervical and endometrial cancer. Intra-operative high-dose rate brachytherapy and other new techniques are also mentioned.     

Antiviral agents in dermatology: current status and future prospects

The majority of current antiviral agents have become available only during the past decade. The above mentioned antiviral drugs, especially the viral-TK-specific agents have attempted to bring antiviral therapy on par with antimicrobial therapy. The fact, that cells infected with viruses can be selected against the relatively low toxicity to the patient, highlights the present state of antiviral therapy. Since viral infection can be viewed as an integral component of the self (i.e., a condition that cannot simply be surgically eliminated), the science of medicine is turning to the components of the self to overcome such conditions. By administering immune-system-derived agents (e.g., interferons) or compounds that stimulate the immune system (e.g., adjuvants like imiquimod), previously unmanageable conditions become manageable. The future of antiviral therapy will undoubtedly be at the molecular level. With greater understanding of the virus and the immune system with which it interacts, more specific and efficacious antiviral agents will be added to the arsenal of the clinician.     

Breast cancer immunotherapy: current status and future prospects

The development of an immunotherapeutic approach to cancer is the concern for many immunologists, but despite the impressive progress over the past decade, such as the identification of tumour antigens and antigenic peptides as potential targets, there are still many obstacles in eliciting an effective immune response to eradicate cancer. Mucins have attracted interest as potential targets for immunotherapy in the development of vaccines for cancers expressing Mucin1 (MUC1; e.g. breast, pancreas, ovary etc.). All of the identified targets for cancer, including MUC1, are normal proteins; however MUC1 expressed on tumours can be considered as tumour specific due to their overexpression, altered glycosylation and its ubiquitous distribution on the cell surface rather than at the secretory pole in adenocarcinomas. These observations have led to the development of several different approaches to immunize against breast cancer using synthetic carbohydrates or peptides conjugated to carriers and given together with a variety of adjuvants to elicit the appropriate immune response. Mannan, a polymannose carbohydrate isolated from the cell wall of yeast, is an appropriate and effective protein carrier for eliciting a cellular (T1-type) or humoral (T2-type) immune response depending on the mode of conjugation (oxidized or reduced). In addition, mannan holds promise and opens many avenues as a carrier for vaccine development for other antigens. Several clinical trials are in progress to evaluate the immunogenicity of MUC1 and its suitability as to use for immunotherapy/vaccine for breast cancer.     

African neurosurgery part II: current state and future prospects

A survey conducted among African neurosurgeons shows that there are now 500 neurosurgeons in Africa; that is, one neurosurgeon for 1,350,000 inhabitants, and 70,000 km2. The distribution of these neurosurgeons shows a striking regional disparity: North Africa has 354 neurosurgeons for 119 million inhabitants; that is, one neurosurgeon for 338,000 inhabitants; and South Africa has 65 neurosurgeons for 40 million inhabitants; that is, one neurosurgeon for 620,000 inhabitants. Between these two areas where neurosurgery is developing quite well, we have the majority of African countries with a scant density of neurosurgeons (81 neurosurgeons for 515 million inhabitants; that is, one neurosurgeon for 6,368,000 inhabitants). The Panafrican Association of Neurological Sciences (PAANS) brings together African neurosurgeons. This continental African association represents African neurosurgeons in the World Federation of Neurosurgical Societies (WFNS). In addition to this continental association, there are national societies of neurosciences. However, there are only six societies of neurosurgery. Two systems of training exist in Africa: (1) local training, and (2) training abroad. These two systems have unequal quality and specific difficulties that are pointed out. Among the optimistic elements that make us believe in the development of neurosurgery in Africa, are the existence of a quite good level of neurosurgery at the two extremities of the continent (North Africa and South Africa), the development of neurosciences in African universities, and the increasing interest that the international community bears to Africa in the last years. However, the real factor of optimism is the African neurosurgeons who should promote neurosurgery in their continent, at the level of their own countries by developing information and health education, setting their specialty in the education syllabus and health planning, and settling into active and performing societies. At the continental and international level, African neurosurgeons should institutionalize inter-African cooperation, expedite their continental association (PAANS), and further exchanges with the other continents through the WFNS. The latter, together with other associations such as the European Association of Neurosurgical Societies (EANS) could provide help to the development of neurosurgery in Africa as far as training, exchanges, research, and organization are concerned.     

