Strategic administration of antioxidant multiminerals and vitamins to transitional buffaloes augments antioxidant and udder defense mechanisms in early lactation.

The aim of the study was to examine the effects of repeated administrations of antioxidant multiminerals and vitamins in transition buffaloes on udder defense mechanism, antioxidant activity and occurrence of intramammary infection (IMI) in early lactation period. Forty clinically healthy pregnant buffaloes were enrolled 45 days before expected date of calving and randomly allocated into five different supplementation groups (n = 8): only basal ration (control), vitamin E and selenium (VES), multiminerals (MM), ascorbic acid (AA) and chromium (Cr) picolinate in basal diet. The udder defense mechanism was monitored by measuring phagocytic activity (PA), myeloperoxidase (MPO) and nitric oxide (NO) productions in milk leukocytes, antioxidant activity was evaluated by measuring total antioxidant capacity (TAC) in plasma and occurrence of IMI was assessed by milk cytology, bacterial count in milk and visible clinical signs of udder until day 28 post-calving. The results showed that the VES and MM supplementations exhibited significantly higher PA, MPO and NO productions of milk leukocytes till first week of lactation whereas, elevated mean TAC in plasma was maintained from day -7 to 1 of calving in MM supplementation group as compared to control group. Statistically, no significant difference in occurrences of subclinical or clinical IMI was noted across the groups until four weeks of lactation. Taken together, it is concluded that repeated administrations of VES and MM to transition buffaloes could be an effective strategy to maintain good udder health by augmenting milk leukocyte functions and antioxidant status and preventing incidence of IMI in early lactation.

An assessment of the quality of antenatal care and pregnancy outcomes in a tertiary hospital in Ghana.

BACKGROUND: Antenatal care (ANC) is imperative to decreasing adverse pregnancy outcomes and their related maternal mortality. However, in sub-Saharan Africa, increases in ANC coverage have not correlated well with improved maternal and fetal outcomes suggesting the quality of ANC received could be the missing link. This study assessed ANC quality and its effect on adverse pregnancy outcomes among women who delivered at Komfo Anokye Teaching Hospital. METHODS: A cross-sectional study was conducted among women who delivered at Komfo Anokye Teaching Hospital within the study period. Women were selected through systematic sampling and interviewed using a pretested structured questionnaire as well as review of their medical records. Data were collected on their sociodemographic and reproductive characteristics, care provided during ANC and delivery outcomes. Categorical variables were compared using the χ2 test. Factors associated with quality of ANC and adverse pregnancy outcomes were assessed using univariate and multivariate logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Statistical analyses were performed using SPSS and GraphPad Prism. P-values of < 0.05 were considered statistically significant. RESULTS: 950 women were recruited into the study with mean age of 30.39±5.57 years. Less than one-tenth (7.6%) of the women received good quality ANC, 63.4% had average quality ANC, and 29.0% received poor quality ANC. Increasing educational level and initiating ANC in the first trimester [aOR 0.2; 95%CI 0.08-0.68; p<0.001] increased the odds of receiving good quality ANC while being unemployed decreased the odds of receiving good quality ANC [aOR 0.3; 95% CI 0.12-0.65; p = 0.003]. Receiving poor and average quality of ANC were significantly associated with increased likelihood of developing anaemia during pregnancy, preeclampsia with severe features or delivering a low birth weight baby. CONCLUSION: Most women did not receive good quality ANC. High quality ANC should be provided while the women are encouraged to comply with the recommendations during ANC.

Perceived preparedness to respond to the COVID-19 pandemic: A study with healthcare workers in Ghana

