Comparison of trigger point injections versus traditional therapies in the management of post-surgical pain in patients who had anterior cervical surgery: A Retrospective Study

Introduction: The opioid epidemic has launched the United States into a public health crisis, resulting in a greater emphasis on non-opioid multimodal pain control methods. At our institution, postoperative posterior neck stiffness and myofascial pain is a common concern after anterior cervical discectomy and fusion or anterior cervical corpectomy with fusion surgery (hereinafter ACS), likely due to prolonged intraoperative positioning in neck extension. Studies have shown successful analgesic outcomes of trigger point injections with local anesthetic for generalized myofascial pain.1-2 This retrospective pilot study aimed to evaluate whether trigger point injections with bupivacaine decreases postsurgical pain compared with traditional therapies in patients undergoing ACS and thereby decrease the amount of opioid medication used. Methods: After IRB approval, we retrospectively reviewed medical records of all patients who received ACS from January 2019 to March 2020 at a single university hospital. We identified patients who received trigger point injections (TP) versus standard care (SC). We excluded patients if TP was performed \u3e3hr from surgery, in recovery for opioid use disorder, underwent a posterior approach, staged surgery, or sustained cervical trauma. The primary outcomes were pain control through the Visual Analog Scale (VAS) and calculated oral morphine equivalents (OME) taken at 6, 12, and 24 hours post-operatively. Secondary outcomes included length of stay (LOS). Results: 137 patients received anterior cervical surgery (100 SC, 37 TP), 62 were excluded. A total of 75 (47 SC, 28 TP) patients were included in this study. The average OME at 6 hours significantly decreased when comparing SC vs TP (32 vs 22, p=0.025). There was no significant difference in average VAS at all time points and average OME at 12 and 24 hours (Table 1). 50% of patients were discharged by 18 hours. Discussion: Our results suggest that TP with bupivacaine significantly reduce opioid consumption within 6 hours of the postoperative period, without increasing overall pain level. There is an opportunity for TP to be included in non-opioid multimodal pain regimens for postoperative myofascial neck pain, especially during the opioid crisis. Limitations of this retrospective study were the small number of study participants, that many patients were discharged before 18 hours and some may have been on chronic pain therapy. The identified limitations will help inform our future investigations and design a prospective randomized control study

A Case of IgE Myeloma: Methodology and Review of the Literature

A 56-year-old man presented with a one-year history of progressive weakness predominantly affecting his extremities and persistent low back pain. Ouchterlony immunodiffusion of the concentrated urine detected a marked increase in lambda light chains. A sternal bone marrow documented a diagnosis of multiple myeloma. Screening high resolution agarose gel electrophoresis revealed diffuse hypogammaglobulinemia and, retrospectively, an equivocal, faint band which migrated in the fast gamma region. By using a combination of Immunoelectrophoresis and immunofixation electrophoresis, this questionable band was determined to represent an IgE lambda monoclonal protein. Radioimmunoassay for IgE documented a serum concentration of 50.6 mg/dl. No intact IgE was found in the urine. Following chemotherapy, the patient\u27s serum IgE level decreased significantly, and he is presently asymptomatic. Features of special interest in this case include the low serum IgE level on presentation, which was difficult to detect on the screening electrophoretogram, and the use of immunofixation electrophoresis in the detection and characterization of these difficult gammopathies

Replication and Meta-analysis of the Association between BDNF Val66Met Polymorphism and Cognitive Impairment in Patients Receiving Chemotherapy.

Cancer-related cognitive impairment (CRCI) adversely affects cancer patients. We had previously demonstrated that the BDNF Val66Met genetic polymorphism is associated with lower odds of subjective CRCI in the multitasking and verbal ability domains among breast cancer patients receiving chemotherapy. To further assess our previous findings, we evaluated the association of BDNF Val66Met polymorphism with subjective and objective CRCI in a temporally separate cohort of patients and pooled findings from both the original (n = 145) and current (n = 193) cohorts in a meta-analysis. Subjective CRCI was assessed using FACT-Cog. Objective CRCI was evaluated using computerized neuropsychological tests. Genotyping was carried out using Sanger sequencing. The association of BDNF Val66Met genotypes and CRCI was examined with logistic regression. A fixed-effect meta-analysis was conducted using the inverse variance method. In the meta-analysis (n = 338), significantly lower odds of CRCI were associated with Met allele carriers based on the global FACT-Cog score (OR = 0.52, 95% CI 0.29-0.94). Furthermore, Met allele carriers were at lower odds of developing impairment in the domains of memory (OR = 0.34, 95% CI: 0.17-0.70), multitasking (OR = 0.33, 95% CI: 0.18-0.59), and verbal ability (OR = 0.46, 95% CI: 0.24-0.88). Consistent with the previous study, lower odds of subjective CRCI among patients with the BDNF Met allele was observed after adjusting for potential confounders in the multitasking (OR = 0.30, 95% CI: 0.14-0.67) domain. In conclusion, carriers of the BDNF Met allele were protected against global subjective CRCI, particularly in the domains of memory, multitasking, and verbal ability. Our findings further contribute to the understanding of CRCI pathophysiology

LSST Science Book, Version 2.0

A survey that can cover the sky in optical bands over wide fields to faint magnitudes with a fast cadence will enable many of the exciting science opportunities of the next decade. The Large Synoptic Survey Telescope (LSST) will have an effective aperture of 6.7 meters and an imaging camera with field of view of 9.6 deg^2, and will be devoted to a ten-year imaging survey over 20,000 deg^2 south of +15 deg. Each pointing will be imaged 2000 times with fifteen second exposures in six broad bands from 0.35 to 1.1 microns, to a total point-source depth of r~27.5. The LSST Science Book describes the basic parameters of the LSST hardware, software, and observing plans. The book discusses educational and outreach opportunities, then goes on to describe a broad range of science that LSST will revolutionize: mapping the inner and outer Solar System, stellar populations in the Milky Way and nearby galaxies, the structure of the Milky Way disk and halo and other objects in the Local Volume, transient and variable objects both at low and high redshift, and the properties of normal and active galaxies at low and high redshift. It then turns to far-field cosmological topics, exploring properties of supernovae to z~1, strong and weak lensing, the large-scale distribution of galaxies and baryon oscillations, and how these different probes may be combined to constrain cosmological models and the physics of dark energy.Comment: 596 pages. Also available at full resolution at http://www.lsst.org/lsst/sciboo

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment