Neurosurgical trauma call: use of a mathematical simulation program to define manpower needs

Resource criteria for trauma centers (TC) mandate a first plus backup neurosurgeon (NS) coverage, an unnecessary expense for TC treating few neurosurgery patients. This report uses a mathematical modeling system to define optimal NS trauma coverage. Random data from 749 patients treated with emergency neurosurgery operations (OR) within 24 hours of admission at 97 TC were used to create a 1-year profile of admission by month, day, and hour, operation times, and operation duration. These data were entered into a simulation program to define the frequency that a patient needing a NS consult would wait beyond 30 minutes because the NS was in the operating room at a trauma center with one, two, or three neurosurgeons on-call. One thousand iterations were done for each sample size of 25 to 300 patients in 25-patient increments. The probability that a patient could not be seen promptly by one NS in a trauma center operating on 25, 50, 75, or 100 patients per year is 0.23, 0.9, 1.6, and 3.66 patients per year. Fewer than one patient (0.75) per year will wait more than 30 min in a trauma center doing 225 emergency ORs when two neurosurgeons are on-call. One patient in 10 years would wait more than 30 min in a trauma center doing 300 ORs with a third NS on-call. Mathematical modeling of patient data helps define optimal hospital resources. Mandatory NS backup for TC performing fewer than 25 neurosurgery procedures is unneeded.

Different pathways mediate cholecystokinin actions in cholelithiasis

Smooth muscle from gallbladders with cholesterol stones exhibits impaired response to cholecystokinin (CCK). This study investigated whether the impaired response is mediated by different signal-transduction pathways responsible for CCK-induced contraction in prairie dog and human gallbladders with cholesterol stones. Gallbladder muscle cells were isolated enzymatically to study contraction. Protein kinase C (PKC) activity was measured by examining the phosphorylation of a specific substrate peptide from myelin basic protein Ac-MBP-(4-14). Gallbladder muscle cells from high-cholesterol-fed prairie dogs contracted less in response to CCK octapeptide (CCK-8) than those from the control group. However, inositol-1,4,5-trisphosphate (IP3), diacylglycerol, and guanosine 5'-O-(3-thiotriphosphate) induced the same magnitudes of contraction in these two groups. In control prairie dog and human gallbladders, the maximal contraction caused by 10(-8) M CCK-8 was blocked by the calmodulin antagonist CGS9343B but not by the PKC inhibitor H-7. Conversely, in gallbladders with cholesterol stones from prairie dogs or human patients, the maximal contraction induced by 10(-8) M CCK-8 was blocked by H-7 and chelerythrine but not by CGS9343B. In these gallbladders CCK-8 caused a significant PKC translocation from the cytosol to the membrane. High CCK concentrations may activate the calmodulin-dependent pathway in functionally normal gallbladder muscle and the PKC-dependent pathway in muscle from gallbladders with cholesterol stones. The defect of gallbladder muscle after cholesterol feeding and stones might reside in the steps before G protein activation.

Myocardial collagen changes and edema in rats with hyperdynamic sepsis

OBJECTIVE

To determine if sepsis, which is accompanied by both systolic and diastolic myocardial dysfunction, involves changes in myocardial collagen, as myocardial collagen changes can affect both myocardial compliance and contractility.

DESIGN

Prospective, randomized, controlled study.

SETTING

Animal laboratory at a university-affiliated hospital.

SUBJECTS

Male Sprague-Dawley rats, weighing 310 to 396 g.

INTERVENTIONS

Cecal ligation and perforation (to induce sepsis) for 24 (n = 9) or 48 hrs (n = 9); sham laparotomy for 24 (n = 10) or 48 hrs (n = 9) with saline fluid resuscitation or normal control (n = 5) groups.

