OBJECTIVES: To examine the factors affecting passive exposure to secondhand smoke (SHS) in non-smoking student nurses. METHODS: A cross-sectional study was performed in 196 college students who had not smoked cigarettes in the past 12 months. Urinary cotinine levels were examined to identify exposure to SHS, and social factors were identified that influenced exposure to SHS, including requests that smokers extinguish cigarettes. Logistic regression analysis was used to predict the factors influencing SHS. RESULTS: Urinary cotinine measurements showed that 32 students (16.3%) were exposed to SHS. Risk factors that increased exposure to SHS affected 80 students (40.8%) in the previous 7 days. Students who were exposed to SHS were 4.45-times more likely to have increased urinary cotinine levels than those who were not exposed. Students who asked others to extinguish their cigarettes were 0.34 times less likely to test positive than those who did not. CONCLUSION: Urinary cotinine was a useful biomarker for identifying exposure to SHS, with respect to the influence of demographic, health-related, and smoking-related factors. In non-smoking nursing students, avoiding exposure to SHS was attributed to self-assertive behavior by requesting smokers to extinguish cigarettes.
Assertiveness ; Cotinine ; Cross-Sectional Studies ; Humans ; Inhalation ; Logistic Models ; Risk Factors ; Smoke ; Students, Nursing ; Tobacco Products ; Tobacco Smoke Pollution

During the last three decades, the management of medulloblastoma (MBL) has made enormous progress with a multidisciplinary approach, incorporating surgery, radiotherapy (RT), and chemotherapy. Despite this improvement, 20%–30% of patients with MBL remain at risk of disease recurrence, with its relapse being possibly fatal. To date, the salvage treatment for relapse remains challenging, and various approaches have been suggested for the retreatment. In this review, I have described the characteristics of patients with relapsed MBL, patterns of relapse and the most commonly prescribed treatment. Further, I have reviewed the studies on re-irradiation and its associated issues to conclusively suggest the RT recommendations for patients with relapsed MBL.

No abstract available.
Brain ; Brain Neoplasms

Pediatric brain tumors present a tremendous challenge to physicians due to their diverse biologic behavior and the developing nervous system. Therefore, flexible and tailored treatment plans are required. Radiation therapy has played an important role in pediatric brain tumors and treatment results have improved. However, to reduce late radiation effects, the modification of the radiation dose and volume with intensified chemotherapy or delay of radiotherapy is the concept of current protocols. With the results of many clinical trials, the understanding of radiation-induced neurotoxicity has progressed, and there have been technical advances in the field of radiotherapy such as image-guided radiation therapy and intensity-modulated radiation therapy. To achieve disease control as well as functional outcomes for children with brain tumors, further studies using high precision radiotherapy combined with other modalities will be needed.
Brain ; Brain Neoplasms ; Child ; Humans ; Nervous System ; Pediatrics ; Radiotherapy, Image-Guided

PURPOSE: Radiotherapy (RT) is considered a mainstay of treatment in parameningeal rhabdomyosarcoma (PM-RMS). We aim to determine the treatment outcomes and prognostic factors for PM-RMS patients who treated with RT. In addition, we tried to evaluate the adequate dose and timing of RT. MATERIALS AND METHODS: Twenty-two patients with PM-RMS from 1995 to 2013 were evaluated. Seven patients had intracranial extension (ICE) and 17 patients had skull base bony erosion (SBBE). Five patients showed distant metastases at the time of diagnosis. All patients underwent chemotherapy and RT. The median radiation dose was 50.4 Gy (range, 40.0 to 56.0 Gy). RESULTS: The median follow-up was 28.7 months. Twelve patients (54.5%) experienced failure after treatment; 4 local, 2 regional, and 6 distant failures. The 5-year local control (LC) and overall survival (OS) were 77.7% and 38.5%, respectively. The 5-year OS rate was 50.8% for patients without distant metastases and 0% for patients with metastases (p < 0.001). Radiation dose (<50 Gy vs. ≥50 Gy) did not compromise the LC (p = 0.645). However, LC was affected by ICE (p = 0.031). Delayed administration (>22 weeks) of RT was related to a higher rate of local failure (40.0%). CONCLUSION: RT resulted in a higher rate of local control in PM-RMS. However, it was not extended to survival outcome. A more effective treatment for PM-RMS is warranted.
Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Ice ; Meninges ; Neoplasm Metastasis ; Radiotherapy* ; Rhabdomyosarcoma* ; Skull Base