Medicare's end-stage renal disease program: current status and future prospects

The twenty-five years of the end-stage renal disease (ESRD) program have been characterized by remarkable clinical achievements, which have prolonged and improved the quality of life for thousands of patients. As the program enters the next millennium, it faces considerable challenges: As the number and acuity of patients increase, the availability of trained nephrologists will decrease, and total costs will continue to rise. Policymakers will need to work closely with the renal professional and patient communities to develop creative approaches to delivering and financing ESRD care that is of the highest quality, yet is affordable.     

The genetics of Alzheimer disease: current status and future prospects

BACKGROUND: Laparoscopic hysterectomy and lymph node dissection have lately been reported as an alternative to an abdominal open procedure for the treatment of malignant gynaecological conditions. The laparoscopic operative technique has been evaluated and compared as to whether it is a safe, feasible and effective procedure. SUBJECTS: The study includes 78 women with indications for surgery for endometrial cancer stage I. A retrospective comparative study was undertaken at Baby Friendly Hospital, Kladno, in which 11 patients treated laparoscopically were compared with 26 patients treated by the open procedure of lymphadenectomy. We evaluated differences in the peri-and postoperative outcomes. RESULTS: All 11 procedures were successfully completed. The mean operating time was 153 min, and mean blood loss was 130 ml. The median hospital stay was 4.7 days. There were no major complications. CONCLUSIONS: Laparoscopic hysterectomy and lymphadenectomy seem to be the procedures which result in a shorter hospital stay and rapid recovery. This approach could potentially decrease morbidity historically associated with hysterectomy and lymphadenectomy performed abdominally. Only prospective randomised studies will be able to demonstrate the ability of operative laparoscopy to improve contemporary management of endometrial cancer.     

Transplantation of fetal tissues in otorhinolaryngology: current status and prospects for the future

The Welfare of Sick Children in Hospital' was the formal title of a report published in Britain in 1959 which came to be known as the Platt Report, after Sir Harry Platt, the chairman of the parliamentary committee which investigated the care of children in hospital. The committee found the hospitals were miserable places for children, where they were expected to conform to ward routines, not allowed to play; where to lie quietly was the accepted norm, and where, under no circumstances, were the parents allowed to visit outside the declared visiting hours. Subsequent to the publication of the Platt Report a revolution occurred in children's hospitals in Britain and other western countries, including Australia. This paper explores these changes, and discusses implications for paediatric care in hospitals and paediatric nursing education today.     

Management of hormone refractory prostate cancer: current standards and future prospects

PURPOSE: Recent advances in the biology and treatment of hormone refractory prostate cancer are reviewed. MATERIALS AND METHODS: A MEDLINE literature search of secondary hormonal therapy and chemotherapy for hormone refractory prostate cancer was performed. Recent advances in the biology of hormone refractory prostate cancer, changes in the measurement of response to therapy, and testing of new drugs and combinations of drugs were reviewed. RESULTS: Historically the treatment of hormone refractory prostate cancer has been disappointing. Useful parameters to monitor clinical response have been lacking but perhaps more importantly a scarcity of apparently active drugs has contributed to these results. Recently several developments have improved the outlook for treatment of hormone refractory prostate cancer. Recognition of antiandrogen withdrawal responses has had important ramifications for clinical trial interpretation and patient care. Secondary hormonal therapies, such as alternative antiandrogens and anti-adrenal agents, are well tolerated and can provide significant clinical benefits. Combining prostate specific antigen values with quality of life and measurable disease responses has made clinical trial end points more objective and more clinically relevant for the patient. Furthermore, a better understanding of the biology of hormone refractory prostate cancer, refinements in measuring response to treatment and availability of agents with proved palliative capabilities and/or generating greater than 50% response have all lead to improvements in treatment management. In 2 randomized studies mitoxantrone in combination with steroids has demonstrated significant palliative benefit compared with steroids alone. In phase II studies more than half of patients respond to estramustine combinations with vinblastine, etoposide or paclitaxel. Other novel combinations and new drugs currently are being tested. CONCLUSIONS: Recent advances suggest that available therapies for hormone refractory prostate cancer can have a meaningful impact on the disease. Improving treatment of hormone refractory prostate cancer remains an area of active investigation.     

