UNASSIGNED: Interpersonal synchronization is increasingly studied as a biomarker of empathy, therapeutic alliance, and treatment outcome. However, most studies average data over sessions, leaving associations between synchrony and actual interactions largely unexplored. We aim to showcase a novel approach examining synchronization during specific micro-processes: Innovative Moments (IM) as markers of exceptions to clients\' problematic patterns of meaning.
UNASSIGNED: Electrodermal activity was recorded over 15 sessions of a psychodynamic psychotherapy single case. Moment-to-moment patient-therapist synchrony was calculated using the Adaptive Matching Interpolated Correlations (AMICo) algorithm. The Innovative Moments Coding System was utilized to identify IMs within session transcripts with precise timing. Monte-Carlo permutation tests were conducted to examine the association between physiological synchrony and IM Levels of increasing complexity (Levels 1-3).
UNASSIGNED: Higher-than-random synchronization emerged during Level 3 IMs (p = 0.046; d = 0.21) but not in lower Levels. Post-hoc qualitative analyses linked high synchrony to sub-processes of Level 3 IMs, such as positive contrasts and attributions for change.
UNASSIGNED: Our findings show it is possible to link moment-by-moment physiological co-regulation to theoretically identified meaning-making processes. While generalization of these observations is undue, this work demonstrates a robust and promising application of a multimodal approach to investigating psychotherapy, providing insights into both the clinical case and the theoretical model adopted.

This paper details the acquisition, structure and preprocessing of the MultiCaRe Dataset, a multimodal case report dataset which contains data from 75,382 open access PubMed Central articles spanning the period from 1990 to 2023. The dataset includes 96,428 clinical cases, 135,596 images, and their corresponding labels and captions. Data extraction was performed using different APIs and packages such as Biopython, requests, Beautifulsoup, BioC API for PMC and EuropePMC RESTful API. Image labels were created based on the contents of their corresponding captions, by using Spark NLP for Healthcare and manual annotations. Images were preprocessed with OpenCV in order to remove borders and split figures containing multiple images, data were analyzed and described, and a subset was randomly selected for quality assessment. The dataset\'s structure allows for seamless integration of different types of data, making it a valuable resource for training or fine-tuning medical language, computer vision or multi-modal models.

Complex regional pain syndrome is a chronic debilitating pain disorder that is difficult to manage, in part due to its heterogeneous clinical presentation and lack of clearly defined pathophysiology. Patients usually require a multidisciplinary approach to treatment, which can entail pharmacotherapy, physical therapy, behavioral therapy, and interventional pain procedures, such as sympathetic nerve blocks, spinal cord stimulation, and dorsal root ganglion stimulation. However, many patients continue to experience pain refractory to these multimodal strategies. Scrambler therapy (ST) is a noninvasive method of neuromodulation that is applied through cutaneous electrodes, and can alleviate chronic neuropathic pain by stimulating C-fibers and replacing endogenous pain signals with synthetic non-nociceptive signals. Although the use of ST has been reported for several types of refractory central and peripheral neuropathic pain, there is a paucity of data regarding the use of ST for complex regional pain syndrome. We present two patients with complex regional pain syndrome of the right lower extremity, who each underwent ST and experienced significant pain relief and improvement in function and quality of life.

A non-small-cell-lung-cancer patient with cerebral metastasis presenting an atypical exon 20 mutation in the EGFR gene had a long-lasting tumor cotrol on mulimodal treatment with osimertinib and stereotaxic radiotherapy on oligoprogressing lesions. Most exon-20 mutations are resistant to first, second and third generation EGFR-directed TKI. This case was discussed on our molecular tumour board. As the more specific exon-20 targeted therapies were not yet available and as sporadic short responses on the third generation EGFR-directed TKI, osimertinib had been described, the patient started osimertinib. She had a prolonged tumoral response on Osimertinib. The patient is still asymptomatic up to 32 months after initiating the medication. This case confirms that not all exon20 EGFR mutations are equal to osimertinib and that the localization of the exon 20 insertion mutation is probably important to consider when treating EGFR mutated NSCLC. The long-term clinical benefit can be maintained through stereotactic radiotherapy on focal progressive lesions.

