Rupture of carotid artery pseudoaneurysm in the modern era of definitive chemoradiation for head and neck cancer: Two case reports.

BACKGROUND: Carotid blowout syndrome (CBS) is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery wall. It is a life-threatening clinical situation. There is no established and effective mode of management of CBS. Furthermore, there is no established preceding sign or symptom; therefore, preventive efforts are not clinically meaningful. CASE SUMMARY: We described two cases of CBS that occurred in patients with head and neck cancer after definitive chemoradiotherapy (CRT) using three-dimensional conformal intensity-modulated radiation therapy. Two men aged 61 and 56 years with locally advanced head and neck cancer were treated with definitive CRT. After completing CRT, both of them achieved complete remission. Subsequently, they had persistent severe pain in the oropharyngeal mucosal region and the irradiated neck despite the use of opioid analgesics and rehabilitation for relief of contracted skin. However, continuous follow-up imaging studies showed no evidence of cancer recurrence. Eleven to twelve months after completing CRT, the patients visited the emergency room complaining about massive oronasal bleeding. Angiograms showed rupture of carotid artery pseudoaneurysms on the irradiated side. Despite attempting to secure hemostasis with carotid arterial stent insertion and coil embolization, both patients died because of repeated bleeding from the pseudoaneurysms. CONCLUSION: In patients with persistent pain in irradiated sites, clinicians should be suspicious of progressing or impending CBS, even in the three-dimensional conformal intensity-modulated radiation therapy era.

The effects of empowered motivation on exercise adherence and physical fitness in college women.

The purpose of this study is to identify the effects of exercise adherence when exercise motivation was empowered. It was planned as a pretest-posttest nonequivalent quasi-experimental design. The study subjects were female college students who wanted exercise and agreed to participate in the Jane Fonda Workout Program (1982) for a period of six months. The subject sample was divided into an experimental group and a control group by college department to prevent contamination of the intervention, which promotes long-term exercise-program adherence through the EMPOWER Step Program. All subjects' body composition and physical fitness were measured using the Inbody (520) Body Composition Analyzer and Helmas (Korea) measuring equipment. Cronbach's α, t-test, odds ratio and analysis of covariance were used to analyze the data using the Statistical Package for the Social Sciences program. According to the results the experimental group showed a 66.66% exercise adherence success rate and the control group showed only a 26.31% success rate (OR= 5.60, P= 0.01; t= 2.932, P= 0.006). Skeletal muscle mass was significantly higher in the experimental group than in the control group (F= 8.45, P= 0.006). Body fat mass decreased significantly more in the experimental group than in the control group (F= 6.08 P= 0.01). Empowered motivation has positive effects on adherence to exercise regimes and physical fitness in female college students. Therefore it is suggested to actively utilize the EMPOWER Step Program to foster long-term exercise.

Pilomatricomas: the diagnostic value of ultrasound.

OBJECTIVE: The purpose of this study was to analyze statistically significant diagnostic factors for pilomatricoma on the basis of ultrasonographic features. METHODS: Sonographic images were retrospectively reviewed from 44 pilomatricomas, and from 43 control subjects with other subcutaneous tumors. Two radiologists determined the tumoral shape, margin, echotexture, echogenicity, posterior shadowing, posterior enhancement, hypoechoic rim, internal calcification, and vascularity. RESULTS: The reliable diagnostic factors for pilomatricoma were hypoechogenicity (P < 0.001), heterogenicity (P < 0.05), internal calcification (P < 0.001), hypoechoic rim (P < 0.001), and posterior shadowing (P < 0.001). Scattered dots were the most common patterns of internal calcification. A combination of hypoechogenicity, heterogenicity, internal calcification of scattered-dot pattern, and a hypoechoic rim was a statistically significant difference between the two groups (P < 0.001; odds ratio, 21). CONCLUSIONS: The features of heterogeneous echotexture, internal echogenic foci in scattered-dot pattern, and a hypoechoic rim or posterior shadowing itself could be discriminative ultrasonographic criteria for differentiating pilomatricomas from other subcutaneous tumors.

Emergent effects of heavy metal pollution at a population level: Littorina brevicula a study case.

Changes in genetic variability and allele frequency can be responses from natural populations when encountering a novel contaminated environment. The genetic diversity and population structuring of natural populations of the gastropod Littorina brevicula from heavy-metal polluted and unpolluted environments along the southeast coast of Korea were examined using two mtDNA markers, cyt b and ND6. This study applied a nested clade analysis to test the existence of structuring association of haplotype distribution with environments (polluted and unpolluted). No genetic differences within cyt b mtDNA were detected between environments. On the other hand, differences in population haplotype diversity and structuring were found within ND6 mtDNA between polluted and unpolluted environments. The ND6-mtDNA haplotype (=genetic) diversity was significant lower in polluted environments. This decreased genetic diversity along with differences in the haplotype distribution within heavy-metal polluted environments compared to those unpolluted ones stand out as emergent effects from pollution at a population level. In this study, we propose the use of different approaches, such as the NCA, that takes into account the rare haplotypes, when assessing the effects of pollution on population genetic structuring.