Citations

Background and ObjectivesTo describe the patterns of failure in patients with in‐transit (IT) melanoma undergoing surgical excision.MethodsA retrospective review of patients who underwent their first IT lesion(s) resection between May 2005 and September 2014. Cumulative incidence of local failure (new lesion within 2 cm of IT resection) was estimated. Associations between clinicopathologic characteristics, local failure, and any recurrence were analyzed.ResultsOne hundred and thirty patients presented to our institution with IT disease over the study period and met the inclusion criteria. The 2‐year cumulative incidence of local failure was 19.5%. Twenty‐four patients developed disease within 2 cm of the resected IT disease; however, only eight were isolated local events. Cumulative incidence of local failure and of any disease differed with respect to less than 1 year disease‐free interval (DFI) from primary melanoma to first IT event, and having greater than 1 IT lesion at presentation. Incidence of local failure was not found to differ with respect to gross margin greater than 5 mm, after adjusting for DFI and greater than 1 IT lesions.ConclusionsPatients with greater than 1 IT lesion and a DFI less than 1 year are at a higher risk of failure after surgical excision of a first IT event. Very few failures were isolated local disease within 2 cm of the IT resection scar, regardless of IT excision margin.

Millennial students born between 1980 and 1999 are currently the most prevalent generation in medical schools. Understanding this generation of inspiring yet challenging learners is key to satisfying instructional interaction. Effective strategies for teaching millennial learners can be summarized with 5 R's: ensuring a relaxed learning environment, building rapport with learners, highlighting the relevance and rationale of learning objectives and assessments, and implementing research‐based educational methods. These strategies are exemplified by anatomists who relate (through platforms that encourage team‐based learning in a relaxed environment), resonate (by highlighting the relevance and rationale of basic science learning objectives and feedback strategies), and innovate (by adopting cutting edge, research‐proven technologies) within their curricula. Anatomists lead the way in effectively engaging, teaching and evaluating Millennial medical students in the 21st century. Broad application of these principles by other medical educators can further enhance Millennial education. Clin. Anat., 2018. © 2018 Wiley Periodicals, Inc.

This commentary is on the original article by Reilly et al. on pages 145–151 of this issue.

ObjectiveTo determine the cross‐sectional and longitudinal associations between diabetes treatment type and cognitive outcomes among type II diabetics.MethodsWe examined the association between metformin use, as compared to other diabetic treatment (ie, insulin, other oral medications, and diet/exercise) and cognitive test performance and mild cognitive impairment (MCI) diagnosis among 508 cognitively unimpaired at baseline type II diabetics enrolled in the Mayo Clinic Study of Aging. We created propensity scores to adjust for treatment effects. We used multivariate linear and logistic regression models to investigate the cross‐sectional association between treatment type and cognitive test z scores, respectively. Mixed effects models and competing risk regression models were used to determine the longitudinal association between treatment type and change in cognitive test z scores and risk of developing incident MCI.ResultsIn linear regression analyses adjusted for age, sex, education, body mass index, APOE ε4, insulin treatment, medical comorbidities, number of medications, duration of diabetes, and propensity score, we did not observe an association between metformin use and cognitive test performance. Additionally, we did not observe an association between metformin use and cognitive test performance over time (median = 3.7‐year follow‐up). Metformin was associated with an increased risk of MCI (subhazard ratio (SHR) = 2.75; 95% CI = 1.64, 4.63, P < .001). Similarly, other oral medications (SHR = 1.96; 95% CI = 1.19, 3.25; P = .009) and insulin (SHR = 3.17; 95% CI = 1.27, 7.92; P = .014) use were also associated with risk of MCI diagnosis.ConclusionsThese findings suggest that metformin use, as compared to management of diabetes with other treatments, is not associated with cognitive test performance. However, metformin was associated with incident MCI diagnosis.