This report presents the imaging findings in a patient with advanced prostate cancer and bone metastases. A superscan pattern on the initial whole-body bone scan suggested extensive disease. The patient responded well to definitive treatment, exhibiting clinical improvement based on decreased PSA levels and CT findings in 6-month follow-up. However, serial follow-up bone scans showed normalization in about 18 months. This paper aims to discuss the limitations of bone scintigraphy in evaluating treatment responses in patients with prostate cancer.

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Physical therapists (PTs) working in primary care settings commonly encounter mechanical causes of knee pain. Non-mechanical causes of knee pain, such as bone tumors, are rare, and therefore, PTs often have a low index of suspicion regarding sinister pathology. The purpose of this case report is to describe the physical therapist\'s clinical reasoning process for a 33-year-old female presenting with medial knee pain and a subsequent history of metastatic melanoma. Initially, subjective and objective testing pointed to a mechanical internal derangement of the knee. However, symptom progression and poor treatment responses between physical therapy visits 2 and 3 raised suspicions as to the cause of the knee pain. This prompted an orthopedic referral and medical imaging, revealing a large bone tumor invading the medial femoral condyle, which was further characterized as metastatic melanoma by a specialty oncology team. Further imaging revealed several metastatic subcutaneous, intramuscular and cerebral lesions. This case highlights the importance of the ongoing medical screening process, including the monitoring of symptoms and treatment responses.
Clinicians should have a high index of suspicion in patients with a prior cancer diagnosis and unresolving pain without a relevant explanation or injury.The screening process should include active monitoring of treatment responses and appropriate referral for plain radiographs where hypothesized timeframes are exceeded or sinister pathology is suspected.Early specialist referral and subsequent oncology team referral is imperative for bone tumors, to assess metastatic disease and initiate treatment.

UNASSIGNED: Cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) has become the commonest first-line treatment of hormonal receptor positive and human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer (MBC). However, therapy is quite individualized after progression of disease (PD) when CDK4/6i fails. Estrogen receptor (ER) status of metastatic lesions of bone, lung or liver might be different from the primary tumor and biopsy of metastatic lesions was invasive and not always available. Prediction of treatment response after PD of CDK4/6i remains unsolved. 18F-fluoroestradiol (FES) PET/CT could non-invasively reveal ER expression both in primary and metastatic breast cancer and recognize heterogeneity of ER status.
UNASSIGNED: A 70-year-old woman with Parkinson\'s disease, osteoporosis and cardiovascular co-morbidity was diagnosed with HR+/HER2- breast cancer (pT2N2M0, stage IIIa). Three years later, she developed metastases in right lung and pleura with pleural effusion and received palbociclib + letrozole. After 8 months the disease progressed, and 18F-FES PET/CT revealed multiple ER-positive pleural lesions and ER-negative pulmonary nodules after PD and the progression-free survival (PFS) of first-line CDK4/6i was 8 months. Since most of the metastatic lesions were ER-positive, abemaciclib + fulvestrant were chosen as the second-line CDK4/6i treatment and the PFS was 15 months. Another 18F-FES PET/CT showed a new ER-positive pleural mass with multiple ER-negative pulmonary nodules. Since 18F-FES PET/CT revealed that the dominant lesions were still ER-positive, dalpiciclib + exemestane + fulvestrant were prescribed as the third-line CDK4/6i treatment. Currently the patient\'s disease had been stable for 2 months.
UNASSIGNED: This case demonstrated that 18F-FES PET/CT could show ER heterogeneity non-invasively and reveal the treatment responses a predictive imaging tool of serial second- and third-line of CDK4/6i treatments when first-line CDK4/6i failed in HR+/HER2- MBC. So long as the dominant or newly-developed metastatic lesion was ER-positive on 18F-FES PET after first-line CDK4/6i, the patient might show certain therapeutic response towards endocrine-based treatment including second- and third-line of CDK4/6i, and thus increased the time to chemotherapy (TTC).

BACKGROUND: Generalised anxiety disorder (GAD) is a common anxiety disorder associated with social and occupational impairment. Recently, a theory was postulated that dysfunctional gamma aminobutyric acid type A receptors (GABAA) are implicated in anxiety symptomology, which could be corrected by flumazenil, an antagonist at the benzodiazepine binding site on the GABAA receptor.
METHODS: Participants had a primary diagnosis of GAD and were treated initially with an eight-day continuous low-dose flumazenil infusion (total 32 mg at a rate of 4 mg/24 h). Some participants were re-treated with a further four- or eight-day infusion. Treatment response was measured as a 50% reduction in anxiety or stress scores on the Depression Anxiety Stress Scale-21 (DASS-21). Remission was measured as scores ≤3 or ≤7 on the anxiety and stress subscales of the DASS-21, respectively.
RESULTS: Eight cases are reported. All cases met the criteria for treatment response on the anxiety and stress subscale of the DASS-21. Remission was achieved in seven participants on the anxiety subscale and in five on the stress subscale. No changes in hepatic, renal, or haematological function were likely attributed to flumazenil.
CONCLUSIONS: Data suggest that low-dose continuous flumazenil infusion manages GAD symptoms and is safe. Although these results are promising, future randomised control trials are required to confirm these results.

