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Hysteria
Published in Francis X. Dercum, Rest, Suggestion, 2019
If paralysis be present, the patient should be encouraged, as much as possible, to try to move the paralyzed member. As a rule the mental effort, even with the best intentions, is grossly insufficient, and the limb fails to move at all. Later on, perhaps under the stimulating suggestion that there is a manifest gain in strength and that the muscles are improving, the limb begins to be moved slightly. At times it is advisable, while the patient is making an effort, to say that the limb is actually stirring a little or that the fingers or toes are being slightly moved. At times the recovery of movement is quite sudden and complete after a skil-fully made suggestion. The slowly interrupted faradaic current or other form of electric application may aid in convincing the patient that there is really nothing of consequence the matter with the muscles themselves. In this connection it is well to recall the fact that, owing to disuse, the response of a muscle to electric stimulation is sometimes diminished as compared with the corresponding muscles of the opposite limb. However, the muscles respond promptly, and this in itself acts as a powerful suggestion upon the patient. The benefit of massage and of pasaive movements need not be pointed out here. It is rarely necessary, or indeed justifiable, in order to reinforce a suggestion, to threaten the patient with operative interference or with unusual or cruel procedures. Indeed, such methods often confirm the patient in her belief that the paralysis from which she suffers is very serious or heroic measures would not be thought of.
Response and survival of metastatic melanoma patients treated with immune checkpoint inhibition for recurrent disease on adjuvant dendritic cell vaccination
Published in OncoImmunology, 2020
Wouter W. van Willigen, Martine Bloemendal, Marye J. Boers-Sonderen, Jan Willem B. de Groot, Rutger H.T. Koornstra, Astrid A.M. van der Veldt, John B. A. G. Haanen, Steve Boudewijns, Gerty Schreibelt, Winald R. Gerritsen, I. Jolanda M. de Vries, Kalijn F. Bol
In the DC vaccination trials, the immunological response was monitored after each DC vaccination cycle except in the MIND-DC trial in which immunological response was determined only following the first cycle. Immunological response was tested using delayed-type hypersensitivity (DTH) skin tests as described previously.14 Briefly, patients received intradermal injections of DC loaded with melanoma antigens. After 48 h, 6 mm punch biopsies were taken from the injected skin. In these biopsies, skin-test infiltrating lymphocytes (SKIL) were analyzed for antigen-specific T-cells using multimeric-MHC complexes containing the relevant antigen epitopes. Furthermore, the presence of functional T-cells in the SKIL was assessed by measuring the interferon (IFN)-γ production upon stimulation with melanoma-associated antigen (supplementary figure 1). Patients with functional T-cells producing IFN-γ and/or having antigen-specific T-cells in at least one of the DTH skin tests were considered to have a melanoma-specific immunological response.
Personalized therapy with peptide-based neoantigen vaccine (EVX-01) including a novel adjuvant, CAF®09b, in patients with metastatic melanoma
Published in OncoImmunology, 2022
Sofie Kirial Mørk, Mohammad Kadivar, Kalijn Fredrike Bol, Arianna Draghi, Marie Christine Wulff Westergaard, Signe Koggersbøl Skadborg, Nana Overgaard, Anders Bundgård Sørensen, Ida Svahn Rasmussen, Lars Vibe Andreasen, Christina Westmose Yde, Thomas Trolle, Christian Garde, Jens Friis-Nielsen, Nis Nørgaard, Dennis Christensen, Jens Vindahl Kringelum, Marco Donia, Sine Reker Hadrup, Inge Marie Svane
SKILs were thawed and rested overnight prior to the initiation of the assays. EVX-01-specific T-cell activation was assessed with 8-hour co-culture at 37°C of SKILs and peptides in the presence of autologous monocytes. Monocytes were isolated from PBMCs with positive enrichment using CD14 microbeads according to manufacturer’s instruction. The SKIL to monocyte ratio was 10:1. The single peptides and peptide pool were added with a final concentration of 0.5 µg/mL alongside a positive control (PMA; 25 ng/mL + Ionomycin; 0.5 µM) and a negative control (irrelevant peptide 1.5 µg/mL). Anti-human CD107a antibody, Brefeldin A (dilution of 1:1000, GolgiPlug™) and Monensin (dilution of 1:1000, GolgiStop™) were added after 2 hours of co-culture. After a total of 8 hours of incubation, the cells were washed twice with DPBS (Sigma-Aldrich/Merck KGaA) and stained with live/dead reagent and antibodies for surface markers (Panel 2, Supplementary Table S1). The cells were then washed, fixed, and permeabilized overnight at 4°C using the FoxP3/Transcription Factor Staining Buffer Set (eBiosciences, Thermo Fisher Scientific). The cells were subsequently stained with antibodies binding intracellular targets (Panel 2, Supplementary Table S1). After staining and washing, cells were analyzed on a NovoCyte Quanteon™ Flow Cytometer. Flow cytometry data were analyzed with FlowJo version 10 (Becton Dickinson). T-cell reactivity was defined as the percentage of live CD8+ or CD4+ T-cells staining positive for at least two of four markers (TNF, IFNγ, CD107a, CD137) minus the background (unstimulated control). SKILs with monocytes and irrelevant peptide served as an unstimulated control while SKILs in the presence of PMA/Ionomycin were used as a positive control. A specific response was defined as the detection of a response greater than twice the background and a minimum of 50 positive flow cytometry events after subtraction of the background.
Improving drug prescription in general practice using a novel quality improvement model
Published in Scandinavian Journal of Primary Health Care, 2021
Nicolas M. F. Øyane, Morten Finckenhagen, Sabine Ruths, Geir Thue, Anne Karin Lindahl
The Centre for Quality Improvement in Medical Practices (SKIL) was founded by the Norwegian Medical Association in 2014. SKIL offers tools for and training in QI to ambulatory clinics, including rGP practices. SKIL has developed a novel QI model based on the BTS collaboration model. The model was designed to train participants in practical QI skills by facilitating improvement within a certain clinical area, such as medication review.