MEASUREMENTS AND MAIN RESULTS

Collagen content and interstitial space were determined, using polarized light microscopy and a computer video densitometry system. At 24 and 48 hrs post surgery, heart rate and cardiac index were increased, and systemic vascular resistance index was decreased significantly in the sepsis vs. the sham rats. Collagen content was decreased significantly in the sepsis vs. the sham groups both at 24 and 48 hrs following surgery (1.83 +/- 0.79 [SD] % [24 hrs], 1.76 +/- 0.31% [48 hrs] vs. 2.83 +/- 0.73% [24 hrs], 2.25 +/- 0.72% [48 hrs]; p < .01). Interstitial space was increased significantly in the sepsis vs. the sham groups (13.9 +/- 3.5% [24 hrs], 15.6 +/- 5.2% [48 hrs] vs. 8.6 +/- 4.2% [24 hrs], 9.9 +/- 4.8% [48 hrs]; p < .01).

CONCLUSIONS

Sepsis is accompanied by changes in myocardial collagen content and myocardial edema. These changes may contribute to the systolic and diastolic myocardial dysfunction, and particularly to the ventricular dilation, observed in sepsis.

A risk-assessment model for foot and mouth disease (FMD) virus introduction through deboned beef importation

We present a risk-assessment model to assess the risk of introduction of foot and mouth disease (FMD) virus associated with deboned beef importation. The model was developed in accordance with the risk-reduction procedures proposed by the European Community for meat importation. The risk reduction procedures include farm-level inspection, ante-mortem inspection, post-mortem inspection, chilling and deboning. The risk assessment was based on the prevalence of FMD-infected cattle in herds as well as the prevalence of infected herds in the exporting country. Computer simulations were carried out to evaluate the probability of FMD virus introduction by importing 100 tons of deboned beef in relation to FMD prevalence, number of cattle selected from each herd, and sample sizes in ante-mortem and post-mortem inspections. The effects of the risk-reduction procedures on the probability of FMD virus introduction were examined.

[Studies on aging enzyme activities of the human dental pulp blood vessels]

Histochemical distribution and age changes of alkaline phosphatase (AKPase E. C. 3. 1. 3. 1) and adenosine triphosphatase (ATPase E. C. 3. 6. 1. 3) in normal human dental pulp blood were investigated qualitatively and quantitatively. 42 dental pulp samples from patients aged 10 to 70 years old were divided into three groups. Results showed that accompanying aging, activities of AKPase and ATPase of dental pulp blood vessels decreased. AKPase staining quantities for group one (10-30 years), group two (31-50 years) and group three (51-70 years) were 40.62 +/- 13.79, 36.75 +/- 9.78 and 19.20 +/- 5.35 and ATPase staining quantities were 33.00 +/- 10.09, 27.53 +/- 16.60 and 23.27 +/- 5.04 respectively. The endothelial cells of capillaries in dental pulp changed greatly. With aging, metabolic ability of dental pulp decreased gradually. In addition, it was observed that the capillaries in sub-odontoblasts decreased and odontoblast layer became thin with aging. The close association of the capillaries of the pulp to the odontoblasts had been demonstrated.

Rate of tendon gap closure in an in vitro collagen gel matrix

Tendon gap closure was examined in a tissue culture model and found to have a similar time course as skin wound closure. Foot tendons from White Rock chickens were mounted in a collagen gel matrix and maintained with the use of Dulbecco's modified Eagle medium, containing fetal calf serum and antibiotics, for 4 weeks at 37 degrees C in an incubator. Gap distances between tendons were measured every 1 to 3 days and plotted against time as the contraction curve. After an initial lag period of 4 to 8 days, gap distance showed a progressive decrease. Gap closure rate was defined as the slope of the contraction curve, and it was found to be a function of initial gap distance (r = 0.643, p 0.045). The time necessary to reduce the initial gap distance by half had a significant correlation with the initial gap distance (r = 0.986, p < 0.001). Fibroblast migration began on days 2 to 3 after a 1- to 2-day lag period. Fibroblasts were visible in the tendon gap region before the start of collagen gel contraction. At this time, the fibroblast migration rate was 0.33 mm/day. A critical density of fibroblasts was necessary to start collagen gel contraction. Once the gap distance began to diminish, fibroblast migration measurements were hampered because the measurable area was decreasing. Collagen gel contraction reduced the measurable fibroblast migration rate by nearly half to 0.18 mm/day. A linear correlation was found between fibroblast distance traveled and time in culture during both the gel lag and gel contraction time periods. This tendon culture model may be potentially useful for wound healing studies because it allows for studies of fibroblast activity in the early lag phase when the cells populate the collagen lattice but before contraction of the gel occurs.

