Prevention of local symptoms in muscle invasive bladder cancer patients: clinical significance of local radiation therapy.

PURPOSE: To evaluate the significance of local radiation therapy (LRT) for prevention of local symptoms (LSs) caused by muscle-invasive bladder cancer (MIBC). METHODS: We retrospectively reviewed the clinical records of 133 patients from 13 hospitals. MIBC patients with or without metastases who were treated with LRT alone from January 2015 through December 2020 were enrolled. Exclusion criteria were urinary diversion (UD) prior to LRT, non-MIBC, or lack of clinical information. LSs were defined as hematuria requiring invasive treatment or transfusion, UD after LRT, bladder tamponade, and opioid use for bladder pain. RESULTS: One hundred fourteen patients were finally enrolled in the study. During the median follow-up period of 13.5 months, 30 patients (26.3%) had LSs. Risk factors of LSs in multivariate analysis were a prior history of non-MIBC (NMIBC) (hazard ratio [HR] 2.99; 95% confidence interval [CI], 1.36 to 6.56; P < 0.01), radiation dose of less than 50 Gray (Gy) (HR 3.99; 95% CI, 1.80 to 8.82; P < 0.01), and tumor stage 3 or more (HR 2.43; 95% CI, 1.14 to 5.21; P = 0.02). Risk factors of overall survival (OS) in multivariate analysis were being female (HR 3.32; 95% CI, 1.68 to 6.58; P < 0.01), an age-adjusted Charlson Comorbidity index of 6 or more (HR 2.19; 95% CI, 1.18 to 4.10; P = 0.01), distant metastases (HR 3.20; 95% CI, 1.39 to 6.58; P < 0.01), and tumor size of 40 mm or more (HR 2.38; 95% CI, 1.34 to 4.52; P < 0.01). Toxicity (all grades) occurred in 40.4% of the patients, 4.8% with grade 3 or more and 95.2% with lower grades. CONCLUSIONS: We determined the risk factors for LSs in MIBC patients treated with LRT alone. An escalated-dose of 50 Gy or more may contribute to prevention of LSs caused by MIBC. Thus, dose-escalated LRT for MIBC patients who can expect favorable survival may be a good option to avoid future annoying LSs.

Use of the amber teething necklace by the child population: risks versus benefits / Uso do colar de âmbar pela população infantil: riscos x benefícios

Abstract Objective: Based on scientific evidence, the objective of the present study is to report the possible risks and benefits of the amber teething necklace for children who use it. Data source: This is an integrative literature review, carried out based on the following guiding question: "Does the amber teething necklace have therapeutic properties that justify its usage during tooth eruption?". The consulted databases were LILACS (Latin American and Caribbean Health Sciences Literature) and PubMed (National Center for Biotechnology Information), with the following descriptors: "Amber," "Deciduous teeth," "Strangulation," and "Local symptoms." Data synthesis: A total of five scientific articles were selected, which indicates an insufficient basis regarding the benefits associated with the use of the amber teething necklace. Conversely, there is a convergence regarding the possibility of health risks such as strangulation, asphyxiation, and swallowing of beads. Conclusions: Health professionals should discourage the use of the amber teething necklace by children insofar more studies on the topic are carried out.

Resumo Objetivo: Com base em evidências científicas, a proposta do presente trabalho é relatar os prováveis riscos e benefícios do uso do colar de âmbar pela população infantil. Fontes de dados: Trata-se de uma revisão integrativa da literatura, realizada a partir da elaboração da questão norteadora: "O colar de âmbar apresenta propriedades que justifiquem seu uso durante a erupção dentária?''. As bases de dados utilizadas foram LILACS (Literatura Latino-americana e do Caribe em Ciências da Saúde), PubMed (National Center for Biotechnology Information), por meio dos descritores: Âmbar; Dentes decíduos; Estrangulamento; Sintomas locais. Síntese dos dados: Após a busca dos dados, foram selecionados cinco artigos, os quais apontam insuficiente embasamento científico que comprove os benefícios relacionados ao uso do colar de âmbar. Em contrapartida, existe uma convergência quanto à possibilidade de riscos à saúde, como estrangulamento, asfixia e deglutição das pedras. Conclusões: Conclui-se que os profissionais da saúde devem desencorajar o seu uso por crianças até que pesquisas clínicas bem delineadas sejam disponibilizadas.

Primary Tumor Surgery for Patients with De Novo Stage IV Breast Cancer can Decrease Local Symptoms and Improve Quality of Life.

