1,034 research outputs found
Cisplatin-induced posterior reversible encephalopathy syndrome and successful re-treatment in a patient with non-seminomatous germ cell tumor: a case report
UNLABELLED: Introduction: Cisplatin is a platinum compound that has revolutionized the treatment of various solid organ tumors. Cisplatin is associated with a variety of side effects and has recently been indicted in the development of posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome is a potentially reversible condition, with the mainstay of therapy being correction of the underlying cause and withdrawal of the offending drug. However, there are no clear guidelines regarding the possibility of subsequent re-treatment with the causative agent.CASE PRESENTATION: A 23-year-old Asian man presented to our Emergency Department with a four-month history of concomitant abdominal pain and backache and a two-week history of left-sided leg swelling. Diagnostic investigations revealed bilateral pulmonary embolism, extensive deep venous thrombosis and widespread lung and liver metastatic deposits with abdomino-pelvic lymphadenopathy. His biopsy and tumor markers were consistent with non-seminomatous germ cell tumor and he was subsequently started on an initial cycle of cisplatin and etoposide chemotherapy. On the second day of treatment he developed posterior reversible encephalopathy syndrome clinically and radiologically. Cisplatin was stopped for the next two days while etoposide was continued, resulting in complete resolution of his symptoms. He was re-challenged with cisplatin on day five of chemotherapy because a platin-based chemotherapy regimen was his only hope of potential cure. He tolerated it well, with no recurrence of his neurological symptoms and the remainder of his in-patient stay remained uneventful. He was discharged on day eight. He has since then completed treatment and is currently in remission.CONCLUSIONS: The occurrence of posterior reversible encephalopathy syndrome after cisplatin use has been well reported in the literature. We strongly believe that our patient also developed posterior reversible encephalopathy syndrome secondary to cisplatin. The uniqueness of our patient\u27s case lies in the successful re-treatment of our patient with the offending drug. To the best of our knowledge, this is the first instance where a patient was successfully re-treated with cisplatin after having developed posterior reversible encephalopathy syndrome as a result of cisplatin use. The excellent response to re-treatment without recurrence of neurological symptoms in our patient\u27s case provides insight into re-treatment as an option in scenarios where treatment options are limited
Promotional Tone in Reviews of Menopausal Hormone Therapy After the Women's Health Initiative: An Analysis of Published Articles
Adriane Fugh-Berman and colleagues analyzed a selection of published opinion pieces on hormone therapy and show that there may be a connection between receiving industry funding for speaking, consulting, or research and the tone of such opinion pieces
Intelligent Cooperative Control Architecture: A Framework for Performance Improvement Using Safe Learning
Planning for multi-agent systems such as task assignment for teams of limited-fuel unmanned aerial vehicles (UAVs) is challenging due to uncertainties in the assumed models and the very large size of the planning space. Researchers have developed fast cooperative planners based on simple models (e.g., linear and deterministic dynamics), yet inaccuracies in assumed models will impact the resulting performance. Learning techniques are capable of adapting the model and providing better policies asymptotically compared to cooperative planners, yet they often violate the safety conditions of the system due to their exploratory nature. Moreover they frequently require an impractically large number of interactions to perform well. This paper introduces the intelligent Cooperative Control Architecture (iCCA) as a framework for combining cooperative planners and reinforcement learning techniques. iCCA improves the policy of the cooperative planner, while reduces the risk and sample complexity of the learner. Empirical results in gridworld and task assignment for fuel-limited UAV domains with problem sizes up to 9 billion state-action pairs verify the advantage of iCCA over pure learning and planning strategies
Studying complex interventions : reflections from the FEMHealth project on evaluating fee exemption policies in West Africa and Morocco
Peer reviewedPublisher PD
Case report and summary of literature: giant perineal keloids treated with post-excisional radiotherapy
BACKGROUND: Keloids are common benign tumors of the dermis, typically arising after insult to the skin. While typically only impinging on cosmesis, large or recurrent keloids may require therapeutic intervention. While no single standardized treatment course has been established, several series report excellent outcomes for keloids with post-surgery radiation therapy. CASE PRESENTATION: We present a patient with a history of recurrent keloids arising in the absence of an ascribed trauma and a maternal familial history of keloid formation, whose physical examination several large perineal keloids of 6-20 cm in the largest dimension. The patient was treated with surgical extirpation and adjuvant radiation therapy. Radiotherapy was delivered to the scar bed to a total dose of 22 Gy over 11 daily fractions. Acute radiotherapy toxicity necessitated a treatment break due to RTOG Grade III acute toxicity (moderate ulceration and skin breakdown) which resolved rapidly during a 3-day treatment break. The patient demonstrated local control and has remained free of local recurrence for more than 2 years. CONCLUSION: Radiotherapy for keloids represents a safe and effective option for post-surgical keloid therapy, especially for patients with bulky or recurrent disease
Genome-Wide Tissue-Specific Occupancy of the Hox Protein Ultrabithorax and Hox Cofactor Homothorax in Drosophila
The Hox genes are responsible for generating morphological diversity along the
anterior-posterior axis during animal development. The
Drosophila Hox gene Ultrabithorax
(Ubx), for example, is required for specifying the identity
of the third thoracic (T3) segment of the adult, which includes the dorsal
haltere, an appendage required for flight, and the ventral T3 leg.
