Citations

Abstract Waldenström macroglobulinemia (WM) is a distinct B-cell lymphoproliferative disorder for which clearly defined criteria for the diagnosis, initiation of therapy, and treatment strategy have been proposed as part of the consensus panels of International Workshops on WM (IWWM). As part of the IWWM-7 and based on recently published and ongoing clinical trials, the panels updated treatment recommendations. Therapeutic strategy in WM should be based on individual patient and disease characteristics (age, comorbidities, need for rapid disease control, candidacy for autologous transplantation, cytopenias, IgM-related complications, hyperviscosity, and neuropathy). Mature data show that rituximab combinations with cyclophosphamide/dexamethasone, bendamustine, or bortezomib/dexamethasone provided durable responses and are indicated for most patients. New monoclonal antibodies (ofatumumab), second-generation proteasome inhibitors (carfilzomib), mammalian target of rapamycin inhibitors, and Bruton's tyrosine kinase inhibitors are promising and may expand future treatment options. A different regimen is typically recommended for relapsed or refractory disease. In selected patients with relapsed disease after long-lasting remission, reuse of a prior effective regimen may be appropriate. Autologous stem cell transplantation may be considered in young patients with chemosensitive disease and in newly diagnosed patients with very-high-risk features. Active enrollment of patients with WM in clinical trials is encouraged.

Abstract Background: The Prostate Cancer Prevention Trial (PCPT) was a 7-year randomized, double-blind, placebo-controlled trial of the efficacy of finasteride for the prevention of prostate cancer with a primary outcome of histologically determined prevalence of prostate cancer at the end of 7 years. Methods: A systematic modeling process using logistic regression identified factors available at year 6 that are associated with end-of-study (EOS) biopsy adherence at year 7, stratified by whether participants were ever prompted for a prostate biopsy by year 6. Final models were evaluated for discrimination. At year 6, 13,590 men were available for analysis. Results: Participants were more likely to have the EOS biopsy if they were adherent to study visit schedules and procedures and/or were in good health (P < 0.01). Participants at larger sites and/or sites that received retention and adherence grants were also more likely to have the EOS biopsy (P < 0.05). Conclusions: Our results show good adherence to study requirements 1 year before the EOS biopsy was associated with greater odds that a participant would comply with the invasive EOS requirement. Impact: Monitoring adherence behaviors may identify participants at risk of nonadherence to more demanding study end points. Such information could help frame adherence intervention strategies in future trials. Cancer Epidemiol Biomarkers Prev; 23(8); 1638–48. ©2014 AACR.

Medication injury in the gastrointestinal tract (GIT) is a rapidly evolving topic. Increasing endoscopy together with an ageing population, polypharmacy, and a burgeoning drug industry offer heightened opportunities to observe the unintended side effects of therapeutic ingestants. In this review, we emphasise the most commonly encountered medication injuries involving the GIT, as well as emerging agents and mimics. While topics are organised by organ system, the reader should keep in mind that injury patterns are generally not site-specific. As such, awareness of these major morphologic patterns can be translated to multiple tissue sites to more broadly facilitate the diagnostic process.

ABSTRACTBACKGROUND AND PURPOSEMild cognitive impairment (MCI) precedes both Alzheimer's disease (AD) dementia and with Lewy bodies (DLB). We investigated proton magnetic resonance spectroscopy (MRS) characteristics of MCI patients who progressed to DLB compared to those who progressed to AD dementia or remained stable.METHODSConsecutive MCI patients who underwent single voxel MRS at baseline and progressed to DLB (n = 10) were identified during a median follow‐up period of 18 months. From the same cohort, we identified age‐ and sex‐matched MCI patients who progressed to AD dementia (n = 27) or remained stable (n = 20) during a similar follow‐up period. This study was approved by the Institutional Review Board and informed consent was from every subject.RESULTSMCI patients who progressed to AD dementia were characterized by lower N‐acetylaspartate (NAA)/Cr ratio in the posterior cingulate voxel compared to those who progressed to DLB (P = .001). Decreased NAA/Cr in the posterior cingulate voxel differentiated MCI patients who progressed to DLB from those who progressed to AD with an area under the receiver operating characteristic curve of .85 (P < .001) on logistic regression analysis.CONCLUSIONSMRS may be useful in differentiating MCI patients with prodromal AD dementia from those with prodromal DLB for early disease‐specific interventions.

AbstractLinear regression is typically taught as a second and potentially last required (bio)statistics course for Public Health and Clinical and Translational Science students. There has been much research on the attitudes of students toward basic biostatistics, but there has not been much assessing students’ understanding of critical regression topics. The REGRESS (REsearch on Global Regression Expectations in StatisticS) quiz developed at Mayo Clinic utilizes 27 questions to assess understanding for simple and multiple linear regression. We performed an initial external validation of this tool with 117 University of Michigan public health students. We compare the results of pre‐ and postcourse quiz scores from the Michigan cohort to scores of Mayo medical students and professional statisticians. University of Michigan students performed higher than Mayo students on the precourse quiz due to previous related coursework, but did not perform as high postcourse indicating the need for course modification. In the Michigan cohort, REGRESS scores improved by a mean (standard deviation) of 4.6 (3.4), p < 0.0001. Our results support the use of the REGRESS quiz as a learning tool for students and an evaluation tool to identify topics for curricular improvement for teachers, while we highlight future directions of research.

PurposeTo develop and validate a method for choosing the optimal two‐dimensional CAIPIRINHA kernel for subtraction contrast‐enhanced MR angiography (CE‐MRA) and estimate the degree of image quality improvement versus that of some reference acceleration parameter set at R ≥ 8.MethodsA metric based on patient‐specific coil calibration information was defined for evaluating optimality of CAIPIRINHA kernels as applied to subtraction CE‐MRA. Evaluation in retrospective studies using archived coil calibration data from abdomen, calf, foot, and hand CE‐MRA exams was accomplished with an evaluation metric comparing the geometry factor (g‐factor) histograms. Prospective calf, foot, and hand CE‐MRA studies were evaluated with vessel signal‐to‐noise ratio (SNR).ResultsRetrospective studies show g‐factor improvement for the selected CAIPIRINHA kernels was significant in the feet, moderate in the abdomen, and modest in the calves and hands. Prospective CE‐MRA studies using optimal CAIPIRINHA show reduced noise amplification with identical acquisition time in studies of the feet, with minor improvements in the hands and calves.ConclusionA method for selection of the optimal CAIPIRINHA kernel for high (R ≥ 8) acceleration CE‐MRA exams given a specific patient and receiver array was demonstrated. CAIPIRINHA optimization appears valuable in accelerated CE‐MRA of the feet and to a lesser extent in the abdomen. Magn Reson Med 73:2234–2242, 2015. © 2014 Wiley Periodicals, Inc.