Recombinations defining centromeric and telomeric borders for the hereditary haemochromatosis locus

Hereditary haemochromatosis (HFE) is a common inherited disorder, affecting approximately five per thousand white people of northern European descent. Genetic linkage and linkage disequilibrium studies indicate that the disease locus is tightly linked to HLA-A and D6S105. Recombination between HFE and HLA class I loci is known to be rare. We report here two pedigrees in which recombinations telomeric of HLA-A occurred. These recombinant events define new centromeric and telomeric borders for the HFE locus.

Significant prognosticators after primary radiotherapy in 903 nondisseminated nasopharyngeal carcinoma evaluated by computer tomography

PURPOSE

To evaluate the significant prognosticators in nasopharyngeal carcinoma (NPC).

METHODS AND MATERIALS

From 1984 to 1989, 903 treatment-naive nondisseminated (MO) NPC were given primary radical radiotherapy to 60-62.5 Gy in 6 weeks. All patients had computed tomographic (CT) and endoscopic evaluation of the primary tumor. Potentially significant parameters (the patient's age and sex, the anatomical structures infiltrated by the primary lesion, the cervical nodal characteristics, the tumor histological subtypes, and various treatment variables were analyzed by both monovariate and multivariate methods for each of the five clinical endpoints: actuarial survival, disease-free survival, free from distant metastasis, free from local failure, and free from regional failure.

RESULTS

The significant prognosticators predicting for an increased risk of distant metastases and poorer survival included male sex, skull base and cranial nerve(s) involvement, advanced Ho's N level, and presence of fixed or partially fixed nodes or nodes contralateral to the side of the bulk of the nasopharyngeal primary. Advanced patient age led to significantly worse survival and poorer local tumor control. Local and regional failures were both increased by tumor infiltrating the skull base and/or the cranial nerves. In addition, regional failure was increased significantly by advancing Ho's N level. Parapharyngeal tumor involvement was the strongest independent prognosticator that determined distant metastasis and survival rates in the absence of the overriding prognosticators of skull base infiltration, cranial nerve(s) palsy, and cervical nodal metastasis.

CONCLUSIONS

The significant prognosticators are delineated after the advent of CT and these should form the foundation of the modern stage classification for NPC.

[A study on changes and its mechanisms of intestinal mucosal permeability after severe burn]

The changes in the intestinal mucosal permeability were observed by quantitatively assessing plasma to luminal clearance of 99mTc-labeled DTPA, and the influence of platelet activating factor (PAF) on it was investigated. The results showed that intestinal permeability was significantly elevated after severe burn and was positively correlated with increase in PAF in the intestinal tissue (r = 0.94, P < 0.01). PAF antagonist therapy could significantly attenuate postburn intestinal mucosal permeability. It is concluded that PAF is one of the important factors causing increased intestinal permeability after severe burn.

