Is the chest radiograph a reliable tool in the assessment of tumor response after radiotherapy in nonsmall cell lung carcinoma?

BACKGROUND: The purpose of this study was to evaluate whether the chest radiograph is a reliable tool to assess response to radiotherapy. MATERIALS AND METHODS: Pre- and post-treatment chest radiographs and computed tomographs (CT) of 63 patients with nonsmall cell lung cancer (NSCLC) treated by radiotherapy were reviewed by four observers with regard to suitability for tumor measurement, and response. Suitability for tumor measurement was expressed as the number of measurable diameters. In addition, the consequences to clinical outcome were studied by survival analysis. RESULTS: The CT turned out to be more suited for tumor measurement before as well as after radiotherapy, resulting in an increase of the number of measurable cases. The number of measurable cases with CT was 52 (83%) as compared to 28 (44%) with chest radiography. Especially in case of centrally localized tumors, the presence of an atelectasis, or squamous cell carcinoma, CT contributed to a higher rate of measurable cases. The interobserver agreement with regard to response using chest radiograph was good (mean kappa = 0.74). In 25 of 28 cases (89%) measurable with CT as well as with chest radiograph, response was equally classified. When CT was used, the median survival of the responders was 14.2 months as compared to 6.8 months of the nonresponders. When chest radiograph was used, the median survival of these groups was 12.0 and 6.6 months respectively, which was not significantly different when response was assessed by CT. CONCLUSION: We conclude that CT is more suited for tumor measurement because more measurable lesions can be found and more evaluable lesions on chest radiograph become measurable on CT. The chest radiograph does have a valuable role to play in those lesions that are measurable because of the good interobserver agreement with regard to the response classification, the high overall agreement between CT and chest radiograph in case of measurable cases, and the lack of important differences with regard to survival.     

Predicting neurologic deterioration in patients with cerebellar hematomas

BACKGROUND: Patients with cerebellar hematomas may appear stable but may worsen suddenly. Whether certain clinical or CT scan findings predict worsening is not known. METHODS: We reviewed clinical and neuroimaging data in 72 patients with cerebellar hematomas at the Mayo Clinic from 1973 through 1993 to identify predictive features for neurologic deterioration. Patients presenting in coma and patients with vascular malformations or malignancies were excluded. Data were analyzed using chi-square or Fisher's exact test, with calculation of odds ratios with 95% confidence intervals. Multivariate logistic regression analysis was performed on appropriate variables. RESULTS: Thirty-three patients (46%) deteriorated, with a decrease in level of consciousness, new brainstem signs, or worsened motor response on the Glasgow Coma Scale. Clinical and neuroradiologic predictors for neurologic deterioration at p < 0.05 were admission systolic blood pressure greater than 200 mm Hg, pinpoint pupils and abnormal corneal or oculocephalic reflexes, hemorrhage extending into the vermis, hematoma size more than 3 cm in diameter, brainstem distortion, intraventricular hemorrhage, upward herniation, and acute hydrocephalus. Multivariate analysis demonstrated that hemorrhage located in the vermis (p = 0.03) and acute hydrocephalus (p = 0.0006) on admission CT scanning independently predicted deterioration. CONCLUSION: Patients with a cerebellar vermian hematoma or acute hydrocephalus are at high risk for neurologic deterioration. These patients should be carefully monitored and are more likely to require consideration for neurosurgical intervention.     

Autoimmunity, immunodeficiency and mucosal infections: chronic intestinal inflammation as a sensitive indicator of immunoregulatory defects in response to normal luminal microflora

Despite the fact that target antigens and the genetic basis of several autoimmune diseases are now better understood, the initial events leading to a loss of tolerance towards self-components remain unknown. One of the most attractive explanations for autoimmune phenomena involves various infections as possible natural events capable of initiating the process in genetically predisposed individuals. The most accepted explanation of how infection causes autoimmunity is based on the concept of "molecular mimicry" (similarity between the epitopes of an autoantigen and the epitopes in the environmental antigen). Infectious stimuli may also participate in the development of autoimmunity by inducing an increased expression of stress proteins (hsp), chaperones and transplantation antigens, which leads to abnormal processing and presentation of self antigens. Superantigens are considered to be one of the most effective bacterial components to induce inflammatory reactions and to take part in the development and course of autoimmune mechanisms. It has long been known that defects in the host defense mechanism render the individual susceptible to infections caused by certain microorganisms. Impaired exclusion of microbial antigens can lead to chronic immunological activation which can affect the tolerance to self components. Defects in certain components of the immune system are associated with a higher risk of a development of autoimmune disease. The use of animal models for the studies of human diseases with immunological pathogenesis has provided new insights into the influence of immunoregulatory factors and the lymphocyte subsets involved in the development of disease. One of the most striking conclusion arising from work with genetically engineered immunodeficient mouse models is the existence of a high level of redundancy of the components of the immune system. However, when genes encoding molecules involved in T cell immunoregulatory functions are deleted, spontaneous chronic inflammation of the gut mucosa (similar to human inflammatory bowel disease) develops. Surprisingly, when such immunocompromised animals were placed into germfree environment, intestinal inflammation did not develop. Impairment of the mucosal immune response to the normal bacterial flora has been proposed to play a crucial role in the pathogenesis of chronic intestinal inflammation. The use of immunodeficient models colonized with defined microflora for the analysis of immune reactivity will shed light on the mode of action of different immunologically important molecules responsible for the delicate balance between luminal commensals, nonspecific and specific components of the mucosal immune system.     

