Monoclonal antibodies in neuro-oncology: Getting past the blood-brain barrier

Monoclonal antibodies (mAbs) are used with increasing success against many tumors, but for brain tumors the blood-brain barrier (BBB) is a special concern. The BBB prevents antibody entry to the normal brain; however, its role in brain tumor therapy is more complex. The BBB is closest to normal at micro-tumor sites; its properties and importance change as the tumor grows. In this review, evolving insight into the role of the BBB is balanced against other factors that affect efficacy or interpretation when mAbs are used against brain tumor targets. As specific examples, glioblastoma multiforme (GBM), primary central nervous system lymphoma (PCNSL) and blood-borne metastases from breast cancer are discussed in the context of treatment, respectively, with the mAbs bevacizumab, rituximab and trastuzumab, each of which is already widely used against tumors outside the brain. It is suggested that success against brain tumors will require getting past the BBB in two senses: physically, to better attack brain tumor targets, and conceptually, to give equal attention to problems that are shared with other tumor sites.Key words: monoclonal antibody, brain tumor, immunotherapy, glioma, primary central nervous system lymphoma, brain metastases, bevacizumab, rituximab, trastuzumab     

Delayed medical consequences of the Chernobyl accident in Armenia. Assessment of life quality and accelerated biological aging of accident liquidators

In this paper, some final results of 25-year investigations carried out in Scientific Centre for Radiation Medicine and Burns MH RA (SCRMB) on the Armenian cohort of the Chernobyl accident consequences liquidators are shown. These results show that health conditions of the liquidators became worse during the whole observation period. A considerable development of both pathological states atypical of radiation damages and diseases, which may be considered as radiation-induced ones, was determined. Rise of the sickness rate of almost all organism systems, first of all, nervous, cardiovascular, respiratory and digestive ones, was observed. In 70% of liquidators the main disease was primarily detected after working on CNPP. In the intervening years, the average number of diagnoses per 1 liquidator increased from 1.5 in 1987 to 7-8 in the recent time. In addition to the detected diseases, particular functional shifts in neuropsychological and vegetative status of the liquidators were observed. The overwhelming majority of them have increased tonicity of the sympathetic vegetative nervous system, asthenic and depressive syndromes occurring in the form of weakness, somnolence, mood instability, mental capacity decrease, and memory defects. In the paper, the results of investigations aimed at clarification of changes in biological aging processes of the liquidators and assessment of their "life quality" features in terms of physical, psychical and social welfare are considered. Biological aged-related passportization in a definite part of liquidators elucidated an accelerated aging rate. The studies were performed with the help of SF-36 inquirer and indicated that health status aggravation of the liquidators also affected their life satisfaction. The "life quality" indices of the liquidators significantly concede the overall average standards by both physical health and psychical and social welfare scales.     

Death and family life in the past

As recently as 1970 about one-fifth of the children living in single-parent households resided in ones created by the death of a father. In colonial and nineteenth-century America, death was a much more important factor in disrupting parent-child relationships than it is today. Past societal reaction to the death of a parent continues to influence social policy; for example, widows and their dependent children receive more public assistance than divorced mothers or single mothers with children born out-of-wedlock. Although the material conditions for widows have improved over time, the social network available to help them cope with the emotional distress caused by the death of a husband probably has diminished.     

Implementing the guidelines for social life cycle assessment: past,present, and future

The International Journal of Life Cycle Assessment - This paper takes a critical review of the UNEP/SETAC (2009) Guidelines for social life cycle assessment (S-LCA) of products. This paper,...     

The national disaster medical system: past, present, and suggestions for the future

This article reviews the history and structure of the National Disaster Medical System (NDMS), with an emphasis on its definitive care component. NDMS's capacity to handle very large mass casualty events, such as those included in the National Planning Scenarios, is examined. Following Hurricane Katrina, Congress called for a reevaluation of NDMS. In that context, we make three key suggestions to improve NDMS's capacity to respond to large mass casualty disasters: (1) increase the level of engagement by the private (i.e., nonfederal) healthcare system in preparedness and response efforts; (2) increase the reliance on regional hospital collaborative networks as part of the backbone of the NDMS system; and (3) develop additional, alternative patient transportation systems, linked to the overall NDMS patient tracking effort, to decrease the sole reliance on DoD long-haul air transport in medical evacuation.     

Yale-China association exchange programs in medical sciences: past,present, and future.

There has been a close association between Yale University and educational institutions in China for almost 80 years. Although this relationship was interrupted during the early years of the People''s Republic of China, collaboration between Yale and medical institutions in China is in the process of being resumed. The history of this collaboration and the opening phases of its resumption are described.     

