Advances in Pain Medicine: a Review of New Technologies.

PURPOSE OF REVIEW: This narrative review highlights the interventional musculoskeletal techniques that have evolved in recent years. RECENT FINDINGS: The recent progress in pain medicine technologies presented here represents the ideal treatment of the pain patient which is to provide personalized care. Advances in pain physiology research and pain management technologies support each other concurrently. As new technologies give rise to new perspectives and understanding of pain, new research inspires the development of new technologies.

Expression and functional role of IGFs during early pregnancy in placenta of water buffalo.

Adequate vascularisation is a key factor for successful fetal development. We hypothesized that Insulin-Like Growth Factor (IGF) family members regulate angiogenesis along with promoting fetal development and growth. In this experiment, we determined the expression and functional role of IGF family in placental compartments (caruncle; CAR, cotyledon; COT) during different stages of early pregnancy in the water buffalo (Bubalus bubalis). Samples were collected from early pregnancy 1 (EP1, 28-45 days), early pregnancy 2 (EP2, 45-90 days), and third stage of estrous cycle (11-16 days), which was taken as control. In addition, the role of IGF1 on mRNA expression of vWF, StAR, CYP11A1, 3ßHSD, PCNA, and BAX were elucidated in cultured trophoblast cells (TCC) obtained from EP2. Quantitative real-time PCR (q-PCR), westernblot, and immunohistochemistry were done to investigate the gene expression, protein expression, and localization of examined factors, and RIA was also done to assess progesterone (P4) concentration. Expression of IGFs, its receptors and binding proteins were found to be significantly higher (p < 0.05) in both CAR and COT as compared to control during early pregnancy, except binding proteins IGFBP1, 3 and 4 which were significantly (p < 0.05) downregulated in COT with advancement of pregnancy. mRNA expression was consistent with the findings of immunoblotting and immunolocalization experiments. Trophoblasts cell culture (TCC) study showed a significant time and dose-dependent effect of IGF1 onsteroidogenic transcript, which was found to be maximum at 100 ng/ml that paralleled with P4 accretion in the media (p < 0.05). Further, IGF1 upregulated the transcripts of vWF, PCNA, and downregulated BAX at the same concentration (p < 0.05). Overall, our results demonstrated that the expression of IGFs is a site-specific phenomenon in placentome, which indicates autocrine/paracrine and endocrine function. Our in-vitro finding support that IGF1 plays a critical role in placental development by promoting angiogenesis, steroid synthesis, and cell proliferation during early pregnancy.

Rectal and Bladder Dose Measurements in the Intracavitary Applications of Cervical Cancer Treatment with HDR Afterloading System: Comparison of TPS Data with MOSFET Detector.

BACKGROUND: Intracavitary brachytherapy plays a major role in management of cervical carcinoma. Assessment of dose received by OAR's therefore becomes crucial for the estimation of radiation toxicities in HDR brachytherapy. OBJECTIVE: Purpose of this study is to evaluate the role of in vivo dosimetry in HDR brachytherapy and to compare actual doses delivered to OAR' s with those calculated during treatment planning. MATERIAL AND METHODS: In this retrospective study, 50 patients of cervical carcinoma were treated by Microselectron HDR. Out of 50 patients, 26 were treated with a dose of 7 Gy and 24 with a dose of 9 Gy, prescribed to point A. Brachytherapy planning and evaluation of dose to bladder and rectum was done on TPS & in vivo dosimetry was performed using portable MOSFET. RESULTS: Calibration factors calculated for both dosimeters are almost equal and are 0.984 cGy/mV and 1.0895 cGy/mV. For bladder, dose deviation was found to be within ± 5% in 28 patients, ± 5-10% in 14 patients, ± 10-15% in 4 patients. Deviation between TPS-calculated dose and dose measured by MOSFET for rectum was within ± 5% in 31 patients, ± 5-10% in 8 patients, and ± 10-15% in 7 patients. CONCLUSION: TPS calculated doses were slightly higher than that measured by MOSFET. The use of small size MOSFET dosimeter is an efficient method for accurately measuring doses in high-dose gradient fields typically seen in brachytherapy. Therefore, to reduce the risk of large errors in dose delivery, in vivo dosimetry can be done in addition to TPS computations.

Radiation Induced Demyelination in Cervical Spinal Cord of the Head and Neck Cancer Patients after Receiving Radiotherapy.

BACKGROUND: Cervical spinal cord is important and radiosensitive. It is the most critical organ for the head and neck (H&N) cancer patients during radiotherapy. If the delivered dose to the cord is more than tolerance dose, demyelination may occur. OBJECTIVE: Current study aims to analyze the post radiotherapy status of cord in the H&N cancer patients. MATERIAL AND METHODS: In this analytical study, sixty patients who received more than 50 Gray (Gy) dose for more than 10 cm length of spinal cord participated in the study. All the patients were clinically examined and magnetic resonance imaging (MRI) was performed for patients who had demyelination symptoms. Adequate medical management was provided for all the patients having demyelination. RESULTS: Out of sixty patients, ten cases were reported with demyelination symptoms, and only six cases gave consent for this study. One patient was found to have irreversible demyelination while five patients had reversible demyelination. CONCLUSION: Demyelination may occur if long segment spinal cord receives dose more than tolerance limit. However target dose should not be compromised up to 54 Gy to spinal cord.

Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline

What are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying tobecome pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or youngadults (such as those ≤30 years old).