A comparison between centrally and systemically administered erythropoietin on kidney protection in a model of fixed-volume hemorrhagic shock in male rats.

BACKGROUND: In this study, a comparison between centrally and systemically administered erythropoietin (EPO) was performed on nephroprotection during hemorrhagic shock (HS) in male rats. METHODS: Male rats were allocated into four experimental groups. (1) Sham; a guide cannula was inserted into the left lateral ventricle and other cannulas were placed into the left femoral artery and vein. (2) HS; stereotaxic surgery was done to insert a cannula in the left lateral ventricle and after a 7-day recovery; hemorrhagic shock and resuscitation were performed. (3) EPO-systemic; the procedure was the same as the HS group except that animals received 300 IU/kg erythropoietin into the femoral vein immediately before resuscitation. (4) EPO-central; animals was treated with erythropoietin (2 IU/rat) into the left lateral ventricle before resuscitation. Arterial oxygen saturation (SaO2) was measured during experiments. Urine and renal tissue samples were stored for ex-vivo indices assessments. RESULTS: Erythropoietin (systemically/centrally administered) significantly improved SaO2, renal functional and oxidative stress parameters and decreased renal inflammatory (TNF-α and IL-6) mRNA expression compared to the HS group. EPO-treated groups showed a decrease in active form of caspase-3 protein level and an increase in autophagy activity in comparison with the HS group. CONCLUSION: Considering the fact that the effective dose of systemic EPO (300 IU/kg) was roughly 50 times higher than that of central administration (2 IU/rat), centrally administered EPO was accompanied by more advantageous consequences than systemic way. EPO is likely to act as a neuro-modulator or neuro-mediator in the central protection of organs including the kidneys.

Application of ultrasound for simulated positioning of brachytherapy in cervical cancer: An alternative to traditional MRI/CT? / 中华放射肿瘤学杂志

The role of three-dimensional brachytherapy (3D-BT) in the radical treatment of cervical cancer has been widely recognized. Obtaining the image information through simulated positioning is a key step of 3D-BT.Currently, MRI/CT positioning has been commonly applied in clinical practice, which has respective limitations when applied in radiosurgery. Consequently, it is of necessity to explore an accurate, highly efficient and convenient positioning approach. Besides MRI and CT, ultrasound is a novel positioning method in clinical settings. Through literature review, the application of ultrasound in 3D-BT was summarized, aiming to provide reliable reference for clinicians.

Sistema auxiliar para colocar el marco estereotactico en el craneo / Auxiliary system for positioning the stereotactic frame to the skull

En neurocirugía funcional y radioneurocirugía estereotáctica, la fijación de un marco en el cráneo, permite el establecimiento de un sistema tridimensional de coordenadas, para localizar y definir con precisión los objetivos en el cerebro. El montaje se basa en la experiencia y la percepción visual del médico, pero los resultados son subjetivos y la calibración de las coordenadas del marco con respecto al cráneo no siempre es la óptima para el desarrollo del procedimiento quirúrgico. Este estudio evalúa la eficacia y la funcionalidad de un sistema auxiliar diseñado para colocar el marco estereotáctico en el cráneo. La evaluación se realiza por medio de un estudio comparativo de dos grupos de 7 pacientes cada uno sometidos a tratamiento de radioneurocirugía. En el primer grupo no es utilizado el sistema, solo en el segundo, se tomaron 165 imágenes (IRM) en promedio por cada estudio. El empleo del sistema auxiliar disminuye la variación de la inclinación y la rotación del marco con respecto al cráneo hasta un 64%, la apreciación subjetiva del médico es sustituida por una medición objetiva, obteniéndose certidumbre al posicionar el marco sobre el cráneo. Los resultados muestran que el sistema auxiliar diseñado es eficaz y funcional.

In functional neurosurgery and stereotactic radioneurosurgery, the fixation of a frame to the skull allows the establishment of a three-dimensional coordinate system, to locate and precisely defined objectives in the brain. The montage is based on experience and visual perception the doctor, the results obtained and the calibration of the coordinates of the frame with respect to the skull is not always the optimal for developing the surgical procedure. This study evaluates the effectiveness and functionality of an auxiliary system designed to collocate the stereotactic frame to the skull. The evaluation is done by means of a comparative study of two groups of 7 patients each underwent radioneurosurgery treatment. The first group is not using the system, only in the second, were performed on average 165 images (MRI) for each study. The use of auxiliary system reduces the variation of the inclination and rotation of the frame with respect to the skull by 64%, the subjective appreciation the doctor is substituted by an objective measure, thus obtaining certainty to position the frame on the skull. The results show that the auxiliary system designed is effective and functional.

The impact of microsurgery, stereotactic radiosurgery and radiotherapy in the treatment of meningiomas depending on different localizations.

SCIENTIFIC BACKGROUND: Meningiomas are the most common benign intracranial neoplasms with a slow growth presented as the intracranial lesion. These tumors are without any symptoms for a long time. At the time of diagnosis it is frequently an asymptomatic tumor. In that case the therapist may well suggest a wait-and-see strategy. The therapy of meningiomas focuses firstly on the microsurgical treatment. Volume reduction can be achieved immediately after treatment. Stereotactic radiosurgery is an important non-invasive treatment option for recurrent tumors or meningiomas with partial resection. The technical equipment for the stereotactic radiosurgery is a cost intensive investment. In this context the high precision of the intervention, presented as a low invasiveness of the treatment, is an important factor. The aim of this assessment is to identify the chances and limitations of the diverse treatment options and to estimate their outcome for different localisations of meningiomas. METHODS: In December 2007 a systematic literature search was conducted using the most relevant medical databases. The whole strategy and the used search terms were documented. The literature search was supplemented with an internet and literature based hand search on law, ethics and economics. Primary studies and systematic reviews which report relevant outcomes are included in this analysis. The current assessment is based on the available evidence that was found at the time of the literature search. RESULTS: A total of 31 publications for the medical focus of assessment and three reports from the economical hand search were included. In general, it is not possible to identify neither randomised clinical trials or prospective, contrasting cohort studies nor studies summarising results from such studies. The results presented in the literature published by surgeons strongly vary regarding localisation of meningiomas. Publications not differentiating between the localisation of meningiomas indicate a progression free survival rate of five years in 77 to 97% of the cases after complete surgical resection of the tumor, in 18 to 70% of the cases after subtotal resection and for patients who had undergone surgical resection and a combined radiotherapeutical treatment of their meningiomas a five year progression free survival rate between 82 and 97%. Other treatment options like hormone therapy or treatments to stop tumor growth had been used unsuccessfully so far. Based on the results presented regarding economic evaluation, costs resulting from radiosurgical treatment are lower in contrast to costs resulting from surgical resection. However, it has to be taken into account that costs resulting from radiosurgical treatment strongly depend on the number of patients treated in total with the radiosurgical equipment. CONCLUSION: Due to the strong dependencies between the results from surgical therapy and the localisation of the tumor, it is only possible to derive recommendations on whether or not to perform the surgical therapy with respect to the localisation of the tumor. Only for patients with tumors with a spinal localisation or WHO Grade I meningiomas with a cortical localisation, primary treatment with by means of microsurgery can be suggested. For all other localisations of the tumor, alternative treatment by radiosurgery should be discussed. From the literature identified, a clear recommendation of one or the other therapy however can not be deduced. Thus, there is a strong need for randomised clinical trials or prospective or contrasting cohort studies, which compare rigorously microsurgery with radiosurgery concerning different localisations of tumors.