Eating disorder (ED) referrals of school age children and adolescents, by their parents and school teachers, have become more common. Also, they are now presenting at an earlier age to the primary health care and school systems, with physical, medical and psychological symptoms. Nevertheless, there is an average of six months to two years between the onset of symptoms to formal assessment and treatment by specialist team. There are also more cases presenting to ED specialist clinic services, especially pre-pubertal children, with early onset and presentation before 14 years old. Mid and late adolescent presentations (after 14 years old) continue to make up more than two third of the cases. More than 60 percent of cases seen in specialist clinics are of the restrictive type anorexia nervosa, and often associated with persistent and excessive exercise. Thirty percent of cases presented are Bulimia nervosa, which tend to be episodic. Majority of single episode bulimia cases do not present themselves early to medical services but take on open source self-directed management. For patients with bulimia who comply to treatment program and recover after 6-12 months of therapy, they can also experience high relapse rate as they often discontinue their follow up. Avoidant-restrictive food intake disorder is more closely related to pre-pubertal onset eating disorder with arrested sexual maturity and growth failure, if left untreated. Psychiatric co-morbidities arising from body image disturbance, overdrive high achievement needs, prior exposure to adverse childhood experiences (ACE), dysfunctional family or peer relationships, include anxiety, avoidance behavior, obsessive rumination, depression, suicidal ideation and attempt. Death can arise from acute presentation and chronic state of ED, when associated with medical complications from refeeding syndrome, severe malnourishment, accidents and suicide. Early identification and assessment by family physicians would significantly improve the prognosis and mitigate against long term chronicity when share care with ED specialist services.

Eating disorder (ED) referrals of school age children and adolescents, by their parents and school teachers, have become more common. Also, they are now presenting at an earlier age to the primary health care and school systems, with physical, medical and psychological symptoms. Nevertheless, there is an average of six months to two years between the onset of symptoms to formal assessment and treatment by specialist team. There are also more cases presenting to ED specialist clinic services, especially pre-pubertal children, with early onset and presentation before 14 years old. Mid and late adolescent presentations (after 14 years old) continue to make up more than two third of the cases. More than 60 percent of cases seen in specialist clinics are of the restrictive type anorexia nervosa, and often associated with persistent and excessive exercise. Thirty percent of cases presented are Bulimia nervosa, which tend to be episodic. Majority of single episode bulimia cases do not present themselves early to medical services but take on open source self-directed management. For patients with bulimia who comply to treatment program and recover after 6-12 months of therapy, they can also experience high relapse rate as they often discontinue their follow up. Avoidant-restrictive food intake disorder is more closely related to pre-pubertal onset eating disorder with arrested sexual maturity and growth failure, if left untreated. Psychiatric co-morbidities arising from body image disturbance, overdrive high achievement needs, prior exposure to adverse childhood experiences (ACE), dysfunctional family or peer relationships, include anxiety, avoidance behavior, obsessive rumination, depression, suicidal ideation and attempt. Death can arise from acute presentation and chronic state of ED, when associated with medical complications from refeeding syndrome, severe malnourishment, accidents and suicide. Early identification and assessment by family physicians would significantly improve the prognosis and mitigate against long term chronicity when share care with ED specialist services.

Lobectomy has been the primary treatment modality for resectable non-small cell lung cancer.However, recent data showed that surgery alone is not adequate for resectable NSCLC treatment. All patients eligible for surgery with curative intent (stage Ⅰ,Ⅱ,and ⅢA) may benefit from adjuvant chemotherapy.Although combined chemoradiation may improve local control for stage ⅢA disease,radiotherapy has been shown to be harmful for patients with stage Ⅰ and Ⅱ NSCLC after complete resection.The role of neoadjuvant chemotherapy or chemoradiation in resectable NSCLC is controversial.RTOG and SWOG have initiated a phase Ⅲ randomised trial to evaluate the effect of preoperative combined chemoradiation followed by surgical resection and consolidation chemotherapy for stage ⅢA disease.In this review,we discuss the current status of combined management of NSCLC and forecast the future direction of treatment by reviewing a number of landmark publications and ongoing clinical trials..

This editorial aims to refine the severe polytrauma management principles. While keeping ABCDE priorities, the termination of futile resuscitation and the early use of tourniquet to stop exsanguinating limb bleeding are crucial. Difficult-airway-management (DAM) is by a structured 5-level approach. The computerised tomography (CT) scanner is the tunnel to death for hemodynamically unstable patients. Focused Abdominal Sonography for Trauma–Ultrasonography (FAST USG) has replaced diagnostic peritoneal lavage (DPL) and is expanding to USG life support. Direct whole-body multidetector-row computed tomography (MDCT) expedites diagnosis & treatment. Non-operative management is a viable option in rapid responders in shock. Damage control resuscitation comprising of permissive hypotension, hemostatic resuscitation & damage control surgery (DCS) help prevent the lethal triad of trauma. Massive transfusion protocol reduces mortality and decreases the blood requirement. DCS attains rapid correction of the deranged physiology. Mortality reduction in major pelvic disruption requires a multi-disciplinary protocol, the novel pre-peritoneal pelvic packing and the angio-embolization. When operation is the definitive treatment for injury, prevention is best therapy.

