Please be advised that this information was generated on 2018-05-12 and may be subject to change.Journal o r N eu ro ph y sio lo g y Vol. 76, No. I. July 1996. Printed in U.S.A. 1 . The phase-dependent modulation of medium-latency (P2) (70-80 ms) responses in semitendinosus (ST), biceps femoris (BF), rectus femoris (RF), and tibialis anterior (TA) was studied with the use of low-intensity stimulation (2 times perception threshold) of the sural nerve. The shocks were given in a random order at 16 phases of the step cycle in 10 normal subjects during forward walking (FW) or backward walking (BW) on a treadmill. Backward and Forward Walking Use Different Patterns of PhaseDependent Modulation of Cutaneous Reflexes in Humans2. All subjects exhibited P2 responses in all muscles studied both during BW and FW. The amplitude of the facilitatory P2 responses showed phase-dependent changes that could not have been predicted on the basis of the variations in background activity throughout the step cycle.5. During FW, the P2 facilitatory responses in BF were large (with respect to the background activity) throughout the whole step cycle except for a short period near the end of the swing phase. In ST the responses were smaller and appeared primarily at the end of the stance phase and during the first part of the swing phase. During the second half of swing the P2 responses were basically suppressive. A modulation pattern similar to the one in ST was found in RF and TA, except that there was no reversal to suppressive responses in the swing phase in RF. Instead, a reduc tion in the amplitude of the facilitatory P2 responses occurred.4. During BW, the modulation pattern recorded in the same subjects was different from the one seen during FW. Large facilita tory P2 responses were present in all muscles in middle and late swing. In the first half of stance the responses were most promi nently seen in BF and RF. At the end of stance and/or at the onset of swing the facilitatory responses decreased in amplitude (BF and RF) or reversed to P2 suppressions (ST and TA).5. We conclude that there are both facilitatory and suppressive pathways from the sural nerve to the leg muscles studied and that the balance of activity in these paths is phase dependent during both FW and BW. It is suggested that the phase-dependent modula tion of P2 responses could largely rely on a central motor program. During BW the same motor program is used as during FW, but possibly running in reverse, thereby causing a shift both in the timing of the reflex reversal and in the periods of reflex suppression.

Low energy brachytherapy dose distributions in tissue differ from water and are influenced by density, mean tissue composition, and patient-to-patient composition variations. The results support the use of a dose calculation algorithm accounting for heterogeneities such as MC. Since this work shows that variations in mean tissue compositions affect MC dosimetry and result in increased dose uncertainties, the authors conclude that imaging tools providing more accurate estimates of elemental compositions such as dual energy CT would be beneficial.

Summary Five patients with a pleural malignancy (four malignant mesotheliomas and one localized low grade carcinoid) were treated with maximal surgical resection of the tumour followed by intraoperative adjuvant photodynamic therapy (PDT). The additional photodynamic treatment was performed with light of 652 nm from a high power diode laser, and meta-tetrahydroxy phenylchlorin as the photosensitizer. The light delivery to the thoracic cavity was monitored by in situ isotropic light detectors. The position of the light delivery fibre was adjusted to achieve optimal light distribution, taking account of reflected and scattered light in this hollow cavity. There was no 30-day post-operative mortality and only one patient suffered from a major complication (diaphragmatic rupture and haematopericardium). The operation time was increased by a maximum of 1 h to illuminate the total hemithoracic surface with 10 J cm-2 (incident and scattered light). The effect of the adjuvant PDT was monitored by examination of biopsies taken 24 h after surgery under thoracoscopic guidance. Significant damage, including necrosis, was observed in the marker lesions with remaining malignancy compared with normal tissue samples, which showed only an infiltration with PMN cells and oedema of the striated muscles cells. Of the five patients treated, four are alive with no signs of recurrent tumour with a follow-up of 9-11 months. One patient was diagnosed as having a tumour dissemination in the skin around the thoracoscopy scar and died of abdominal tumour spread. Light delivery to large surfaces for adjuvant PDT is feasible in a relatively short period of time (< 1 h). In situ dosimetry ensures optimal light distribution and allows total doses (incident plus scattered light) to be monitored at different positions within the cavity. This combination of light delivery and dosimetry is well suited for adjuvant treatment with PDT in malignant pleural tumours.

The purpose of this study was to increase the potential of dose redistribution by incorporating estimates of oxygen heterogeneity within imaging voxels for optimal dose determination. Cellular oxygen tension (pO(2)) distributions were estimated for imaging-size-based voxels by solving oxygen diffusion-consumption equations around capillaries placed at random locations. The linear-quadratic model was used to determine cell survival in the voxels as a function of pO(2) and dose. The dose distribution across the tumour was optimized to yield minimal survival after 30 x 2 Gy fractions by redistributing the dose based on differences in oxygen levels. Eppendorf data of a series of 69 tumours were used as a surrogate of what might be expected from oxygen imaging datasets. Dose optimizations were performed both taking into account cellular heterogeneity in oxygenation within voxels and assuming a homogeneous cellular distribution of oxygen. Our simulations show that dose redistribution based on derived cellular oxygen distributions within voxels result in dose distributions that require less total dose to obtain the same degree of cell kill as dose distributions that were optimized with a model that considered voxels as homogeneous with respect to oxygen. Moderately hypoxic tumours are expected to gain most from dose redistribution. Incorporating cellular-based distributions of radiosensitivity into dose-planning algorithms theoretically improves the potential gains from dose redistribution algorithms.