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Biomedical subjects

R Shih

Publications and source records attributed to R Shih.

At least 19 recordsLinked to original sources
PubMed2001

Dose effects of guide wires for catheter-based intravascular brachytherapy.

PURPOSE: Guide wires with high torquability and steerability are commonly used to navigate through a tortuous and/or branching arterial tree in a catheter-based intravascular brachytherapy procedure. The dosimetric effects due to the presence of metallic guide wires have not been addressed. This work investigates these dose effects for the three most commonly used beta and gamma sources (90Sr, 32P, and 192Ir). METHODS AND MATERIALS: The EGS4 Monte Carlo codes were used to calculate the dose distributions for the 90Sr(NOVOSTE), 32P (Guidant), and 192Ir (BEST Ind.) with and without a guide wire in place. Energy spectra for particles exiting the sources were calculated from the full phase-space data obtained from the Monte Carlo simulations of the source constructions. Guide wires of various thicknesses and compositions were studied. RESULTS: The dose perturbations due to the presence of guide wires were found to be far more significant for the 90Sr/90Y and 32P beta sources than those for the 192Ir gamma source. Because of the attenuation by the guide wires, a dose reduction of up to 60% behind a guide wire was observed for the beta sources, whereas the dose perturbation was found to be negligible for the gamma source. For a beta source, the dose perturbations depend on the thickness and the material of the guide wire. When the region behind a guide wire is part of an intravascular brachytherapy target, the presence of the guide wire results in a significant underdosing for beta sources. The underdosed region can extend a few mm behind the guide wire and up to 1 mm in other directions. CONCLUSION: Significant dose perturbations by the presence of a metallic guide wire have been found in catheter-based intravascular brachytherapy using beta sources. The dose effects should be considered in the dose prescription and/or in analyzing the treatment outcome for beta sources. Such precautions are not necessary if using a gamma source.

Beta Particles↗
PubMed2001

Dosimetric characteristics of dynamic wedged fields: a Monte Carlo study.

We have developed a Monte Carlo (MC) technique using the EGS4/BEAM system to calculate dosimetric characteristics of dynamic wedges (DW) for photon beam radiotherapy. The simulation of DW was accomplished by weighting the history numbers of the electrons, which are incident on the target in accordance with the segmented treatment table. Calculations were performed for DW with wedge angles ranging from 15 degrees to 60 degrees as well as for open fields with different field sizes for both degrees 6 and 18 MV beams. The MC-calculated percentage depth dose (PDD) and beam profiles agreed with the measurements within +/- 2% (of the dose maximum along the beam axis) or +/- 2 mm in high dose gradient region. The DW slightly affects energy spectra of photons and contaminating electrons. These slight changes have no significant effects on PDD as compared to the open field. The MC-calculated dynamic wedge factors agree with the measurements within +/- 2%. The MC method enables us to provide more detailed beam characteristics for DW fields than a measurement method. This beam characteristic includes photon energy spectra, mean energy, spectra of contaminating electrons and effects of moving jaw on off-axis beam quality. These data are potentially important for treatment planning involving dynamic wedges.

Electrons↗
PubMed2001

Monte Carlo dose verification for intensity-modulated arc therapy.

Intensity-modulated arc therapy (IMAT), a technique which combines beam rotation and dynamic multileaf collimation, has been implemented in our clinic. Dosimetric errors can be created by the inability of the planning system to accurately account for the effects of tissue inhomogeneities and physical characteristics of the multileaf collimator (MLC). The objective of this study is to explore the use of Monte Carlo (MC) simulation for IMAT dose verification. The BEAM/DOSXYZ Monte Carlo system was implemented to perform dose verification for the IMAT treatment. The implementation includes the simulation of the linac head/MLC (Elekta SL20), the conversion of patient CT images and beam arrangement for 3D dose calculation, the calculation of gantry rotation and leaf motion by a series of static beams and the development of software to automate the entire MC process. The MC calculations were verified by measurements for conventional beam settings. The agreement was within 2%. The IMAT dose distributions generated by a commercial forward planning system (RenderPlan. Elekta) were compared with those calculated by the MC package. For the cases studied, discrepancies of over 10% were found between the MC and the RenderPlan dose calculations. These discrepancies were due in part to the inaccurate dose calculation of the RenderPlan system. The computation time for the IMAT MC calculation was in the range of 20-80 min on 15 Pentium-Ill computers. The MC method was also useful in verifying the beam apertures used in the IMAT treatments.