IntroductionHealthcare workers (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-resource countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system and high COVID-19 cases, we examined HCWs perceived preparedness to respond to COVID-19 and associated factors. Methods472 HCWs completed questions in a cross-sectional self-administered online survey. Perceived preparedness was assessed using a 15-question scale (Cronbach alpha=0.91) and summative scores were created (range=0-45). Higher scores meant greater perceived preparedness. We used linear regression with robust standard errors to examine associations between perceived preparedness and potential predictors. ResultsThe average preparedness score was 24 (SD=8.9); 27.8% of HCWs felt prepared. In multivariate analysis, factors associated with higher perceived preparedness were: training ({beta}=3.35, 95%CI: to 4.69); having adequate PPE ({beta}=2.27, 95%CI: 0.26 to 4.29), an isolation ward ({beta}=2.74, 95%CI: 1.15 to 4.33), and protocols for screening ({beta}=2.76, 95%CI: 0.95 to 4.58); and good perceived communication from management ({beta}=5.37, 95%CI: 4.03 to 7.90). When added to the model, perceived knowledge decreased the effect of training by 28.0%, although training remained significant, suggesting a partial mediating role. Perceived knowledge was associated with a 6-point increase in perceived preparedness score ({beta}=6.04, 95%CI: 4.19 to 7.90). ConclusionHCWs reported low perceived preparedness to respond to COVID-19. Training, clear protocols, PPE availability, isolation wards, and communication play an important role in increasing preparedness. Government stakeholders must institute necessary interventions to increase HCWs preparedness to respond to the ongoing pandemic and prepare for future pandemics. Strengths and limitations of this studyO_LIThis is one of the few studies globally to empirically examine Healthcare workers (HCWs) perceived preparedness to respond to COVID-19, and the first study to do so among HCWs in Ghana and in Africa. C_LIO_LIWe developed a perceived preparedness for COVID-19 scale and conducted psychometric analysis to confirm its validity and reliability; this scale can facilitate similar research in other settings. C_LIO_LIWe show that providers have low perceived preparedness to respond to the COVID-19 pandemic, and that this is associated with a lack of training on COVID-19, PPE, clear protocols, and isolation wards, as well as poor communication from management. C_LIO_LIThe use of an online survey with recruitment via social media may have accounted for a relatively young sample. C_LIO_LIFindings are based on self-reported data from a cross-sectional survey, thus, there may be social desirability bias and associations described are not causal. C_LI

Porcine sapelovirus among diarrhoeic piglets in India.

Porcine sapelovirus (PSV) A belongs to the genus Sapelovirus, family Picornaviridae. PSV infections in pigs have been reported from European countries, United States, Japan, China, Korea and Brazil. The virus has been isolated/detected from faeces of healthy pigs as well as those affected with diarrhoea, respiratory signs, encephalitis, skin lesions and fertility disorders. This study was planned to investigate whether PSV is prevalent among pigs in India and to characterize PSV encountered in the study population. The study revealed that five of 70 (7.14%) faecal samples were found positive for PSV using RT-PCR. Three viruses were successfully isolated from faecal samples using IB-RS-2 cell line. Complete genome sequencing and analysis of one Indian PSV isolate revealed highest homology (88%) with V13 strain from England. Phylogenetic analysis of the complete polyprotein nucleotide sequences of 14 strains of PSV classified the viruses into four distinct clades. This first report from India adds to our knowledge on genetic diversity of PSV detected so far among pigs in different countries. A large-scale surveillance of the virus is required to understand its genomic diversity and economic impact.

Consensus recommendations for the diagnosis and treatment of multiple sclerosis in Kuwait.

OBJECTIVES: We aim to develop consensus recommendations to guide neurologists in the community for the diagnosis and treatment of Multiple Sclerosis (MS). METHODS: After reviewing the available literature, a group of neurologists with expertise in MS met to discuss the evidence and develop consensus recommendations for the diagnosis and treatment of MS. RESULTS: The revised 2010 McDonald criteria is the established diagnostic criteria for MS and has wide international acceptance among international MS experts. Several red flags in the history and examination, along with certain laboratory tests were pointed out to exclude MS mimickers in the diagnostic phase. The available approved disease modifying therapies (DMTs) were listed in an algorithmic fashion based on initial assessment of disease severity and subsequent disease breakthrough while on DMTs. Risk stratification based on the benefit versus risk ratio was used to help choosing the appropriate therapy to MS patients using an "individualized therapy" approach. The requirements for initiation and monitoring of treated MS patients were highlighted with emphasis on early identification of disease breakthrough, adverse events, and safety concerns. The role of multi-disciplinary MS clinics was discussed and a guide for referral to specialized MS clinics was developed. CONCLUSIONS: Consensus recommendations have been developed to guide local neurologists on the diagnosis and treatment of patients with MS. Implementation of the revised 2010 McDonald diagnostic criteria was advised while a personalized treatment approach was recommended using a treatment algorithm based on risk stratification and patient-centered outcomes.