BACKGROUND: It was unknown whether surgery for primary tumor would affect the occurrence of local symptoms caused by tumor progression in patients with de novo stage IV breast cancer (BC). Our work attempted to probe the effect of local resection on controlling local symptoms and improving the quality of life in de novo stage IV BC patients. METHODS: Our study included patients presenting with de novo stage IV BC at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2008 to December 2014. In this study, we defined a new term called "local progress/recurrence of symptoms" (LPRS) to refer to the local problems caused by tumor progression/recurrence. All the patients were grouped into surgery and non-surgery groups. The characteristics of the two groups were analyzed by Chi square and Fisher's test. Univariate and multivariate Cox regression models were designed to evaluate independent prognostic factors. RESULTS: This study contained 177 patients. The follow-up deadline was April 1, 2019. The median follow-up time was 33 months (range 1-135 months). In included patients, 77 (43.5%) underwent surgery for primary tumors. Primary tumor surgery could reduce the occurrence of LPRS (relative risk/risk ratio (RR = 0.440; 95% CI 0.227-0.852; p = 0.015)) and patients without LPRS had longer OS (45 months vs 29 months, p < 0.001). In addition, patients who had only one symptom had better OS than those who had two or three symptoms (p = 0.0175). CONCLUSIONS: The quality of life in patients with de novo stage IV breast cancer can be improved by reducing the incidence of local symptoms through primary tumor surgery.

Envenomation by a western green mamba (Dendroaspis viridis) - A report of three episodes in Switzerland.

The African elapid snake genus Dendroaspis comprises four species, with D. polylepsis the most dangerous of them. D. viridis is believed to cause stronger neurotoxic symptoms than the potentially least toxic of the genus, D. angusticeps, but seems less toxic compared to either of the D. jamesoni species (D. j. jamesoni(TRAILL 1843) and D. j. kaimosae (Loveridge 1936)). We present three episodes of bites byD. viridis in the same patient, sustained on three different occasions, caused by three different and unrelated snakes. While the first bite remained oligosymptomatic with a slight tightness of the throat and speedy resolution of symptoms without specific therapy, episodes two and three resulted in the patient developing massive local swelling. However, the patient showed only minimal neurologic and systemic symptoms such as tightness of the throat and a tingling sensation of the body. Episode two resolved with fasciotomy after compartment syndrome was diagnosed with a measured intracompartmental pressure of 52 mmHg. In episode three, antivenom was administered with good resolution of symptoms. The clinical courses in this patient were remarkable as he displayed mainly local symptoms after three individual bites by a supposedly neurotoxic snake.

A confirmed bite by a Beautiful Pit Viper (Trimeresurus venustus) resulting in local symptoms.

This case report describes the effect of an envenomation by the Beautiful Pit Viper Trimeresurus venustus (or Cryptelytrops venustus), which is a green pit viper native to Thailand and Malaysia. A previously healthy 60-year-old snake breeder with no relevant medical history was bitten by his adult T. venustus in the third finger of his right hand while taking it out of the feeding box. The bite was painful and swelling progressed to include his whole hand within an hour after the bite. He was treated symptomatically with pre-emptive antibiotics and analgesics, never developed any hematological disorders such as coagulopathy and bleeding or disseminated intravascular coagulation and was discharged 26 hours after the bite. The clinical course in our patient matched two other well-documented cases reported to our Poisons Centre, and one further case presented as a conference-poster. All patients recovered with symptomatic therapy and never required antivenom. Therefore, bites by T. venustus seem to present with less severe symptoms compared to other Trimeresurus species.

Safety of human papillomavirus vaccines in healthy young women: a meta-analysis of 24 controlled studies.

BACKGROUND: Human papillomavirus (HPV) vaccines have been shown to be effective for the eradication of HPV and prevention of cervical cancer. However, the number of women who receive HPV vaccinations has decreased over the last several years in Japan, due to concerns about adverse reactions associated with the vaccines. We evaluated the safety of three types of HPV vaccines separately in young women and the difference in the risk of adverse reactions between HPV and other vaccines by conducting a meta-analysis. METHODS: Primary literature was retrieved from MEDLINE, the Cochrane Central Register of Controlled Trials, and Japana Centra Revuo Medicina. Prospective controlled studies with participants consisting exclusively of healthy women who received bivalent, quadrivalent, or 9-valent HPV (2vHPV, 4vHPV or 9vHPV) vaccines were included. Primary safety outcome was the incidence of solicited local and systemic symptoms, and unsolicited symptoms. When two or more studies were found for the same analysis, a meta-analysis was applied. RESULTS: A total of 24 controlled studies from 22 articles were included in our study. Of the 24 studies, 16 were placebo-controlled and eight were active-controlled (different HPV vaccine or hepatitis vaccine). Average ages of the participants ranged from 12 to 37 years. A significantly higher incidence of solicited local symptoms was observed following injection of HPV vaccines (2vHPV and 4vHPV) compared to placebo, but there was no difference between HPV vaccines [risk ratio (RR) for 2vHPV: 1.25, 95% confidence interval (CI): 1.09 to 1.43, RR for 4vHPV: 1.16, 95% CI: 1.11 to 1.20]. The incidence of solicited systemic symptoms was not different between HPV vaccines and placebo (RR: 1.04, 95% CI: 0.99 to 1.09). The incidence of unsolicited symptoms was significantly higher for 2vHPV vaccine compared to placebo (RR: 1.28, 95% CI: 1.01 to 1.63), but was not significantly different between 2vHPV and hepatitis B vaccines. CONCLUSIONS: HPV vaccines had significantly higher risk of any injection site symptom compared to placebo or other vaccines (hepatitis A and B vaccines), and the incidence of solicited local symptoms was no difference between 2vHPV vaccination and 4vHPV vaccination. However, the most adverse reactions were transient.

