Shoulder pain in a patient with renal cell carcinoma? Suprascapular neuropathy caused by bone metastasis of renal cell carcinoma: A case report.

BACKGROUND: Pain management is crucial in palliative care for patients with advanced cancer. Here, we report a case of shoulder pain in a patient with renal cell carcinoma. CASE PRESENTATION: A 36-year-old male diagnosed metastatic renal cell carcinoma presented with pain and weakness on left shoulder for more than 6 months. Physical examination showed limited range of motion and atrophic changes on supraspinatus and infraspinatus muscles. Weakness in shoulder abduction and external rotation was also noted. POSSIBLE COURSES OF ACTION: In this case, suprascapular neuropathy, adhesive capsulitis of shoulder and metastatic lesions involving shoulder joint were suspected. FORMULATION OF A PLAN: We planned imaging studies including X-ray, bone scan, magnetic resonance imaging, and electrodiagnostic studies. OUTCOME: Imaging and electrodiagnostic studies showed suprascapular neuropathy by bone metastasis. Conservative treatment including injection and rehabilitation therapy reduced the patient's pain and improved the range of motion limitation. LESSONS FROM THE CASE: Clinicians should be aware that bone metastasis in patients with advanced cancer can cause suprascapular neuropathy, shoulder pain and shoulder dysfunction. VIEW ON RESEARCH PROBLEMS, OBJECTIVES, OR QUESTIONS GENERATED BY THE CASE: More research is expected on development of an early surveillance model, barriers to cancer pain management, communication from patients' perspectives.

Decreased Maximal Tongue Protrusion Length May Predict the Presence of Dysphagia in Stroke Patients.

OBJECTIVE: To investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients. METHODS: Free tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS). RESULTS: The MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p<0.001). MTPL and RMF showed significant correlations with PAS, FOIS and VDS scores. The cut-off value in RMF for the prediction of aspiration was 1.56, with a sensitivity of 84% and a specificity of 86%. CONCLUSION: There is a relationship between MTPL and dysphagia in post-stroke patients. MTPL and RMF can be useful for detecting aspiration in post-stroke patients.

CORRIGENDUM: Correction of funding statement in ACKNOWLEDGEMENTS section: Epigenetic inactivation of RUNX3 in colorectal cancer.

[This corrects the article on p. 19 in vol. 94, PMID: 29333422.].

Epigenetic inactivation of RUNX3 in colorectal cancer.

PURPOSE: Emerging evidence indicates that runt-related transcription factor 3 (RUNX3) is an important tumor suppressor gene in several cancer types, including colorectal cancer (CRC). However, the clinical significance of RUNX3 inactivation in CRC remains unclear. The aim of this study was to examine the correlation between clinicopathologic factors and RUNX3 hypermethylation/expression in CRC. METHODS: Sixty-two CRC patients who were treated at the Soonchunhyang University College of Medicine were recruited in this study. The hypermethylation of CpG islands in the RUNX3 promoter and the expression of RUNX3 mRNA were identified by methylation-specific polymerase chain reaction (PCR) and reverse transcriptase-PCR, respectively. The expression of RUNX3 was determined by immunohistochemical staining. RESULTS: Of the 62 CRC tissue samples, 20 (32.3%) presented hypermethylated RUNX3 promoters. Aberrant RUNX3 hypermethylation was found to be associated with vascular (P = 0.006) and lymphatic (P = 0.002) invasion. Hypermethylation of RUNX3 was associated with poor survival outcomes (P = 0.038). However, expression of RUNX3 was not a prognostic factor (P = 0.363). CONCLUSION: Hypermethylation of RUNX3 may be a predictor of a poor prognosis in CRC.