Tumor volume and uterine body invasion assessed by MRI for prediction of outcome in cervical carcinoma treated with concurrent chemotherapy and radiotherapy.

OBJECTIVE: The aim of this study was to evaluate the prognostic significance of primary tumor volume and uterine body invasion assessed by pre-treatment MRI for uterine cervical cancer patient treated with concurrent chemotherapy and radiotherapy. METHODS: A retrospective analysis of 106 patients with IB-IIIB cervical carcinoma was performed. Potential prognostic factors were stage, clinical tumor diameter, histology, age, pelvic lymph node, vaginal extension, parametrial invasion, tumor volume and uterine body invasion status. Multivariate analyses were performed to identify the prognostic factor for overall survival (OS) and disease-free survival (DFS). RESULTS: The 5-year OS, DFS rate were 59.7 and 56.6%. Using multivariate analyses, a large tumor volume (>/=30 ml; P = 0.012) and uterine body invasion (P = 0.020) and positive pelvic lymph node (LN) enlargement (P = 0.040) showed a significantly unfavorable influence on OS. Using these three factors, patients were divided into four subgroups: the OS rates of patients with risk 0 (volume <30 ml, no uterine body invasion, and negative LN), risk 1 (one of these three factors), risk 2 (two of these three factors) and risk 3 (volume >/=30 ml, uterine body invasion, and positive LN) were 96.3, 77.5, 53.0 and 14.8%, respectively (P < 0.0001). CONCLUSIONS: Tumor volume and uterine body invasion determined by MRI were significant prognostic factors for patients with cervical carcinoma. Pelvic lymph node enlargement diagnosed by CT also proved to be a significant prognostic factor in OS. Using these three parameters, we devised a practical and effective model to predict OS.

Rectum dose analysis employing a multi-purpose brachytherapy phantom.

PURPOSE: It is difficult to reproduce a brachytherapy measurement because of changes in the rectal shape during inter-fraction. We constructed a multi-purpose brachytherapy phantom (MPBP) and reproduced the same conditions found in actual therapy. We further attempted to apply the measured optimal dose to reduce rectal complications. METHODS: A measured dose was administered at rectal reference point R1 using a diode detector in four patients who used a tandem and ovoid in brachytherapy for carcinoma of the cervix. A total number of 20 rectal dose measurements were performed five times per patient. In addition, discrepancies in the set-up of the diode detector were analyzed with each repetitive measurement. After reproducing the same conditions as found in actual therapy using a multi-function applicator (MFA) in the multi-purpose brachytherapy phantom constructed for this study, the dose was measured at reference points in the rectum using a thermoluminescence dosimeter (TLD). RESULTS: According to the discrepancies measured in the set-up using a diode detector, Patient 1 showed a maximum value of 11.25 +/- 0.95 mm in the Y direction, Patients 2 and 3 exhibited 9.90 +/- 2.40 mm and 20.85 +/- 4.50 mm in the Z direction, respectively. Patient 4 showed 19.15 +/- 3.33 mm in the Z direction. In addition, values of the mean dose according to the position of the diode detector were recorded as 122.82 +/- 7.96-323.78 +/- 11.16 cGy. In the measured results for TLD in an MPBP, relative error for Patients 1 and 4 at the rectal reference point R2 were a maximum of 8.6 and 7.7%, respectively. For Patients 2 and 3 they were 1.7 and 1.2%, respectively. Furthermore, the dose measured at point R1 and R2 exhibited values approximately 1.7-8.6% higher than the dose calculated in advance, excluding point R1 in Patient 2. The discrepancies in the set-up owing to repetitive measurements and alterations in dosage according to these changes were not analyzed. It was evident that the relative error between the calculated and measured value was within 15%, which was allowable according to the recommendations by the American Association of Physicists in Medicine (AAPM). CONCLUSIONS: The multi-purpose brachytherapy phantom constructed for this study successfully reproduced an optimal dose measured under the same conditions found in actual therapy in which the dose was precisely analyzed at a rectal reference point. In addition, these results were considered reliable and applicable for dose optimization before applying therapy using the measured data from the phantom in order to reduce rectal complications.