Dose-Response Relationship, Radiation↗
PubMed2001

Dynamic wedge versus physical wedge: a Monte Carlo study.

The purpose of this study is to analyze the characteristics of dynamic wedges (DW) and to compare DW to physical wedges (PW) in terms of their differences in affecting beam spectra, energy fluence, angular distribution, contaminated electrons, and dose distributions. The EGS4/BEAM Monte Carlo codes were used to simulate the exact geometry of a 6 MV beam and to calculate 3-D dose distributions in phantom. The DW was simulated in accordance with the segmented treatment tables (STT). The percentage depth dose curves and beam profiles for PW, DW, and open fields were measured and used to verify the Monte Carlo simulations. The Monte Carlo results were found to agree within 2% with the measurements performed using film and ionizing chambers in a water phantom. The present EGS4 calculation reveals that the effects of a DW on beam spectral and angular distributions, as well as electron contamination, are much less significant than those for a PW. For the 6 MV photon beam, a 45 degrees PW can result in a 30% increase in mean photon energy due to the effect of beam hardening. It can also introduce a 5% dose reduction in the build-up region due to the reduction of contaminated electrons by the PW. Neither this mean-energy increase nor such dose reduction is found for a DW. Compared to a DW, a PW alters the photon-beam spectrum significantly. The dosimetric differences between a DW and a PW are significant and clearly affect the clinical use of these beams. The data presented may be useful for DW commissioning.

Electrons↗
PubMed2000

Lower limb skeletal muscle mass: development of dual-energy X-ray absorptiometry prediction model.

Although magnetic resonance imaging (MRI) can accurately measure lower limb skeletal muscle (SM) mass, this method is complex and costly. A potential practical alternative is to estimate lower limb SM with dual-energy X-ray absorptiometry (DXA). The aim of the present study was to develop and validate DXA-SM prediction equations. Identical landmarks (i.e., inferior border of the ischial tuberosity) were selected for separating lower limb from trunk. Lower limb SM was measured by MRI, and lower limb fat-free soft tissue was measured by DXA. A total of 207 adults (104 men and 103 women) were evaluated [age 43 +/- 16 (SD) yr, body mass index (BMI) 24.6 +/- 3.7 kg/m(2)]. Strong correlations were observed between lower limb SM and lower limb fat-free soft tissue (R(2) = 0.89, P < 0.001); age and BMI were small but significant SM predictor variables. In the cross-validation sample, the differences between MRI-measured and DXA-predicted SM mass were small (-0.006 +/- 1.07 and -0.016 +/- 1.05 kg) for two different proposed prediction equations, one with fat-free soft tissue and the other with added age and BMI as predictor variables. DXA-measured lower limb fat-free soft tissue, along with other easily acquired measures, can be used to reliably predict lower limb skeletal muscle mass.

Absorptiometry, Photon↗
PubMed1999

Age-related defects in spatial memory are correlated with defects in the late phase of hippocampal long-term potentiation in vitro and are attenuated by drugs that enhance the cAMP signaling pathway.

To study the physiological and molecular mechanisms of age-related memory loss, we assessed spatial memory in C57BL/B6 mice from different age cohorts and then measured in vitro the late phase of hippocampal long-term potentiation (L-LTP). Most young mice acquired the spatial task, whereas only a minority of aged mice did. Aged mice not only made significantly more errors but also exhibited greater individual differences. Slices from the hippocampus of aged mice exhibited significantly reduced L-LTP, and this was significantly and negatively correlated with errors in memory. Because L-LTP depends on cAMP activation, we examined whether drugs that enhanced cAMP would attenuate the L-LTP and memory defects. Both dopamine D1/D5 receptor agonists, which are positively coupled to adenylyl cyclase, and a cAMP phosphodiesterase inhibitor ameliorated the physiological as well as the memory defects, consistent with the idea that a cAMP-protein kinase A-dependent signaling pathway is defective in age-related spatial memory loss.

Aging↗
PubMed1999

Stages at presentation, prognostic factors, and outcome of breast cancer in males.

