Association between perineal trauma and pain in primiparous women

Objective To identify the association between perineal trauma and pain in 473 primiparous women. Method Cross-sectional study in which pain was measured by the numerical pain scale (0 to 10 - 0 being no pain and 10 maximal pain). Results The prevalence and mean intensity of pain were 33.0% and 4.7 points (standard deviation = 2.0) in the numeric scale, respectively. Episiotomy represented the most frequent trauma (46.7%). The occurrence and intensity of the pain were associated with perineal trauma and postpartum time. Having perineal trauma tripled the chance of pain. Each hour elapsed following the birth reduced the chance of pain by 4.8%. Conclusion Primiparous women are subject to a high frequency of perineal trauma, with episiotomy being the most prominent. Perineal pain affects approximately one-third of primiparous women and is associated with the postpartum time and perineal traumas

Suppression of interferon gene expression overcomes resistance to MEK inhibition in KRAS-mutant colorectal cancer.

Despite showing clinical activity in BRAF-mutant melanoma, the MEK inhibitor (MEKi) trametinib has failed to show clinical benefit in KRAS-mutant colorectal cancer. To identify mechanisms of resistance to MEKi, we employed a pharmacogenomic analysis of MEKi-sensitive versus MEKi-resistant colorectal cancer cell lines. Strikingly, interferon- and inflammatory-related gene sets were enriched in cell lines exhibiting intrinsic and acquired resistance to MEK inhibition. The bromodomain inhibitor JQ1 suppressed interferon-stimulated gene (ISG) expression and in combination with MEK inhibitors displayed synergistic effects and induced apoptosis in MEKi-resistant colorectal cancer cell lines. ISG expression was confirmed in patient-derived organoid models, which displayed resistance to trametinib and were resensitized by JQ1 co-treatment. In in vivo models of colorectal cancer, combination treatment significantly suppressed tumor growth. Our findings provide a novel explanation for the limited response to MEK inhibitors in KRAS-mutant colorectal cancer, known for its inflammatory nature. Moreover, the high expression of ISGs was associated with significantly reduced survival of colorectal cancer patients. Excitingly, we have identified novel therapeutic opportunities to overcome intrinsic and acquired resistance to MEK inhibition in colorectal cancer

Computed tomographic colonography for diagnosis of early cancer and polyps?

Computed tomographic (CT) colonography comprises thin-section CT scanning of the prepared, gas-distended colon, acquired in more than one patient position. The test is widely available internationally and is highly sensitive for colorectal cancer, including significant polyps and early colorectal cancers (SPECC). In this article, we will discuss the basic technique of CT colonography, its diagnostic performance, the challenge of detecting serrated polyps and handling of diminutive polyps. Since CT colonography permits a detailed assessment of polyp morphology, radiologists must communicate their descriptions of the CT appearances of larger polyps accurately and using widely-accepted terminology. This allows services to plan their resection strategy for these larger lesions in timely fashion and ensure availability of appropriate staff and equipment for that patient. Close collaboration between all members of the multi-disciplinary team will ensure that all patients have access to high-quality colonic imaging services

Place and Punishment: The Spatial Context of Mass Incarceration

OBJECTIVES: Research on race and urban poverty views incarceration as a new and important aspect of social disadvantage in inner-city neighborhoods. However, in quantitative studies of the spatial distribution of imprisonment across neighborhoods, the pattern outside urban areas has not been examined. This paper offers a unique analysis of disaggregated prison admissions and investigates the spatial concentrations and levels of admissions for the entire state of Massachusetts. METHODS: Spatial regressions estimate census tract-level prison admission rates in relation to racial demographics, social and economic disadvantage, arrest rates, and violent crime; an analysis of outlier neighborhoods examines the surprisingly high admission rates in small cities. FINDINGS: Regression analysis yields three findings. First, incarceration is highly spatially concentrated: census tracts covering 15% of the state’s population account for half of all prison admissions. Second, across urban and non-urban areas, incarceration is strongly related to concentrated disadvantage and the share of the black population, even after controlling for arrest and crime rates. Third, the analysis shows admission rates in small urban satellite cities and suburbs comprise the highest rates in the sample and far exceed model predictions. CONCLUSION: Mass incarceration emerged not just to manage distinctively urban social problems but was characteristic of a broader mode of governance evident in communities often far-removed from deep inner-city poverty. These notably high levels and concentrations in small cities should be accounted for when developing theories of concentrated disadvantage or policies designed to ameliorate the impacts of mass incarceration on communities.Accepted manuscrip