Tumor volume and invasion to uterine body assessed by magnetic resonance imaging in the prediction of outcome for stage II cervical cancer / 부인종양

OBJECTIVE: The aim of this study was to evaluate the prognostic significance of primary tumor volume and uterine corpus invasion assessed by MRI in stage II uterine cervical cancer patients treated by concurrent chemotherapy and radiotherapy. METHODS: Fifty-two patients diagnosed with stage II cervical carcinoma were entered into the study. The tumor volume was calculated by the equation (Volume=widthXlengthXheightXpi/6) as an ellipsoid approximation. Univariate and multivariate analyses were performed to identify the prognostic factors for overall survival (OS), disease-free survival (DFS), pelvic control (PC), and distant metastasis-free survival (DMFS). RESUITS: The 5-year OS, DFS, PC, and DMFS rates were 65.8%, 59.3%, 72.6%, and 79.9%, respectively. The average volume of primary cervical tumor on MRI was 29.5 ml (5-109) and volume was not correlated with stage (p=0.180). Corpus invasion was exhibited in 50.0% and 93.8% of patients with small tumor volume ( or =30 ml), respectively; and strongly correlated with tumor volume (p<0.001). By univariate analyses, larger clinical tumor diameter (p=0.031), positive pelvic lymph node (p=0.033), uterine corpus invasion (p=0.045), and larger tumor volume (p=0.003) showed a statistically significantly relation to worse survival. In multivariate analyses, dividing patients according to whether the tumor volume was more or less than 30 ml predicted OS (p=0.048) and uterine corpus invasion also predicted DFS (p=0.042). CONCLUSION: Tumor volume and uterine corpus invasion determined by pre-treatment MRI examinations were significant prognostic factors for patients with invasive cervical carcinoma treated with concurrent chemotherapy and radiotherapy.

Evaluation of p53 and Bax Expression as Prognostic Markers in Invasive Cervical Carcinoma Stage IIB Patients Treated with Radiation Therapy / 대한방사선종양학회지

PURPOSE: The objective of our study was to evaluate the immunohistochemical expression of p53 and bax proteins as prognostic markers in FIGO stage IIb invasive squamous cell carcinoma of the uterine cervix. MATERIALS AND METHODS: Sixty-five cases of squamous cell carcinoma of the cervix (stage IIb) that were diagnosed from October 1996 to December 2003 were analyzed retrospectively for the bax and p53 expression. These expressions were determined immunohistochemically and they were correlated to the patients' overall survival and disease-free survival. RESULTS: The overall 5-year survival (OS) rate and the disease-free survival (DFS) rate were 65.1% and 62.9%, respectively. p53 and bax immunoreactivity was seen in 26.2% and 52.3% of cases, respectively, with variable levels of expression. On the univariate analysis, only p53 positivity correlated with poor survival in DFS (log-rank test p=0.027), but this significance was not maintained on multivariated analysis by Cox's regression. The nine cases with the immunophenotype p53+/bax- had the poorest survival. CONCLUSION: Neither p53 nor bax expression are independent predictors of the prognosis for stage IIb cervical squamous cancers. Evaluation of p53 and bax co-expression may affect the clinical outcome and further investigation is needed.

Comparison of the Result of Radiation Alone and Radiation with Daily Low Dose Cisplatin in Management of Locally Advanced Cervical Cancer / 대한방사선종양학회지

