Treatment of patients with multiple brain metastases by isolated radiosurgery:Toxicity and survival

BACKGROUND Radiosurgery for multiple brain metastases has been more reported recently without using whole-brain radiotherapy.Nevertheless,the sparsity of the data still claims more information about toxicity and survival and their association with both dosimetric and geometric aspects of this treatment.AIM To assess the toxicity and survival outcome of radiosurgery in patients with multiple(four or more lesions)brain metastases.METHODS In a single institution,data were collected retrospectively from patients who underwent radiosurgery to treat brain metastases from diverse primary sites.Patients with 4-21 brain metastases were treated with a single fraction with a dose of 18 Gy or 20 Gy.The clinical variables collected were relevant to toxicity,survival,treatment response,planning,and dosimetric variables.The Spearman’s rank correlation coefficients,Mann-Whitney test,Kruskal-Wallis test,and Log-RESULTS From August 2017 to February 2020,55 patients were evaluated.Headache was the most common complaint(38.2%).The median overall survival(OS)for patients with karnofsky performance status(KPS)>70 was 8.9 mo,and this was 3.6 mo for those with KPS≤70(P=0.047).Patients with treated lesions had a median progression-free survival of 7.6 mo.There were no differences in OS(19.7 vs 9.5 mo)or progression-free survival(10.6 vs 6.3 mo)based on prior irradiation.There was no correlation found between reported toxicities and planning,dosimetric,and geometric variables,implying that no additional significant toxicity risks appear to be added to the treatment of multiple(four or more)lesions.CONCLUSION No associations were found between the evaluated toxicities and the planning dosimetric parameters,and no differences in survival rates were detected based on previous treatment status.

Anemia in the Elderly: Neuropsychiatric Repercussions

The purpose of this review is to evaluate the role of chronic anemia on neuropsychiatric symptoms and conditions among the elderly. Anemia is defined as hemoglobin levels below 120 and 130 g/L for women and men, respectively. Anemia is not a consequence of the aging process. It is common in the elderly and easily overlooked. Nevertheless, chronic anemia is a risk factor associated with increased mortality, several geriatric syndromes including functional and cognitive impairments. Investigations have shown that anemic elderly and those with hemoglobin borderline levels may present higher proportion of neuropsychiatric impairment, such as Executive Function Disorder and Alzheimer disease. The association between anemia and depression is well established, but its causal pathway is not known: anemia can be regarded as cause or consequence of depression. There is evidence that dementia due to anemia can be prevented;renal chronic anemic patients who received erythropoietin (EPO) replacement therapy showed a lower risk for dementia, compared to those who did not receive it. Anemia may be associated with chronic psychiatric diseases such as bipolar disorders and cause their symptoms to become more severe.

Functional Capacity and Anemia in the Community Elderly

Anemia in the elderly population has been associated to clinical manifestations such as functional dependence, low cognitive performance, increased mortality and geriatric syndromes (dementia, delirium, depression and falls). Recent investigations have shown an association between low hemoglobin levels, reduction in muscular strength and physical fitness. The objective of this review was to identify, in the scientific literature, evidence of an association between anemia and functional capacity among older persons. PubMed and Bireme were used as references source. The most relevant evidence pointing towards this association was identified in the epidemiological studies Women’s Health and Aging Studies I and II (WHAS I and II). Functional capacity was evaluated by the walking, balance and sitting back and getting out of the chair tests. Elderly women with either 13 or 14 g/dl have a better performance compared to women with 12 g/dl of hemoglobin, respectively. This study also reported an increase in the mortality risk among women (65 years old and plus) living in community with less than 13.4 g/dl of hemoglobin. Participants were followed for 11 years. WHAS I and II investigators suggested a new criterion, already adopted by the World Health Organization (WHO), to define anemia among elderly women. Conclusion: anemia is common among the elderly and may have an involvement in the impairment of their functional capacity. However, in spite of the importance of these findings, it should be emphasized that an etiologic association (anemia as a cause of functional impairment) has yet to be demonstrated.

易燃易爆环境中的安全生产 易燃易爆危险场合中保障安全的标准和技术规范

为了满足法律法规的有关规定，必须定期对生产过程中的机床和设备进行防爆安全检查，特别是有易燃易爆粉尘的生产环境，其危险性很高。按照有关法律法规的规定，在这样的生产环境中工作的流程设备操作者，有义务根据自己的经验在生产过程中准备安全可靠的劳动工具，并且要考虑到与劳动工具或接触劳动介质而引起的危险。

Quasi-periodic variations of low energy cosmic rays

Cosmic rays(CR)play an important role in space weather-related studies.Their temporal variability,both of a quasi-periodic character as well as an irregular one,has been studied from ground-based direct measurements,as well as from cosmogenic nuclides,over a long time.We attempt to describe the current knowledge of selected quasi-periodicities in CR flux in the energy range above the atmospheric threshold,from direct measurements.The power spectrum density(PSD)of the CR time series as measured by neutron monitors(NMs)and by muon detectors has a rather complicated character.Along with the shape(slope)of the PSD,knowledge of the contribution of quasi-periodic variations(q-per)to the CR signal is of importance for the modulation,as well as for checking the links of CR to space weather,and/or to space climate effects.The rotation of the Earth and solar rotation cause two types of mechanisms behind the certain q-per observed in secondary CR on the Earth’s surface.Solar activity and solar magnetic field cyclicities contribute to the q-per signals in CR if studied over a longer time.The complexity of the spatial structure of the interplanetary magnetic field(IMF)and its evolution within the heliosphere,in addition to the changes in the geomagnetic field,cause variability in contributions of the q-per in CR.Wavelet spectra are useful tools for checking the fine structure of q-per and their temporal behaviour.Over a long time NMs and muon telescopes provide information about q-per in CR.

世界贸易组织、环境和生态批评

本文研究了环境问题是如何考验世贸组织的。它涉及全球政治经济以及生态经济学。第一部分探讨环境问题的处理。第二部分讨论生态批评并对其主要建议做了评价。作者提出三个特别的观点。 (1)环境问题虽然没有荣登乌拉圭回合的议题 ,然而如今世贸组织再也不能对之置若罔闻 :生态批评由于在贸易组织中引进生物圈有限、政治主导的思想 ,已经改变了争论的方向。 (2 )世贸组织秘书处现在能够而且愿意讨论生态批评的实质内容 ;认识到贸易政策处在大有可辩的领域 ,尤其在涉及自由贸易的地位以及均衡、安全而公平贸易的地位的时候。(3)在处理与环境相关的贸易争端时;;世贸组织仍然只限于采用其他方面的标准;;这些标准是由有着各式各样构型的多边协议和具有混合地位的国际政治机构制定的。采用外部标准意味着权威的转移;;这在有关贸易和环境的全球政治经济学中已经成为一个至关重要的议题。