Pre-hospital times and clinical characteristics of severe trauma patients: A comparison between mountain and urban/suburban areas

Objective

We investigated pre-hospital times, clinical characteristics and therapeutic interventions in multisystem trauma patients injured in mountainous areas in comparison to both urban and suburban trauma patient admissions.

The dosimetric impact of supraclavicular nodal irradiation on the thyroid gland in patients with breast cancer

PurposeThe thyroid is not routinely considered an organ at risk in supraclavicular (SC) nodal radiation therapy (RT) for breast cancer. We compared the dosimetric impact of the following 2 RT planning techniques on the thyroid: (1) conventional single anterior field to encompass the SC nodal volume defined clinically; and (2) 3-dimensional conformal radiation therapy (3DCRT) planning to encompass the computed tomography (CT)-contoured SC nodal volume.Methods and MaterialsThe thyroid, SC nodal volumes, and organs at risk were contoured on the planning CT of 20 patients who received 50 Gy in 2-Gy daily fractions to the breast or chest wall, and SC nodes. Comparisons of dosimetric parameters between the techniques were performed: thyroid, mean and maximum dose, V5, V30, and V50 (percentage of thyroid receiving ≥ 5 Gy, ≥ 30 Gy, and ≥ 50 Gy, respectively); SC nodal volume, homogeneity index (HI, percentage volume receiving 95%-107% of prescribed dose); and maximum doses of spinal cord and brachial plexus. Anatomic characteristics that influenced the dose distributions were investigated.ResultsThe 3DCRT planning technique significantly increased all thyroid dosimetric measures (mean dose 17.2 Gy vs 26.7 Gy; maximum dose 48.5 Gy vs 51.9 Gy; V5 45.7% vs 64.9%; V30 33.7% vs 48%; and V50 0.6% vs 26.7%; P < .001). It improved HI for the SC nodal volumes (P < .001) but resulted in higher maximum doses to the spinal cord (6.1 Gy vs 30 Gy) and brachial plexus (43.2 Gy vs 51.4 Gy). The thyroid volume and depth of SC nodes did not influence the thyroid dose distribution. The depth of SC nodes impacted on the HI of SC nodal volumes in the conventional technique (P = .004).ConclusionsThe 3DCRT planning improved dosimetric coverage of the SC nodal volume but increased thyroid radiation doses. The potential adverse effects of incidental thyroid irradiation should be considered while improving dosimetric coverage in SC nodal irradiation for breast cancer.     

A study on skin tumour formation in mice with 50 Hz magnetic field exposure

In order to test the possibility that magnetic fields (MF) actas a tumour promoter, a long-term skin carcinogenicity studyof 50 Hz sinusoidal MF with flux densities of 50 µT and0.5 mT was performed in female NMRI mice. 7, 12–dimethylbenz[a]anthracene(DMBA) in acetone was applied to the dorsal skin, as an initiator,and exposure to MF was performed for 19 (weekdays) or 21 h/day(weekends and holidays) for 103 weeks starting one week afterthe initiator treatment. The phorbol ester 12–O–tetradecanoylphorbol-13-acetate(TPA) was used as a positive control for skin tumour promotingactivity. MF was also evaluated for complete carcinogenic actionin groups of mice that were treated with acetone only. Six animalsfrom each group were taken for skin hyperplasia analysis andwere killed after 9, 26 and 52 weeks. The appearance of skinlesions were carefully followed and histopathological diagnosiswas made for all neoplasms present at death. The statisticalanalyses on occurrence of skin tumour bearing animals and cumulatedskin tumours, with corrections for survival, did not reveala difference between the controls and the MF exposed groups.The epithelial thickness of DMBA + MF-treated animals was ofthe same magnitude as for DMBA-treated animals. Leukaemia wasa little more frequent among animals exposed to 0.5 mT MF comparedto the control animals. However this difference was not statisticallysignificant.     

