Improving Bone Health in Patients with Metastatic Prostate Cancer with the Use of Algorithm-Based Clinical Practice Tool.

Background: The bone health of patients with locally advanced and metastatic prostate cancer is at risk from treatment-related bone density loss and skeletal-related events from metastatic disease in bones. Evidence-based guidelines recommend using denosumab or zoledronic acid at bone metastasis-indicated dosages in the setting of castration-resistant prostate cancer with bone metastases and at the osteoporosis-indicated dosages in the hormone-sensitive setting in patients with a significant risk of fragility fracture. For the concerns of jaw osteonecrosis, a dental evaluation is recommended before starting bone-modifying agents.

Bone Health in Patients With Prostate Cancer: An Evidence-Based Algorithm.

Background: The veteran population has an increasingly high number of patients who have either survived, are currently living with, or are being treated for prostate cancer. Survivorship concerns related to the treatment of this disease is a relevant topic in the Veterans Health Administration, given the longevity of life with localized disease treatment and the fairly durable therapies for metastatic disease. Long-term androgen deprivation therapy (ADT) forms the backbone of treatment for advanced and metastatic castration-sensitive prostate cancer.

The D-dimer assay.

D-dimer is an indirect marker of fibrinolysis and fibrin turnover; this molecule exhibits unique properties as a biological marker of hemostatic abnormalities as well as an indicator of intravascular thrombosis. D-dimer is a soluble fibrin degradation product that results from the systematic degradation of vascular thrombi through the fibrinolytic mechanism. Because of this, the D-dimer serves as a valuable marker of activation of coagulation and fibrinolysis in a number of clinical scenarios.

Nivolumab-induced hypothyoidism with consequent hypothyroid related myopathy.

Purpose: Nivolumab is a fully human IgG4 programmed death 1 immune checkpoint inhibitor (ICI) antibody that has anti-tumor activity by selectively blocking the interaction of the programmed death 1 receptor with its two known programmed death ligands PD-L1 and PD-L2. In doing so, this immune checkpoint inhibitor removes the negative signal stifling T cell activation and proliferation within the tumor microenvironment and demonstrates favorable antitumor activity.

Case Report: We report an interesting case of immune checkpoint inhibitor-induced primary hypothyroidism with associated hypothyroid myopathy in a young patient with surgically resected stage IIIB melanoma receiving adjuvant nivolumab.

Primary Cystic Pleuropulmonary Synovial Sarcoma Presenting as Recurrent Pneumothorax.

Primary pleuropulmonary synovial sarcomas are quite rare, representing 0.1-0.5% of all pulmonary malignancies.

Individual differences in conflict detection during reasoning.

Decades of reasoning and decision-making research have established that human judgment is often biased by intuitive heuristics. Recent "error" or bias detection studies have focused on reasoners' abilities to detect whether their heuristic answer conflicts with logical or probabilistic principles. A key open question is whether there are individual differences in this bias detection efficiency.

Malignant Phyllodes Tumor Presenting in Bone, Brain, Lungs, and Lymph Nodes.

Introduction: Phyllodes tumors (PTs) are rare fibroepithelial tumors of the breast which are classified as benign, borderline, or malignant. Malignant PTs account for <1% of malignant breast tumors, and borderline tumors have potential to progress to malignant tumors. Metastatic recurrences are most commonly documented in bone and lungs.

Structural mapping in statistical word problems: A relational reasoning approach to Bayesian inference.

Presenting natural frequencies facilitates Bayesian inferences relative to using percentages. Nevertheless, many people, including highly educated and skilled reasoners, still fail to provide Bayesian responses to these computationally simple problems. We show that the complexity of relational reasoning (e.

The Doubting System 1: Evidence for automatic substitution sensitivity.

A long prevailing view of human reasoning suggests severe limits on our ability to adhere to simple logical or mathematical prescriptions. A key position assumes these failures arise from insufficient monitoring of rapidly produced intuitions. These faulty intuitions are thought to arise from a proposed substitution process, by which reasoners unknowingly interpret more difficult questions as easier ones.

Comprehension and computation in Bayesian problem solving.

Humans have long been characterized as poor probabilistic reasoners when presented with explicit numerical information. Bayesian word problems provide a well-known example of this, where even highly educated and cognitively skilled individuals fail to adhere to mathematical norms. It is widely agreed that natural frequencies can facilitate Bayesian inferences relative to normalized formats (e.

Reasoning and choice in the Monty Hall Dilemma (MHD): implications for improving Bayesian reasoning.

The Monty Hall Dilemma (MHD) is a two-step decision problem involving counterintuitive conditional probabilities. The first choice is made among three equally probable options, whereas the second choice takes place after the elimination of one of the non-selected options which does not hide the prize. Differing from most Bayesian problems, statistical information in the MHD has to be inferred, either by learning outcome probabilities or by reasoning from the presented sequence of events.

Screening ancient tuberculosis with qPCR: challenges and opportunities.

