Do topical anesthetics reduce periareolar injectional pain before sentinel lymph node biopsy?

Background

Topical anesthetics have been used in various procedures. The purpose of this study was to evaluate efficacy of lidocaine/prilocaine cream in decreasing the pain of injection for sentinel lymph node biopsy.

Methods

A prospective, randomized, placebo-controlled study was conducted on female breast cancer patients undergoing periareolar injection for sentinel lymph node isolation. Subjects applied lidocaine/prilocaine cream or a placebo cream before injection and completed a survey postoperatively.

Results

Twenty treatment and 19 control patients were studied. There was a trend for control subjects to indicate that the injection was “painful” or “extremely painful” more often than treatment subjects (52.6% vs 25.0%, respectively, P = .074). The treatment group was more likely to recommend the cream to other cancer patients (70.0% vs 42.1%), with a trend toward significance (P = .076).

Conclusions

This study showed no statistically significant reduction in pain scores in subjects receiving the topical anesthetic. Further studies targeting patients with low pain tolerance may prove more effective.     

Individual differences in novelty-seeking predict differential responses to chronic antidepressant treatment through sex- and phenotype-dependent neurochemical signatures

Women experience major depression at roughly twice the rate of men. Inconclusive clinical evidences assist the notion that responsiveness to antidepressant pharmacotherapy is sexually dimorphic with the two sexes presenting differential responses when treated with tricyclic antidepressants (TCAs). Notably, responsiveness to antidepressive agents presents marked inter-individual variability, the biological basis of which remains elusive. Herein, we sought to investigate putative sex differences to chronic antidepressant treatment with the TCA clomipramine in rats selected on the basis of their reactions to novelty. Our data revealed that high novelty-seeker (HR) male rats were more responsive to clomipramine treatment as far as the alleviation of anxiety and nociception are concerned, compared to low novelty-seeker (LR) males and HR/LR female rats. Surprisingly, chronic clomipramine treatment attenuated depressive-like symptomatology in the forced swim test (FST) of behavioral despair in both sexes albeit in the opposite novelty-seeking phenotypes (i.e. in male HR and female LR). Interestingly in male HR rats, clomipramine treatment diminished serotonergic neurochemical responses post-FST exposure in all limbic brain regions examined, while these were boosted in their LR counterparts. Dopaminergic and glutamatergic neurochemistry also presented phenotype-related alterations. On the contrary, in females the neurochemical substrate was only modestly affected. Notably, corticosteroid responses were augmented in female but attenuated in male drug-treated rats. Overall, the current dataset lends further support that the male sex may benefit to a greater extent when treated with TCAs and reveals that individual differences are associated with qualitative and quantitative sex-related behavioral and neurochemical manifestations in response to chronic antidepressant treatment.     

三阴性乳腺癌与HER-2过表达乳腺癌患者的临床病理特征及预后比较

目的 探讨三阴性乳腺癌与HER-2过表达乳腺癌患者的l临床病理特征及预后.方法 回顾1997年1月至2007年1月行手术治疗的725例原发性乳腺癌的临床资料,根据免疫组化染色结果确定三阴性和HER-2过表达乳腺癌表型,并对2组的临床病理学资料进行比较和生存分析.结果 三阴性和HER-2过表达乳腺癌分别占12.29%及24.96%;三阴性乳腺癌有恶性肿瘤家族史者占18.4%,明显高于HER-2过表达组的5.5%(P=0.001);组织学分级3级者占54.0%,也高于HER-2过表达组42.0%(P=0.01);三阴性乳腺癌(74.7%)较HER-2过表达乳腺癌(64.6%)更易发生淋巴结转移(P=0.045);在2年内复发、转移及脑转移(分别为25.3%及8.0%)明显高于HER-2过表达乳腺癌(分别为8.8%和2.2%)(P<0.05),其5年无病生存率(55.6%)明显低于HER-2过表达乳腺癌(69.8%)(P=0.041).2组在年龄、月经状态、肿瘤大小、病理分期、手术方式、病理类型、辅助放化疗、肝肺骨转移比例和总生存率之间差异均无统计学意义(P>0.05).结论 与HER-2过表达乳腺癌相比,三阴性乳腺癌更多有恶性肿瘤家族史,肿瘤恶性度更高,更易发生淋巴结和脑转移,无病生存期更短,预后差.     

Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema

Purpose

To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy.

Methods

Twenty-eight eyes from 28 subjects who were diagnosed with nontractional DME refractory to three or more sequential anti-VEGF injections underwent sequential vitrectomy, IVTA, and macular laser photocoagulation. Changes in best-corrected visual acuity (BCVA) and central subfield thickness (CST) during the six months following vitrectomy were evaluated. Additionally, the CST and BCVA outcomes were compared with those of 26 eyes treated with the same triple therapy for nontractional DME refractory to conventional treatment, such as IVTA or macular laser photocoagulation, or both.

Results

The mean logarithm of the minimum angle of resolution BCVAs before and one, three, and six months after vitrectomy were 0.44 ± 0.15, 0.36 ± 0.18, 0.31 ± 0.14, and 0.34 ± 0.22, respectively. The mean CSTs were 433.3 ± 77.9, 329.9 ± 59.4, 307.2 ± 60.2, and 310.1 ± 80.1 microns, respectively. The values of both BCVA and CST at one, three, and six months were significantly improved from baseline (p < 0.05). The extent of CST reduction during the first month after triple therapy was greater in eyes refractory to conventional treatment than in eyes refractory to anti-VEGF (p = 0.012).

Conclusions

Vitrectomy combined with IVTA and macular laser photocoagulation had a beneficial effect on both anatomical and functional outcomes in eyes with nontractional DME refractory to anti-VEGF therapy.     

Eradication of H pylori infection in a rural population： One-day quadruple therapy versus 7-day triple therapy

AIM: To compare the one-day quadruple therapy with a standard 7-d triple therapy for H pylori eradication in a rural population of China. METHODS: A total of 396 patients with 13C-urea breath test positive for H pylori were assigned into two groups: 239 patients received one-day quadruple therapy (amox icillin 2000 mg qid; metronidazole 500 mg qid; bismuth citrate 900 mg qid and lansoprazole 60 mg once daily) and 157 patients received 7-d standard triple therapy (amoxicillin 1000 mg bid; clarithromycin 500 mg bid and lansoprazole 30 mg bid). All the patients underwent a 13C-UBT to assess the eradication of H pylori infection six weeks after treatment. RESULTS: Two hundred and twenty-nine patients completed the one-day therapy (95.8%) and 148 patients completed the 7-d therapy (94.2%). The one day therapy eradicated H pylori infection in 64 patients (27.95%). In contrast, 103 patients (69.59%) were H pylori negative after the 7-d therapy (P < 0.01). CONCLUSION: This pilot study suggests there is no beneficial effect of the one-day therapy in treatment of H pylori infection compared with the 7-d standard therapy.     

Premature Loss of Permanent Teeth in Allgrove (4A) Syndrome in Two Related Families

Background

Allgrove syndrome is a rare autosomal recessive condition characterized by adrenal insufficiency, achalasia, alacrima and occasionally autonomic disturbances. Mutations in the AAAS gene, on chromosome 12q13 have been implicated as a cause of this disorder.

Case(s) Presentation

We present various manifestations of this syndrome in two related families each with two affected siblings in which several members had symptoms including reduced tear production, mild developmental delay, achalasia, neurological disturbances and also premature loss of permanent teeth in two of them.

Conclusion

The importance of this report is dental involvement (loss of permanent teeth) in Allgrove syndrome that has not been reported in literature.     