Ubx mutants show homeotic transformations of the T3 leg
towards the identity of the T2 leg and the haltere towards the wing. All Hox
genes, including Ubx, encode homeodomain containing
transcription factors, raising the question of what target genes
Ubx regulates to generate these adult structures. To
address this question, we carried out whole genome ChIP-chip studies to identify
all of the Ubx bound regions in the haltere and T3 leg imaginal discs, which are
the precursors to these adult structures. In addition, we used ChIP-chip to
identify the sites bound by the Hox cofactor, Homothorax (Hth). In contrast to
previous ChIP-chip studies carried out in Drosophila embryos,
these binding studies reveal that there is a remarkable amount of tissue- and
transcription factor-specific binding. Analyses of the putative target genes
bound and regulated by these factors suggest that Ubx regulates many downstream
transcription factors and developmental pathways in the haltere and T3 leg.
Finally, we discovered additional DNA sequence motifs that in some cases are
specific for individual data sets, arguing that Ubx and/or Hth work together
with many regionally expressed transcription factors to execute their functions.
Together, these data provide the first whole-genome analysis of the binding
sites and target genes regulated by Ubx to specify the morphologies of the adult
T3 segment of the fly
Exploring the uncertainties of early detection results: model-based interpretation of mayo lung project
Background: The Mayo Lung Project (MLP), a randomized controlled clinical trial of lung cancer screening conducted between 1971 and 1986 among male smokers aged 45 or above, demonstrated an increase in lung cancer survival since the time of diagnosis, but no reduction in lung cancer mortality. Whether this result necessarily indicates a lack of mortality benefit for screening remains controversial. A number of hypotheses have been proposed to explain the observed outcome, including over-diagnosis, screening sensitivity, and population heterogeneity (initial difference in lung cancer risks between the two trial arms). This study is intended to provide model-based testing for some of these important arguments.Method: Using a micro-simulation model, the MISCAN-lung model, we explore the possible influence of screening sensitivity, systematic error, over-diagnosis and population heterogeneity.Results: Calibrating screening sensitivity, systematic error, or over-diagnosis does not noticeably improve the fit of the model, whereas calibrating population heterogeneity helps the model predict lung cancer incidence better.Conclusions: Our conclusion is that the hypothesized imperfection in screening sensitivity, systematic error, and over-diagnosis do not in themselves explain the observed trial results. Model fit improvement achieved by accounting for population heterogeneity suggests a higher risk of cancer incidence in the intervention group as compared with the control group
Observation of an Exotic Baryon in Exclusive Photoproduction from the Deuteron
In an exclusive measurement of the reaction , a
narrow peak that can be attributed to an exotic baryon with strangeness
is seen in the invariant mass spectrum. The peak is at
GeV/c with a measured width of 0.021 GeV/c FWHM, which is largely
determined by experimental mass resolution. The statistical significance of the
peak is . The mass and width of the observed peak are
consistent with recent reports of a narrow baryon by other experimental
groups.Comment: 5 pages, 5 figure
Onset of asymptotic scaling in deuteron photodisintegration
We investigate the transition from the nucleon-meson to quark-gluon
description of the strong interaction using the photon energy dependence of the
differential cross section for photon energies above 0.5 GeV and
center-of-mass proton angles between and . A possible
signature for this transition is the onset of cross section scaling
with the total energy squared, , at some proton transverse momentum, .
The results show that the scaling has been reached for proton transverse
momentum above about 1.1 GeV/c. This may indicate that the quark-gluon regime
is reached above this momentum.Comment: Accepted by PRL; 5 pages, 2 figure
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