Ototoxicity evaluation in medulloblastoma patients treated with involved field boost using intensity-modulated radiation therapy (IMRT): a retrospective review

Background: Ototoxicity is a known side effect of combined radiation therapy and cisplatin chemotherapy for the treatment of medulloblastoma. the delivery of an involved field boost by intensity modulated radiation therapy (IMRT) may reduce the dose to the inner ear when compared with conventional radiotherapy. the dose of cisplatin may also affect the risk of ototoxicity. A retrospective study was performed to evaluate the impact of involved field boost using IMRT and cisplatin dose on the rate of ototoxicity.Methods: Data from 41 medulloblastoma patients treated with IMRT were collected. Overall and disease-free survival rates were calculated by Kaplan-Meier method Hearing function was graded according to toxicity criteria of Pediatric Oncology Group (POG). Doses to inner ear and total cisplatin dose were correlated with hearing function by univariate and multivariate data analysis.Results: After a mean follow-up of 44 months (range: 14 to 72 months), 37 patients remained alive, with two recurrences, both in spine with CSF involvement, resulting in a disease free-survival and overall survival of 85.2% and 90.2%, respectively. Seven patients (17%) experienced POG Grade 3 or 4 toxicity. Cisplatin dose was a significant factor for hearing loss in univariate analysis (p < 0.03). in multivariate analysis, median dose to inner ear was significantly associated with hearing loss (p < 0.01). POG grade 3 and 4 toxicity were uncommon with median doses to the inner ear bellow 42 Gy (p < 0.05) and total cisplatin dose of less than 375 mg/m(2) (p < 0.01).Conclusions: IMRT leads to a low rate of severe ototoxicity. Median radiation dose to auditory apparatus should be kept below 42 Gy. Cisplatin doses should not exceed 375 mg/m(2).

Clinical Use of the Volume-Time Curve for Endotracheal Tube Cuff Management

BACKGROUND: Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. the purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting. METHODS: A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n = 222) and volume-time curve group (n = 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale. RESULTS: the volume-time curve group presented significantly lower cuff pressure (30.9 +/- 2.8 vs 37.7 +/- 3.4 cm H2O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 +/- 1.8 vs 7.1 +/- 1.7), better preservation of FVC (49.5 +/- 9.9 vs 41.8 +/- 12.9%, P = .005), and FEV1, (46.6 +/- 1.8 vs 38.6 +/- 1.4%, P = .005) compared with the MOV group. CONCLUSIONS: the subjects who received the volume-time curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.

Reaction time and replenishment time of SP and CGRP after incision in rat skin

Background. the skin neurogenic inflammation is mainly related to Substance P (SP) and Calcitonin Gene-related Peptide (CGRP). There is no data on their availability in the dynamics of skin nerve endings, concerning their release and replenishment after a nociceptive stimulus, so this was investigated. Materials and methods. 25 rats were randomly distributed in 5 groups. the animals of the control group (CG) determined the baseline levels of neuropeptides in the skin. the groups S0 and S30 did not receive any cutaneous stimulus at 30 and 60 minutes, respectively. in the group S1, an incision stimulus was made at 30 minutes. in the group S31, a nociceptive stimulus was performed by subdermal scratching at 30 minutes and, at 60 minutes, the incision stimulus was carried out in the same location (nociceptive hyperstimulation). the skin samples of the other animals were harvested from the back 1 minute after their death. SP, pro-CGRP and CGRP were quantified by Western Blotting. Results. the incision stimulus released SP, S1 compared to S0 (p < 0.05) detected in the first minute, and the replenishment time was more than 30 minutes. Also, it cleaved pro-CGRP, S1 compared to S31 (p < 0.05) in the first minute, and its replenishment time less than 30 minutes. Release of CGRP was not detected. Conclusion. the incision released SP already detected in the first minute; its replenishment time is more than 30 minutes. the incision decreased pro-CGRP, also detected in the first minute; and its replenishment time is less than 30 minutes.

A importância da marca no processo de tomada de decisão de compra industrial

Dissertação de Mestrado apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Ciências da Comunicação, com especialização em Marketing e Comunicação Estratégica.

Crianças Respiradoras Bucais e possíveis tratamentos Ortodônticos

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Patient education preferences in ophthalmic care.

BACKGROUND: The learning preferences of ophthalmology patients were examined. METHODS: Results from a voluntary survey of ophthalmology patients were analyzed for education preferences and for correlation with race, age, and ophthalmic topic. RESULTS: To learn about eye disease, patients preferred one-on-one sessions with providers as well as printed materials and websites recommended by providers. Patients currently learning from the provider were older (average age 59 years), and patients learning from the Internet (average age 49 years) and family and friends (average age 51 years) were younger. Patients interested in cataracts, glaucoma, macular degeneration, and dry eye were older; patients interested in double vision and glasses were younger. There were racial differences regarding topic preferences, with Black patients most interested in glaucoma (46%), diabetic retinopathy (31%), and cataracts (28%) and White patients most interested in cataracts (22%), glaucoma (22%), and macular degeneration (19%). CONCLUSION: MOST OPHTHALMOLOGY PATIENTS PREFERRED PERSONALIZED EDUCATION: one-on-one with their provider or a health educator and materials (printed and electronic) recommended by their provider. Age-related topics were more popular with older patients, and diseases with racial risk factors were more popular with high risk racial groups.

Efecto de reguladores de crecimiento en plantas jóvenes de ciruelo Cv. Golden Japan (Prunus salicina Lindl.)

p.143-149

La función seno mediada por la calculadora TI-92+

Se presentan en este reporte algunos resultados obtenidos en el aula de matemática a propósito del desarrollo de la situación problema: ¿Qué relación existe entre el ángulo en posición normal y el cociente del lado opuesto y la hipotenusa del triángulo rectángulo? (Fig. 1) Esta actividad se implementó con el objetivo de contribuir al desarrollo del pensamiento variacional de los alumnos de 10º grado jornada de la tarde del Colegio Nacional Loperena de Valledupar, a través de la mediación instrumental de la calculadora algebraica TI-92+ y el uso de las distintas representaciones semióticas para movilizar el aprendizaje de la red conceptual subyacente a la función Seno.