Intraoperative irradiation: current and future status

Intraoperative radiation therapy (IORT) in its broadest sense refers to the delivery of irradiation at the time of an operation. This article will discusses the rationale for and results of both intraoperative electron radiation therapy and intraoperative high dose rate brachytherapy when used in conjunction with surgical exploration and resection and external beam radiation therapy and chemotherapy. Both IORT methods evolved with similar philosophies as an attempt to achieve higher effective doses of irradiation while dose limiting structures are surgically displaced.     

Oral cancer: current status and future hope

Lasers hve been used experimentally for nearly 40 years. Most applications in dentistry maintain use in oral and periodontal pathology. The use of lasers as an adjunct therapy in a general dental practice has recently been considered within the last 5 years. This article will consist of a literature review of the most recent applications in a clinical dental practice.     

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.     

Prenatal medicine: development, current status and future perspectives

Prenatal diagnosis and therapy are based mainly on the progress of diagnostic ultrasound and laboratory methods in genetics. There is a general tendency to replace second trimester fetal diagnoses by first trimester approaches. Transvaginal sonography and chorionic villus sampling in particular have been proven helpful in this context. The aim of all prenatal diagnostic measures is fetal therapy in time to prevent untreatable abnormalities. There has been some progress in this area; in particular, the application of stem cells for the correction of single cell diseases seems to be promising. Because all prenatal interventions involve a risk to the mother and especially the fetus, there is a concentrated effort to develop non-invasive screening or diagnostic methods. Extensive work on the isolation of fetal cells from the maternal circulation has revealed that such cells are present physiologically in pregnancy, but further trials need to show whether this method is safe enough for routine diagnostic use.     

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.     

Twenty years of cognitive assessment: current status and future directions

This commentary examines a number of methodological and conceptual issues that were raised in this special section on cognitive assessment. Although progress has been made in a number of areas since cognitive-clinical researchers first addressed the assessment of cognition almost 20 years ago, important conceptual and methodological questions still remain unresolved. These include questions about the validity of retrospective self-report questionnaires of cognition, the low convergent validity between different assessment methods, and the failure to specify the range of generalizability of specific cognition measures. Further advances in cognitive assessment will depend on a more concerted research focus on the methodological and conceptual issues raised in this special section.     

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.     

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.     

Everyday competence in later life: current status and future directions

This article reviews the literature on the antecedents and outcomes of everyday competence in later life and discusses future directions. It is argued that there is a fairly solid knowledge base with regard to the antecedents and outcomes but not in terms of the components and mechanisms of older adults' everyday competence. Five key issues are identified and discussed in terms of a future research agenda. For each key issue, directions for future research are outlined and a transactional approach is advocated. It is emphasized that older adults should be viewed as proactive individuals who are motivated to minimize the losses and maximize the gains associated with the aging process.     

乳腺癌抗血管生成治疗:现状与前景

Tumor angiogenesis plays an important role in the growth, invasion and metastasis of breast cancer, therefore recently a very active area of breast cancer research involves the addition of antiangiogenic therapy. Numerous clinical studies for several antiangiogenic agents have recently been conducted in breast cancer patients and have shown clinically significant improvement in outcomes. This review gives a brief background to breast cancer angiogenesis, also focusing on current progress in the field of antiangiogenic therapy for breast cancer and issues regarding future therapeutic development.     

Race and serum prostate-specific antigen levels: current status and future directions

The usefulness of thallium-201 (201Tl) myocardial scintigraphy was studied in 109 patients with vasospastic angina who had nearly normal coronary arteries (degree of stenosis < 50%). Coronary spasm was confirmed by pharmacologic agents in all 109 patients from January 1991 to June 1996. The appearance rate of visual redistribution on 201Tl myocardial scintigraphy was compared between four groups, 34 patients performing graded bicycle ergometer exercise starting at a work load of 50 W with increments of 25 W every 3 min [Ergo (3) group], 14 patients performing hyperventilation for 5 min [HV (5) group], 31 patients performing bicycle ergometer exercise with increments of 25 W every 1 min after 5 min hyperventilation [HV (5) + Ergo (1) group], and 30 patients at rest (Rest group). The value of the visual redistribution rate on 201Tl myocardial scintigrams in the HV(5) + Ergo (1) group (65%) was higher than that in the patients of other groups [Ergo (3) 41%, HV (5) 43%, Rest 33%]. However, there were no significant differences between the four groups. Stress 201Tl imaging after hyperventilation and accelerated exercise is useful to disclose ischemic evidence in about two thirds of patients with vasospastic angina and nearly normal coronary arteries, whereas about 40% of patients had visual redistribution on 201Tl myocardial scintigrams by performing standard procedures.     

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.     

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.     

Implantable defibrillator diagnostic storage capabilities: evolution, current status, and future utilization

There has been a rapid and significant evolution in the stored diagnostic information available from implantable cardioverter defibrillators (ICDs). The diagnostic information available in current generation ICDs has greatly enhanced the clinicians' ability to determine the rhythm triggering device therapy as well as to identify potential problems with the ICD system. Furthermore, this information may be useful in identifying triggers of ventricular arrhythmias in patients at high risk for sudden death. The history, evolution, value, and limitations of the stored diagnostic capabilities of implantable defibrillators are discussed.