A Comprehensive Review of the Diagnosis, Treatment, and Management of Postmastectomy Pain Syndrome.

PURPOSE OF REVIEW: Postmastectomy pain syndrome (PMPS) remains poorly defined, although it is applied to chronic neuropathic pain following surgical procedures of the breast, including mastectomy and lumpectomy in breast-conserving surgery. It is characterized by persistent pain affecting the anterior thorax, axilla, and/or medial upper arm following mastectomy or lumpectomy. Though the onset of pain is most likely to occur after surgery, there may also be a new onset of symptoms following adjuvant therapy, including chemotherapy or radiation therapy. RECENT FINDINGS: The underlying pathophysiology is likely multifactorial, although exact mechanisms have yet to be elucidated. In this regard, neuralgia of the intercostobrachial nerve is currently implicated as the most common cause of PMPS. Numerous pharmacological options are available in the treatment of PMPS, including gabapentinoids, tricyclic antidepressants, selective serotonin reuptake inhibitors, NMDA receptor antagonists, and nefopam (a non-opioid, non-steroidal benzoxazocine analgesic). Minimally invasive interventional treatment including injection therapy, regional anesthesia, botulinum toxin, and neuromodulation has been demonstrated to have some beneficial effect. A comprehensive update highlighting current perspectives on the treatment of postmastectomy pain syndrome is presented with emphasis on treatments currently available and newer therapeutics currently being evaluated to alleviate this complex and multifactorial condition.

Review of Cardiometabolic Effects of Prescription Omega-3 Fatty Acids.

PURPOSE OF REVIEW: Populations with significant dietary fish intake tend to have lower cardiovascular (CV) risk and demonstrable physiologic differences including lower lipid/lipoprotein levels and other direct and indirect effects on the arterial wall and inhibiting factors that promote atherosclerosis. Treatment with high doses of pharmacologic-grade omega-3 fatty acid (n-3FA) supplements achieves significant reductions in triglycerides (TG), non-high-density lipoprotein- (non-HDL-) and TG-rich lipoprotein- (TRL-) cholesterol levels. n-3FA supplements have significant effects on markers of atherosclerosis risk including endothelial function, low-density lipoprotein (LDL) oxidation, cellular and humoral markers of inflammation, hemodynamic factors, and plaque stabilization. This review summarizes the lipid and cardiometabolic effects of prescription-grade n-3FAs and will discuss clinical trials, national/organizational guidelines, and expert opinion on the impact of supplemental n-3FAs on CV health and disease. RECENT FINDINGS: Clinical trial evidence supports use of n-3FAs in individuals with established atherosclerotic cardiovascular disease (ASCVD), but the data either does not support or is lacking for other types of cardiometabolic risk including prevention of stroke, treatment in patients with heart failure, diabetes mellitus and prediabetes, and for primary prevention in the general population. Despite inconsistent findings to support widespread benefit, there is persistent population-wide enthusiasm for n-3FA as a dietary supplement for its cardiometabolic benefits. Fortunately, there are ongoing clinical trials to assess whether the lipid/lipoprotein benefits may be extended to other at-risk populations and whether lower-dose therapy may provide background benefit for primary prevention of ASCVD.

Stormwater contaminant loading following southern California wildfires.

Contaminant loading associated with stormwater runoff from recently burned areas is poorly understood, despite the fact that it has the potential to affect downstream water quality. The goal of the present study is to assess regional patterns of runoff and contaminant loading from wildfires in urban fringe areas of southern California. Postfire stormwater runoff was sampled from five wildfires that each burned between 115 and 658 km(2) of natural open space between 2003 and 2009. Between two and five storm events were sampled per site over the first one to two years following the fires for basic constituents, metals, nutrients, total suspended solids, and polycyclic aromatic hydrocarbons (PAHs). Results were compared to data from 16 unburned natural areas and six developed sites. Mean copper, lead, and zinc flux (kg/km(2)) were between 112- and 736-fold higher from burned catchments and total phosphorus was up to 921-fold higher compared to unburned natural areas. Polycyclic aromatic hydrocarbon flux was four times greater from burned areas than from adjacent urban areas. Ash fallout on nearby unburned watersheds also resulted in a threefold increase in metals and PAHs. Attenuation of elevated concentration and flux values appears to be driven mainly by rainfall magnitude. Contaminant loading from burned landscapes has the potential to be a substantial contribution to the total annual load to downstream areas in the first several years following fires.