BACKGROUND: In order to support or refute conventional notions of breast cancer in males as a late-presenting disease associated with a worse prognosis than the same disease in females, we reviewed a recent, multi-institutional experience. METHODS: A case series from three area hospital system cancer data bases was reviewed. Demographics, pathology, stages at presentation, and treatment were determined from the data set and correlated with outcomes (recurrence/survival). RESULTS: Fifty-four patients (mean age 64.5, SD = 12.8) were identified; half of the tumors were stage T0 or T1, 62% were node negative (N0), and 57% had an American Joint Committee on Cancer (AJCC) stage grouping of IIA or less. Eighty-five percent of tumors examined expressed hormone receptors. There were no local-only recurrences in the 50 cases resected for cure, including 5 cases of minimal breast cancer treated by lumpectomy only. Five- and 10-year overall disease-free survival was AJCC stage related: 100% and 71%, respectively, for early stage (0-IIA) disease, and 71% and 20%, respectively, for advanced (IIB-IV) stage (P = 0.0051 by log-rank). Only AJCC stage and its components (tumor size, nodal status, presence of metastases) correlated with survival by multivariate analysis; other factors such as age, family history, and presenting symptoms/signs did not. CONCLUSIONS: The majority of breast cancers in males present at early stages and are hormone receptor positive. In contrast to older notions of this disease as uniformly aggressive, we conclude that prognostic factors and stage-for-stage outcomes for breast cancer in males are similar to those published for the disease in females.

Adult↗
PubMed1999

Shorter survival in advanced human immunodeficiency virus type 1 infection is more closely associated with T lymphocyte activation than with plasma virus burden or virus chemokine coreceptor usage.

To define predictors of survival time in late human immunodeficiency virus type 1 (HIV-1) disease, long- and short-duration survivors were studied after their CD4+ T cells fell to </=50/mm3. Immune activation of CD4+ and CD8+ T cells, as measured by elevated cell surface expression of CD38 antigen, was strongly associated with shorter subsequent survival (P</=.002). The naive CD45RA+CD62L+ T cell reserve was low in all subjects and did not predict survival (P=.34 for CD4+ and.08 for CD8+ cells). Higher virus burden correlated with CD8+ but not CD4+ cell activation and, after correcting for multiple comparisons, was not associated with shorter survival (P=.02). All of the patients' viruses used CCR5, CXCR4, or both, and coreceptor usage did not predict survival (P=. 27). Through mechanisms apparently unrelated to higher virus burden, immune activation is a major determinant of survival in advanced HIV-1 disease.

ADP-ribosyl Cyclase↗
PubMed1999

Calculation of head scatter factors at isocenter or at center of field for any arbitrary jaw setting.

The purpose of this work is to calculate the head scatter factors for any arbitrary jaw setting by using two different semi-empirical methods. The head scatter factor at the center of field (COF) for any arbitrary jaw setting can be defined as H(COF)(X1,X2,Y1,Y2,r)=DairCOF(XI1,X2,Y1,Y2,r)/ [Dair(5,5,5,5,0)*OAR(r)], where X1, X2, Y1, and Y2 are the jaw positions; r is the distance between COF and isocenter (IC); OAR(r) is the Off-Axis-Ratio; DairCOF(X1,X2,Y1,Y2,r) is the dose in air measured at COF; Dair(5,5,5,5,0) is the dose in air measured at IC for the 10 x 10 cm2 field. In certain clinical situations, doses are prescribed at IC instead of COF for asymmetric fields. In these cases, head scatter factors should be determined at IC. It is found that the head scatter factors at IC for asymmetric fields [H(IC)(X1,X2,Y1,Y2)] are lower than H(COF)(X1,X2,Y1,Y2,r) for the same jaw setting by up to 4%. The values of H(IC)(X1,X2,Y1,Y2) and H(COF)(X1,X2,Y1,Y2,r) for a variety of jaw settings were measured using a miniphantom of 3-cm diameter for a 6- and a 18-MV photon beams. An equivalent square formula, derived presently at the source plane for any jaw setting, was used to calculate H(COF)(X1,X2,Y1,Y2,r). The calculation and the measurement agree within +/-1% (+/-0.5% for most clinical situations). To calculate H(IC)(X1,X2,Y1,Y2), we have generalized the Day's "quarter-field" method, i.e., H(IC)(X1,X2,Y1,Y2) = [H(X1,X1,Y1,Y1) + H(X1,X1,Y2,Y2) + H(X2,X2,Y1,Y1) + H(X2,X2,Y2,Y2)]/4. We found that the calculation and the measurement agree within +/-0.8% for the beams studied.

