Background: A major concern in interventional studies is the inability to accurately link patient report with objective measures. In this study, we associated functional brain measures with self-reported pain after patients underwent a neuromodulatory intervention. Specifically, Chemotherapy-Induced Peripheral Neuropathy (CIPN) adversely affects many cancer patients but few effective treatment options are available, and mechanisms are not well understood. Objectives: We present three representative cases from a doubleblind, randomized, placebo-controlled trial which examined the efficacy of a targeted therapy of Electroencephalogram (EEG) Neurofeedback (NFB), in attenuating symptoms of CIPN. The primary outcome of the trial was efficacy of neurofeedback versus control groups. In this case series we explore mechanism, by linking patient reported outcomes with objective measures. Methods: Symptom descriptions and EEG data were collected for patients enrolled in neurofeedback, placebo feedback, and waitlist conditions. Subjective pain ratings and EEG data were compared before and after the 10-week intervention. Results: A patient receiving neurofeedback demonstrated decreased beta oscillations in Brodmann Area 6 (BA6) and reported noticeable decreases in numbness and temperature sensitivity. A patient receiving placebo demonstrated increased beta in BA6 and increased alpha oscillations in Brodmann areas 3 and 7 with improvement of symptoms. A waitlist participant showed no change in BA6 and reported increased neuropathic symptoms while on waitlist but subsequently received NFB treatment and reported symptom improvement. Conclusions: This case series indicates that NFB may be used to achieve targeted reduction in beta oscillations to treat CIPN. Possible mechanisms of action and implications for CIPN treatment are discussed.
INTRODUCTION: Sarcoidosis is an idiopathic, multiorgan, inflammatory disease characterized by the presence of noncaseating granulomas. Although mycobacterial infection has long been a candidate as a causative agent in sarcoidosis, only recently has strong evidence supported a causal connection. Mycobacterium abscessus is a rapidly growing mycobacterium (RGM), found worldwide in the environment. It is increasingly being recognized as a cause of human disease, including pulmonary infections. Clinical features of progressive RGM lung disease include bilateral lung involvement and fibrocavitary disease. Here, we describe a case of Mycobacterium abscessus infection detected two years after sarcoidosis. CASE PRESENTATION: A 63 year old Chinese female, who worked as a farmer, presented with episodes of hemoptysis for 33 years, which was treated empirically with azithromycin on multiple occasions, resulting in good response according to the patient.
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