The prognostic significance and optimal management of tetraploidy/near-tetraploidy acute myeloid leukemia (T/NT AML) remains unclear given its limited data. This is especially true after factoring in ...additional chromosomal alterations, which carry their own prognostic weight. Here, we analyze 128 cases of T/NT in AML from the literature along with two additional cases, which is the largest review of this subject to date. Based on our retrospective analysis, we found that regardless of the risk status attributed to cytogenetics, the prognosis of tetraploid or near-tetraploid AML is dismal and should be incorporated within the unfavorable risk group. Complete remission is paramount to survival in this population. Specific induction protocols for high-risk AML appear to have higher rates of complete remission in the T/NT AML population. Moreover, longer overall survival can be achieved with chemotherapy followed by allogeneic stem cell transplantation at first complete remission.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Primary dural diffuse large B-cell lymphoma (PD-DLBCL) is a rare and aggressive B-cell non-Hodgkin lymphoma that can present in intracranial or intraspinal locations. Although the optimal management ...is unknown, PD-DLBCL therapy is often mirrored after primary central nervous system lymphoma therapy and aggressive treatment with a high dose methotrexate-based regimen is frequently used. Our comprehensive, retrospective study of 24 reported cases of PD-DLBCL provide the most complete analysis of this rare disease including data on biology, treatment outcomes, and survival. Our findings demonstrate good outcomes following induction treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), suggesting that these cases can be treated as DLBCL rather than primary central nervous system lymphoma, obviating the need for more aggressive and toxic approaches. The durable responses following R-CHOP also confirm that PD-DLBCL is not protected by the blood brain barrier.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Primary adrenal lymphoma (PAL) and primary renal lymphoma (PRL) are rare extranodal lymphomas, predominantly of diffuse large B-cell lymphoma subtype. Primary adrenal and renal lymphomas (PARL) ...exhibit a high predilection for the central nervous system (CNS). Therefore, current guidelines support the use of CNS prophylaxis in PARL, particularly in cases of high-risk Central Nervous System International Prognostic Index (CNS-IPI). However, the route of administration (i.e. systemic vs. intrathecal chemotherapy) has not been clearly elucidated. With this in mind, we initiated an international collaboration and literature review to analyze 50 patient cases, 20 of whome received CNS prophylaxis. Based on our analysis, we conclude that PARL may indicate a need for CNS chemo-prophylaxis in the form of systemic high-dose methotrexate (HD-MTX) over intrathecal methotrexate (IT-MTX), although IT-MTX may still have utility in certain cases.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
“Accelerated” chronic lymphocytic leukemia/small lymphocytic lymphoma (A-CLL) is a rare histological variant of CLL/SLL, which tends to exhibit an aggressive clinical behavior compared to CLL. Due to ...the rarity of A-CLL (<1% of all cases), the optimal management remains ill-defined. We report two cases of A-CLL from our institution, in which both relapsed following initial chemoimmunotherapy regimens. Both patients were treated with single agent ibrutinib, a Bruton's tyrosine kinase inhibitor (BTKi), and achieved rapid, deep and durable responses. With the absence of clear guidance on A-CLL treatment, BTKi agents should be considered in the frontline treatment of A-CLL.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Formalin is commonly thought to decrease the risk of
Mycobacterium tuberculosis infection. However, the true disinfection efficacy of formalin for tissue infected with
M tuberculosis is unclear. We ...reviewed all pertinent literature from 1900 until the present regarding the disinfection efficacy of formalin for tissue infected with
M tuberculosis. We also retrospectively cultured five cases of
M tuberculosis from formalin-fixed archival pulmonary tissue. All cultures from our archived tissue were negative. The literature review revealed limited and contradictory information concerning the viability of
M tuberculosis in formalin-fixed human tissue. There are no studies which specifically address the viability of
M tuberculosis in tissue exclusively fixed in 10% buffered formalin. The disinfection efficacy of formalin for tuberculosis infected tissue remains unclear. Larger, prospective studies using current methodologies are needed to establish guidelines to ensure the safety for those handling infected, fixed tissue.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Neighborhood supports have been associated with walking, but this association may be modified by reports about the usefulness of these supports for promoting walking. This study examined the ...association between reported presence of neighborhood supports and walking and whether usefulness modified this association in a nationwide sample of U.S. adults. Measures of reported presence and use or potential use (i.e., usefulness) of neighborhood supports (shops within walking distance, transit stops, sidewalks, parks, interesting things to look at, well-lit at night, low crime rate, and cars following speed limit) were examined in 3973 adults who completed the 2014 SummerStyles survey. Multinomial regression models were used to examine the association between presence of supports with walking frequency (frequently, sometimes, rarely (referent)) and the role usefulness had on this association. The interaction term between reported presence and usefulness was significant for all supports ( p < 0.05). For adults who reported a support as useful, a positive association between presence of the support and walking frequency was observed for all supports. For adults who did not report a support as useful, the association between presence of the support and walking frequency was null for most supports and negative for sidewalks, well-lit at night, and low crime rate. The association between presence of neighborhood supports and walking is modified by reported usefulness of the support. Tailoring initiatives to meet a community's supply of and affinity for neighborhood supports may help initiatives designed to promote walking and walkable communities succeed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Endovascular renal denervation reduces blood pressure in patients with mild-to-moderate hypertension, but its efficacy in patients with true resistant hypertension has not been shown. We aimed to ...assess the efficacy and safety of endovascular ultrasound renal denervation in patients with hypertension resistant to three or more antihypertensive medications.