The field of ancient DNA (aDNA) has rapidly accelerated in recent years as a result of new methods in next-generation sequencing, library preparation and targeted enrichment. Such research is restricted, however, by the highly variable DNA preservation within different tissues, especially when isolating ancient pathogens from human remains. Identifying positive candidate samples via quantitative PCR (qPCR) for downstream procedures can reduce reagent costs, increase capture efficiency and maximize the number of sequencing reads of the target.

Integrating human health and environmental health into the DPSIR framework: a tool to identify research opportunities for sustainable and healthy communities.

The U.S. Environmental Protection Agency has recently realigned its research enterprise around the concept of sustainability.

Crux vena cava filter.

Inferior vena cava filters are widely accepted for pulmonary embolic prophylaxis in high-risk patients with contraindications to anticoagulation. While long-term complications have been associated with permanent filters, retrievable filters are now available and have resulted in the rapid expansion of this technology. Nonetheless, complications are still reported with optional filters.

Evaluation of wall motion and dynamic geometry of the inferior vena cava using intravascular ultrasound: implications for future device design.

Purpose: To use intravascular ultrasound (IVUS) to define the wall motion of the inferior vena cava (IVC) during normal respiratory cycles and evaluate its dynamic geometry during Valsalva maneuvers.

Methods: Between September 2005 and October 2006, 10 patients who were having IVC filters placed underwent IVUS prior to filter implantation. With the anesthetized patient in a supine position, a 10-second IVUS recording of IVC motion below the renal veins was made during both normal respiratory cycles and Valsalva maneuvers.

Evaluation of the Crux IVC Filter in an animal model.

Purpose: To determine the safety and performance of a new inferior vena cava (IVC) filter in an ovine model and evaluate the retrievability at 5 weeks.

Methods: The Crux Vena Cava Filter (VCF) is composed of 2 nitinol spiral supports with a polymeric filter suspended between them. Retrieval tails on each end facilitate retrieval.

Dynamic geometry and wall thickness of the aortic neck of abdominal aortic aneurysms with intravascular ultrasonography.

Background: It is commonly assumed that the aortic wall deforms uniformly and has uniform wall thickness about the circumference. The purpose of this study was to evaluate the aortic wall motion and thickness in the infrarenal aortic neck of patients with abdominal aortic aneurysms who were undergoing endovascular repair (EVAR) and to compare the dynamic measurements of intravascular ultrasonography with the static measurements of computed tomographic angiography (CTA).

Methods: A total of 25 patients were evaluated before surgery with CTA and three-dimensional reconstructions on a Vitrea workstation, followed by intraoperative assessment of the proximal aortic neck with intravascular ultrasonography (IVUS) before EVAR.

Device-specific resistance to in vivo displacement of stent-grafts implanted with maximum iliac fixation.

Purpose: To compare the in vivo device-specific downward displacement force of various externally supported endografts implanted with maximum iliac fixation.

Methods: Twenty female sheep had aneurysms created with a graft patch in the infrarenal aorta. In 12 animals, a fully supported modular bifurcated stent-graft [AneuRx (n=4), Talent (n=4), or Zenith (n=4)] was deployed; in the other 8, a bifurcated aortic graft was surgically anastomosed to the infrarenal aorta.

Developmental divergence of sleep-wake patterns in orexin knockout and wild-type mice.

Narcolepsy, a disorder characterized by fragmented bouts of sleep and wakefulness during the day and night as well as cataplexy, has been linked in humans and nonhuman animals to the functional integrity of the orexinergic system. Adult orexin knockout mice and dogs with a mutation of the orexin receptor exhibit symptoms that mirror those seen in narcoleptic humans. As with narcolepsy, infant sleep-wake cycles in humans and rats are highly fragmented, with consolidated bouts of sleep and wakefulness developing gradually.

Separable brainstem and forebrain contributions to ultrasonic vocalizations in infant rats.

Competing views persist concerning the functional significance of ultrasonic vocalizations (USVs) emitted by infant rats. One perspective holds that USVs result from an emotional state of fear and anxiety, the adult expression of which depends in part on forebrain mechanisms. Here the authors examine whether pups lacking forebrain input are capable of emitting USVs.

Inhibition of ultrasonic vocalizations by beta-adrenoceptor agonists.

Infant rat ultrasonic vocalizations (USVs) are widely believed to result from the induction of an emotional state of anxiety or distress. This perspective, however, is not easily reconciled with the demonstration by W. J.

Sleep homeostasis in infant rats.

Homeostatic regulation is a defining characteristic of sleep but has rarely been examined in infants. This study presents an automated method of sleep deprivation in which 5-day-old rats were shocked whenever the nuchal muscle became atonic. The intensity of shock was always set at the minimal level required to maintain arousal.

Thermoregulatory behavior in infant Norway rats (Rattus norvegicus) and Syrian golden hamsters (Mesocricetus auratus): arousal, orientation, and locomotion.

The responses of 2- and 8-day-old rats (Rattus norvegicus) and hamsters (Mesocricetus auratus) to thermal stimulation were assessed in 4 experiments. In Experiment 1, the surface underlying the pup was cooled, and the latency to escape to a region of warmth was measured. Experiment 2 required pups to locomote farther to gain access to warmth.