Older people with dementia (PWD) in nursing homes (NHs) tend to have decreased cognitive function, which may cause behavioral and psychological symptoms of dementia (BPSDs) and hinder activities of daily living (ADLs). Therefore, taking measures against the cognitive decline of PWD in NH and, in turn, the decline of BPSDs and ADLs is crucial. The purpose of this study was to test whether a multimodal non-pharmacological intervention (MNPI) is effective in maintaining and improving global cognitive function, BPSDs, and ADLs in PWD in NHs.
An intervention study using a single-case AB design was conducted in three subjects in NHs. During the non-intervention phase, participants underwent follow-up assessments, and during the intervention phase, they participated in an MNPI. The ABC Dementia Scale (which concurrently assesses ADLs [\"A\"], BPSDs [\"B\"], and cognitive function [\"C\"]) was used for the assessment.
One of the three patients showed improvement in dementia severity, global cognitive function, ADLs, and BPSDs. However, the other two participants showed no improvement following the MNPI, although the possibility of a maintenance effect remained.
Although there is room for improvement of the MNPI, it may be effective in maintaining and improving cognitive function, ADLs, and BPSD, in PWD in NHs.
The University Hospital Medical Information Network Clinical Trials Registry ( http://www.umin.ac.jp/ , No. UMIN000045858, registration date: November 1, 2021).

Soft tissue sarcomas (STS) invading the skull base are rare with little data to guide surgical management. Here we aimed to determine the factors affecting tumor control rates and survival in patients with T4 stage head and neck STS involving the skull base. A retrospective review of STS patients, surgically treated at our institution between 1994 and 2017 was conducted. Variables were collected and assessed against progression-free survival. Tumors were graded using the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) system. A total of 51 patients (mean age of 35) were included, of whom 17 (33.3%) patients were FNCLCC grade 1, 8 (15. 7%) were FNCLCC grade 2 and 26 (51%) were FNCLCC grade 3. The median PFS was 236.4 months while the 5- and 10-year PFS rates were 44% and 17%, respectively. Recurrence occurred in 17 (33.3%) patients. Local recurrence occurred in 10 (58.8%). Univariate analysis revealed R0 resection had a near-significant impact on tumor control in radiation-naïve patients. Otherwise, prior radiation (HR 6.221, CI 1.236-31.314) and cavernous sinus involvement (HR 14.464, CI 3.326-62.901) were negative predictors of PFS. The most common cause of treatment failure was local recurrence. In T4 stage head and neck STS with skull-base involvement, FNCLCC grade, radiation status, and anatomic spread should be considered in determining the overall treatment strategy.

We report a case of a patient with mixed dementia successfully treated with a personalized multimodal therapy. Monotherapeutics are inadequate for the treatment of Alzheimer\'s disease (AD) and mixed dementia; therefore, we approach treatment through an adaptive personalized multimodal program. Many multimodal programs are pre-determined, and thus may not address the underlying contributors to cognitive decline in each particular individual. The combination of a targeted, personalized, precision medicine approach using a multimodal program promises advantages over monotherapies and untargeted multimodal therapies for multifactorial dementia. In this case study, we describe successful treatment for a patient diagnosed with AD, using a multimodal, programmatic, precision medicine intervention encompassing therapies targeting multiple dementia diastheses. We describe specific interventions used in this case that are derived from a comprehensive protocol for AD precision medicine. After treatment, our patient demonstrated improvements in quantitative neuropsychological testing, volumetric neuroimaging, PET scans, and serum chemistries, accompanied by symptomatic improvement over a 3.5-year period. This case outcome supports the need for rigorous trials of comprehensive, targeted combination therapies to stabilize, restore, and prevent cognitive decline in individuals with potentially many underlying causes of such decline and dementia. Our multimodal therapy included personalized treatments to address each potential perturbation to neuroplasticity. In particular, neuroinflammation and metabolic subsystems influence cognitive function and hippocampal volume. In this patient with a primary biliary cholangitis (PBC) multimorbidity component, we introduced a personalized diet that helped reduce liver inflammation. Together, all these components of multimodal therapy showed a sustained functional and cognitive benefit. Multimodal therapies may have systemwide benefits on all dementias, particularly in the context of multimorbidity. Furthermore, these therapies provide generalized health benefits, as many of the factors - such as inflammation - that impact cognitive function also impact other systems.

OBJECTIVE: This case is designed to aid practitioners in understanding the potential role of multi-modal care with vibration rehabilitative exercise for a complete ACL tear in a high-level Poomsae athlete.
METHODS: A 16-year-old male world-class Poomsae athlete presented with a right ACL rupture and LCL sprain. An extensive clinical examination and imaging confirmed a right grade 3 ACL tear. Due to the complete tear and impending participation in World Championships, a pre-operative rehabilitation strategy was implemented with treatment modalities aimed to accelerate return-to-play.
CONCLUSIONS: An appropriate clinical history and physical examination of the knee is required when instability is present. Imaging is indicated when testing criteria are positive. Clinicians should be aware that multiple therapies can each serve a role in conservative care to better suit patient demands, especially at high levels of sport. In the article, the author proposes a tailored protocol using vibration rehabilitative exercise, bracing, vibration therapy, neuromuscular electrical stimulation, and laser to improve healing and sport-specific outcomes.
OBJECTIVE: Le présent exposé de cas vise à aider les praticiens à comprendre le rôle que pourrait jouer le traitement multimodal associé à des exercices de rééducation par vibrations chez un athlète de haut calibre pratiquant le poomsae ayant subi une déchirure complète du LCA.
UNASSIGNED: Un athlète de 16 ans de calibre international, pratiquant le poomsae, avait subi une déchirure du LCA droit et une entorse du ligament latéral externe (LLE). Un examen clinique approfondi et un examen par imagerie ont confirmé une déchirure du LCA droit de grade 3. Comme il s’agissait d’une déchirure complète et que la participation de l’athlète aux championnats internationaux était imminente, on a opté pour une rééducation préopératoire et des modalités thérapeutiques pour accélérer le retour au jeu de l’athlète.
UNASSIGNED: Un examen du tableau clinique et un examen physique du genou s’avèrent nécessaires en cas de genou instable. Un examen par imagerie est indiqué lorsque les critères d’instabilité sont satisfaits. Les cliniciens devraient savoir qu’on pourrait avoir recours à une approche multimodale lorsqu’on envisage un traitement conservateur pour mieux répondre aux besoins du patient, en particulier ceux qui pratiquent des sports de haut niveau. L’auteur de l’article propose un protocole personnalisé comprenant des exercices de rééducation par vibrations, le port d’une attelle, un traitement par vibrations, la neurostimulation électrique transcutanée et des traitements par laser pour favoriser la guérison et l’obtention de résultats axés sur ce sport en particulier.

暂无摘要。

UNASSIGNED: The purpose of this study is to review the pain and functional outcomes of a multimodal intervention in three patients with knee osteoarthritis (OA). This study explores how manual therapy can be delivered within an evidence-based framework for the management of knee OA.
UNASSIGNED: Medical records were reviewed for three patients with knee OA who underwent a standardized multimodal intervention including education, exercise, and manual therapy. Changes in pain intensity and function from baseline to post-intervention were calculated and compared to thresholds for minimal clinically important differences.
UNASSIGNED: One participant met the threshold for clinically significant improvement in pain and two participants for function. No adverse events were reported.
UNASSIGNED: Combined education, exercise, and manual therapy delivered over a 6-week period improved function in two of the three patients reviewed. Higher quality research is required to explore whether this multimodal intervention may improve outcomes in individuals with knee OA.
UNASSIGNED: Le but de cette étude est d’examiner les résultats en matière de douleur et de fonction d’une intervention multimodale chez trois patients atteints d’arthrose du genou. Cette étude explore comment la thérapie manuelle peut être dispensée dans un cadre fondé sur des données probantes pour la prise en charge de l’arthrose du genou.
UNASSIGNED: On a examiné les dossiers médicaux de trois patients atteints d’arthrose du genou qui ont subi une intervention multimodale normalisée comprenant l’éducation, l’exercice et la thérapie manuelle. Les changements concernant l’intensité de la douleur et la fonction entre le début et la fin de l’intervention ont été calculés et comparés aux seuils pour connaître les différences minimales importantes sur le plan clinique.
UNASSIGNED: Un participant a atteint le seuil d’amélioration significative du point de vue clinique pour ce qui est de la douleur et deux participants pour ce qui est de la fonction. Aucun effet indésirable n’a été signalé.
UNASSIGNED: L’éducation, l’exercice et la thérapie manuelle combinés sur une période de six semaines ont amélioré les fonctions chez deux des trois patients examinés. Des recherches de meilleure qualité sont nécessaires pour déterminer si cette intervention multimodale peut améliorer les résultats chez les personnes atteintes d’arthrose du genou.