A Schmorl’s node is a common incidental finding encountered during radiologic imaging. Despite the vertebral body being a common site of metastatic disease, a lytic lesion adjacent to an endplate ...with typical imaging features can often confidently be called a Schmorl’s node. This is a case report of a patient with a single well-defined FDG-avid papillary thyroid carcinoma metastasis to the spine that had imaging findings characteristic of a Schmorl’s node on CT and MRI. This case is important to consider as it demonstrates that the imaging characteristics of metastatic disease and Schmorl’s nodes can overlap.
Time-limited psychodynamic psychotherapy is garnering empirical support as an intervention for clinical depression. However, research is needed to examine the efficacy of psychodynamic approaches ...among patients presenting with diverse psychiatric and medical problems. This case study
examined the efficacy of eight sessions of pragmatic psychodynamic psychotherapy (PPP) in treating a woman with major depression and breast cancer. Pre- to post-treatment assessment indicated significant reductions in depression and weekly assessment indicated increased environmental reward
was associated with reduced depression. Secondary aims involved piloting a functional magnetic resonance imaging (fMRI) task as a neurobiological indicator of depression attenuation as a function of PPP. This assessment was conducted to explore alternative means of evaluating treatment responsiveness
and addressing the problem of arbitrary metrics in measuring change. Clinical and assessment implications are discussed, with a focus on innovative approaches to evaluate treatment outcome and behavioral and neurobiological mechanisms of change associated with PPP.
This single case study examined symptom change in the treatment of a 22-year-old Caucasian female college student presenting with anxious and depressive symptoms and maladaptive coping strategies in ...the context of an interpersonal dispute. The treatment integrated mindfulness skills training with interpersonal psychotherapy (IPT) to treat symptoms of anxiety, depression, overall total symptoms, and relational problems across the 18-session treatment. We assessed symptoms across treatment and analyzed change in symptom severity over time. Reliable change index analyses indicated significant symptom reduction between baseline levels at the start of treatment and the final sessions in all measured symptoms (anxiety, depression, total symptoms, and interpersonal relations), with decreases in symptom severity occurring gradually over the course of treatment. A 1-month follow-up assessment of symptoms indicated sustained reductions in anxious and depressive symptoms since baseline measurements. We discuss recommendations on the importance of therapeutic flexibility in treating comorbid conditions and therapist willingness to combine multiple treatment approaches for better treatment outcomes.
This clinical case study explores the psychodynamic treatment possibilities of excessive Internet virtual reality environment use. The client discussed resides in the virtual world Second Life and ...experiences her relationships in this environment as more real and meaningful than those in her real life. Instead of focusing on reducing Internet use, therapy conceptualized use of the virtual environment as a compensatory strategy of escapism and conceptualized the relationships and process in a psychodynamic paradigm. This allowed the therapy to address the defenses of splitting and the recapitulation of traumatic events that were evident in the virtual world within an environment that was safer for the client to explore. As a result of accepting the use of the virtual reality environment as an aid to therapy, the client was able to gain insight into her intrapersonal conflicts and eventually bridge the virtual environment to her real life to initiate a trauma-focused therapy.
Data from three separate single-center studies were combined to assess the pharmacokinetics of orally administered pilocarpine. Pilocarpine concentration-time data were used to generate a data set ...including 42 subjects (34 males, 8 females) with varying degrees of renal function (average of two estimated creatinine clearance rates of 10 to 112 mL/min). Age ranged from 19 to 88 years. Subjects received single oral doses (range: 2.5-20 mg) of pilocarpine. Plasma samples were collected at time 0; at 20 and 40 minutes; and at 1, 1.5, 2, 3, 4, 6, 8, 12, 16, and 24 hours following dose administration. Cmax and AUC were normalized to a 5 mg exposure in those subjects who received doses other than 5 mg. Plasma pilocarpine concentrations were determined by gas chromatography/mass spectrometry. The pharmacokinetic parameters (elimination rate constant, Cmax, tmax, AUC, Vd/F, and Cl/F) in subjects with impaired renal function were similar to results found in other pharmacokinetic studies involving normal healthy volunteers with only Cmax being significantly higher (p < 0.05). No significant regression relationships were noted between creatinine clearance and pilocarpine elimination rate constant, tmax, Vd/F, Cl/F, or AUC. Pilocarpine clearance does not appear to be impaired in patients with varying degrees of renal insufficiency.
Changes in the death qualification process suggest an increasing probability that jurors in capital cases will reject an insanity defense. The present study of 312 college undergraduates compares ...demographics and attitudes of death-qualified participants with those of their excludable counterparts, by varying standards for exclusion. When demographics were considered together, only religion predicted bias against the insanity defense, which was higher in those who identified with some form of Christianity. Further, religious fundamentalism, Christian orthodoxy, sociopolitical conservatism, and pro-prosecution bias were associated with stronger negative attitudes against the insanity defense. Results also support the contention that seating a death-qualified jury under either the Witherspoon or Witt standards increases bias against the insanity defense, although the consideration of automatic-death penalty jurors eliminates this effect.
Abstract Background and Aims Agents that induce an immune response against tumors by altering T-cell regulation have increased survival times of patients with advanced-stage tumors, such as melanoma ...or lung cancer. We aimed to characterize molecular features of immune cells that infiltrate hepatocellular carcinomas (HCCs) to determine whether these types of agents might be effective against liver tumors. Methods We analyzed HCC samples from 956 patients. We separated gene expression profiles from tumor, stromal, and immune cells using a non-negative matrix factorization algorithm. We then analyzed the gene expression pattern of inflammatory cells in HCC tumors samples. We correlated expression patterns with the presence of immune cell infiltrates and immune regulatory molecules, determined by pathology and immunohistochemical analyses, in a training set of 228 HCC samples. We validated the correlation in a validation set of 728 tumor samples. Using data from 190 tumors in the Cancer Genome Atlas, we correlated immune cell gene expression profiles with numbers of chromosomal aberrations (based on single-nucleotide polymorphism array) and mutations (exome sequence data). Results We found approximately 25% of HCCs to have markers of an inflammatory response, with high expression levels of the CD274 molecule (PD-L1) and programmed cell death 1 (PD-1), markers of cytolytic activity, and fewer chromosomal aberrations. We called this group of tumors the Immune class. It contained 2 subtypes, characterized by markers of an adaptive T-cell response or exhausted immune response. The exhausted immune response subclass expressed many genes regulated by transforming growth factor beta 1 (TGFB) that mediate immunosuppression. We did not observe any differences in numbers of mutations or expression of tumor antigens between the immune-specific class and other HCCs. Conclusions In an analysis of HCC samples from 956 patients, we found almost 25% to express markers of an inflammatory response. We identified 2 subclasses, characterized by adaptive or exhausted immune responses. These findings indicate that some HCCs might be susceptible to therapeutic agents designed to block the regulatory pathways in T cells, such as PD-L1, PD-1, or TGFB inhibitors.
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