Carbohydrate chromatography: towards yoctomole sensitivity

Ward atmosphere was assessed with the help of the Ward Atmosphere Scale (WAS) by patients, nurses and physicians on 8 admission units before and after the introduction of the partial open door system. On average, on 45% of the days on which the units could have been potentially open, they were indeed at least temporarily open. Several significant changes in the WAS scores, mostly in desirable direction, were registered. However, close relationship with the partial opening of the units could be substantiated only with regard to the scale "praxis orientation"; still a positive result. No unequivocal relationships could be demonstrated between the introduction of the partial open door system and the changes in the frequency of "special events".     

Human oogenesis in organ culture

The authors compared the extent of development of the germ cells of the human fetus ovaries developing in the organ culture and of control ovaries obtained of fetuses of "equivalent" age. The capacity to enter the meiosis prophase under conditions of the organ culture was expressed by the germ cells of fetuses of 8-9 week of gestation, and older; only individual oocytes reached the leptotene stage in the explants of the ovaries of 7-8 week fetuses. The oocytes at the leptotene, zygotene and pachitene stage appeared in the culture at the same periods as in the organism. However, the percentage of cells of these stages in the explant was as a rule lower than in control ovaries. In case of pulse administration of thymidine-3H into the culture labeled oocytes at the zygotene stage appeared in 4, and at the pachitene stage - in 14 days.     

Criticality and Environmental Uncertainty in Step-Level Public Goods Dilemmas.

The author examined a public goods (PG) dilemma with environmental uncertainty in a sequential protocol of play paradigm. Using a 5-person game, Experiment 1 examined provision point (PP) uncertainty and found that a certain PP requiring 3 contributors produced the PG more frequently than an uncertain PP of the same expectation that varied uniformly among 2, 3, and 4 contributors. Fixing PP at 3, Experiment 2 showed that PG provision rate was higher with a certain group size of 5 persons than an uncertain group size of the same expectation that varied uniformly among 4, 5. and 6 persons. Further analyses showed that a fear of wasting one's contribution and pessimistic beliefs of environmental uncertainty could have undermined contribution. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural interaction of natural and synthetic inhibitors with the venom metalloproteinase, atrolysin C (form d)

The structure of the metalloproteinase and hemorrhagic toxin atrolysin C form d (EC 3.4.24.42), from the venom of the western diamondback rattlesnake Crotalus atrox, has been determined to atomic resolution by x-ray crystallographic methods. This study illuminates the nature of inhibitor binding with natural (< Glu-Asn-Trp, where < Glu is pyroglutamic acid) and synthetic (SCH 47890) ligands. The primary specificity pocket is exceptionally deep; the nature of inhibitor and productive substrate binding is discussed. Insights gained from the study of these complexes facilitate the design of potential drugs to treat diseases where matrix metalloproteinases have been implicated, e.g., arthritis and tumor metastasis.     

FDTD simulation of TE and TM plane waves at nonzero incidence in arbitrary Layered media

Plane wave scattering is an important class of electromagnetic problems that is surprisingly difficult to model with the two-dimensional finite-difference time-domain (FDTD) method if the direction of propagation is not parallel to one of the grid axes. In particular, infinite plane wave interaction with dispersive half-spaces or layers must include careful modeling of the incident field. By using the plane wave solutions of Maxwell's equations to eliminate the transverse field dependence, a modified set of curl equations is derived which can model a "slice" of an oblique plane wave along grid axes. The resulting equations may be used as edge conditions on an FDTD grid. These edge conditions represent the only known way to accurately propagate plane wave pulses into a frequency dependent medium. An examination of grid dispersion between the plane wave and the modeled slice reveals good agreement. Application to arbitrary dispersive media is straightforward for the transverse magnetic (TM) case, but requires the use of an auxiliary equation for the transverse electric case, which increases complexity. In the latter case, a simplified approach, based on formulating the dual of the TM equations, is shown to be quite effective. The strength of the developed approach is illustrated with a comparison with the conventional simulation based on an analytic incident wave specification with half-space, single frequency reflection and transmission for the edges. Finally, an example of a possible biomedical application is given and the implementation of the method in the perfectly matched layer region is discussed.