The Evolution of the Sentinel Node Biopsy in Melanoma.

The growing repertoire of approved immune-checkpoint inhibitors and targeted therapy has revolutionized the adjuvant treatment of melanoma. While the treatment of primary cutaneous melanoma remains wide local excision (WLE), the management of regional lymph nodes continues to evolve in light of practice-changing clinical trials and dramatically improved adjuvant therapy. With large multicenter studies reporting no benefit in overall survival for completion lymph node dissection (CLND) after a positive sentinel node biopsy (SLNB), controversy remains regarding patient selection and clinical decision-making. This review explores the evolution of the SLNB in cutaneous melanoma in the context of a rapidly changing adjuvant treatment landscape, summarizing the key clinical trials which shaped current practice guidelines.

Current management of benign retroperitoneal tumors.

Benign retroperitoneal tumors (BRT) represent a rare group of heterogeneous diseases. The literature lacks high-quality evidence about the optimal management of BRT, and most of the information available takes the form of case reports or case series. The aim of this review is to provide an overview of current management strategies for adult patients with BRT. A literature search using PubMed indexed articles was conducted and BRT were classified into five different biological subgroups: 1) lipomatous tumors, 2) smooth muscle tumors, 3) peripheral nerve sheath tumors, 4) myofibroblastic tumors, and 5) others. Tumors that are primarily pelvic in origin were excluded. Despite the significant heterogeneity of the disease, several generic considerations have emerged and can be applied to the management of BRT. Specifically, the risk of misdiagnosing a BRT with another pathology such as retroperitoneal sarcoma is notable. When encountered, suspected BRT should therefore be referred to a specialized sarcoma center. Multidisciplinary tumor boards, present at these centers, have a pivotal role in managing BRT. The decision of whether to offer surgery, nonsurgical treatment or a "watch-and-wait" approach should be made after multidisciplinary discussion, depending on tumor histology. Moving forward, collaborative research efforts dedicated to BRT remain crucial in gathering evidence and knowledge to further optimize patient care.

Injury prevention in medical education: a Canadian medical school survey.

BACKGROUND: Injury has a major societal impact. In Canada, injury is the leading cause of death among those aged 1-44 years, the fifth-leading cause of death among those of all ages and is responsible for a burden of US$26.8 billion in 2010. It holds that most injuries are predictable and preventable, and therefore, such statistics represent a serious public health concern. Given that physicians play a vital role in the prevention and control of injuries, further information regarding the current state of injury prevention education in medical undergraduate programmes in Canada would be beneficial. We hypothesise that the results of an observational survey distribute to all Canadian medical schools will demonstrate a substantial gap in injury prevention education integration in the existing medical school curriculums. STUDY OBJECTIVE: To evaluate the current status of Injury Prevention Education in Canadian Medical Schools preclerkship and clerkship medical curriculum. METHODS: Electronic surveys evaluating the current status of injury prevention education were sent via email to each of the 16 Canadian medical schools. RESULTS: Nine Canadian medical faculties (56%, n=9) responded. Eight of the nine medical schools (88.89%, n=8) offered at least five injury prevention related topics in their respective curricula. The most common injury-related courses were Role of physicians in the prevention of injuries (100%, n=9) and epidemiology of injury (88.89%, n=8). All respondent medical faculties (100%, n=9) offered at least a single injury prevention specific topic in their curricula. Most surveyed medical faculties (88.89%, n=8) offered nine injury-specific topics. The most common injury-specific topics included falls, suicide and self-harm, alcohol, burns and scalds, and concussion (100%, n=9).

Retroperitoneal Sarcoma Care in 2021.

Soft-tissue sarcomas are biologically heterogenous tumors arising from connective tissues with over 100 subtypes. Although sarcomas account for <1% of all adult malignancies, retroperitoneal sarcomas are a distinct subgroup accounting for <10% of all sarcomatous tumors. There have been considerable advancements in the understanding and treatment of retroperitoneal sarcoma in the last decade, with standard treatment consisting of upfront primary surgical resection. The evidence surrounding the addition of radiation therapy remains controversial. There remains no standard with regards to systemic therapy, including immunotherapy. Adjunctive therapy remains largely dictated by expert consensus and preferences at individual centers or participation in clinical trials. In this 2021 review, we detail the anatomical boundaries of the retroperitoneum, clinical characteristics, contemporary standard of care and well as recent advancements in retroperitoneal sarcoma care. Ongoing international collaborations are encouraged to advance our understanding of this complex disease.

Injury Prevention in Medical Education: A Systematic Literature Review.