The dopamine hypothesis of schizophrenia: current status, future prospects

The dopamine hypothesis of schizophrenia is reviewed in the context of recent advances in dopamine research. These include the following: the discovery that there are several subtypes of dopamine receptor, the recognition that the activity of dopamine neurons is controlled by negative feedback systems; insights into the functions of different subsystems of dopamine neurons; the discovery that different subsystems of dopamine neurons interact with one another; and a growing understanding of the functions and mode of operation of the forebrain regions that the dopamine projections innervate. The paper reviews some of the complexities that the dopamine hypothesis has encountered, and continues to encounter, with a particular focus on three issues: the adequacy of our understanding of neuroleptic drug action, the heterogeneity of schizophrenic symptoms and the paucity of direct evidence to support the hypothesis. It is concluded that schizophrenia does not reflect primary abnormalities of dopamine transmission, but probably does reflect abnormalities in systems that have an intimate interaction with the dopamine system. The primary substrates for schizophrenia will probably be found within the major targets of the ascending dopamine projections: the fronto-striato-pallido-thalamic loops, and the limbic structures, such as amygdala and hippocampus, with which the fronto-striatal system interacts.     

HIV prevention case management: current practice and future directions

The NIMH Genetics Initiative is a multi-site collaborative study designed to create a national resource for genetic studies of complex neuropsychiatric disorders. Schizophrenia pedigrees have been collected at three sites: Washington University, Columbia University, and Harvard University. This article-one in a series that describes the results of a genome-wide scan with 459 short-tandem repeat (STR) markers for susceptibility loci in the NIMH Genetics Initiative schizophrenia sample-presents results for African-American pedigrees. The African-American sample comprises 30 nuclear families and 98 subjects. Seventy-nine of the family members were considered affected by virtue of having received a DSMIII-R diagnosis of schizophrenia (n = 71) or schizoaffective disorder, depressed (n = 8). The families contained a total of 42 independent sib pairs. While no region demonstrated evidence of significant linkage using the criteria suggested by Lander and Kruglyak, several regions, including chromosomes 6q16-6q24, 8pter-8q12, 9q32-9q34, and 15p13-15q12, showed evidence consistent with linkage (P = 0.01-0.05), providing independent support of findings reported in other studies. Moreover, the fact that different genetic loci were identified in this and in the European-American samples, lends credence to the notion that these genetic differences together with differences in environmental exposures may contribute to the reported differences in disease prevalence, severity, comorbidity, and course that has been observed in different racial groups in the United States and elsewhere.     

School psychology: The current state of practice and future practice of the specialty.

Defines 6 conceptual issues that form a partial basis for the practice of school psychology and delineates 16 domains of competence that may be necessary for the effective practice of school psychology. These issues and domains of competence present a frame of reference for future practice and training that differs from current approaches. An example illustrates the implications of these factors for future practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

高炉炼铁技术创新实践及未来展望

 炼铁工业已迈入绿色化、智能化发展之路。中冶赛迪根据多年冶金技术研发与工程实践,在高效、长寿高炉领域取得了一系列成果,开发了多项低耗低碳冶炼技术,助力炼铁工业的绿色化发展。同时,将智能化作为引领炼铁技术从传统工业向高质量发展的重要引擎,基于冶金工程流程学理论,创建了全球首个铁区一体化智能管控平台,未来将进一步运用大数据、人工智能、数字孪生和数学模型,打造新一代智慧高炉,并大力开发氢冶金等低碳炼铁新工艺技术,朝着绿色炼铁的新目标前进。     

Techniques of MRI cholangiopancreatography. History, current status and future prospects