Effects of a wireless local area network (LAN) system, a telemetry system, and electrosurgical devices on medical devices in a hospital environment

Concerns have been raised about interference of wireless local area network (LAN) systems and telemetry systems with medical devices in hospitals. The authors have investigated the susceptibility of 65 electromedical devices to a wireless LAN system and a telemetry system in preselected areas of a hospital. Testing was based on the American National Standards Institute Standard C63.18. The wireless LAN system operated at 2.42 GHz with an output power of 100 mW. The telemetry system operated at 466 MHz with an output power of 4 mW. Of the 65 devices tested, only two hand-held Doppler units, a Mini Doppler Model D900 (Huntleigh Healthcare Ltd) and a Ultrasonic Doppler Model 811 (Parks Medical Electronics, Inc.), were affected by the LAN system. Placed within 10 cm of the LAN system in standby mode, both units emitted periodic high-pitched beating sounds, which could be misinterpreted as normal beating sounds from the patient. These changed to random static noise during data transmission by the LAN. Under normal conditions of use, a LAN system would never be placed this close to a medical device. The quality of data transmission from the LAN system changed from "good" to "acceptable" in the colonoscopy room. This deterioration in transmission quality could have been caused by the lead shielding in the room. Electrosurgical devices operating at 0.5 to 1 MHz did not affect the LAN system at distances up to 3 m. None of the devices was affected by the telemetry system. These findings suggest that wireless LAN systems and telemetry systems can be acceptable for use in hospitals. Nevertheless, other systems should be tested on potentially susceptible devices by the hospital before use.     

Economics of microsurgical cases and routine cases in a medical center

This report describes the economic impact of microsurgical cases and routine plastic surgery cases in our medical center. The study is based on a financial analysis of the practices of two surgeons. Financial data of patient encounters (admission to the hospital or a surgical unit) identified with each surgeon were categorized into microsurgical and related cases and routine cases (including cosmetic procedures and general hand cases). Revenues, costs, and profits were tabulated. Data were analyzed for 2 fiscal years (1994-95 and 1995-96). Analysis of the first fiscal year showed that microsurgery encounters (n = 188) generated $4.4 million in revenue with a profit margin after direct costs of $2.5 million (57 percent) and a net profit, after indirect costs, of $1 million (23 percent). Routine encounters (n = 262) generated $1.7 million with a net loss of -$145,000 after direct and indirect costs. In the second fiscal year, microsurgery encounters (n = 230) had income of $4.7 million, a profit over direct costs of $2.5 million (53 percent), and a net profit after indirect costs of $0.9 million (19 percent). Routine cases (n = 202) in the same period earned $1.3 million with a net loss of -$107,000. This analysis formulates a comprehensive definition of microsurgical practice and shows that cases within this definition generated dramatically higher hospital incomes and profits compared with routine plastic surgical practice. In the circumstances of our medical center, development of this subspecialty is fiscally justifiable.     

Drug reps and the academic medical center: a case for management rather than prohibition

Abstract:Academic physicians and bioethicists are increasingly voicing objections to "drug rep" detailing. Leaders in academic medical centers are considering proposals to ban the small gifts of detailing within their walls. Such bans would be a mistake, as the small gifts are unlikely to act as bribes and do not create unacceptable conflicts of interest for physicians. Drug rep detailing does influence physician behavior, but this influence has not been shown to be harmful. Calls for a ban are premised on empirical evidence for harm that is inconclusive at best, and emerging literature in economics suggests that detailing may well be socially beneficial. A preponderance of harm over benefit is not, however, the primary source of the animus against detailing, which stems from moral considerations that are independent of its social consequences. However, pharmaceutical advertising, including detailing, is a morally legitimate aspect of the world of medical practice that we in academic medicine ought to be preparing our trainees to encounter and properly sift.     

Rehabilitation in a rural setting of a young quadriplegic accident victim. Integrative clinicopathological conference: medical, psychosocial, economic, preventive, and ethical dimensions of a case study

Problems encountered by a young, unmarried woman who, as a result of a spinal injury in an automobile accident, loses use of all four limbs and requires complex home health care services delivered by a network of health and social service agencies in a rural area of Kentucky. Economic, psychosocial, ethical, preventive, and medical aspects of health care are discussed.     

The impartial medical examiner; a neurosurgeon's differences and agreements with the industrial accident commission

In 147 industrial compensation cases the evaluation reached by a neurosurgeon acting as an impartial medical examiner was compared with the disposition made by the Industrial Accident Commission. There was complete or general agreement in 71 per cent of the cases, pretty sharp disagreement in about 30 per cent. In general, the Industrial Accident Commission was more liberal than the neurosurgeon acting as impartial medical examiner.