OBJECTIVE: Traumatic injury is the first cause of death for Canadians aged 1 to 44 years old. To reduce the global burden of injury, the need for healthcare professionals with injury prevention proficiency is growing. The aim of this study was to review the literature to identify and analyze current injury prevention curriculums amongst medical undergraduate and residency programs. DESIGN: A systematic literature review (no date restriction was used) was conducted using Embase, Medline, ERIC, and CINAHL. Three reviewers independently selected studies, extracted data, checked accuracy, assessed risk of bias, and assessed quality. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed. The study was registered with PROSPERO, #CRD42016048805. PARTICIPANTS: Articles were included if they were peer-reviewed, published in the English language, and reported data on injury prevention and control curriculum. RESULTS: Eight hundred and twenty-four articles were identified with the initial search strategy. Internal consistency reliability, generalizability, evidence for content, criterion-related and construct validity was performed. The systematic review synthesized the characteristics (population, intervention type, outcome measures) described in the literature. This review is the first step in identifying gaps in injury prevention teaching and curriculums for medical students and residents. CONCLUSION: The number of studies reporting the incidence and/or effectiveness of injury prevention and control curriculum is limited across the literature. Therefore, there is a knowledge gap in providing injury prevention education. Given that physicians play a vital role in the prevention or control of injuries, further development of medical undergraduate and residency programs to include core concepts of injury prevention would be unquestionably paramount.

Chordoid meningiomas: incidence and clinicopathological features of a case series over 18 years.

Chordoid meningioma (CM) is a rare subtype of meningioma, classified as grade II, which exhibits a high rate of recurrence following subtotal resection. We retrospectively examined nine cases of chordoid meningioma over a case series of 1743 meningiomas (0.52%) operated upon at our institution from 1995 to 2013. All the reported clinicopathological findings were analyzed. Two hundred and twenty-one CM cases have been published to date worldwide and few single-center large case series have been issued. Seventy-five percent of the cases that underwent subtotal resection at our institution had recurrence within 1 year. Total resection of the tumor should be the major objective of surgery to reduce the possibility of tumor recurrence. The percentage of chordoid features within the tumor specimen could assist in predicting the pathogenesis of the lesion. The correlation of the index of proliferation to recurrence rate is still controversial. Much debate exists with regard to the role of adjuvant radiotherapy in CM cases. Immunohistochemical, cytological and ultrastructural studies should be used in combination to assure a correct diagnosis of CM. Owing to the rare occurrence of this meningioma subtype, larger case series are required to assist in providing a reference for diagnosis and to improve the therapeutic management of CM.

Autobiographically significant concepts: more episodic than semantic in nature? An electrophysiological investigation of overlapping types of memory.

A common assertion is that semantic memory emerges from episodic memory, shedding the distinctive contexts associated with episodes over time and/or repeated instances. Some semantic concepts, however, may retain their episodic origins or acquire episodic information during life experiences. The current study examined this hypothesis by investigating the ERP correlates of autobiographically significant (AS) concepts, that is, semantic concepts that are associated with vivid episodic memories. We inferred the contribution of semantic and episodic memory to AS concepts using the amplitudes of the N400 and late positive component, respectively. We compared famous names that easily brought to mind episodic memories (high AS names) against equally famous names that did not bring such recollections to mind (low AS names) on a semantic task (fame judgment) and an episodic task (recognition memory). Compared with low AS names, high AS names were associated with increased amplitude of the late positive component in both tasks. Moreover, in the recognition task, this effect of AS was highly correlated with recognition confidence. In contrast, the N400 component did not differentiate the high versus low AS names but, instead, was related to the amount of general knowledge participants had regarding each name. These results suggest that semantic concepts high in AS, such as famous names, have an episodic component and are associated with similar brain processes to those that are engaged by episodic memory. Studying AS concepts may provide unique insights into how episodic and semantic memory interact.

Analysis of intracranial pressure: past, present, and future.

The monitoring of intracranial pressure (ICP) is an important tool in medicine for its ability to portray the brain's compliance status. The bedside monitor displays the ICP waveform and intermittent mean values to guide physicians in the management of patients, particularly those having sustained a traumatic brain injury. Researchers in the fields of engineering and physics have investigated various mathematical analysis techniques applicable to the waveform in order to extract additional diagnostic and prognostic information, although they largely remain limited to research applications. The purpose of this review is to present the current techniques used to monitor and interpret ICP and explore the potential of using advanced mathematical techniques to provide information about system perturbations from states of homeostasis. We discuss the limits of each proposed technique and we propose that nonlinear analysis could be a reliable approach to describe ICP signals over time, with the fractal dimension as a potential predictive clinically meaningful biomarker. Our goal is to stimulate translational research that can move modern analysis of ICP using these techniques into widespread practical use, and to investigate to the clinical utility of a tool capable of simplifying multiple variables obtained from various sensors.