PURPOSE: An analysis was to compare the results of radiation alone with those of radiation with daily low dose cisplatin as a radiation sensitizer in locally advanced cervical cancer. MATERIALS AND METHODS: A retrospective analysis of 59 patients diagnosed with locally advanced uterine cervix cancer between December 1996 and March 2001 was performed. Thirty one patients received radiation alone and 28 patients received daily low dose cisplatin, as a radiation sensitizer, and radiation therapy. The median follow-up period was 34 months, ranging from 2.5 to 73 months. The radiation therapy consisted of 4500 cGy external beam irradiation to the whole pelvis (midline block after 3060 cGy), a 900~1,000 cGy boost to the involved parametrium and high dose-rate intracavitary brachytherapy (a total dose of 3,000~3,500 cGy/500 cGy per fraction to point A, twice per week). In the chemoradiation group, 10 mg of daily intravenous cisplatin was given daily from the 1st day of radiation therapy to the 20th day of radiation therapy. According to the FIGO classification, the patients were subdivided into 51 (86.4%) and 8 (13.6%) stages IIB and stage IIIB, respectively. RESULTS: The overall 5 year survival rate was 65.65% and according to treatment modality were 56.75% and 73.42% in the radiation alone and chemoradiation groups, respectively (p=0.180). The 5 year disease-free survival rates were 49.39% and 63.34% in the radiation alone and chemoradiatoin groups, respectively (p=0.053). The 5 year locoregional control rates were 52.34% and 73.58% in the radiation alone and chemoradiation groups, respectively (p=0.013). The 5 year distant disease-free survival rates were 59.29% and 81.46% in the radiation alone and chemoradiation groups, respectively (p=0.477). Treatment related hematologic toxicity were prominent in the chemoradiation group. Leukopenia (> or =3 grade) occurred in 3.2% and 28.5% of the radiation alone and chemoradiation groups, respectively (p=0.02). There were no statistical differences in the incidences of vesical, rectal and small bowel complications between two groups. CONCLUSION: Radiation therapy with low dose cisplatin did not improve the rates of survival and response rates, but did improve the rate of disease free survival and locoregional control rates in locally advanced cervical cancer. The incidence of bone marrow suppression was higher in the chemoradiation group.

Development of potent non-carbohydrate imidazole-based small molecule selectin inhibitors with antiinflammatory activity.

A novel series of non-carbohydrate imidazole-based selectin inhibitors has been discovered via high-throughput screening using a P-selectin ELISA-based assay system. The initial lead 1 had an IC(50) of 17 microM in the P-selectin ELISA; this potency was significantly improved via an extensive SAR exploration. One of the current lead compounds (29) has an IC(50) of 300 nM in a P-selectin ELISA; it also has good activity in P- and E-selectin cell adhesion assays and shows efficacy in vivo. These compounds represent a novel series of sLe(X) mimetics with antiinflammatory activity. Their unique profile supports our interest in their further evaluation as drug candidates for the treatment of inflammation. Herein we describe the syntheses, optimization, and SAR of this series of novel potent selectin antagonists.

LiF TLD in TLD Holder for In Vivo Dosimetry / 대한방사선종양학회지

PURPOSE: LiF TLD has a problem to be used in vivo dosimetry because of the toxic property of LiF. The aim of this study is to develop new dosimeter with LiF TLD to be used in vivo dosimetry. MATERIALS AND METHODS: We designed and manufactured the teflon box(here after TLD holder) to put TLD in. The external size of TLD holder is 4x4x1 mm3. To estimate the effect of TLD holder on TLD response for radiation, the linearity of TLD response to nominal dose were measured for TLD in TLD holder. Measurement were performed in the 10 MV x-ray beam with LiF TLD using a solid water phantom at SSD of 100 cm. Percent Depth Dose (PDD) and Tissue-Maximum Ratio (TMR) with varying phantom thickness on TLD were measured to find the effect of TLD holder on the dose coefficient used for dose calculation in radiation therapy. RESULTS: The linearity of response of TLD in TLD holder to the nominal dose was improved than TLD only used as dosimeter. And in various measurement conditions, it makes a marginnal difference between TLD in TLD holder and TLD only in their responses. CONCLUSION: It was proven that the TLD in TLD holder as a new dosimetry could be used in vivo dosimetry.

Determination of N(pp)(gas) and N(pp)(D) for a plane-parallel chamber.

The purpose of this work is to investigate the consistency of determining N(pp)(gas) and N(pp)(D) by using three independent calibration methods from the AAPM TG 39 and IAEA TRS 381 protocols: 1) calibration with a high-energy electron beam in a phantom; 2) in-phantom calibration in a (60)Co beam; and 3) in-air calibration in a (60)Co beam. The plane-parallel chamber considered was the PTW-Markus and the comparisons were made against a calibrated PTW cylindrical Farmer-type chamber 30001. The phantom material used for the electron beam and (60)Co in-phantom methods was a solid water phantom (RW3). For the electron beam method, the nominal energies were 18 and 21 MeV. An acrylic buildup of 0.5 g/cm(2) thickness was used for the (60)Co in-air method. For each method, N(pp)(gas) and N(pp)(D) were obtained for the plane-parallel chamber as proposed by the AAPM TG 39 and IAEA TRS 381 protocols. The absorbed doses were measured along the central axis at a distance of 100 cm (SSD=100 cm) with 10 x 10 cm(2) field size at the depth of the maximum for each electron beam. The values of N(pp)(gas) by the three independent calibration methods agreed to within +/-0.6%. This meant that any of the methods would give a fairly good value. Similar results were obtained for N(pp)(D). In comparing the results for the electron beam method at energies of 18 and 21 MeV, the latter gave better agreement. The ratios of N(pp)(gas) and N(pp)(D) for the three methods were in agreement within 0.7%. The results for the absorbed dose intercomparison in the AAPM TG 39 and IAEA TRS 381 protocols showed that they agreed to within +/-0.7% which meant that any of the calibration methods and two different protocols would give an accurate result.