STAT3 pathway regulates lung-derived brain metastasis initiating cell capacity through miR-21 activation

Brain metastases (BM) represent the most common tumor to affect the adult central nervous system. Despite the increasing incidence of BM, likely due to consistently improving treatment of primary cancers, BM remain severely understudied. In this study, we utilized patient-derived stem cell lines from lung-to-brain metastases to examine the regulatory role of STAT3 in brain metastasis initiating cells (BMICs). Annotation of our previously described BMIC regulatory genes with protein-protein interaction network mapping identified STAT3 as a novel protein interactor. STAT3 knockdown showed a reduction in BMIC self-renewal and migration, and decreased tumor size in vivo. Screening of BMIC lines with a library of STAT3 inhibitors identified one inhibitor to significantly reduce tumor formation. Meta-analysis identified the oncomir microRNA-21 (miR-21) as a target of STAT3 activity. Inhibition of miR-21 displayed similar reductions in BMIC self-renewal and migration as STAT3 knockdown. Knockdown of STAT3 also reduced expression of known downstream targets of miR-21. Our studies have thus identified STAT3 and miR-21 as cooperative regulators of stemness, migration and tumor initiation in lung-derived BM. Therefore, STAT3 represents a potential therapeutic target in the treatment of lung-to-brain metastases.     

Correction to: Serum microRNA is a biomarker for post-operative monitoring in glioma

Journal of Neuro-Oncology - We performed a systematic review and meta-analysis of clinical outcomes for patients with acromegaly treated with stereotactic radiosurgery (SRS). Primary outcomes were...     

Retrospective Immunodiagnosis of Malaria in Nonimmune Travelers Returning From the Tropics

Background: Since travelers are now frequently advised to carry emergency self medication for the treatment of suspected malaria, the issue of retrospective diagnosis of malaria in nonimmune patients has recently gained more importance. Reliable methods for evaluating the frequency and justifying the use of self medication in clinically suspected malaria are warranted.
Methods: One hundred and eighty-five sera from 132 nonimmune travelers returning to a nonendemic area, and with a microscopically confirmed diagnosis of malaria, were investigated for the presence of antibodies against blood stages of Plasmodium falciparum or Plasmodium vivax, by the indirect fluorescence antibody test (IFAT). Eighty-eight patients suffered from infection with P. falciparum and 44 from the infection with P. vivax. In falciparum malaria, 97.1% of patients had positive reactions during a period of 15–60 days after onset of symptoms. During the same period after onset of symptoms, significant titers were demonstrated in 88.2% of patients with vivax malaria. Extended cross-reactions between the antigens used and a wide range of interindividual differences in antibody titers were observed. One hundred sera from Germans recovering from nonmalarial febrile illnesses were used as negative control group in the investigation, of which none resulted in a positive IFAT.
Conclusions: We conclude from these results that the IFAT is a specific and sensitive tool for the retrospective confirmation of malaria in the differential diagnosis of fever imported from endemic areas by nonimmune travelers. Nevertheless, when dealing with the individual patient, a careful interpretation, with inclusion of all available clinical data, is mandatory. However, by using blood stage antigens, the IFAT can be considered a sensitive tool in epidemiologic surveys. The tool can be used with a high degree of reliability, even without access to additional clinical data.     

Reoperations with the Right Gastroepiploic Artery without Cardiopulmonary Bypass

A bstract The right gastroepiploic artery (RGEA) has been utilized as the bypass conduit on the inferior surface of the heart with a minimally invasive approach. Fourteen patients had reoperative coronary bypass surgery for severely symptomatic single-vessel disease of the right coronary artery. All surgeries were performed since May 1996. A small mid-line incision including splitting of the lower sternum gave excellent exposure. The inferior surface of the heart was dissected to expose and stabilize the target vessel. The heart rate was controlled with a diltiazem drip. Cardiopulmonary bypass was not necessary in any case. The right coronary artery was bypassed in three patients, the posterior descending artery branch in ten patients, and the terminal circumflex of the left coronary artery in one. After grafting, patency of the anastomosis was demonstrated by Doppler echocardiogram. Two patients had left anterior descending artery (LAD) grafts with LIMA (left mammary artery) and RGEA grafts performed simultaneously with two port access incisions. No patient had perioperative mortality or complications. No patient had recurrent angina. Doppler color echocardiographic imaging studies before discharge confirmed patency of the graft in 13 of 14 cases. In one case, the gastroepiploic artery could not be visualized. Angiographic visualization was positive in seven cases; seven patients were not studied yet. The gastroepiploic artery is an excellent conduit for vascularization of the inferior aspect of the heart. The operation can be done with a minimally invasive technique and without the use of cardiopulmonary bypass. This approach seems especially applicable in selective reoperative cases.