Calibration↗
PubMed1999

Regional skeletal muscle measurement: evaluation of new dual-energy X-ray absorptiometry model.

Although there is growing interest in studying muscle distribution, regional skeletal muscle (SM) mass measurement methods remain limited. The aim of the present study was to develop a new dual-energy X-ray absorptiometry (DEXA) model for estimating regional adipose tissue-free skeletal muscle mass (AT-free SM). Relationships were derived from Reference Man data between tissue-system- level components (i.e., AT-free SM, AT, skeleton, and skin) and molecular-level components including fat-free soft tissue, fat, and bone mineral. The proposed DEXA-SM model was evaluated by multiscan computerized axial tomography (CT). Twenty-seven male subjects [age, 36 +/- 12 (SD) yr; body mass, 73.2 +/- 12.4 kg; 20 were healthy, and 7 had acquired immunodeficiency syndrome] completed DEXA and CT studies. Identical landmarks for DEXA and CT measurements were selected in three regions, including calves, thighs, and forearms. There was a strong correlation for AT-free SM estimates between the new DEXA and CT methods (e.g., sum of three regions, r = 0.86, P < 0.001). Regional AT-free SM measured in the 27 subjects by DEXA and CT, respectively, were 3.44 +/- 0.60 and 3. 47 +/- 0.55 kg (difference 0.9%, P > 0.05) for calves, 10.49 +/- 1. 77 and 10.05 +/- 1.79 kg (difference 4.4%, P < 0.05) for thighs, 1. 36 +/- 0.49 and 1.20 +/- 0.41 kg (difference 13.3%, P < 0.01) for forearms, and 15.29 +/- 2.33 and 14.72 +/- 2.33 kg (difference 3.9%, P < 0.05) for the sum all three regions. Although the suggested DEXA-SM model needs minor refinements, this is a promising in vivo approach for measurement of regional SM, because DEXA is widely available, relatively inexpensive, and radiation exposure is low.

Absorptiometry, Photon↗
PubMed1999

Telemedicine in the emergency department: a randomized controlled trial.

Emergency physicians and nurses were trained in telemedicine techniques in two emergency departments, one rural (low volume) and one suburban (high volume). Fifteen patient complaints were selected as appropriate for the study. Of 122 patients who met the inclusion criteria, 104 (85%) consented to participate. They were randomized to control and experimental groups. The suburban emergency physician diagnosed and treated the control patients. Experimental patients presenting to the high-volume emergency department were evaluated and treated by the telemedicine nurse in person and the rural emergency physician via the telemedicine link. Immediately before discharge all telemedicine patients were re-evaluated by the suburban emergency physician. Data collected on each patient included: diagnosis; treatment; 72 h return visits; need for additional care; and satisfaction of patient, physicians and nurses. There were no significant differences (P > 0.05) for occurrence of 72 h return visits, need for additional care or overall patient satisfaction. The average patient throughput time (from admission to discharge) was 106 min for the telemedicine group and 117 min for the control group. Telemedicine was a satisfactory technique for the chosen group of patients in the emergency department and was acceptable to the participants.

Emergency Service, Hospital↗
PubMed1998

A randomized controlled trial of telemedicine in an emergency department.

A prospective study of emergency department telemedicine was carried out at two hospitals in northern New Jersey. One hundred and twenty-two patients met the inclusion criteria. One hundred and four (85%) consented to participate, with 54 being randomized to the telemedicine group and 50 to the control group. Four patients did not complete the protocol. No significant differences were seen between the groups for: occurrence of 72 h emergency department return visits (0% vs 0%); need for additional care (2.3% vs 2.4%); positive patient-physician interaction (98% vs 100%); positive patient-nurse interaction (98% vs 98%); positive overall patient satisfaction (98% vs 95%). The average patient throughput time (time from admission to discharge) for the telemedicine group was 106 min; the average for the control group was 117 min. Telemedicine was found to be a satisfactory technique for pre-selected emergency department patients and was viewed by the physicians as an acceptable method of complementary care.