Family intervention for intellectually disabled children. Randomised controlled trial.

BACKGROUND: Resources to address the needs of parents of intellectually disabled children in developing countries are limited. AIMS: The efficacy of interactive group psychoeducation on measures of parental attitude towards intellectual disability was assessed in southern India. METHOD: Fifty-seven parents randomised to 10 weeks of experimental and control therapy were assessed using the Parental Attitude Scale towards the Management of Intellectual Disability. The pre- and post-intervention measurements were done by a single-blinded rater and compared. RESULTS: The intervention group had a statistically significant increase in the outcome scores and clinical improvement in the total parental attitude score, orientation towards child-rearing knowledge towards intellectual disability and attitude towards management of intellectual disability, but no change in attitude towards the intellectual disability subscale. CONCLUSIONS: Interactive group psychoeducation is effective for changing the attitude of parents with intellectually disabled children, and is a viable option to be developed in situations where resources are limited.

Self-injurious behaviour: a kindling phenomenon?

Self-injurious behaviour continues to be a drain on the resources for rehabilitation of the children with developmental disabilities. Pathogenesis and therapy seems fragmentary, with virtually every major neurotransmitter system being identified as the putative substrate for self-injurious behaviour. This phenomenon as it cuts across the diagnostic boundaries, although it is suggestive of a heterogeneous neurochemical basis, should call for the exploration of the biological event preceding the neurochemical cascade resulting in the behaviour. The authors argue that kindling is the preceding neurophysiological event resulting in self-injurious behaviour and, thus, can be effectively prevented pharmacologically.

A Survey for the Hospital Utilization of Cancer patients in Inchon / 대한암학회지

PURPOSE: The purpose of this study was to evaluate the hospital utilization of cancer patients in Inchon and to assess the feasibility of Inchon Cancer Registry (ICR). MATERIALS AND METHODS: We used two data sources from Korean Central Cancer Registry (KCCR) and Korean Medical Insurance (KMI) for analysis. RESULTS: KCCR data analysis showed that 50.8% of cancer patients visited hospitals in Seoul, 46% visited hospitals in Inchon, and 2.6% in other areas at first visit. The analysis of KMI data showed that 43% of cancer patients visited hospital in Seoul, 38.5% visited hospitals in Inchon, and 18.5% in other areas at first visit. From these results, we found many cancer patients visited hospitals located in Seoul. We estimated that 52.1% would be missed when we performed cancer registry project in Inchon area alone from the KCCR data analysis. On the other hand, 60% would be missed from the KMI data. However, if we used registration data at the nation-wide level and actively registered cancer patient data in Inchan, expected unregistration rates would be 5%. CONCLUSION: Even though registration rate to KCCR was relatively low (74%) in Inhon and many patients were treated in other area, we are convinced that almast all cancer patients would be registered because most cancer patients visited at least one of the cancer registry hospitals at the nation-wide level. Therefore, if ICR used KCCR and encouraged the hospitals in Inchon to actively participate in cancer registration, the population-based cancer registration in Inchon would be possible.

