The Experiences of Patients With Adjuvant and Metastatic Melanoma Using Disease-Specific Social Media Communities in the Advent of Novel Therapies (Excite Project): Social Media Listening Study.

BACKGROUND: Immunotherapy and targeted therapy treatments are novel treatments available for patients with metastatic and adjuvant melanoma. As recently approved treatments, information surrounding the patients' and caregivers' experience with these therapies, perceptions of treatments, and the effect the treatments have on their day-to-day life are lacking. Such insights would be valuable for any future decision-making with regard to treatment options. OBJECTIVE: This study aims to use health-related social media data to understand the experience of patients with adjuvant and metastatic melanoma who are receiving either immunotherapy or targeted therapies. This study also included caregivers' perspectives. METHODS: Publicly available social media forum posts by patients with self-reported adjuvant or metastatic melanoma (and their caregivers) between January 2014 to October 2019 were programmatically extracted, deidentified, cleaned, and analyzed using a combination of natural language processing and qualitative data analyses. This study identified spontaneously reported symptoms and their impacts, symptom duration, and the impact of treatment for both treatment groups. RESULTS: Overall, 1037 users (9023 posts) and 114 users (442 posts) were included in the metastatic group and adjuvant group, respectively. The most identified symptoms in both groups were fatigue, pain, or exanthema (identified in 5%-43% of patients dependent on the treatment group). Symptom impacts reported by both groups were physical impacts, impacts on family, and impacts on work. Positive treatment impacts were reported in both groups and covered the areas of work, social and family life, and general health and quality of life. CONCLUSIONS: This study explored health-related social media to better understand the experience and perspectives of patients with melanoma receiving immunotherapy or targeted therapy treatments as well as the experience of their caregivers. This exploratory work uncovered the most discussed concerns among patients and caregivers on the forums including symptoms and their impacts, thus contributing to a deeper understanding of the patient/caregiver experience.

Differential subcellular distribution and chemical forms of cadmium and copper in Brassica napus.

Metal subcellular fractions and chemical profile highly reflect their level of toxicity to plants. Cadmium and Cu, two different but potentially toxic metals, were compared in the present study for their subcellular distribution and chemical forms in two Brassica napus cultivars (Zheda 622 and ZS 758). Five-week-old seedlings were hydroponically exposed to metal stress and analyzed after 15 days of treatment. In both cultivars, Cd was less retained at cell wall, thus major part of Cd accumulated in the soluble fraction. By contrast, handsome amount of Cu was sequestrated in both cell wall and vacuole containing fraction. Across sensitive organelles, Cu preferentially accumulated in chloroplasts, while Cd was equally distributed in chloroplasts and mitochondria; the two metals intruded nucleus at lesser degree. Further, Cd and Cu differentially interacted with various cellular ligands, and the extent of interaction was higher in the tolerant cultivar ZS 758. Copper was remarkably sequestrated by phosphates, and secondarily by peptide-ligands; inversely, the role of phosphates was secondary in Cd complexation, which was mainly achieved by peptide-ligands. Additional amount of Cu was aggregated with oxalates, but oxalate-bound Cd was scarcely detected. Current results have demonstrated varied toxicological and detoxification pathways of Cd and Cu in B. napus, suggesting that the efficiency of different alleviation strategies could vary against Cd and Cu toxicity to plants.

Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma.

BACKGROUND: Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Acute subdural haematoma is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcome of patients conservatively managed may help the neurosurgeon in the decision-making process. METHODS: We prospectively analysed 27 patients with age ranges 15-90 years, in whom a CT scan diagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was not initially performed, to the neurosurgery department of Ayub Teaching Hospital Abbottabad (2008-2011). Patients with deranged bleeding profile, anticoagulant therapy, chronic liver disease, any other associated intracranial abnormalities, such as cerebral contusions, as shown on CT, were excluded from this study. All patients were followed by serial CT scans, and a neurological assessment was done. RESULTS: There were 18 male and 9 female patients, Cerebral atrophy was present in over half of the sample. In 22 of our patients, the acute subdural haematoma resolved spontaneously, without evidence of damage to the underlying brain, as shown by CT or neurological findings. Four patients subsequently required burr hole drainage for chronic subdural haematoma. In each of these patients, haematoma thickness was greater than 10 mm. The mean delay between injury and operation in this group was 15-21 days. Among these patients 1 patient required craniotomy for haematoma removal due to neurological deterioration. CONCLUSION: Certain conscious patients with small acute subdural haematomas, without mass effect on CT, may be safely managed conservatively, but due to high risk of these acute subdural haematoma changing into chronic subdural haematoma these patients should be reinvestigated in case of neurological deterioration.

Anterior stabilisation of sacroilliac joint for complex pelvic injuries.

Sacroilliac joint diasthesis from high energy trauma is always complicated with chronic pain and long term morbidity. Open anterior stabilisation with plate allow direct reduction and stabilisation with biomechanically advantages. Here we report on four cases of pelvic injury with sacroiliac joint disruption treated with anterior plate stabilisation through a surgical approach similar to that used for anterior ring fractures.