Oxygen consumption in the avascular guinea pig retina

Oxygen consumption across the retina of a mammal with a naturally avascular retina has not previously been investigated. The oxygen consumption across the avascular retina of the guinea pig was measured in vivo by spatial analysis of the intraretinal oxygen profile. The avascular nature of the guinea pig retina allows the inner retina to be included in the analysis without disrupting the normal physiological state of the retina. Oxygen-sensitive microelectrodes (1-micron tip) were used to make high-resolution measurements of oxygen tension through the retina of anesthetized, mechanically ventilated guinea pigs (n = 10). Oxygen profiles were then analyzed in terms of oxygen tension as a function of distance from the choriocapillaris/Bruch's membrane, and the data were fitted to an established mathematical model of retinal oxygen consumption. The average oxygen consumption of the full thickness of the guinea pig retina was 1.1 +/- 0.09 ml O2.min-1 x 100 g-1 (n = 10). The average oxygen consumption of the outer half of the retina was 2.07 +/- 0.17 ml O2.min-1 x 100 g-1, while that of the inner half was only 0.12 +/- 0.04 ml O2.min-1 x 100 g-1. A localized region of high oxygen consumption was identified in the outer retina in every case, and this region accounted for an average of 93.9 +/- 2.0% of the total retinal oxygen consumption. Only 5.2 +/- 1.4% of the total oxygen consumption was attributable to the inner half of the retina. When choroidal oxygen tension was increased via a combination of systemic hyperoxia and hypercapnia, high oxygen levels could be sustained in all retinal layers. Under these conditions of an excess oxygen supply, the inner retina still consumed only 0.45 +/- 0.11 ml O2.min-1 x 100 g-1, which was 13.8 +/- 2.5% of the total retinal oxygen consumed. The relatively low oxygen consumption in the inner retina of the guinea pig may reflect an interesting adaptation to the constraints imposed by the absence of a retinal circulation in this species.

Membrane cholesterol alters gallbladder muscle contractility in prairie dogs

The cause and effect relationship between membrane cholesterol and gallbladder muscle contractility was examined by altering membrane cholesterol to phospholipid mole ratio using cholesterol-rich or cholesterol-free liposomes. Gallbladder single muscle cells, from prairie dogs that were fed either a regular or high-cholesterol (1.2%) diet, were isolated enzymatically with collagenase. Plasma membranes of gallbladder muscle were purified in sucrose gradient. Cholesterol was measured using the cholesterol oxidase method. Phospholipids were measured with the method of G.R. Bartlett (J. Biol. Chem. 234: 466-468, 1959). The results of this experiment are 1) after high-cholesterol feeding, cholesterol contents and cholesterol/ phospholipid mole ratio in plasma membranes of gallbladder muscle increased 90%, and muscle cell contraction in response to cholecystokinin octapeptide decreased 58%; 2) similar changes were observed when normal gallbladder muscle cells were incubated with cholesterol-rich liposomes for 2 h; and 3) the changes induced either in vivo or in vitro were reversed when muscle cells were subsequently incubated with cholesterol-free liposomes for 2-6 h. We conclude that gallbladder muscle may incorporate excess cholesterol into its plasma membrane when exposed to a cholesterol-rich environment, that excess membrane cholesterol impairs muscle contractility, and that these changes appear to be reversible.

Crystal structures of an NH2-terminal fragment of T4 DNA polymerase and its complexes with single-stranded DNA and with divalent metal ions

We report the crystal structure of an NH2-terminal 388-residue fragment of T4 DNA polymerase (protein N388) refined at 2.2 A resolution. This fragment contains both the 3'-5' exonuclease active site and part of the autologous mRNA binding site (J. D. Karam, personal communication). The structure of a complex between the apoprotein N388 and a substrate, p(dT)3, has been refined at 2.5 A resolution to a crystallographic R-factor of 18.7%. Two divalent metal ion cofactors, Zn(II) and Mn(II), have been located in crystals of protein N388 which had been soaked in solutions containing Zn(II), Mn(II), or both. The structure of the 3'-5' exonuclease domain of protein N388 closely resembles the corresponding region in the Klenow fragment despite minimal sequence identity. The side chains of four carboxylate residues that serve as ligands for the two metal ions required for catalysis are located in geometrically equivalent positions in both proteins with a rms deviation of 0.87 A. There are two main differences between the 3'-5' exonuclease active site regions of the two proteins: (I) the OH of Tyr-497 in the Klenow fragment interacts with the scissile phosphate in the active site whereas the OH of the equivalent tyrosine (Tyr-320) in protein N388 points away from the active center; (II) different residues form of the binding pocket for the 3'-terminal bases of the substrate. In the protein N388 complex the 3'-terminal base of p(dT)3 is rotated approximately 60 degrees relative to the position that the corresponding base occupies in the p(dT)3 complex with the Klenow fragment. Finally, a separate domain (residues 1-96) of protein N388 may be involved in mRNA binding that results in translational regulation of T4 DNA polymerase (Pavlov & Karam, 1994).

