Pain flare following external beam radiotherapy and meaningful change in pain scores in the treatment of bone metastases.

BACKGROUND AND PURPOSE: To examine the incidence of pain flare following external beam radiotherapy and to determine what constitutes a meaningful change in pain scores in the treatment of bone metastases. PATIENTS AND METHODS: Patients with bone metastases treated with external beam radiotherapy were asked to score their pain on a scale of 0-10 before the treatment (baseline), daily during the treatment and for 10 days after completion of external beam radiation. Pain flare was defined as a two-point increase from baseline pain in the pain scale of 0-10 with no decrease in analgesic intake or a 25% increase in analgesic intake employing daily oral morphine equivalent with no decrease in pain score. To distinguish pain flare from progression of pain, we required the pain score and analgesic intake to return back to baseline levels after the increase/flare. They were also asked to indicate if their pain changed during that time compared to pre-treatment level. The change in pain score was compared with patient perception. RESULTS: Eighty-eight patients were evaluated in this study. There were 49 male and 39 female patients with the median age of 70 years. Twelve of 88 patients (14%) had pain flare on day 1. The overall incidence of pain flare during the study period ranged from 2 to 16%. A total of 797 pain scorings were obtained. Patients perceived an improvement in pain when their self-reported pain score decreased by at least two points. CONCLUSIONS: Our study confirms the occurrence of pain flare following the external beam radiotherapy in the treatment of bone metastases. Further studies are required to predict who are at risk for flare. Appropriate measures can be taken to alleviate the pain flare. The finding in the meaningful change in pain scores supports the investigator-defined partial response used in some clinical trials.     

Two Cases of Lassa Fever Successfully Treated with Ribavirin and Adjunct Dexamethasone for Concomitant Infections

Lassa fever is a viral hemorrhagic fever treated with supportive care and the broad-spectrum antiviral drug ribavirin. The pathophysiology, especially the role of hyperinflammation, of this disease is unknown. We report successful remission of complicated Lassa fever in 2 patients in Nigeria who received the antiinflammatory agent dexamethasone and standard ribavirin.     

Preliminary evidence of cannabinoid effects on brain-derived neurotrophic factor (BDNF) levels in humans

Background  Acute and chronic exposure to cannabinoids has been associated with cognitive deficits, a higher risk for schizophrenia and other drug abuse. However, the precise mechanism underlying such effects is not known. Preclinical studies suggest that cannabinoids modulate brain-derived neurotrophic factor (BDNF). Accordingly, we hypothesized that Δ⁹-tetrahydrocannabinol (Δ⁹-THC), the principal active component of cannabis, would alter BDNF levels in humans. Materials and methods  Healthy control subjects (n = 14) and light users of cannabis (n = 9) received intravenous administration of (0.0286 mg/kg) Δ⁹-THC in a double-blind, fixed order, placebo-controlled, laboratory study. Serum sampled at baseline, after placebo administration, and after Δ⁹-THC administration was assayed for BDNF using ELISA. Results  Δ⁹-THC increased serum BDNF levels in healthy controls but not light users of cannabis. Further, light users of cannabis had lower basal BDNF levels. Δ⁹-THC produced psychotomimetic effects, perceptual alterations, and “high” and spatial memory impairments. Implications  The effects of socially relevant doses of cannabinoids on BDNF suggest a possible mechanism underlying the consequences of exposure to cannabis. This may be of particular importance for the developing brain and also in disorders believed to involve altered neurodevelopment such as schizophrenia. Larger studies to investigate the effects of cannabinoids on BDNF and other neurotrophins are warranted.     

Carbonaceous Materials Porosity Investigation in a Wet State by Low-Field NMR Relaxometry

The porosity of differently wetted carbonaceous material with disordered mesoporosity was investigated using low-field ¹H NMR relaxometry. Spin–spin relaxation (relaxation time T₂) was measured using the CPMG pulse sequence. We present a non-linear optimization method for the conversion of relaxation curves to the distribution of relaxation times by using non-specialized software. Our procedure consists of searching for the number of components, relaxation times, and their amplitudes, related to different types of hydrogen nuclei in the sample wetted with different amounts of water (different water-to-carbon ratio). We found that a maximum of five components with different relaxation times was sufficient to describe the observed relaxation. The individual components were attributed to a tightly bounded surface water layer (T₂ up to 2 ms), water in small pores especially supermicropores (2 < T₂ < 7 ms), mesopores (7 < T₂ < 20 ms), water in large cavities between particles (20–1500 ms), and bulk water surrounding the materials (T₂ > 1500 ms). To recalculate the distribution of relaxation times to the pore size distribution, we calculated the surface relaxivity based on the results provided by additional characterization techniques, such as thermoporometry (TPM) and N₂/−196 °C physisorption.     

