Validity and reliability of EQ-5D-3L for breast cancer patients in Korea.

BACKGROUND: Recently, breast cancer incidence and prevalence has been increasing. Patients' health related quality of life is important considerations in the treatment of breast cancer. The EQ-5D-3L is one of most popular instruments to measure health related quality of life. This study was aimed to evaluate the validity and reliability of EQ-5D-3L in post-operative breast cancer patients from Korea. METHODS: A total of 827 patients visiting the ambulatory cancer center of 1 tertiary hospital after breast cancer surgery self-administered the EQ-5D-3L and Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B). We evaluated known-group validity using differences in the EQ-5D-3L index and EQ-VAS score according to demographic and clinical data. The discriminatory ability of the EQ-5D-3L was determined by comparing the mean FACT-B subscale scores between subjects with no problems and subjects with moderate or severe problems in each EQ-5D-3L dimension. Construct validity was evaluated by Pearson correlation coefficients among the EQ-5D-3L index and FACT-B subscales, respectively. Reliability was assessed in terms of test-retest reliability using Cohen's kappa value and intra-class correlation coefficient (ICC). RESULTS: The EQ-5D-3L index and EQ-VAS score were higher in the educated, current radiotherapy and unmarried groups. The correlation of EQ-5D-3L index and subscales for the FACT-B was highest in physical well-being (r = 0.553) and lowest in social well-being (r = 0.199). For reliability, the Kappa values' range was from 0.32 to 0.70, and ICCs of the EQ-5D-3L index and EQ-VAS scores were 0.70 and 0.48, respectively. CONCLUSIONS: This study indicated that the EQ-5D-3L could be a valid health related quality of life instrument for postoperative breast cancer patients.

[Operating Room Nurses' Experiences of Securing for Patient Safety].

PURPOSE: This study was done to evaluate the experience of securing patient safety in hospital operating rooms. METHODS: Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. RESULTS: The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. CONCLUSION: The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

[Estrogen attenuates the pressor response mediated by the group III mechanoreflex].

PURPOSE: We investigated the effects of group III mechanoreceptors to cardiovascular responses in both pre-menopausal woman and post-menopausal woman during passive ankle dorsiflexion (PAD). METHODS: Twenty healthy volunteers (10 post-menopausal women and 10 pre-menopausal women) were recruited for this study. Stroke volume (SV), heart rate (HR), cardiac output (CO), and total vascular conductances (TVC) were measured continuously throughout the experiment. To stimulate the group III mechanoreceptors, PAD was performed for one minute. RESULTS: The results showed that mean arterial pressure (MAP) mediated by the mechanoreflex activation was significantly increased in both groups. However, this pressor response was significantly higher in post-menopausal women. This reflex significantly increased both SV and CO in pre-menopausal women, while there were no differences in post-menopausal women. There was no difference in HR in either group. The mechanoreflex significantly decreased TVC in post-menopausal woman, while there was no difference in pre-menopausal woman. CONCLUSION: The results indicate that the excessive pressor response mediated by the mechanoreflex occurs due to overactivity of group III mechanorecptors and the mechanism is produced mainly via peripheral vasoconstriction in post-menopausal women.

Optimized therapeutic neutron beam for accelerator-based BNCT by analyzing the neutron angular distribution from (7)Li(p,n)(7)Be reaction.

Perpendicular neutrons (i.e., solid angle bin of 50-150 degrees ) among ones generated from (7)Li(p,n)(7)Be reaction were used to produce an optimized therapeutic neutron beam for accelerator-based BNCT. A new beam port assembly was also designed to shape the fast neutrons into epithermal ones and to reduce unnecessary radiation including gammas. As a result of a simulation, it is found that a tumor at a depth of 60mm from the head skin could be treated within 5 minutes, if a typical tumor is assumed to be taken about 20RBEGy for therapeutic treatment. It is, thus, expected that the neutrons emitted into the solid angle bin of 50-150 degrees from (7)Li(p,n)(7)Be reaction are very effective in producing epithermal neutron beams for BNCT.

A treatment planning study on glioblastoma with different techniques using boron neutron capture therapy, 3-dimensional conformal radiotherapy, and intensity modulated radiotherapy.