The prognostic significance of parapharyngeal tumour involvement in nasopharyngeal carcinoma

From 1984 to 1989, 903 treatment-naive non-disseminated nasopharyngeal carcinomas (NPCs) were given primary radical radiotherapy. All patients had computed tomographic and endoscopic evaluation of the primary tumour. Potentially significant parameters were analysed by both univariate and multivariate methods for independent significance. In the whole group of patients, the male sex, skull base and cranial nerves(s) involvement, advanced Ho N-level, presence of fixed or partially fixed nodes and nodes contralateral to the side of the bulk of the nasopharyngeal primary, significantly determined survival and distant metastasis rates, whereas skull base and cranial nerve involvement, advanced age and male sex significantly worsened local control. However in the Ho T2No subgroup, parapharyngeal tumour involvement was the most significant prognosticator that determined distant metastasis and survival rates in the absence of the overriding prognosticators of skull base infiltration, cranial nerve(s) palsy, and cervical nodal metastasis. The local tumour control of the Ho T2No was adversely affected by the presence of oropharyngeal tumour extension. The administration of booster radiotherapy (20 Gy) after conventional radiotherapy (60-62.5 Gy) in tumours with parapharyngeal involvement has led to an improvement in local control, short of statistical significance.

Exercise hemodynamic benefits of rate adaptive ventricular pacing

OBJECTIVE

To investigate the exercise hemodynamic benefits of activity-sensing rate adaptive ventricular pacing (VVIR) over fixed rate pacing (VVI) mode.

METHODS

Activity sensing rate adaptive pacemaker was implanted in 19 patients (13 males and 6 females, mean age 54.8 years) with bradycardia. All patients underwent symptom-limited upright bicycle exercise in VVIR and VVI pacing modes in random order after implantation. With electrocardiogram monitor and M-mode echocardiography, heart rate, stroke volume and cardiac output were measured at rest and at each stage of exercise.

RESULTS

All patients were pacemaker dependent, without any spontaneous heart rhythm throughout this study. In the activity sensing ventricular pacing mode, all patients achieved a significant increase in exercise duration compared to fixed rate ventricular pacing mode (mean +/- s, 437 +/- 45 vs 323 +/- 23sec; P < 0.01), with a mean maximum pacing rate of 113 +/- 23ppm. Although the cardiac output was significantly improved in both pacing modes (10.2 +/- 1.4L/min with VVIR and 7.5 +/- 1.1L/min with VVI), the maximum exercise cardiac output in VVIR was increased over VVI by 46% (P < 0.05). Additionally, the stroke volume was significantly increased by 50% or more at rest in VVI mode, but was relatively maintained in VVIR mode (P > 0.05).

CONCLUSION

Rate adaptive ventricular pacing can significantly improve the exercise capacity and cardiac output in patients with bradycardia. The increment of exercise cardiac output in VVIR mode is mainly dependent upon the pacing rate during exercise.

[Changes of circulating Lps and cytokines in burned patients after anti-endotoxin therapy]

OBJECTIVE

Endotoxin as the inciting agent of cytokines and other mediators, whose high level expression correlates with the septic shock and MOF, has been the one of leading causes of death in ICU.

METHODS

For treating sepsis and MOF caused by endotoxin, the anti-lipid A of LPS antibody was used, 19 burned patients whose TBSA varied from 50% to 100% were divided into anti-LPS treatment group and nontreated group.

