Radiotherapy of plantar heel spurs: indications, technique, clinical results at different dose concepts

BACKGROUND: In a retrospective study the efficacy of orthovoltage radiotherapy for refractory painful plantar heel spur was analyzed for 3 different radiation dose concepts. PATIENTS AND METHODS: From 1.1 1984 through 1.3.1994, 182 patients with refractory painful heel symptoms and radiologically proven plantar heel spur received radiotherapy. A total of 141 patients and 170 heels (due to double-sided symptoms) were completely documented in long-term follow-up. Clearly defined semi-quantitative criteria (9-point score) were used to analyze heel pain and ankle function prior to RT, 6 to 12 weeks post-radiation, and at last follow-up. The treatment outcome, i.e. (un)favourable response, of 3 radiation dose concepts were compared: Group A (n = 72 heels) received 12 Gy total radiation dose in 3 fractions per week and 2 series (6 x 1 Gy per series) separated by 6 weeks; group B (n = 98 heels) received 3 Gy total radiation dose in 10 fractions of 0.3 Gy (n = 50) or 5 Gy (10 x 0.5 Gy) (n = 48) with conventional fractionation in 1 series. RESULTS: Radiotherapy was very effective: at last follow-up 67% (group A) and 71% (group B) remained completely free of pain. The rate of "complete pain relief" (i.e. free of any pain symptoms) was not different between the 3 radiation concepts. However, significant differences were observed with regard to "incomplete or insufficient pain relief", i.e. a subjective pain relief of less than 80%, a delayed pain relief after more than 4 weeks or a relapse of pain symptoms in long-term follow-up. More favourable results were achieved in patients receiving 5 Gy or 12 Gy total dose, while patients with 3 Gy total dose had significantly worse results. Prognostic factors for "complete pain relief" were short duration of pain symptoms and acute pain symptoms prior to radiotherapy; with regard to "in-complete or insufficient pain relief" the total dose was found to be a prognostic parameter. CONCLUSIONS: Patients with refractory heel pain can yield a high response to radiotherapy even after failing various conventional treatments previously. Thus, radiotherapy should not be solely regarded as a last resort due to its low costs and high efficacy at low radiation doses.     

Progressive subretinal fibrosis and blindness in patients with multifocal granulomatous chorioretinitis

Since women with a first-degree relative with breast cancer are at increased risk for breast cancer, it is of special importance that they adhere to early detection programs. In this study, women with (389) and without (3295) a family history of breast cancer were compared with respect to risk perception, breast cancer anxiety, and early detection behavior. Special attention was paid to the role of knowing that family history is a breast cancer risk factor. It was found that 46% of "family history positives" did not know that their risk was increased by their family history. Still, family history positives had increased risk perception; our results suggest that this was partly caused by their knowing they belonged to a risk group and partly by their having experienced the disease at close range. Although family history positives had higher risk perceptions, no differences in early detection behavior were found. This could not be attributed to high anxiety levels. Implications for health education are discussed.     

Excess false positive rate caused by population stratification and disease rate heterogeneity in case-control association studies

Case-control association studies using unrelated cases and controls may suffer from potential confounding due to population stratification. Bias and variance distortion caused by population stratification in the commonly used allele-based tests can considerably inflate the Type I error rate. It is shown that the bias vanishes in the absence of disease rate heterogeneity. If only population stratification exists, a proper estimate of the variance of the allele-based test statistic is developed. Using this estimated variance yields a valid Type I error. However, when the frequencies of the allele under study and the disease rates differ among the subpopulations, it is difficult to correct for this bias. Explicit expressions for the excess false positive rate (EFPR) of the test due to bias and variance distortion are derived. It turns out that the bias created when both population stratification and disease rate heterogeneity are present usually has a greater effect on the EFPR than variance distortion. Comprehensive simulation studies strongly support these results.     

Proteomic analysis of the response of the human neutrophil-like cell line NB-4 after exposure to anthrax lethal toxin

We used 2‐D DIGE to analyze the early response of NB‐4 cells, a human promyelotic leukemia cell line, exposed to lethal toxin from Bacillus anthracis at the proteome level. After a 2 h exposure, cells were still viable and 43% of spots (n = 1042) showed a significant change in protein level. We identified 59 spots whose expression had changed significantly, and these reflected cytoskeleton damage, mitochondrial lysis and endoplasmic reticulum stress. Actin filament assembly was disrupted as evidenced by an increase in both actin subunits and phosphorylated cofilin, whilst levels of tropomyosin, tropomodulin and actin related protein 2/3 complex subunit decreased. Lower levels of ATP synthase subunits and mitochondrial inner membrane protein were identified as markers of mitochondrial lysis. Levels of various stress response proteins rose and, uniquely, levels of Ca²⁺ binding proteins such as translationally controlled tumor protein rose and hippocalcin‐like protein 1 decreased. This response may have mitigated effects brought about by mitochondrial lysis and endoplasmic reticulum stress, and delayed or prevented apoptosis in NB‐4 cells. These results resemble findings of similar proteomics studies in murine macrophages, although quantitative differences were observed.     