Percentage Ratios of Cutting Forces during High-Reed Face Milling

This research paper is concerned with the experimental study of high-feed end milling of 1.4541 (X6CrNiTi18-10) stainless steel with replaceable cermet plates. Several machining operations were performed under different cutting conditions. The variable values were depth of cut, feed per tooth and cutting speed. The results were analyzed, and cutting forces were evaluated for dependence on cutting conditions (cutting speed, depth of cut, feed per tooth). The obtained data were statistically processed and plotted in graphs. It was found that the percentage distribution of cutting forces changed as the tool load increased. The ratio of forces acting in individual axes also changed with varying trends. An increasing trend was recorded in the x and y axes, while a decreasing trend was recorded in the z axis. Measured change, approximately 10%, can no longer be neglected as it can significantly influence the clamping stability of a part.     

Mental disorders into adulthood among adolescents placed in residential care: A prospective 10-year follow-up study

BackgroundChild welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood.MethodsSeventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed.ResultsIn the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples.ConclusionsOur findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.     

Triangulo-{ErIII3} complex showing field supported slow magnetic relaxation

The triangulo-{Er₃} complex [Er₃Cl(o-van)₃(OH)₂(H₂O)₅]Cl₃·nH₂O (n = 9.4; H(o-van) = o-vanillin) (1) was generated by an in situ method. The isolated Er(iii) complex 1 was characterized by elemental analysis and molecular spectroscopy. The results of single crystal X-ray diffraction studies have shown that 1 is built up of trinuclear [Er₃Cl(o-van)₃(OH)₂(H₂O)₅]³⁺ complex cations, chloride anions and water solvate molecules. Within the complex cation the three Er(iii) central atoms are placed at the apexes of a triangle which are bridged by three (o-van)⁻ ligands with additional chelating functions and two μ₃-OH⁻ ligands. Additionally five aqua and one chlorido ligands complete the octa-coordination of the three Er(iii) atoms. AC susceptibility measurements reveal that the compound exhibits slow magnetic relaxation with two relaxation modes.

The triangulo-{Er₃} complex [Er₃Cl(o-van)₃(OH)₂(H₂O)₅]Cl₃·nH₂O (n = 9.4; H(o-van) = o-vanillin) (1) was generated by an in situ method.     

Outbreak of OXA-48-producing Enterobacterales in a haematological ward associated with an uncommon environmental reservoir,France, 2016 to 2019

The hospital water environment, including the wastewater drainage system, is increasingly reported as a potential reservoir for carbapenemase-producing Enterobacterales (CPE). We investigated a persistent outbreak of OXA-48 CPE (primarily Citrobacter freundii) in a haematological ward of a French teaching hospital by epidemiological, microbiological and environmental methods. Between January 2016 and June 2019, we detected 37 new OXA-48 CPE-colonised and/or ‑infected patients in the haematological ward. In October 2017, a unit dedicated to CPE-colonised and/or ‑infected patients was created. Eleven additional sporadic acquisitions were identified after this date without any obvious epidemiological link between patients, except in one case. Environmental investigations of the haematological ward (June–August 2018) identified seven of 74 toilets and one of 39 drains positive for OXA-48 CPE (seven C. freundii, one Enterobacter sakazakii, one Escherichia coli). Whole genome comparisons identified a clonal dissemination of OXA-48-producing C. freundii from the hospital environment to patients. In addition to strict routine infection control measures, an intensive cleaning programme was performed (descaling and bleaching) and all toilet bowls and tanks were changed. These additional measures helped to contain the outbreak. This study highlights that toilets can be a possible source of transmission of OXA-48 CPE.