RESULTS

The levels of serum endotoxin, IL-6, IL-8, TNF and soluble IL-2R were lower obviously in patients of anti-LPS group than those of nontreated group (P < 0.05).

CONCLUSION

Clinical study surggests that anti-lipid A of LPS antibody can act as an therapeutic agent against gram-negative bacterin infection in burned patients.

Protective role of CD40 in Leishmania major infection at two distinct phases of cell-mediated immunity

CD40-deficient mice are susceptible to Leishmania major infection while their wild-type littermates can resolve the infection. Upon stimulation with L. major antigens, draining lymph node T cells of the mutant mice and the susceptible mice, BALB/c, secrete comparable amounts of IL-4. The mutant mice produce less IFN gamma than wild-type mice. The expression of IL-12 p40 mRNA was significantly lower in L. major antigen-stimulated cells of mutant mice than those of wild-type or BALB/c mice. In normal mice, engagement of CD40 activates macrophages to a leishmanicidal state in vitro in the presence of IFN gamma. The results suggest that the CD40-CD40 ligand interaction plays an important role in two critical steps of cell-mediated immunity to L. major infection: the generation of a Th1 response and activation of macrophages to a leishmanicidal state.

Early tumour response and treatment toxicity after hyperfractionated radiotherapy in nasopharyngeal carcinoma

The aim of the present study was to undertake a planned interim analysis of a prospective randomized trial comparing the tumour response and the acute and subacute complications of hyperfractionated radiotherapy and conventional radiotherapy in non-metastatic nasopharyngeal carcinoma (NPC). 100 patients with newly diagnosed non-metastatic NPC were randomized to receive either conventional radiotherapy (Arm I) or hyperfractionated radiotherapy (Arm II). Stratification was done according to the T-Stage (modified Ho's T-Stage classification). The biological effective dose (10 Gy) to the primary and the upper cervical lymphatics were 75.0 and 73.1 for Arm I and 84.4 and 77.2 for Arm II, respectively. Hyperfractionated radiotherapy was associated with significant mucositis which is of higher grade than conventional radiotherapy (p = 0.0001), but the duration of mucositis was similar between the two Arms and all study patients completed radiotherapy on schedule without interruption of radiotherapy. Early survival and tumour recurrence rates were comparable between the Arms. The preliminary results indicate that the hyperfractionated radiotherapy has excellent patient compliance in Chinese patients, with acceptable acute and subacute toxicities and the local and regional complete tumour response rates being comparable with conventional radiotherapy. The significance of the time required after start of radiotherapy to achieve a complete tumour response is discussed.

[Projections from pontine pneumotaxic center to medullary Bötzinger complex in cats]

Experiments were done on 33 adults cats. After injection of WGA-HRP (5%, 30-60 nl) into the Bötzinger complex, labelled cells were observed in the lateral parabrachial nucleus and the Kölliker-Fuse nucleus. Injection into control sites failed to label the cells in the above two nuclei. Ninety-one respiratory related neurons recorded from the pneumotaxic center were tested by electrical stimulation of the Bötzinger complex. Thirteen neurons (14.3%, inspiratory 11, phase-spanning 2) could be antidromically activated. Results of the present study showed that neurons in the pneumotaxic center sent axons to the Bötzinger complex concerning respiratory control.

[Computed tomography of the ethmoid labyrinth and adjacent structures]

In order to study the relation of ethmoid labyrinth to the adjacent structures, continuous axial CT scan of the ethmoid labyrinth was performed on 9 normal subjects. Meanwhile, coronal and axial CT scans of ethmoid labyrinth were obtained in 20 normal subjects. On an average, 22 scan sections were done on each subject. The relation of ethmoid labyrinth to adjacent structures was observed and the remarkable intersubject variations in this anatomic area were noted. The relation of posterior ethmoid cells or sphenoid sinus to the optic canal, and the relation of internal carotid artery to the sphenoid sinus were clearly demonstrated on axial scans. The detailed anatomic structure of the ostiomeatal complex and the anatomic relation of ethmoid labyrinth to orbit and anterior skull base were revealed by coronal CT scans. CT scan of the paranasal sinuses was of great importance in clinical practice for the purpose of etiological analysis of sinusitis, design of endoscopic sinus surgery and prevention of complication.

