Updates in Management of Bone Metastatic Disease in Primary Solid Tumors with Systemic Therapies.

PURPOSE OF REVIEW: The purpose of this review is to highlight novel and impactful discoveries in systemic treatment of bone metastatic disease in solid tumors published within the past 5 years. RECENT FINDINGS: Major developments in systemic treatment of bone metastatic disease in solid tumors include evidence that decreasing frequency of dosing zoledronic acid in metastatic breast and prostate cancer maintains efficacy in preventing skeletal-related events while decreasing costs. The landmark findings on the use of Radium-223 to treat metastatic prostate cancer were reported in 2013. Recently, it has been found that not all systemic therapy combinations with Radium-223 are necessarily safe or effective unless bone-targeted therapy is also included in the regimen. More cost-effective dosing intervals of zoledronic acid and efficacy and safety nuances of combination radiopharmaceutical and chemotherapy treatment have been better delineated.

Impact of adjuvant chemotherapy regimen on survival outcomes in immunohistochemical subtypes of ampullary carcinoma.

BACKGROUND AND OBJECTIVES: Ampullary adenocarcinoma (AA) is classified by immunohistochemical (IHC) subtypes into intestinal (IN), pancreatobiliary (PB), and ambiguous (AM). The impact of adjuvant therapy on IHC subtype and disease stage is unclear. We examined the effect of adjuvant chemotherapy regimen on survival of ampullary cancers by IHC subtype and disease stage. METHODS: Review of pancreatoduodenectomy (PD) performed for AA between 2005 and 2013 at a single center. The impact of regimen on IHC subtype and stage was analyzed. RESULTS: One hundred and twenty-one patients were subtyped: IN = 32%, PB = 48%, and AM = 20% with overall survival of 45.6, 31.3, and 46.9 months, respectively. PB had higher pathologic T-stage, positive lymph node disease, and perineural and lymphovascular invasion (P < .05). 5-Fluorouracil (FU)-based adjuvant therapy improved survival compared to no treatment (87.4 vs 32.1 months; P = .046), and receipt of 5-FU emerged as an independent predictor of improved survival (hazard ratio [HR] 0.244; P = .031) regardless of subtype. 5-FU was superior to Gemcitabine in advanced-stage disease (stage IIB and III vs I+IIA, HR: 0.35; P < .05). CONCLUSIONS: Adjuvant therapy with 5-FU confers a survival benefit in patients with advanced-stage AA regardless of subtype. The impact of various chemotherapy regimens on subtypes of ampullary cancer warrants further investigation.

Aggressive fibromatosis of the parotid gland.

Extra-abdominal fibromatosis (EAF) is a rare, locally aggressive tumor that originates in fascial structures. It accounts for less than 0.3% of all tumors diagnosed. Head and neck tumors account for only 7% of those, and only a few cases occurring in the parotid gland have been previously reported. We describe the case of a 34-year-old woman who presented with a painful parotid mass. She was found to have an EAF of her right parotid gland. Medical management with antibiotics and immunosuppression therapy was unsuccessful. Surgical resection was required for both a definitive diagnosis and management. Preoperative findings on computed tomography, magnetic resonance imaging, and both fine-needle aspiration biopsy and surgical biopsy were nonspecific, as is typical in EAF cases.

Behavioral and Neural Adaptation in Approach Behavior.

People often make approachability decisions based on perceived facial trustworthiness. However, it remains unclear how people learn trustworthiness from a population of faces and whether this learning influences their approachability decisions. Here we investigated the neural underpinning of approach behavior and tested two important hypotheses: whether the amygdala adapts to different trustworthiness ranges and whether the amygdala is modulated by task instructions and evaluative goals. We showed that participants adapted to the stimulus range of perceived trustworthiness when making approach decisions and that these decisions were further modulated by the social context. The right amygdala showed both linear response and quadratic response to trustworthiness level, as observed in prior studies. Notably, the amygdala's response to trustworthiness was not modulated by stimulus range or social context, a possible neural dynamic adaptation. Together, our data have revealed a robust behavioral adaptation to different trustworthiness ranges as well as a neural substrate underlying approach behavior based on perceived facial trustworthiness.

Physical Strength as a Cue to Dominance: A Data-Driven Approach.

We investigate both similarities and differences between dominance and strength judgments using a data-driven approach. First, we created statistical face shape models of judgments of both dominance and physical strength. The resulting faces representing dominance and strength were highly similar, and participants were at chance in discriminating faces generated by the two models. Second, although the models are highly correlated, it is possible to create a model that captures their differences. This model generates faces that vary from dominant-yet-physically weak to nondominant-yet-physically strong. Participants were able to identify the difference in strength between the physically strong-yet-nondominant faces and the physically weak-yet-dominant faces. However, this was not the case for identifying dominance. These results suggest that representations of social dominance and physical strength are highly similar, and that strength is used as a cue for dominance more than dominance is used as a cue for strength.

Contributions of facial expressions and body language to the rapid perception of dynamic emotions.

Correctly perceiving emotions in others is a crucial part of social interactions. We constructed a set of dynamic stimuli to determine the relative contributions of the face and body to the accurate perception of basic emotions. We also manipulated the length of these dynamic stimuli in order to explore how much information is needed to identify emotions. The findings suggest that even a short exposure time of 250 milliseconds provided enough information to correctly identify an emotion above the chance level. Furthermore, we found that recognition patterns from the face alone and the body alone differed as a function of emotion. These findings highlight the role of the body in emotion perception and suggest an advantage for angry bodies, which, in contrast to all other emotions, were comparable to the recognition rates from the face and may be advantageous for perceiving imminent threat from a distance.

Validation of data-driven computational models of social perception of faces.

People rapidly form impressions from facial appearance, and these impressions affect social decisions. We argue that data-driven, computational models are the best available tools for identifying the source of such impressions. Here we validate seven computational models of social judgments of faces: attractiveness, competence, dominance, extroversion, likability, threat, and trustworthiness. The models manipulate both face shape and reflectance (i.e., cues such as pigmentation and skin smoothness). We show that human judgments track the models' predictions (Experiment 1) and that the models differentiate between different judgments, though this differentiation is constrained by the similarity of the models (Experiment 2). We also make the validated stimuli available for academic research: seven databases containing 25 identities manipulated in the respective model to take on seven different dimension values, ranging from -3 SD to +3 SD (175 stimuli in each database). Finally, we show how the computational models can be used to control for shared variance of the models. For example, even for highly correlated dimensions (e.g., dominance and threat), we can identify cues specific to each dimension and, consequently, generate faces that vary only on these cues.