Development of clinical indicators for performance measurement and improvement: an HMO/purchaser collaborative effort

This article describes a collaborative effort between a major health care purchaser, three area health maintenance organizations, and a state Medicaid agency to develop clinical indicators as the basis for a comparison database. Some of the difficulties in developing a "common yardstick" of quality and value are candidly discussed.     

A Stress and Coping Model of Medication Adherence and Viral Load in HIV-Positive Men and Women on Highly Active Antiretroviral Therapy (HAART).

The authors tested a structural model that incorporated age, time since diagnosis, social support, coping, and negative mood as predictors of medication adherence and HIV viral load on 188 men and 134 women on highly active antiretroviral therapy (HAART). The authors used psychosocial latent factors formed from baseline measures to predict latent factors of adherence, as assessed by electronic monitoring and self-report, and viral load defined by indicators assessed over a 15-month period. Results from the model indicate that greater negative mood and lower social support are related to greater use of avoidance-oriented coping strategies. Use of these coping strategies by patients on HAART is related to poorer medication adherence and, subsequently, higher viral load. This model advances researchers' understanding of the contribution of psychosocial variables in predicting treatment adherence and disease progression in HIV-positive men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Diffusion Model Analysis of the Effects of Aging in the Lexical-Decision Task.

The effects of aging on response time (RT) are examined in 2 lexical-decision experiments with young and older subjects (age 60-75). The results show that the older subjects were slower than the young subjects, but more accurate. R. Ratcliff s (1978) diffusion model provided a good account of RTs, their distributions, and response accuracy. The fits show an 80-100-ms slowing of the nondecision components of RT for older subjects relative to young subjects and more conservative decision criterion settings for older subjects than for young subjects. The rates of accumulation of evidence were not significantly different for older compared with young subjects (less than 2% and 5% higher for older subjects relative to young subjects in the 2 experiments). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Remote sensing of wetlands in South America: status and challenges

South America has a large proportion of wetlands compared with other continents. While most of these wetlands were conserved in a relatively good condition until a few decades ago, pressures brought about by land use and climate change have threaten their integrity in recent years. The aim of this article is to provide a bibliometric analysis of the available scientific literature relating to the remote sensing of wetlands in South America. From 1960 to 2015, 153 articles were published in 63 different journals, with the number of articles published per year increasing progressively since 1990. This rise is also paralleled by an increase in the contribution of local authors. The most intensively studied regions are the wetland macrosystems of South American mega-rivers: the Amazon and Paraná Rivers, along with the Pantanal at the headwaters of Paraguay River. Few studies spanned more than two countries. The most frequent objectives were mapping, covering all types of wetlands with optical data, and hydrology, focusing on floodplain wetlands with microwave data as the preferred data source. The last decade substantial growth reflects an increase in technological and scientific capacities. Nevertheless, the state of the art regarding the remote sensing of wetlands in South America remains enigmatic. Fundamental questions and guidelines which may contribute to the understanding of the functioning of these ecosystems are yet to be fully defined and there is considerable dispersion in the use of data and remote-sensing approaches.     

A simple and effective heuristic for the resource constrained project scheduling problem

This paper investigates the development and application of a simple heuristic to the resource constrained project scheduling problem (RCPSP). This computer heuristic, which is based on the COMSOAL heuristic, constructs a feasible solution at each iteration and chooses the best solution of several iterations. Although COMSOAL was originally a solution approach for the assembly-line balancing problem, it can be extended to provide solutions to the resource allocation problem. The Modified COMSOAL technique presented in this paper uses priority schemes intermittently with a random selection technique. This hybrid of randomness and priority scheme allows a good solution to be found quickly while not being forced into the same solution at each iteration. Several different priority schemes are examined within this research. The COMSOAL heuristic modified with the priority schemes heuristic was tested on several established test sets and the solution values are compared with both known optimal values and the results of several other resource allocation heuristics. In the vast majority of cases, the Modified COMSOAL heuristic outperformed the other heuristics in terms of both average and maximum percentage difference from optimal. The Modified COMSOAL heuristic seems to have several advantages over other RCPSP heuristics in that it is easy to understand, easy to implement, and achieves good results.