Emergency Medical Services↗
PubMed1997

Tylenol Extended Relief overdose.

In this report we describe the toxicokinetics of the Tylenol Extended Relief (TER) preparation of acetaminophen in human overdose. We collected 41 cases of TER overdose from five regional poison centers. Patients who met the following criteria were studied: a single ingestion of TER alone; confirmed time of ingestion; at least four acetaminophen determinations; and normal concentrations of liver function enzymes. With the exception of standard decontamination measures, treatment with N-acetylcysteine (NAC) if any acetaminophen level was above the treatment line of the Rumack-Matthew nomogram, and additional acetaminophen determinations, no interventions were recommended. Our study group comprised 13 patients, 12 female and 1 male, with single overdoses of 10.4 to 65 g TER. The acetaminophen elimination half-life was 3.1 +/- .8 hours (mean +/- SD; range, 1.3 to 4.0 hours; n = 12). The elimination phase for patients 2, 3, 4, 6, 8, 9, 11, 13 was delayed until 8.0 +/- 2.8 hours (range, 5 to 14 hours) after ingestion. Patients 3, 8, and 11--who had initial acetaminophen levels below the "possible toxicity" line of the Rumack-Matthew nomogram--later had acetaminophen levels above this line. No patient demonstrated a late or second acetaminophen peak. We conclude that the elimination half-life of TER acetaminophen is similar to that reported in overdose of immediate-release acetaminophen overdose. In a subgroup of patients, drug absorption continued beyond the 2 to 4 hours previously reported in immediate-release acetaminophen overdose. On the basis of our data, the use of a single 4-hour acetaminophen determination may lead to failure to recognize patients with potentially toxic TER ingestion. Until more toxicokinetic data are available, a reasonable approach would be to obtain at least one additional acetaminophen determination at least 4 to 6 hours after the first, if the first is obtained 4 to 8 hours after ingestion. NAC treatment should be initiated if either level is above the nomogram line but not if both levels fall below the nomogram line.

Acetaminophen↗
PubMed1995

Aplastic anemia induced by an adulterated herbal medication.

Herbal medication use is common in many cultural groups. Because these products are unregulated, the potential for significant toxicity exists. We report a case of aplastic anemia associated with the use of an herbal medication by a 12-year-old boy. On analysis, the herbal medication was found to contain phenylbutazone, which has been strongly associated with the production of similar hematologic abnormalities. The medication was not listed as an ingredient and no warning was present on the box.

Anemia, Aplastic↗
PubMed1994

The treatment of lead poisoning from gunshot wounds with succimer (DMSA)

Lead poisoning is an unusual complication of gunshot wounds that occurs when retained lead bullet fragments are in contact with body fluids capable of solubilizing lead. The epidemic of violence by gunfire may result in increasing numbers of lead poisoning cases from this exposure. The use of oral chelation for toxicity resulting from this mode of exposure has not been previously discussed. Cases of lead poisoning arising from bullet lead in the synovial cavity of the hip, synovial cavity of the chest, and pleural space are reported. A combination of surgical debridement and chelation therapy with oral succimer produced a satisfactory outcome in all three cases. Oral succimer may be a safe and effective chelation agent for treating lead toxicity in adults with high lead levels secondary to gun shot wounds.

Adult↗
PubMed1992

Delaware Emergency Medical Services System: cardiac resuscitation.

The Delaware EMS system has been in existence for 20 years. Initially begun as one paramedic unit serving New Castle County, it now comprises 15 units in a statewide system. The goal of this report is to detail the EMS system's impact on prehospital cardiac resuscitation and airway management. Emergency Medical Services (EMS) encompass all aspects of managing a sick or injured patient prior to arrival to the hospital. From the time a patient dials 911 until they arrive in the care of a doctor in an emergency room, the EMS system provides initial medical evaluation and care as well as transportation to the hospital. The components of Delaware's EMS system include: 1. Bystanders--the public is often called upon to perform CPR until trained rescuers arrive. 2. Medical Dispatchers--they receive incoming 911 calls and determine the personnel needed. 3. First responders--ambulance crews trained in basic life support (BLS). 4. Second responders--ambulance crews trained in advanced life support (ALS), paramedics. 5. Medical Control--doctors who are in radio contact with paramedics to provide medical advice.

Adult↗