A Systematic and Evidence-Based Approach to the Management of Vertebral Metastasis

Diagnosis and management of vertebral metastasis requires a systematic approach to patient identification as well as selection of appropriate therapy. Rapid identification and prompt intervention in the treatment of malignant epidural spinal cord compression (MESCC) is key to maintaining quality of life. This paper provides a series of tools as well as guidance in selecting effective and evidence-based therapy individualized to the specific patient

Artificial minds with consciousness and common sense aspects

The research work presented in this article investigates and explains the conceptual mechanisms of consciousness and common-sense thinking of animates. These mechanisms are computationally simulated on artificial agents as strategic rules to analyze and compare the performance of agents in critical and dynamic environments. Awareness and attention to specific parameters that affect the performance of agents specify the consciousness level in agents. Common sense is a set of beliefs that are accepted to be true among a group of agents that are engaged in a common purpose, with or without self-experience. The common sense agents are a kind of conscious agents that are given with few common sense assumptions. The so-created environment has attackers with dependency on agents in the survival-food chain. These attackers create a threat mental state in agents that can affect their conscious and common sense behaviors. The agents are built with a multi-layer cognitive architecture COCOCA (Consciousness and Common sense Cognitive Architecture) with five columns and six layers of cognitive processing of each precept of an agent. The conscious agents self-learn strategies for threat management and energy level maintenance. Experimentation conducted in this research work demonstrates animate-level intelligence in their problem-solving capabilities, decision making and reasoning in critical situations

Euthyroid Graves' orbitopathy and incidental papillary thyroid microcarcinoma

AbsTrAcT Euthyroid Graves' orbitopathy (GO) combined with incidental papillary thyroid microcarcinoma has rarely been reported. cAsE rEPOrT: A 61-year-old caucasian woman initially presented with progressive fatigue, exophthalmos, and thyroid function tests within normal limits. she underwent thyroidectomy, was found to have two incidental papillary thyroid microcarcinomas, and received radioactive iodine ablation to eliminate thyroid antigen. In addition to following her eye disease, TsH-receptor antibodies, thyroid stimulating immunoglobulins, and serum thyroglobulin measurements were recorded, demonstrating no evidence of thyroid cancer at four-year follow-up. At first, she had mild GO, developing into moderate-to-severe GO, and at 4 years she had Hertel measurements of 20 mm in both eyes. CONCLUSION: This report underscores the difficulty of managing GO even when thyroid function is normal(ized) and thyroid antigen exposure has been minimized. In addition, it illustrates why antithyroidal antibodies should be considered in cases of concomitant papillary thyroid cancer, as thyroid cells can be stimulated not only by TsH but also by TsH-receptor stimulating antibodies

[123I]Ioflupane imaging in Caucasians and non-Caucasians: Are there any differences?

Purpose of the report: To compare diagnostic performance of [123I]ioflupane SPECT imaging in different racial groups. In previous registration trials of [123I]ioflupane, 99% of the subjects enrolled were Caucasians. Materials and methods: A multicenter retrospective case-control study was conducted to evaluate whether the diagnostic performance of [123I]ioflupane SPECT imaging is different in non-Caucasians than in Caucasians matched by age, sex, and final clinical diagnosis. Subjects who had received an initial diagnosis of suspected Parkinson's disease (PD) or essential tremor (ET) and then underwent [123I]ioflupane SPECT imaging to assist with the subject's final clinical diagnosis were enrolled. Each subject's image was rated as normal or abnormal by 3 blinded expert readers. The majority interpretation was then compared with the final clinical diagnosis. Diagnostic performance of [123I]ioflupane SPECT imaging (as measured by positive percent agreement (equivalent to sensitivity), negative percent agreement (equivalent to specificity), overall percent agreement (OPA), and measures of inter-rater agreement) were compared between the Caucasian and non-Caucasian groups. Results: In total, 102 non-Caucasians (58 with PD and 44 with ET as a final clinical diagnosis) and 102 Caucasians (58 with PD, 43 with ET, and 1 with “other”) were included in the intent-to-diagnose (ITD) population. There was no significant difference between Caucasians and non-Caucasians in the diagnostic performance of [123I]ioflupane SPECT imaging as measured by sensitivity, specificity, OPA, and measures of inter-rater agreement. Conclusion: In this study, the diagnostic performance of [123I]ioflupane SPECT imaging was comparable between Caucasians and non-Caucasians

Molecular Analysis of Central Nervous System Disease Spectrum in Childhood Acute Lymphoblastic Leukemia

Treatment of the central nervous system (CNS) is an essential therapeutic component in childhood acute lymphoblastic leukemia (ALL). The goal of this study was to identify molecular signatures distinguishing patients with CNS disease from those without the disease in pediatric patients with ALL. We analyzed gene expression data from 207 pediatric patients with ALL. Patients without CNS were classified as CNS1, while those with mild and advanced CNS disease were classified as CNS2 and CNS3, respectively. We compared gene expression levels among the three disease classes. We identified gene signatures distinguishing the three disease classes. Pathway analysis revealed molecular networks and biological pathways dysregulated in response to CNS disease involvement. The identified pathways included the ILK, WNT , B-cell receptor, AMPK, ERK5 , and JAK signaling pathways. The results demonstrate that transcription profiling could be used to stratify patients to guide therapeutic decision-making in pediatric ALL