Estudo descritivo de cirurgia de pterígio primário com adesivo de fibrina / A descriptive study of primary pterygium surgery with fibrin glue

Objetivo: Avaliar a técnica cirúrgica de exérese de pterígio primário com adesivo de fibrina, quanto à sintomatologia e dados epidemiológicos. Métodos: Ensaio clínico prospectivo, não-controlado e aleatório com 30 pacientes do Hospital Universitário Lauro Wanderley, concordantes com o termo de consentimento livre e esclarecido, aprovado pelo Comitê de Ética em Pesquisa. As cirurgias foram avaliadas nos 1º, 7º e 21º pós-operatório (PO). Resultados: Dos 30 pacientes operados, 16 (53,3%) eram do sexo feminino, com idade variando de 21 a 67 anos (42,2). Quanto à graduação do pterígio (1 a 3): grau 1-10 (33,3%), grau 2-10 (33,3%) e grau 3-10 (33,3%), sendo 16 (53,3%) no olho direito e 14 (46,7%) no olho esquerdo. 56,7% dos pacientes afirmaram intensa exposição solar durante a vida e possuíam casos semelhantes na família. No transoperatório, houve queixas de dor (43,3%) e sensação de corpo estranho (46,7%). O tempo cirúrgico variou de 11 a 32 minutos (17,7). As queixas no 1º, 7º e 21º PO, respectivamente, foram: dor (60%, 26,6% e 6,66%), hiperemia (93,3%, 66,6% e 36,6%), sensação de corpo estranho (53,3%, 46,6% e 20%), epífora (83,3%, 43,3% e 6,66%), secreção (33,3%, 36,6% e 6,66%), ardência (53,3%, 36,6% e 16,6%) e olho seco (6,66%, 26,6% e 23,3%). 43,3% afirmaram estar muito satisfeitos com a cirurgia e 63,8% consideraram o aspecto estético excelente. Três pacientes (10%) não compareceram ao 7 DPO e 5 (16,6%) ao 21 DPO. Não houve perda do enxerto nos casos estudados. Conclusão: O transplante autólogo de conjuntiva é atualmente a alternativa mais eficaz para o tratamento do pterígio. Associado ao uso do adesivo de fibrina, que é composto de fibrinogênio e trombina e tem a vantagem de ser totalmente absorvível, apresenta vantagens, dentre elas a redução do tempo cirúrgico. Neste estudo, corroborando com estudos recentes, o tempo cirúrgico médio foi 19,05 (±6,1) minutos e houve alta incidência de familiares portadores de pterígio e exposição aos raios ultravioleta...

Objective: To evaluate the surgical technique for excision of primary pterygium with fibrin glue, as the symptoms and epidemiological data. Methods: Clinical prospective non-controlled and randomized study with 30 patients of the Hospital Universitário Lauro Wanderley, consistent with the term informed consent, approved by the Ethics in Research. The surgeries were evaluated at 1, 7 and 21 postoperatively (PO). Results: Of the 30 operated patients, 16 (53,3%) were female, aged 21-67 years (42.2). As for the degrees of pterygium (1-3): grau 1-10 (33,3%), grade 2-16 (33,3%) and grade 3-10 (33,3%), 16 (53,3%) in the right eye and 16 (44.4%) in the left eye. 56,7% of patients had intense sun exposure during their lifetime and cases in the family. In the trans-operative period, there were complaints of pain (43,3%) and foreign body sensation (46,7%). Surgical time ranged from 11 to 32 minutes (17.7). The complaints in the first, seventh and 21 PO, respectively, were pain (60%, 26,6% e 6,66%), redness (93,3%, 66,6% e 36,6%), foreign body sensation (53,3%, 46,6% e 20%), epiphora (83,3%, 43,3% e 6,66%), discharge (33,3%, 36,6% e 6,66%),burning (53,3%, 36,6% e 16,6%) and dry eye (6,66%, 26,6% e 23,3%). 43,3% reported being very satisfied with the surgery and 63.8% considered excellent aesthetic appearance. 3 (10%) patients did not attend the 7 DPO and 5(16,6%),at 21 DPO. There was no graft loss in the cases studied. Conclusion: Autologous conjunctiva is currently the most effective alternative for the treatment of pterygium. Associated with the use of fibrin adhesive, which is composed of fibrinogen and thrombin and has the advantage of being totally absorbable, has advantages, among them a reduction in surgical time. In this study, corroborating recent studies, the mean operative time was 19.05 (± 6.1) minutes and there was a high incidence of family pterygium patients and UV exposure...