Ipilimumab, an anticytotoxic T-lymphocyte antigen (CTLA)-4 monoclonal antibody, is a first-line therapy for stage IV melanoma. Although high-grade immune-related adverse events occur in 25% of patients receiving ipilimumab, serious neurologic toxicity, primarily consisting of transient sensory and motor neuropathies, affects less than 1% of patients. We present a case report of a patient with melanoma who received highdose ipilimumab at 10 mg/kg as first-line therapy for metastatic disease. After the third dose, the patient developed "mild" encephalopathy with a reversible splenial lesion (MERS) of the corpus callosum by MRI and neurogenic bladder, two novel immune-related adverse events during checkpoint inhibition. In addition to headache, delirium, and altered consciousness commonly seen with MERS, the patient also developed tremor, gait instability, paresthesias, and neurogenic bladder. The latter two symptoms were thought to represent sensory and autonomic neuropathies, respectively. The syndrome gradually resolved following intravenous methylprednisolone at 2 mg/kg divided twice daily for 5 days and a slow taper of oral prednisone over 8 weeks. Cancer Immunol Res; 3(6); 598-601. Ó2015 AACR.
Abstract-Studies of decision making in animals suggest a neural mechanism of evidence accumulation for competing percepts according to Bayesian sequential analysis. This model of perception is embodied in a biomimetic tactile sensing robot based on the rodent whisker system. We implement simultaneous perception of object shape and location using two psychological test paradigms: first, a free-response paradigm in which the agent decides when to respond, implemented with Bayesian sequential analysis; and second an interrogative paradigm in which the agent responds after a fixed interval, implemented with maximum likelihood estimation. A benefit of free-response Bayesian perception is that it allows tuning of reaction speed against accuracy. In addition, we find that large gains in decision performance are achieved with unforced responses that allow null decisions on ambiguous data. Thus, free-response Bayesian perception offers benefits for artificial systems that make them more animal-like in behavior.
Background
Low back pain is a common cause of chronic pain in HIV-infected patients. The American College of Physicians and American Pain Society guidelines for diagnostic imaging in low back pain are difficult to apply to patients with chronic illnesses like HIV who may have risk factors for cancer or compression fractures, but whether imaging all such patients for low back pain improves outcomes is unknown.
Objective
Our objective was to describe patients referred to a chronic pain-focused HIV/Palliative care clinic with back pain, and their associated lumbar spine imaging findings.
Methods
We conducted a retrospective chart review of patients at a palliative care clinic that sees patients with HIV, most of whom have chronic pain. Charts with a diagnosis of low back pain were cross-referenced with an imaging database, and any MRIs of the lumbar spine with or without contrast were identified.
Results
Seventy-six patients of 137 patients referred to the HIV/palliative care clinic were found to have back pain. These patients were mainly young (median age 45, IQR 40–51) with well-controlled HIV. Twenty-two (29%) of these patients had an MRI of the lumbar spine, and 11 (50%) of these warranted follow-up, most of whom had degenerative disc disease, including four with findings concerning for malignancy.
Discussion
This is the first study to explore the role of spinal imaging in HIV-infected patients. In our study, four patients had findings concerning for malignancy. These findings suggest that spinal imaging should be performed in the work up of HIV-infected patients with moderate to severe back pain.
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