Re-examining the role of adjuvant radiation therapy

Previously important roles for adjuvant radiotherapy (RT) in melanoma patients included improved regional control after resection of high-risk nodal disease, to reduce local recurrence for desmoplastic, and other subtypes of melanoma with neurotropism, reducing in-brain relapse of brain metastases after surgery and other situations on a case-by-case basis. This review evaluates the integration of adjuvant RT into clinical practice at this time of rapidly evolving knowledge and improving outcomes from effective systemic therapy.     

O bloqueio contínuo do plano serrátil anterior fornece analgesia em fraturas múltiplas de costelas: relato de caso

Thoracic trauma with rib fractures is a challenging condition due to the severe associated pain. Uncontrolled pain impairs breathing and an adequate pain control is necessary to provide comfort and to avoid further complications. Serratus Anterior Plane block is a procedure safe and easy to accomplish. The authors describe a case of thoracic trauma with rib fractures and respiratory compromise. Pain control was only achieved after performing a Serratus Anterior Plane block. The technique was done as described in the medical literature with placement of a catheter. Pain relief was achieved with a low concentration infusion of local anesthetic.     

Nonresectional regional therapies for metastatic colorectal cancer to the liver

The liver is the second leading site of colorectal cancer metastases, following the lymph nodes. Although metastatic resection for colorectal cancer liver metastases has been shown to improve survival, many patients cannot undergo surgery. Several nonsurgical therapies are available in these situations, however high-quality evidence comparing the effectiveness of these therapies is sparse. Here, we review the currently available evidence in support of nonresectional regional therapies for colorectal metastases to the liver.     

远用矫正眼镜对近视少年儿童阅读的影响

目的探讨远用近视矫正眼镜对近视少年儿童阅读姿势的影响。方法横断面调查研究。对148例屈光度为-0.50～-6.50 D,散光度小于-0.75 D的少年儿童开展调查,以照相机拍摄的方式记录阅读姿势,并测量其不戴镜与戴镜状态下远、近距离阅读时头眼转动幅度,以探讨戴镜与否对近视儿童阅读的影响。数据采用配对t检验和Pearson相关分析处理。结果?譹?訛近视是否矫正影响阅读时的头、眼位置,配戴矫正眼镜可以减小阅读时头（t=10.661,P<0.01）、眼移动幅度（t=-4.079,P＜0.01）;?譺?訛阅读时眼与镜片非共轴且视线不经过光心,远用眼镜不能适应阅读时的眼位变化。结论远用矫正眼镜在一定程度上能帮助近视少年儿童矫正阅读姿势,但是还不完全符合近距离阅读的需求。     

Breast Cancer Clustering in Kanagawa,Japan: A Geographic Analysis

Background: The purpose of the present study was to determine geographic clustering of breast cancerincidence in Kanagawa Prefecture, using cancer registry data. The study also aimed at examining the associationbetween socio-economic factors and any identified cluster. Materials and Methods: Incidence data were collectedfor women who were first diagnosed with breast cancer during the period from January to December 2006 inKanagawa. The data consisted of 2,326 incidence cases extracted from the total of 34,323 Kanagawa CancerRegistration data issued in 2011. To adjust for differences in age distribution, the standardized mortality ratio(SMR) and the standardized incidence ratio (SIR) of breast cancer were calculated for each of 56 municipalities(e.g., city, special ward, town, and village) in Kanagawa by an indirect method using Kanagawa female populationdata. Spatial scan statistics were used to detect any area of elevated risk as a cluster for breast cancer deaths and/or incidences. The Student t-test was performed to examine differences in socio-economic variables, viz, personsper household, total fertility rate, age at first marriage for women, and marriage rate, between cluster and otherregions. Results: There was a statistically significant cluster of breast cancer incidence (p=0.001) composed of11 municipalities in southeastern area of Kanagawa Prefecture, whose SIR was 35 percent higher than that ofthe remainder of Kanagawa Prefecture. In this cluster, average value of age at first-marriage for women wassignificantly higher than in the rest of Kanagawa (p=0.017). No statistically significant clusters of breast cancerdeaths were detected (p=0.53). Conclusions: There was a statistically significant cluster of high breast cancerincidence in southeastern area of Kanagawa Prefecture. It was suggested that the cluster region was related tothe tendency to marry later. This study methodology will be helpful in the analysis of geographical disparitiesin cancer deaths and incidence.     

The role of enhanced cutaneous IL-1β signaling in a rat tibia fracture model of complex regional pain syndrome

Tibia fracture in rats initiates a syndrome resembling the complex regional pain syndrome type I. Accumulating evidence indicates that IL-1β is involved in the modulation of nociceptive information and it acts as an intermediate inflammatory mediator via up-regulation of NGF. We hypothesized that IL-1β signaling might mediate the development of the CRPS-like changes after tibial fracture, either directly or by stimulating NGF expression. Rats underwent distal tibia fracture and casting for 4 weeks and were chronically treated with an IL-1 receptor antagonist (IL-1ra). Nociceptive testing and assessment of edema and hindpaw warmth were performed at baseline and after cast removal. Bone microarchitecture was evaluated by micro-computed tomography. Confocal immunofluorescence and in situ hybridization techniques were used to evaluate changes in the cutaneous expression of IL-1β at 4 weeks post-fracture. The nociceptive and vascular effects of intraplantar IL-1β injections were evaluated in intact rats at different time points after injection. We found that: (1) IL-1ra reduced fracture-induced nociceptive sensitization, but did not decrease hindpaw edema or warmth, (2) fracture chronically up-regulated IL-1β mRNA and protein expression in hindpaw skin keratinocytes, (3) IL-1β intraplantar injection induced mechanical allodynia in a dose-dependent manner and stimulated keratinocyte NGF expression in the hindpaw skin, and (4) intraplantar injection of NGF-induced nociceptive sensitization. Collectively, these results indicate that cutaneous IL-1β signaling can contribute to chronic regional nociceptive sensitization after fracture, possibly by stimulating NGF over-expression in keratinocytes. Our data also highlight the importance of the keratinocyte as the primary source of post-traumatic IL-1β over-expression.