Post-stroke dysphagia (PSD) is a common functional deficit after stroke. Temporal muscle thickness (TMT) had been proven to be an independent factor for PSD. However, the relationship between TMT and PSD based on quantitative swallowing kinematic analysis remains unexplored. We aimed to investigate the association between TMT and PSD using videofluoroscopic swallow study (VFSS).
Grade 1 tumors almost never metastasize or invade adjacent structures.However, as this case demonstrates, a subset of grade 1 meningiomas can have malignant potential.One potential predictor of aggressive meningioma is the Ki-67 index, a marker of cell proliferation.The Ki-67 proliferative index (PI) has been identified as an independent predictor of both survival and tumor recurrence in meningiomas, 14 but is not part of the WHO staging system.In a retrospective study by Ohta et al, 14 recurrent meningiomas had a mean PI of 5.7%, metastatic meningiomas had a mean PI of 14.7%, and nonrecurrent, nonmetastatic meningiomas had a mean PI of 1%.In addition to PI, primary tumor appearance on imaging may be useful.One study indicated that multiple lobulations and a "mushrooming" appearance may correlate with malignant potential. 2Based on these criteria, our patient's initial imaging studies (Figs 1A and 1B) may have been an early clue to the aggressive nature of her disease, though the prolonged time course between initial surgery and symptoms of recurrent disease is not compatible.In summary, most meningiomas are benign and never undergo malignant transformation.However, a small subset of meningiomas, usually those with atypical histological features, can metastasize.For this reason, we emphasize the importance of considering the possibility of metastasis in patients with a history meningioma who present with symptoms that cannot be explained solely by tumor mass effect in the brain.This is especially true for patients with recurrent meningiomas.The clinician should also consider performing additional tests, like staining for Ki-67, to identify those histologically benign-appearing meningiomas with increased malignant potential.
The use of empathetic dialogue systems has grown recently. However, establishing them for users experiencing mental depression requires more advanced consoling skills. In this paper, a dialogue system based on Emotional Support was developed. The system offers coping strategies through stages designed to address users' distress in long-term conversations. It employs a recurrent-based approach integrated with reinforcement learning for a decision model, which selects a generator from three specialized conditional generation models to generate empathetic responses. Experimental results showed improvements in BLEU, Rouge-L, and Distinct-n metrics compared to the baseline. On average, the system's BLEU score increased by 0.87, Rouge-L by 1.85, Distinct-1 by 0.69, and Distinct-2 by 2.26. As a result, the system generates responses aligned with Emotional Support skills, ultimately comforting the user's distress.
Cancer stem cell (CSC) theory has drawn much attention, with evidence supporting the contribution of stem cells to tumor initiation, relapse, and therapy resistance.To screen drugs that target CSCs to improve the current treatment outcome and overcome drug resistance in patients with lung cancer.We used publicly available embryonic stem cell and CSC-associated gene signatures to query the Connectivity Map for potential drugs that can, at least in part, reverse the gene expression profile of CSCs. High scores were noted for several phenothiazine-like antipsychotic drugs, including trifluoperazine. We then treated lung CSCs with different EGFR mutation status with trifluoperazine to examine its anti-CSC properties. Lung CSCs resistant to epidermal growth factor receptor-tyrosine kinase inhibitor or cisplatin were treated with trifluoperazine plus gefitinib or trifluoperazine plus cisplatin. Animal models were used for in vivo validation of the anti-CSC effect and synergistic effect of trifluoperazine with gefitinib.We demonstrated that trifluoperazine inhibited CSC tumor spheroid formation and down-regulated the expression of CSC markers (CD44/CD133). Trifluoperazine inhibited Wnt/β-catenin signaling in gefitinib-resistant lung cancer spheroids. The combination of trifluoperazine with either gefitinib or cisplatin overcame drug resistance in lung CSCs. Trifluoperazine inhibited the tumor growth and enhanced the inhibitory activity of gefitinib in lung cancer metastatic and orthotopic CSC animal models.Using in silico drug screening by Connectivity Map followed by empirical validations, we repurposed an existing phenothiazine-like antipsychotic drug, trifluoperazine, as a potential anti-CSC agent that could overcome epidermal growth factor receptor-tyrosine kinase inhibitor and chemotherapy resistance.
Among the histologic types of lung cancer, adenocarcinoma is the most common. Moreover, lung adenocarcinoma with neuroendocrine differentiation (LANED) is a rare histologic character. So far, the clinical significance remains unclear. We searched for the patients diagnosed with LANED from the electronic pathology database between January 2000 and June 2020 in a tertiary hospital. The tumor specimens were reviewed by a pathologist to confirm the diagnosis. EGFR mutation, ALK translocation, as well as programmed death ligand 1 (PD-L1) and rearranged during transfection (RET) expression were tested in the specimens of LANED. The clinical data were also collected and analyzed. A total of 10 patients diagnosed with LANED were included. Most were male (80%) and ever smokers (70%). The median age was 71.5 years old. At diagnosis, most had tumors harboring no EGFR mutation (70%), negative ALK translocation (88.9%), and without PD-L1 expression (90%). All specimens tested by immunohistochemical staining for RET expression (n = 9) showed positive results. Among the 10 patients, five underwent operation (stage I, n = 4; stage II, n = 1). The patient with stage II disease had recurrence 11 months later. For patients with advanced stages (stage III, n = 1; stage IV, n = 4), the treatment modalities varied and the overall survival ranged from 11.0 to 46.7 months. LANED might be associated with a high proportion of RET expression, whereas EGFR mutation, ALK alteration, and PD-L1 expression were uncommon. Further large-scale prospective studies on molecular testing profile and clinical significance of LANED are warranted.
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