Objectives
To verify the incidence of calcified brain metastases (CBM), illustrating the different presentation patterns and histology of primary tumor.
Methods
A series of 1002 consecutive brain ...computed tomography (CT) scans of patients with known primary tumors was retrospectively assessed. CBM were defined by the presence of calcification within intra-axial-enhancing lesions; identification of CBM was based on visual examination and ROI analysis (> 85 Hounsfield units). Also, calcifications in the primary tumor of all patients with brain metastases were evaluated. In CBM patients, we investigated the type of calcifications (punctate, nodular, cluster, ring, coarse), the histology of primary tumor, and if a previous RT was performed.
Results
Among 190 (18.9%) patients with brain metastatic disease, 34 presented with CBM (17.9%). Sixteen patients were previously treated with RT, while 18 presented calcifications ab initio (9.5% of all brain metastases). The majority of patients with CBM had a primitive lung adenocarcinoma (56%), followed by breast ductal invasive carcinoma (20%) and small cell lung carcinoma (11.8%). CBM were single in 44.1% of patients and multiple in 55.9%. With regard to the type of calcifications, the majority of CBM were punctate, without specific correlations between calcification type and histology of primary tumor. No patients with ab initio CBM had calcifications in primary tumor.
Conclusion
In conclusion, our data show that CBM are more common than usually thought, showing an incidence of 9.5% ab initio in patients with brain metastases. This study underlines that neuroradiologists should not overlook intraparenchymal brain calcifications, especially in oncologic patients.
Key Points
• Among the differential diagnosis of brain intraparenchymal calcifications, metastases are considered uncommon and found predominantly in patients treated with radiotherapy (RT).
• Our data show that CBM are more common than usually thought, showing an incidence of 9.5% ab initio in patients with brain metastases.
• A proportion of intraparenchymal brain calcifications, especially in oncologic patients, might represent evolving lesions and neuroradiologists should not overlook them to avoid a delay in diagnosis and treatment.
The 2019 coronavirus pandemic (COVID-19) has been very stressful, but more so for those with cancer. Patients with cancer experienced more pandemic-related stress and psychological distress than ...those without a cancer diagnosis. This case report, about a breast cancer patient, is presented in order to emphasize (1) the importance of the management of psychological care in oncology, (2) the need for a thorough understanding of the efficacy of the role of the psycho-oncologist and related interventions in a breast care unit for the health of both patients and professionals to improve clinical outcomes, and (3) the emerging health concerns of breast cancer patients in the context of the COVID-19 pandemic.
In the last decade, Mindfulness-based interventions have been increasingly used in health care settings, particularly in the context of cancer. Research documents the efficacy of these interventions ...for decreasing the burdens of stress, anxiety, depression, fatigue, sleep disorders, and other symptoms. This article describes the case report of a patient with breast cancer, highlighting her personality, defense mechanisms, and traumatization connected with the disease. General information about the patient’s personal and medical history is presented in addition to the trajectory of psychoncological support, focusing on objectives, intervention strategies based on Mindfulness, and outcomes. The intervention is a combination of individual and group therapies, with particular reference to the use of Mindfulness in a group setting. The goal is to provide the patient with both a peer sharing experience as well as the tools to manage psychoemotional reactions through the development of awareness and a better relationship with herself. The main hypothesized consequences are an increase in self-esteem and coping strategies, which are necessary for a successful adaptation to cancer. The objective of the Mindfulness intervention is to promote the maintenance of an adequate Quality of Life (QoL) and psychological well-being, during and after treatment, transferring these skills into daily life.
Previous positron emission tomography (PET) studies have shown that nonmanifesting carriers of the DYT1 dystonia mutation express an abnormal pattern of resting glucose metabolism. To determine ...whether motor behavior is impaired in these subjects, we compared movement and sequence learning in 12 clinically unaffected DYT1 carriers with 12 age‐matched controls. Regional differences in brain function during task performance were assessed with simultaneous H215O/PET. We found that motor performance was similar in the DYT1 and control groups, with no significant differences in movement time and spatial accuracy measured during each of the tasks. In contrast, sequence learning was reduced in gene carriers relative to controls (p < 0.01). PET imaging during motor execution showed increased activation in gene carriers (p < 0.001, uncorrected) in the left premotor cortex and right supplementary motor area, with concomitant reduction in the posterior medial cerebellum. During sequence learning, activation responses in DYT1 carriers were increased in the left ventral prefrontal cortex, and lateral cerebellum. These findings suggest that abnormalities in motor behavior and brain function exist in clinically nonmanifesting DYT1 carriers. Although localized increases in neural activity may enable normal movement execution in these subjects, this mechanism may not compensate for their defect in sequence learning. Ann Neurol 2003;54:102–109
Social relationship coping efficacy (SRCE) represents the ability to maintain or enhance social relationships in the context of serious illness. The purpose of the current study was to confirm the ...factor structure, psychometric properties, and utility of the Italian version of the SRCE scale. 181 breast cancer patients completed the SRCE-Italian (SRCE-I), the Cancer Behavior Inventory-Brief/Italian (CBI-B/I), quality of life (QOL) measures (EORTC QLQ-C30; EORTC QLQ-BR23), and the Hospital Anxiety and Depression Scale (HADS). The SRCE-I was internally consistent (Cronbach alpha = .95) and factor analysis confirmed that the SRCE-I was a unidimensional construct. In terms of validity, the SRCE-I was correlated with QOL (EORTC QLQ-30, Social Functioning, r = .33, Emotional Functioning, r = .57, and Global Health/Quality of Life; r = .54) and scales of the EORTC QLQ-BR23 (e.g., Future Perspective, r = .38; Breast Symptoms, -.31). SRCE-I was also correlated negatively with the HADS (r = -.72) and positively with the CBI-B/I (r = .79), a measure of coping efficacy (all ps < .001). Mediation analyses confirmed the utility of the SRCE-I scale as a mediating mechanism in enhancing social functioning and QOL. The SRCE-I is a structurally sound, reliable, and valid measure that assesses the ability to maintain or enhance social support and mitigate the loss of social support. The SRCE-I can be used as a screening measure to assess low efficacy for maintaining social support or as a measure to detect the change in efficacy for enhancing social support in interventions to improve the QOL of patients.