Photon Energy Dependence of the Sensitivity of LiF TLDs Loaded with Thin Material / 대한방사선종양학회지

PURPOSE: An investigation has been carried out on the factors which affect the response reading of thermoluminescent dosimeters (TLD-100) loaded with thin material in high energy photon. The aim of the study was to assess the energy response of TLD-100 to the therapeutic ranges of photon beam. MATERIALS AND METHODS: In this technique, TLD-100 (abbreviated as TLD) chips and three different thin material (Tin, Gold, and Tissue equivalent plastic plate) which mounted on the TLD chip were used in the clinical photon beam. The thickness of each metal plates was 0.1 mm and TE plastic plate was 1 mm thick. These compared with the photon energy dependence of the sensitivities of TLD (normal chip), TLD loaded with Tin or Gold plate, for the photon energy range 6 MV to 15 MV, which was of interest in radiotherapy. RESULTS: The enhancement of surface dose in the TLD with metal plate was clearly detected. The TLD chips with a Gold plate was found to larger response by a factor of 1.83 in 10 MV photon beam with respect to normal chip. The sensitivity of TLD loaded with Tin was less than that for normal TLD and TLD loaded with Gold. The relative sensitivity of TLD loaded with metal has little energy dependence. CONCLUSION: The good stability and linearity with respect to monitor units of TLD loaded with metal were demonstrated by relative measurements in high energy photon (6~15 MV) beams. The TLD laminated with metals embedded system in solid water phantom is a suitable detector for relative dose measurements in a small beam size and surface dose.

Low Dose Cisplatin as a Radiation Sensitizer in Management of Locally Advanced Squamous Cell Carcinoma of the Uterine Cervix: Evaluation of Acute Toxicity and Early Response / 대한방사선종양학회지

PURPOSE: To evaluate possible acute toxicity and early response of concurrent radiation therapy and low dose daily cisplatin as a radiosensitizer in patients with locally advanced uterine cervical carcinomas. MATERIALS AND METHODS: From December 1996 to January 1999, 38 previously untreated patients with locally advanced squamous cell carcinoma of the uterine cervix (from stage IIB to stage IIIB) were treated at Inha University Hospital. All patients underwent standard pretreatment staging procedures after the initial evaluation by gynecologists and radiation oncologists. Sixteen patients with huge cervical mass (>4 cm) were submitted to the group treated with concurrent radiation therapy and low dose daily cisplatin while the remainder was treated with radiation therapy alone. Radiation therapy consisted of 4500 cGy external beam irradiation to whole pelvis (midline block after 3060 cGy), 900~1000 cGy boost to involved parametrium, and high dose-rate intracavitary brachytherapy (a total dose of 3000~3500 cGy/500 cGy per fraction to point A, twice per week). In the group treated with low dose cisplatin concurrently, 10 mg of daily intravenous cisplatin was given from the 1st day of radiation therapy to the 20th day of radiation therapy. Acute toxicity was measured according to expanded common toxicity criteria of the NCI (C) Clinical Trials. Early response data were analyzed at minimum 4 weeks' follow-up after completion of the treatment protocol. RESULTS: Hematolgic toxicity was more prominent in patients treated with radiation therapy and cisplatin. Six of 16 patients (37.5%) treated with radiation therapy and cisplatin and one of 22 patients (4.5%) treated with radiation therapy alone experienced grade 3 leukopenia. In Fisher's exact test, there was statistically significant difference between two groups regarding leukopenia (P=0.030). There was no apparent difference in the frequency of gastrointestinal and genitourinary toxicity between two groups (P=0.066). Three of 16 patients (18.7%) treated with radiation therapy and cisplatin and two of 22 patients (9.1%) treated with radiation therapy alone experienced more than 5 kg weight loss during the treatment. There was no statistically significant difference on weight loss between two groups (P=0.63). Two patients on each group were not evaluable for the early response because of incomplete treatment. The complete response rate at four weeks' follow-up was 80% (16/20) for the radiation therapy alone group and 78% (11/14) for the radiation therapy and cisplatin group. There was no statistically significant difference in early response between two treatment groups (P=0.126). CONCLUSION: This study led to the conclusion that the hematologic toxicity from the treatment with concurrent radiation therapy and low dose daily cisplatin seems to be more prominent than that from the treatment of radiation therapy alone. There was no grade 4 hematologic toxicity or mortality in both groups. The hematologic toxicity in both treatment groups seems to be well managable medically. Since the risk factors were not balanced between two treatment groups, the direct comparison of early response of both groups was not possible. However, preliminary results regarding early response for patients with bulky cervical tumor mass treated with radiation therapy and low dose daily cisplatin was encouraging. Longer follow-up is necessary to evaluate the survival data. A phase III study is needed to evaluate the efficacy of concurrent daily low dose cisplatin with radiation therapy in bulky cervical cancer.