The present study shows first attempts to automatically classify oncology treatment responses on the basis of the textual conclusion sections of radiology reports according to the RECIST classification. After a robust and extended manual annotation of 543 conclusion sections (5-to-50-word long), and after the training of several machine learning techniques (from traditional machine learning to deep learning), the best results show an accuracy score of 0.90 for a two-class classification (non-progressive vs. progressive disease) and of 0.82 for a four-class classification (complete response, partial response, stable disease, progressive disease) both with Logistic Regression approach. Some innovative solutions are further suggested to improve these scores in the future.

Negative symptoms (NS) severely affect daily functioning already at the psychosis onset. However, most studies investigating beneficial effects of specific treatments for NS mainly included individuals with prolonged psychotic disorders. Furthermore, evidence on psychosocial rehabilitation for NS in early psychosis is still relatively poor. The aims of this study therefore were (A) to longitudinally examine NS stability in people with first episode psychosis (FEP) along a 2-year follow-up period, and (B) to overtime explore any relevant association of NS levels with the specific intervention components of an \'early intervention in psychosis\' (EIP) protocol during the follow-up.
At baseline, 266 FEP subjects (aged 12-35 years) completed the positive and negative syndrome scale (PANSS). Multiple linear regression analyses were then performed.
Along the follow-up, FEP participants had a relevant improvement in NS levels. This was specifically predicted by the total number of case management sessions offered within our 2-year EIP protocol, as well as by shorter duration of untreated psychosis at entry and by longitudinal reduction in PANSS depressive and positive symptom dimension levels. No association with antipsychotic medication was found.
NS are clinically relevant in FEP, already at the recruitment time in specialized EIP services. However, their severity appears to improve over time together with the delivery of patient-tailored, integrated EIP case management.

Purpose: Approximately 30% of patients with major depressive disorder (MDD) are treatment resistant. There is an unquestionable need for new treatment strategies. Subanesthetic doses of intravenous (IV) ketamine have a rapid antidepressant effect in treatment-resistant depression (TRD). This paper describes the efficacy of repeated series of intravenous ketamine infusions as an add-on treatment in five TRD inpatients. Methods: Eligible patients aged 43-63 were given eight ketamine infusions as an add-on treatment for patients with MDD. The subjects have readministered the intervention due to worsening depressive symptoms. Results: Of the five inpatients given ketamine as a series of eight infusions, one underwent three, and four had two treatment series. Four patients achieved remission after first series and three after the second series of ketamine infusions. The adverse reactions were mild and transient with no sequelae. Limitations: Presented case series applies to short-term intervention with IV ketamine as an add-on therapy. The results cannot be generalized to the long-term maintenance treatment nor other ketamine formulations as well as different administration schedules and dosing. Conclusions: This case series showed efficacy and safety of the repeated series of IV ketamine treatment in TRD in MDD and bipolar disorder type I. The subsequent interventions were safe and observed adverse events were mild and transient. Interestingly, the IV ketamine treatment at successive administrations seems to alter the major depression severity of the next affective episode. There is a critical need for further research regarding IV ketamine treatment effectiveness and long-term safety in future studies.

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Predicting treatment failure and switching effective treatment immediately in patients with multiple sclerosis (MS) is important. We aimed to evaluate the usefulness of Modified Rio score (MRS) in predicting treatment failure in MS patients. This is a retrospective study, which was conducted in two University Hospital. 129 MS patients treated with İnterferon or glatiramer-acetate from 2 clinical sites, were retrospectively selected. MRS was calculated after the first year of therapy. Treatment failure was defined as the presence of a 1 point increase in EDSS, 2 clinical attacks, 1 clinical attack and progression, 1 clinical attack and new lesion on MRI except associated with an attack, or new lesion in 2 different MRI taken at least 3 months apart. The sensitivity, specificity, positive and negative predictive values of the MRS in predicting treatment failure were determined. 71 (55%) patients with score \'0\', 41 (31.8%) patients with score \'1\', 11 (8.5%) patients with score \'2\', 6 (4.7%) patients with score \'3\' were detected. 14 patients needed treatment switching during the first three years of the treatment. Sensitivity was 57%, specificity was 92%, positive predictive value was 95%, negative predictive value was 47% and accuracy was 89%. Modified Rio score (MRS) was found to be effective in determining the treatment failure as mentioned before. This study will be useful for clinicians who evaluate the treatment failure like us, and this study revealed that the MRS may also help predict treatment failure.