A retrospective study of the role of intracavitary brachytherapy and prognostic factors determining local tumour control after primary radical radiotherapy in 903 non-disseminated nasopharyngeal carcinoma patients

The aims of this retrospective study were to determine the role of intracavitary brachytherapy given shortly after external beam radiotherapy in the primary radical treatment of non-metastatic nasopharyngeal (NPC) cancer patients, and the prognostic factors governing local tumour control. From 1984 to 1989, 903 patients with non-disseminated NPC who had had no previous treatment were managed at the Prince of Wales Hospital, where investigation and treatment methods had been standardized according to a departmental protocol. The external radiotherapy dose of 60.0-62.5 Gy in 6 weeks was given to all patients. Parapharyngeal booster radiotherapy with a single photon beam to 20 Gy in 2 weeks was given to those with parapharyngeal tumour extension. Computed tomography of the nasopharynx and skull base, and pretreatment nasopharyngoscopy and biopsy were performed in all patients. Nasopharyngoscopy was repeated at 4 weeks after the last day of external irradiation. Local persistence in 99 patients was treated additionally by intracavitary brachytherapy to 24 Gy in three fractions over 15 days. Fifty-one patients with early stage primary disease (Ho Stage T1 and T2n (nasal)) who responded completely to external radiotherapy were given adjuvant intracavitary brachytherapy to 18 Gy in three fractions over 15 days. Intracavitary therapy was an inadequate salvage treatment for the locally persisting T3, T20 (oropharyngeal) and T2p (parapharyngeal) disease, but there was a trend towards improved local control after intracavitary brachytherapy for the locally persisting T1 tumours. Adjuvant brachytherapy did not enhance local tumour control for the early T-stage tumours that completely responded to external radiotherapy. Both forms of intracavitary brachytherapy were safe with few and acceptable complications. In the 903 non-disseminated NPCs, the patient's age and tumour involvement of the skull base and cranial nerves were significant independent prognostic factors governing local tumour control. In the 358 patients with Ho T3 disease, tumour involvement of the orbits and the laryngopharynx significantly worsened local tumour control. The presence of local persistence at 4 weeks after external radiotherapy, for which therapeutic brachytherapy was given, was marginally significant as a prognostic factor in addition to the presence of cranial nerve palsy.

In vitro uptake of bromodeoxyuridine by human nasopharyngeal carcinoma (NPC) and its relation to clinical findings

A cell kinetic study of 27 newly diagnosed patients with nasopharyngeal carcinoma (NPC) using the in vitro bromodeoxyuridine (BrdU) technique was performed. The results were reproducible as demonstrated by three independent sections performed on each patient. No correlation between BrdU labelling index (LI) and Ho's clinical staging was found. A higher LI was associated with the development of distant metastases (P = 0.057). Statistically significant correlation was found between low LI and longer duration required to achieve complete remission in the primary site of disease (P = 0.026). This study suggests a potential role for in vitro BrdU labelling index as a prognosticator for NPC prior to treatment.

Tests for possible effects of selection by domestic pyrethroids for resistance in culicine and anopheline mosquitoes in Sichuan and Hubei, China

Resistance tests, by conventional methods and by observing the time for knockdown, showed no evidence for any build up of resistance to deltamethrin in malaria vectors from areas where millions of bednets have been treated with this compound annually for up to 7 years. However, a strain of Culex quinquefasciatus which had been bred in a factory in which volatile pyrethroids are handled had developed unequivocal resistance to deltamethrin. Observation of the time for knockdown gave clearer discrimination between resistant and susceptible strains than did observation of percentage mortality after a standard exposure time.