This study investigates the effects of long-term passive heat exposure and a 16-week basic military training program on heat acclimatization. Thirty recruits were tested on the zero (T1), 2nd (T2), 6th (T3), and 16th (T4) weeks of the basic military training program. The trials involved 1 hour of marching on a treadmill at 5.5 km h-1, with a 5% gradient. The subjects wore their camouflage uniforms during the trials, with simulated combat loads. The trials were conducted in a climatic chamber programmed at 32 degrees C, 60% relative humidity, 900 Wm-2 of simulated solar radiation, and wind speed of 3 m s-1. There was no fluid replacement during the trials. Because only 9 subjects attended all the trials, the results presented are based on these subjects. No significant difference was found in mean skin temperature in all the four trials. Tympanic temperature was significantly reduced (p < 0.05) only at 20 minutes. Pairwise analysis was significant (p < 0.05) only between T1 (37.18 +/- 0.38 degrees C) and T4 (36.48 +/- 0.53 degrees C). Average body temperature was significantly different only at 10 and 60 minutes (p < 0.05). A significant pairwise difference (p < 0.05) was found only between T1 (36.61 +/- 0.33 degrees C) and T4 (36.07 +/- 0.46 degrees C) in 10 minutes. No pairwise difference was found at 60 minutes. Mean heart rate (HR) was significantly reduced during the 16 weeks at 10, 20, and 30 minutes. Mean HR at 10 minutes was reduced from 152.11 +/- 14.18 beats min-1 in T1 to 130.78 +/- 10.43 beats min-1 in T4 (p < 0.001). Mean HR at 20 and 30 minutes was reduced from 156.11 +/- 17.74 beats min-1 (T1) to 137.25 +/- 11.42 beats min-1 (T4) (p < 0.001), and from 157.14 +/- 15.77 beats min-1 (T1) to 146.11 +/- 12.64 beats min-1 (T4) (p < 0.05). There was no significant difference in sweat loss and mean sweat rate during the 16 weeks. This study concluded that long-term passive heat exposure was effective at inducing heat acclimatization in terms of tympanic temperature, average body temperature, mean skin temperature, sweat loss, and mean sweat rate, but not in terms of HR. Physical training was still necessary to induce further adaptation in HR. The limiting factor to task completion during the trials was physical fitness rather than beat fitness.     

The technology of CO2 sequestration by mineral carbonation: current status and future prospects

Mineral carbonation (MC) has been extensively researched all over the world since it was found as a naturally exothermic process to permanently sequester CO₂. In order to accelerate the natural process, various methods for carbonation of Mg-/Ca- silicate minerals have been studied. It has been found that the MC efficiency will increase with an increase in CO₂ pressure, retention time, temperature, mass ratio of Mg/Ca to Si in minerals, specific surface area, and the slurry concentration in a specific range, and with the introduction of NaCl and NaHCO₃ or carbonic anhydrase. However, there is still no successful industrial application because of high economic costs and slow reaction rate. It is not economic to exploit Mg-/Ca- silicate minerals deposits or tailings to sequester CO₂ by the MC due to the cost of grinding and heat pre-treatment. In some cases, the whole sequestration process may result in more CO₂ emissions than the sequestered CO₂ due to the requirements of energy inputs. The process, however, may be profitable as a whole (with carbon credits). It is suggested to combine the MC with valuable metals recovery from ore deposits in order to reduce the cost of the MC by cost sharing for mineral recovery.     

Fertility in Botswana: the recent decline and future prospects

Recent estimates of fertility in Botswana suggest a rapid decline of more than two births per woman between 1981 and 1988. This paper proposes that the baseline fertility was overestimated but that nonetheless fertility declined by about one birth per woman during the 1980s. The decline in fertility was linked to a deterioration in social and economic conditions caused by a major drought in the early 1980s and to the increased availability of family planning services in the same period. Fertility apparently began to rebound in the late 1980s in response to improved conditions, which came about as a result of a successful drought relief program. Future declines in fertility depend on the continued success of the family planning program, particularly in rural areas.     

Synthesis and future prospects

Peripheral venous tumors are uncommon and their delayed clinical expression leads to poor prognosis. We report a series of 7 cases including 6 leiomyosacromas and 1 hemangioendothelioma. Duplex Doppler and MR imaging appeared to be best suited for diagnosis, allowing an evaluation of extension and an analysis of associated endoluminal thrombi. These imaging techniques help guide surgery and improve prognosis.     

Obstructive sleep apnea syndrome in the Community of Valencia: current situation, study of needs and future prospects]

Experimental simian varicella virus (SVV) infection of St. Kitts vervet monkeys was evaluated as an animal model to investigate human varicella-zoster virus (VZV) infections. During the incubation period, viremia disseminated infectious virus throughout the body via infected peripheral blood lymphocytes (PBLs). A vesicular skin rash in the inguinal area, and on the abdomen, extremities, and face appeared on day 7-10 postinfection. Necrosis and hemorrhage in lung and liver tissues from acutely infected monkeys were evident upon histologic analysis. Recovery from simian varicella was accompanied by a rise in the serum neutralizing antibody response to the virus. SVV latency was established in trigeminal ganglia of monkeys which resolved the acute infection. This study indicates that experimental SVV infection of St. Kitts vervets is a useful animal model to investigate SVV and VZV pathogenesis and to evaluate potential antiviral agents and vaccines.