截瘫三联针法对外伤性脊髓损伤患者感觉及运动功能的影响

目的:客观评价"截瘫三联针"法对外伤性脊髓损伤患者感觉及运动功能的影响。方法:采用前瞻性随机对照试验设计,共48例符合研究标准的胸腰段脊髓损伤患者纳入研究,随机分为治疗组和对照组,两组均进行常规康复治疗训练。治疗组在此基础上采用"截瘫三联针"法,对照组采用目前常用体针穴位针刺。两组每日治疗1次,1个月为1个疗程,每个疗程间休息2天,共治疗3个疗程。治疗前、1个月、2个月、3个月、随访时(全部疗程结束后1个月)分别进行ASIA感觉(针刺觉、轻触觉)评分、ASIA运动评分。统计分析中,以针刺觉评分、轻触觉评分、运动评分为因变量分别拟合最优多水平模型,观察治疗组与对照组的针刺觉评分、轻触觉评分、运动评分随着时间的变化趋势。结果:两组间针刺觉、轻触觉、运动评分在几个评定时间点的比较,经两独立样本t检验均没有统计学意义(P>0.05)。从增长趋势看,在观察的4个月内,所有患者的针刺觉、轻触觉和运动评分有呈增长的趋势,但是趋势不为线性,而且增长呈先快后慢的趋势即抛物线形式增长;对照组和治疗组治疗前的针刺觉、轻触觉和运动评分没有差异,而且随着时间的推移平均变化趋势相同。其中,针刺觉的回归模型方程为y(估计值)=78.467+3.799time-0.640time2,轻触觉的回归模型方程为回归模型:y(估计值)=76.943+2.803time-0.487time2,运动评分的回归模型方程为y(估计值)=58.556+4.415time-0.659time2。即说明两组的治疗效果在针刺觉、轻触觉和运动评分方面没有任何差异。结论:"截瘫三联针"法和常用体针法均能改善外伤性胸腰段SCI患者的感觉功能、运动功能,但两种方法在改善感觉、运动功能方面没有疗效差异。     

Putting attention on the line: investigating the activation-orientation hypothesis of pseudoneglect

Neurologically healthy participants systematically misbisect horizontal lines to the left of centre, a phenomenon termed 'pseudoneglect'. According to the activation-orientation hypothesis, the distribution of attention is biased in the direction opposite to the more activated hemisphere. Since visuospatial tasks involve activation of the right hemisphere, the hypothesis suggests that a leftward line-bisection bias might be explained by the uneven distribution of attention to the left and right line segments. A crucial assumption of this explanation is that the more attended half of the line will be perceived as longer than the less attended half. This study uses a tachistoscopic Landmark test and an attention cueing paradigm to explore this assumption. Three conditions were met to demonstrate the relative elongation of the more attended half of the line: (1) attention was biased to the cued end of the line, (2) subjective line midpoint was shifted towards the cued end, and (3) alternative biasing factors were ruled out. The results also demonstrate that increased hemispheric activation, resulting from presentation of stimuli in one or the other visual field, leads to subjective midpoints that are biased away from the more activated hemisphere.     

Modulation of hemispatial neglect by directional and numerical cues in the line bisection task

We investigated the effects of arrows, eye gaze, and digits presented as irrelevant flankers in a line bisection task that was administered to 17 right brain damaged patients with or without left neglect. The rightward bias of neglect patients was selectively modulated by the direction of eye gaze and by the magnitude of two identical digits. The bisection error was shifted contralesionally by leftward-gazing eyes and "small" digits, whereas it was shifted ipsilesionally by rightward-gazing eyes and "large" digits. Therefore, the performance of neglect patients was influenced by task-irrelevant cues whose directional meaning was either explicitly represented (eye gaze) or related to the activation of a spatially oriented mental representation (digits). Regression analyses of the overall performance revealed that size of the rightward bias and error variability were predicted by neglect assessment scores across the entire sample of right brain damaged patients. The increased variability in line bisection performance is consistent with the "indifference zone" theory and it appears to be a subtle but stable marker of neglect.