BACKGROUND: Left ventricular thrombus is a common complication after acute myocardial infarction. Methods and RESULTS: To Study the incidence of left ventricular thrombosis (LVT) after acute myocardial infarction, we performed serial two-dimensional echocardiography (2D-Echo) in 35 consecutive patients with acute myocardial infarction prospectively ; 10 patients had inferior wall myocardial infarction, 25 patients had anterior wall myocardial infarction. 2D-Echo was obtained within 3 days of acute myocardial infarction, at 4-10 days after symptom onset, and 2-4 weeks after symptom onset serially in each case. 19 out of 35 patients received thrombolytic therapy with urokinase. Left ventricular thrombi were identified in 9(25.7%) of the 35 study patients. The location of myocardial infarction was anterior and apical in all cases with left ventricular thrombi. The shape of thrombi was mural in 6 cases and protruding in 3 cases. The incidence of left ventricular thrombi in patients who received urokinase was not significantly different from that in patients who didn't(31.9% vs 18.8%,p=0.22). Wall motion score was significantly higher in patients who developed left ventricular thrombi than in patients who had no left ventricular thrombus(8.2+/-1.9 vs 5.8+/-2.6, p<0.005). All thrombi appeared within 10 days after myocardial infarction. CONCLUSIONS: Thus left ventricular thrombi develops within 10 days following myocardial infarction with large anterior and apical location. The thrombolysis therapy has no effect in the incidence of left ventricular thrombi in this study. But because of confounding effect of thrombolysis and location of myocardial infarction and extent of myocardial infarction, further investigation is needed.
Anterior Wall Myocardial Infarction ; Echocardiography ; Humans ; Incidence* ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Prospective Studies ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator

In gastric adenocarcinoma, high rates of loco-regional recurrences have been reported even after complete resection, and various studies have been tried to find the role of postoperative adjuvant therapy. Among them, Intergroup 0116 trial was a landmark trial, and demonstrated the definite survival benefit in adjuvant chemoradiotherapy, compared with surgery alone. However, the INT 0116 trial had major limitation for global acceptance of the INT 0116 regimen as an adjuvant treatment modality because of the limited lymph node dissection. Lately, several randomized studies that were performed to patients with D2-dissected gastric cancer were published. This review summarizes the data about patterns of failure after surgical resection and the earlier prospective studies, including INT 0116 study. Author will introduce the latest studies, including ARTIST trial and discuss whether external beam radiotherapy should be applied to patients receiving extended lymph node dissection and adjuvant chemotherapy.
Adenocarcinoma ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Humans ; Lymph Node Excision ; Radiotherapy, Adjuvant ; Recurrence ; Stomach Neoplasms ; Tetrazolium Salts

In gastric adenocarcinoma, high rates of loco-regional recurrences have been reported even after complete resection, and various studies have been tried to find the role of postoperative adjuvant therapy. Among them, Intergroup 0116 trial was a landmark trial, and demonstrated the definite survival benefit in adjuvant chemoradiotherapy, compared with surgery alone. However, the INT 0116 trial had major limitation for global acceptance of the INT 0116 regimen as an adjuvant treatment modality because of the limited lymph node dissection. Lately, several randomized studies that were performed to patients with D2-dissected gastric cancer were published. This review summarizes the data about patterns of failure after surgical resection and the earlier prospective studies, including INT 0116 study. Author will introduce the latest studies, including ARTIST trial and discuss whether external beam radiotherapy should be applied to patients receiving extended lymph node dissection and adjuvant chemotherapy.
Adenocarcinoma ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Humans ; Lymph Node Excision ; Radiotherapy, Adjuvant ; Recurrence ; Stomach Neoplasms ; Tetrazolium Salts

This study aimed to evaluate the effects of volume adapted re-planning for radiotherapy (RT) after gross total resection (GTR) for glioblastoma. Nineteen patients with glioblastoma who underwent GTR and postoperative RT were analyzed. The volumes of the surgical cavity on computed tomography (CT) obtained one day after GTR (CT0), the first RT simulation CT (sim-CT1), and the second simulation CT for the boost RT plan (sim-CT2) were compared. The boost RT plan was based on the surgical cavity observed on the sim-CT2 (boost RTP2) and was compared with that based on the surgical cavity observed on the sim-CT1 (boost RTP1). The volume reduction ratios were 14.4%-51.3% (median, 29.0%) between CT0 and sim-CT1 and -7.9%-71.9% (median, 34.9%) between sim-CT1 and sim-CT2 (P < 0.001). The normal brain volumes in boost RTP1 were significantly reduced in boost RTP2, especially at high dose levels. Target volume in sim-CT2 which was not covered with the boost RTP1, developed in five cases (26.3%). The surgical cavity volume was reduced following surgery in patients with glioblastoma who underwent GTR. The application of volume-adapted re-planning during RT could decrease the irradiated volume of normal brain and prevent a target miss for boost RT.
Aged ; Aged, 80 and over ; Brain Neoplasms/*radiotherapy/surgery ; Female ; Glioblastoma/*radiotherapy/surgery ; Humans ; Male ; Middle Aged ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Tomography, X-Ray Computed