Motor sequence learning is abnormal in PD. However, it is not known whether this defect is present during the earliest stages of the illness or whether it reflects specific limitations in dividing ...attention between cognitive and motor requirements.
Fifteen patients with early stage PD and 10 age-matched and 9 younger normal controls moved the right dominant hand on a digitizing tablet to eight targets presented on a screen in synchrony with a tone at 1-second intervals. The tasks were as follows: 1) CCW--a timed-response task where targets appeared in a predictable counterclockwise order; 2) RAN--a reaction time task where targets were random and unpredictable; 3) SEQ--a task with multiple demands emphasizing explicit learning and target anticipation in which subjects learned a sequence while reaching for targets; and 4) VSEQ--subjects learned a visual sequence without moving.
CCW and RAN yielded similar results in all groups. In patients with PD, sequence learning was the same in SEQ and VSEQ and was slower compared to both control groups. In older controls, learning was faster in VSEQ than in SEQ, whereas younger controls learned equally fast in both tasks.
Despite normal motor execution, the initial phases of sequence learning are impaired in early PD independent of task requirements, possibly reflecting reduced working memory. Learning was slower in older than younger controls only in tasks with multiple demands, presumably due to reduced attentional resources.
Nowadays, but also in the geological record, coral communities living in marginal conditions (i.e. low light, high turbidity, extreme temperatures, high nutrients and sediment input) are quite common ...and there is evidence that some of these reefs, often associated with mesophotic environments, may be more resilient to the current global warming trend, thus serving as possible ecological refugia.
As an attempt to understand the response and resilience to past warming events of marine calcifying organisms, such as zooxanthellate corals of marginal reefs, herein we reconstruct the palaeoenvironment of an Oligocene mixed siliciclastic‑carbonate system in the Tertiary Piedmont Basin (NW Italy), where a suite of coral assemblages formed small buildups at the edge of a coarse-grained delta system. Geochronological dating by strontium isotope stratigraphy places the coral buildups in the middle Chattian, thus within the Late Oligocene Warming Event (LOWE): a crucial climatic event for coral reefs as characterised by substantial warming coincident with declining atmospheric CO2.
The depositional model that we propose is ascribed to a fan-delta system, deposited within a narrow valley cutting through the metamorphic basement, where small and laterally discontinuous coral buildups grow-up in the prodelta setting, thus suggesting a mesophotic environment. In this context, the coral buildups appear to have been intermittently deactivated or smothered by fine-grained terrigenous input during flood phases or shifts in distributary channels until their final suffocation by fluvial sediments input.
Within the coral buildups, the four distinguished coral facies (branching Stylophora floatstone, Acropora-Stylophora floatstone/rudstone, Goniopora/Caulastraea pillarstone, and mixed-coral domestone) are characterised in general by sediment-resistant corals and by specific taphonomic features.
These coral facies shifted in time and space during the LOWE, highlighting the noteworthy adaptability and resilience of Oligocene corals to a complex interplay of environmental stressors such as turbidity, hydrodynamic energy, sediment and nutrient supply within a mesophotic setting.
•We show the first depositional model of Oligocene coral reefs in a fan-delta system.•We document small coral buildups in the prodelta-mesophotic setting.•Coral assemblages shifted in time and space under a strong fluviatile control.•The coral buildups developed during the Late Oligocene Warming Event (LOWE).•Mesophotic deltaic conditions are suitable for reef corals during warming events.
Accurate diagnostic testing to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is critical. Although highly specific, SARS-CoV-2 reverse transcriptase–polymerase chain ...reaction (RT-PCR) has been shown in clinical practice to be affected by a noninsignificant proportion of false-negative results. This study seeks to explore whether the integration of lung ultrasonography with clinical evaluation is associated with increased sensitivity for the diagnosis of coronavirus disease 2019 pneumonia, and therefore may facilitate the identification of false-negative SARS-CoV-2 RT-PCR results.
This prospective cohort study enrolled consecutive adult patients with symptoms potentially related to SARS-CoV-2 infection who were admitted to the emergency department (ED) of an Italian academic hospital. Immediately after the initial assessment, a lung ultrasonographic evaluation was performed and the likelihood of SARS-CoV-2 infection, based on both clinical and lung ultrasonographic findings (“integrated” assessment), was recorded. RT-PCR SARS-CoV-2 detection was subsequently performed.
We enrolled 228 patients; 107 (46.9%) had SARS-CoV-2 infection. Sensitivity and negative predictive value of the clinical–lung ultrasonographic integrated assessment were higher than first RT-PCR result (94.4% 95% confidence interval {CI} 88.2% to 97.9% versus 80.4% 95% CI 71.6% to 87.4% and 95% 95% CI 89.5% to 98.2% versus 85.2% 95% CI 78.3% to 90.6%, respectively). Among the 142 patients who initially had negative RT-PCR results, 21 tested positive at a subsequent molecular test performed within 72 hours. All these false-negative cases were correctly identified by the integrated assessment.
This study suggests that, in patients presenting to the ED with symptoms commonly associated with SARS-CoV-2 infection, the integration of lung ultrasonography with clinical evaluation has high sensitivity and specificity for coronavirus disease 2019 pneumonia and it may help to identify false-negative results occurring with RT-PCR.
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