A CLINICAL STUDY FOR EVALUATING EARLY RADIOTHERAPY EFFECT IN PATIENTS WITH BRAIN TUMOR USING ^(99)Tc^m-HL91 SPECT

Objective： The purpose of this study was to evaluate the early radiotherapy effect using ^99Tc^m-HL91 SPECT in patients with brain tumors. Methods： Twenty-one patients with brain tumors who were treated by radiotherapy were studied. KPS grade, tumor size on ^99Tc^m-HL91 SPECT, tumor size on MRI, and ratio of T/N （tumor counts/sec over normal brain tissue counts/sec） were investigated before ,during and after radiotherapy. Results： The average tumor size on ^99Tc^m-HL91 SPECT and MRI was 11.34±5.88 cm^2, 9.46±5.66 cm^2, respectively before radiotherapy. The tumor size on ^99Tc^m-HL91 SPECT was not in accordance with to that on MRI （P〈0.05）. KPS grade, tumor size on ^99Tc^m-HL91 SPECT and ratio of T/N had significance differences before, during and after radiotherapy （P〈0.05）, but the tumor size on MRI imaging had no significance differences before, during and after radiotherapy （P〉0.05）. The rate of symptom improvement was 80% during radiotherapy and 100% after radiotherapy. The rates of imaging remission based on the brain tumor size on ^99Tc^m-HL91 SPECT, MRI and T/N were 75%, 15%, and 80%, respectively during radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptom improvement were 70%, 40%, and 60% respectively during radiotherapy. The rates of imaging remission based on the brain tumor sizes on ^99Tc^m-HL91 SPECT, MRI and T/N were 100%, 25%, and 95% respectively after radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptoms improvement were 100%, 20%, and 95% respectively after radiotherapy. Conclusion： The tumor size on ^99Tc^m-HL91 SPECT is a valuable tool for evaluating early radiotherapy effect of brain tumor in process of radiotherapy. T/N is not a feasible method in evaluating radiotherapy effect of brain tumor because it may show elevation unrelated to the curative effect during radiotherapy.

Identification of Questionnaire Improvements to Assess Familial Support in Malignant Brain Tumor Patient

BACKGROUND: To support decision-making for patients with malignant brain tumors, it is necessary to understand family needs during the hospitalization period. The assessment sheets and checklists generally used in the ward focus on the patient’s condition with only a few items related to family information. Many checklists are not tailored to the patient’s disease and therefore do not address changes in condition and neurological symptoms. Thus, based on previous research, this study aimed to extract items that clinical nurses consider necessary for the family members of patients with malignant brain tumors by filling out a self-administered assessment. METHODS: For the 92 self-made questions, the Delphi method was performed three times for the panelists;consensus was reached on the necessity of a family self-administered information gathering item. The patients’ families answered questions using a 1 - 5 rating scale to assess support required, with 5 being necessary and 1 being unnecessary. In the analysis of the 3rd survey, the consensus rate was calculated as follows: out of 5 options for each question, scores of 5 and 4 were combined and judged to be necessary. The average value was calculated as 87.3% and this value was used as the criterion for agreement. RESULTS: In the final round, answers from 45 panelists were obtained, and consensus was obtained for 47 questions. The 47 questions were extracted using the Delphi method based on reasonable condition settings and yielded reliable results. CONCLUSION: The data collected in this study can contribute to support programs aimed at helping families of patients with malignant brain tumors.

Definition,prediction,prevention and management of patients with severe ischemic stroke and large infarction

Severe ischemic stroke carries a high rate of disability and death.The severity of stroke is often assessed by the degree of neurological deficits or the extent of brain infarct,defined as severe stroke and large infarction,respectively.Critically severe stroke is a life-threatening condition that requires neurocritical care or neurosurgical intervention,which includes stroke with malignant brain edema,a leading cause of death during the acute phase,and stroke with severe complications of other vital systems.Early prediction of high-risk patients with critically severe stroke would inform early prevention and treatment to interrupt the malignant course to fatal status.Selected patients with severe stroke could benefit from intravenous thrombolysis and endovascular treatment in improving functional outcome.There is insufficient evidence to inform dual antiplatelet therapy and the timing of anticoagulation initiation after severe stroke.Decompressive hemicraniectomy(DHC)<48 h improves survival in patients aged<60 years with large hemispheric infarction.Studies are ongoing to provide evidence to inform more precise prediction of malignant brain edema,optimal indications for acute reperfusion therapies and neurosurgery,and the individualized management of complications and secondary prevention.We present an evidence-based review for severe ischemic stroke,with the aims of proposing operational definitions,emphasizing the importance of early prediction and prevention of the evolution to critically severe status,summarizing specialized treatment for severe stroke,and proposing directions for future research.