To propose adequate indices predicting efficacy of boron neutron capture therapy (BNCT) for glioblastoma, a comparative treatment planning study between BNCT, 3-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT) was performed, and dose-volume histograms (DVHs) on planning target volume (PTV) and normal brain were calculated. Therapeutic benefit of BNCT was quantitatively evaluated using conformity indices, which have been previously suggested by radiation therapy oncology group (RTOG) and Saint-Anne, Lariboisière, Tenon (SALT). Although dose homogeneities from the BNCT plans were poor than the other modalities due to simple irradiation fields, lesion coverage factor, CVF, from the BNCT plans were comparable to those from the 3D-CRT and IMRT plans (median values, 0.991, 0.989, and 0.961, respectively). The geometrical factors, g, from the BNCT plans, which describes target volumes receiving doses under the prescribed doses and normal brain volume covered by the prescribed doses, were lowest compared to those for the other modalities (median values, 0.009, 0.115, and 0.043). For the BNCT plans, maximum dose escalation up to 2.080 times the prescribed dose was possible without exceeding normal brain tolerance dose. As the indices can evaluate the quantitative benefit of BNCT and maximum dose escalation for the individual patient, it is expected that the indices can effectively evaluate the treatment plan of BNCT.

Chlorella dichloromethane extract ameliorates NO production and iNOS expression through the down-regulation of NF kappa B activity mediated by suppressed oxidative stress in RAW 264.7 macrophages.

BACKGROUND: It has been proposed that chlorella extracts have antioxidative and anti-inflammatory effects. METHODS: RAW 264.7 murine macrophage cell line was preincubated with various concentrations (0-100 mug/ml) of chlorella dichloromethane extract (CDE) and stimulated with lipopolysaccharide (LPS) to induce oxidative stress and inflammation. RESULTS: Treatments of CDE reduced thiobarbituric acid-reactive substances (TBARS) accumulation, enhancing glutathione level and activities of antioxidative enzymes including superoxide dismutase (SOD), catalase, glutathione peroxidase (GSH-px), and glutathione reductase in LPS-stimulated macrophages than LPS-only treated cells. Nitric oxide (NO) production was significantly suppressed in a dose-dependent manner (p<0.05) with an IC(50) of 30.5 microg/ml. Treatment of CDE at 50 microg/ml suppressed NO production to 6% of LPS-control. Treatment with CDE suppressed the levels of inducible nitric oxide synthase (iNOS) protein and mRNA expressions. The specific DNA binding activities of nuclear factor kappa B (NF kappa B) on nuclear extracts from CDE treatments were significantly suppressed with an IC(50) of 62.7 mug/ml in a dose-dependent manner. CONCLUSIONS: CDE ameliorates NO production and iNOS expression through the down-regulation of NF kappa B activity, which may be mediated by attenuated oxidative stress in RAW 264.7 macrophages.

An accelerator-based epithermal neutron beam design for BNCT and dosimetric evaluation using a voxel head phantom.

The beam shaping assembly design has been investigated in order to improve the epithermal neutron beam for accelerator-based boron neutron capture therapy in intensity and quality, and dosimetric evaluation for the beams has been performed using both mathematical and voxel head phantoms with MCNP runs. The neutron source was assumed to be produced from a conventional 2.5 MeV proton accelerator with a thick (7)Li target. The results indicate that it is possible to enhance epithermal neutron flux remarkably as well as to embody a good spectrum shaping to epithermal neutrons only with the proper combination of moderator and reflector. It is also found that a larger number of thermal neutrons can reach deeply into the brain and, therefore, can reduce considerably the treatment time for brain tumours. Consequently, the epithermal neutron beams designed in this study can treat more effectively deep-seated brain tumours.

Use of the CT images for BNCT calculation: development of BNCT treatment planning system and its applications to dose calculation for voxel phantoms.

A BNCT (Boron Neutron Capture Therapy) treatment planning system (BTPS) was developed for BNCT study and treatment planning. Three kinds of CT images, VHP, PINNACLE and DICOM images, were employed to make voxel phantoms for BNCT patient treatment using the BTPS. The thermal neutron, fast neutron, gamma and boron doses are calculated and background, tissue, and tumour doses for idealised standard reactor neutron field (ISRNF) neutron beam were calculated by using BTPS and MCNP code. It was noted that the total computing times needed for BNCT analysis could be greatly reduced since the BTPS system provides a dose analysis tool and a lengthy MCNP input in a short time. It is, thus, expected that the BTPS can significantly contribute the BNCT study for the treatment of patients.