Adolescent ; Adult ; Drug and Narcotic Control ; trends ; Humans ; Male ; Paranoid Disorders ; etiology ; Plant Poisoning ; prevention & control ; psychology ; Product Packaging ; legislation & jurisprudence ; trends ; Psychotropic Drugs ; pharmacology ; Salvia ; adverse effects ; chemistry ; Street Drugs ; adverse effects ; legislation & jurisprudence

PURPOSE: The American Joint Committee on Cancer 8th edition (AJCC8) prognostic stage (PS) was implemented January 1, 2018, but it is complex due to multiple permutations. A North American group proposed a simpler system using the anatomic stage with a risk score system (RSS) of 1 point each for grade 3 tumor and human epithelial growth factor receptor 2 (HER2) and estrogen receptor (ER) negativity. Here we aimed to evaluate this risk score system with our database of Asian breast cancer patients and compare it against the AJCC8 PS. METHODS: Patients diagnosed with breast cancer stage I–IV in 2006–2012 were identified in the SingHealth Joint Breast Cancer Registry. Five-year breast cancer-specific survival (CSS) and overall survival (OS) were calculated for each anatomic stage according to the risk score and compared with the AJCC8 PS. RESULTS: A total of 6,656 patients were analyzed. The median follow-up was 61 (interquartile range, 37–90) months. There was a high receipt of endocrine therapy (84.6% of ER+ patients), chemotherapy (84.3% of node-positive patients), and trastuzumab (86.0% of HER2+ patients). Within each anatomic stage, there were significant differences in survival in all sub-stages except IIIB. On multivariate analysis, the hazard ratio for negative ER was 1.74 (1.48–2.06), for negative HER2 was 1.49 (1.26–1.74), and for grade 3 was 1.84 (1.55–2.19). On multivariate analysis controlled for age, ethnicity, and receipt of chemotherapy, the RSS (Akaike information criterion [AIC] = 10,649.45; Harrell's Concordance Index [C] = 0.85) was not inferior to the AJCC8 PS (AIC = 10,726.65; C = 0.84) for CSS, nor was the RSS (AIC = 14,714.4; C = 0.82) inferior to the AJCC8 PS (AIC = 14,784.69; C = 0.81) for OS. CONCLUSION: The RSS is comparable to the AJCC8 PS for a patient population receiving chemotherapy as well as endocrine- and HER2-targeted therapy and further stratifies stage IV patients.
Asian Continental Ancestry Group ; Biomarkers ; Breast Neoplasms ; Breast ; Drug Therapy ; Estrogens ; Follow-Up Studies ; Humans ; Joints ; Multivariate Analysis ; Trastuzumab

BACKGROUND: Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is an important problem with potential complications such as contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction. It is a common practice to tape the connection of the system. This study aimed to evaluate the materials and methods of connection of chest drain system to minimize drainage dislodgement. METHODS: We conducted an experimental study to assess the tightness of the connection with various taping materials and methods. We selected three commonly used adhesive materials (3M?Transpore? Medical tape, 3M? Micropore? Medical tape, 3M? Soft Cloth Tape on Liner) and three different methods (cross method, straight method, nylon band) to secure the junction between the thoracostomy tube and the bi-conical adaptor in the drainage system. The measured outcome was the weight causing visible loosening of the junction between thoracotomy tube and the adaptor. RESULTS: For each taping material and taping method, 10 trials were performed. The median weight required to disconnect the junction is 26.22 lb for Transpore?, 31.29 lb for Micropore? and 32.44 lb for Soft Cloth Tape on Liner. A smaller force was required to disconnect if Transpore? is used (P<0.001). There was no statistical significant difference between Micropore? and Soft Cloth Tape on Liner (P=0.98). The median disconnecting force is 32.44 lb for straight taping method, 40.55 lb for cross taping method and 21.15 lb for plastic band. The cross-taping method was the more secure method (P<0.0001 when compared with plastic band) (P=0.033 when compared with straight method). CONCLUSION: Cross-taping is the most secure method among the tested varieties in connecting the thoracostomy tube to the chest drainage system. Transpore? is not a recommended material for thoracostomy tube taping.

Steatocystoma multiplex (SM) is an uncommon cutaneous disorder characterised by multiple intradermal cysts distributed over the trunk and proximal extremities. This condition affects both genders and is often inherited as an autosomal dominant trait, although sporadic cases have been described. This report describes the mammographic and sonographic features of the cysts, which presented as breast lumps, for evaluation. The cysts appeared as numerous well-circumscribed, radiolucent nodules with thin radiodense rims on mammography. On sonography, the cysts could be hypoechoic, isoechoic or demonstrate mixed echoes containing debris-fluid levels, depending on the amount of clear oily liquid and keratinous material. SM can be diagnosed based on a clinical setting of multiple asymptomatic small intradermal nodules over the trunk and proximal extremities, positive family history and imaging findings.
Breast Diseases ; diagnosis ; Diagnosis, Differential ; Female ; Humans ; Mammography ; methods ; Middle Aged ; Steatocystoma Multiplex ; diagnosis ; Ultrasonography, Mammary ; methods