Meningeal carcinomatosis diagnosed during stroke evaluation in the emergency department

A 70-year-old female presented to the emergency department with a 3-day history of intermittent dysphasia and right facial droop. Computed tomography (CT) and magnetic resonance imaging (MRI) were obtained, and the patient was found to have meningeal carcinomatosis, also known as leptomeningeal metastases. Meningeal carcinomatosis is a rare metastatic complication of some solid tumors and hematopoietic neoplasms, and has a median survival rate of 2.4 months. The role of the emergency physician is to appropriately diagnose this condition, treat emergent side effects, provide symptomatic relief, and ensure multi-disciplinary management

Does the Therapeutic Relationship Predict Outcomes of Psychiatric Treatment in Patients with Psychosis A Systematic Review

Background: Numerous studies have shown that the quality of the therapeutic relationship (TR) between the patient and the clinician is an important predictor of the outcome of different forms of psychotherapy. It is less clear whether the TR also predicts outcomes of psychiatric treatment programmes in patients with psychosis (i.e. outside conventional psychotherapy). Methods: We conducted a systematic review and identified 9 primary studies that prospectively tested the association of the TR with 3 outcomes, i.e. hospitalisation, symptom levels and functioning. Because of the heterogeneity of the methods used, a meta-analysis was not feasible. A vote counting method was used to determine the number of statistically significant effects in the hypothesised direction (i.e. that a more positive TR predicts more favourable outcomes). Results: For each outcome, a χ2 analysis showed that the number of statistically significant findings in the hypothesised direction was greater than expected if the null hypothesis of no association were true. However, studies had methodological shortcomings, and the effect sizes of positive associations were rather small. Conclusion: It may be concluded that there is some, but not overwhelming, evidence that the TR predicts outcomes of complex psychiatric treatment programmes in patients with psychosis, and that methodologically more rigorous research is required. Such research should measure the TR at initial stages of treatment and use validated assessment instruments for both TR and outcomes

DNA damage response (DDR) pathway engagement in cisplatin radiosensitization of non-small cell lung cancer

Non-small cell lung cancers (NSCLC) are commonly treated with a platinum-based chemotherapy such as cisplatin (CDDP) in combination with ionizing radiation (IR). Although clinical trials have demonstrated that the combination of CDDP and IR appear to be synergistic in terms of therapeutic efficacy, the mechanism of synergism remains largely uncharacterized. We investigated the role of the DNA damage response (DDR) in CDDP radiosensitization using two NSCLC cell lines. Using clonogenic survival assays, we determined that the cooperative cytotoxicity of CDDP and IR treatment is sequence dependent, requiring administration of CDDP prior to IR (CDDP-IR). We identified and interrogated the unique time and agent-dependent activation of the DDR in NSCLC cells treated with cisplatin-IR combination therapy. Compared to treatment with CDDP or IR alone, CDDP-IR combination treatment led to persistence of γH2Ax foci, a marker of DNA double-strand breaks (DSB), for up to 24h after treatment. Interestingly, pharmacologic inhibition of DDR sensor kinases revealed the persistence of γ-H2Ax foci in CDDP-IR treated cells is independent of kinase activation. Taken together, our data suggest that delayed repair of DSBs in NSCLC cells treated with CDDP-IR contributes to CDDP radiosensitization and that alterations of the DDR pathways by inhibition of specific DDR kinases can augment CDDP-IR cytotoxicity by a complementary mechanism

Employment relations and social stratification in contemporary urban China: does Goldthorpe’s class theory still work?

Goldthorpe’s class theory suggests that social class arises from employment relations in industrialised societies. This article assesses whether class in urban China can be approached from the same perspective by addressing three issues: 1) whether employment relations can capture China’s class structure, 2) how differently class is shaped by occupational structure in China, and 3) how useful class is to help us understand income inequality. Based on a recent Chinese social survey, the analysis finds three clusters of Chinese employees that fit into the ‘service’, ‘intermediate’ and ‘labour contract’ class typologies suggested by Goldthorpe’s class theory. Also, there is evidence that class links to occupational structures in a similar way between Chinese and Western societies. Finally class, when directly measured from employment relations, displays a reasonable degree of explanatory power for inter-class income inequality whereas the Goldthorpe class classification fails to differentiate between intermediate and labour class positions

A step towards testing general relativity using weak gravitational lensing and redshift surveys

Using the linear theory of perturbations in General Relativity, we express a set of consistency relations that can be observationally tested with current and future large scale structure surveys. We then outline a stringent model-independent program to test gravity on cosmological scales. We illustrate the feasibility of such a program by jointly using several observables like peculiar velocities, galaxy clustering and weak gravitational lensing. After addressing possible observational or astrophysical caveats like galaxy bias and redshift uncertainties, we forecast in particular how well one can predict the lensing signal from a cosmic shear survey using an over-lapping galaxy survey. We finally discuss the specific physics probed this way and illustrate how $f(R)$ gravity models would fail such a test.Comment: 12 pages, 10 figure

Two approaches to testing general relativity in the strong-field regime

Observations of compact objects in the electromagnetic spectrum and the detection of gravitational waves from them can lead to quantitative tests of the theory of general relativity in the strong-field regime following two very different approaches. In the first approach, the general relativistic field equations are modified at a fundamental level and the magnitudes of the potential deviations are constrained by comparison with observations. In the second approach, the exterior spacetimes of compact objects are parametrized in a phenomenological way, the various parameters are measured observationally, and the results are finally compared against the general relativistic predictions. In this article, I discuss the current status of both approaches, focusing on the lessons learned from a large number of recent investigations.Comment: To appear in the proceedings of the conference New Developments in Gravit

Ring closing reaction in diarylethene captured by femtosecond electron crystallography

The photoinduced ring-closing reaction in diarylethene, which serves as a model system for understanding reactive crossings through conical intersections, was directly observed with atomic resolution using femtosecond electron diffraction. Complementary ab initio calculations were also performed. Immediately following photoexcitation, subpicosecond structural changes associated with the formation of an open-ring excited-state intermediate were resolved. The key motion is the rotation of the thiophene rings, which significantly decreases the distance between the reactive carbon atoms prior to ring closing. Subsequently, on the few picosecond time scale, localized torsional motions of the carbon atoms lead to the formation of the closed-ring photoproduct. These direct observations of the molecular motions driving an organic chemical reaction were only made possible through the development of an ultrabright electron source to capture the atomic motions within the limited number of sampling frames and the low data acquisition rate dictated by the intrinsically poor thermal conductivity and limited photoreversibility of organic materials