In a randomised, international, multicentre, single-blind, sham-controlled trial done at 28 tertiary centres in the USA and 25 in Europe, we included patients aged 18–75 years with office blood pressure of at least 140/90 mm Hg despite three or more antihypertensive medications including a diuretic. Eligible patients were switched to a once daily, fixed-dose, single-pill combination of a calcium channel blocker, an angiotensin receptor blocker, and a thiazide diuretic. After 4 weeks of standardised therapy, patients with daytime ambulatory blood pressure of at least 135/85 mm Hg were randomly assigned (1:1) by computer (stratified by centres) to ultrasound renal denervation or a sham procedure. Patients and outcome assessors were masked to randomisation. Addition of antihypertensive medications was allowed if specified blood pressure thresholds were exceeded. The primary endpoint was the change in daytime ambulatory systolic blood pressure at 2 months in the intention-to-treat population. Safety was also assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02649426.
Between March 11, 2016, and March 13, 2020, 989 participants were enrolled and 136 were randomly assigned to renal denervation (n=69) or a sham procedure (n=67). Full adherence to the combination medications at 2 months among patients with urine samples was similar in both groups (42 82% of 51 in the renal denervation group vs 47 82% of 57 in the sham procedure group; p=0·99). Renal denervation reduced daytime ambulatory systolic blood pressure more than the sham procedure (−8·0 mm Hg IQR –16·4 to 0·0 vs –3·0 mm Hg –10·3 to 1·8; median between-group difference –4·5 mm Hg 95% CI –8·5 to –0·3; adjusted p=0·022); the median between-group difference was –5·8 mm Hg (95% CI –9·7 to –1·6; adjusted p=0·0051) among patients with complete ambulatory blood pressure data. There were no differences in safety outcomes between the two groups.
Compared with a sham procedure, ultrasound renal denervation reduced blood pressure at 2 months in patients with hypertension resistant to a standardised triple combination pill. If the blood pressure lowering effect and safety of renal denervation are maintained in the long term, renal denervation might be an alternative to the addition of further antihypertensive medications in patients with resistant hypertension.
ReCor Medical.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A fusion between the
PDGFRA
and
FIP1L1
genes was found in some cases of the hypereosinophilic syndrome, a fatal disorder in which eosinophils invade and destroy various organs. The fusion protein is ...a constitutively active tyrosine kinase, which explains the effect of imatinib, an inhibitor of tyrosine kinases, in the disease. The immortalization of hematopoietic cells by the fusion protein indicates its role in causing the syndrome.
The hypereosinophilic syndrome is rare, but these findings have implications for a wide range of cancers.
The hypereosinophilic syndrome is a rare hematologic disorder with sustained overproduction of eosinophils in the bone marrow, eosinophilia, tissue infiltration, and organ damage. The diagnosis is based on the criteria of Chusid et al.
1
: sustained eosinophilia (more than 1500 eosinophils per cubic millimeter) for more than six months; the absence of other causes of eosinophilia, including parasitic infections and allergies; and signs and symptoms of organ involvement, most frequently the heart, the central and peripheral nervous system, the lungs, and the skin. The syndrome is more common in men than women (ratio, 9:1) and occurs predominantly between the ages . . .
Active People, Healthy NationSM is an initiative led by the US Centers for Disease Control and Prevention to improve the health of 27 million Americans by 2027 by increasing their level of physical ...activity.1 An earlier commentary provided the rationale and an overall description of Active People, Healthy NationSM.2 A core goal of this initiative is to galvanize action across communities, government and nongovernmental organizations, and institutions to use a set of proven strategies to increase physical activity (Figure 1). Every Active People, Healthy NationSM strategy can be designed to support equitable and inclusive access to opportunities for physical activity for all people, regardless of age, race, education, socioeconomic position, disability status, sexual orientation, or geographic location. And, as illustrated in Figure 1, equity and inclusive access are at the foundation of all of these approaches. When these strategies engage people at the local level, they can ensure that activities are community driven. Figure 1 Figure 1 * Download Figure * Download figure as PowerPoint slide —Strategies recommended by The Community Guide as effective at promoting physical activity. Implementation approaches associated with these strategies are listed on the right. Citation: Journal of Physical Activity and Health 18, 4; 10.1123/jpah.2020-0656 The Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity provides financial and technical support to help state and local health departments, land grant universities, and community organizations to improve physical activity levels in communities affected by health inequities. This commentary describes strategies that have been proven to increase physical activity and factors to consider when selecting strategies to match community needs. The strategies are based on evidenced-based recommendations in The Guide to Community Preventive Services (The Community Guide) and supported by a scientific report from the Physical Activity Guidelines Advisory Committee.3,4 What Works: Strategies to Increase Physical Activity The Community Guide has 4 types of findings: recommend against, insufficient evidence, recommend with sufficient evidence, and recommend with strong evidence. Seven strategies recommended as having sufficient or strong evidence of effectiveness by the Community Guide are described next. Activity-Friendly Routes to Everyday Destinations This strategy uses built environment approaches to create or enhance community characteristics to make physical activity easier, more appealing, and more accessible. When implemented successfully, the result is routes such as sidewalks, walking and hiking trails, bicycle lanes, and public transit that connect to destinations such as parks, green spaces, stores, homes, schools, worksites, and libraries.5,6 Communities with activity-friendly features report higher levels of physical activity among their residents than those without these features.7,8 Several policy approaches can be used to implement this strategy. Complete Streets policies support safe and convenient access to streets for all users through features such as physically protected bike lanes, dedicated space for transit, accessible transit stops, frequent crossing opportunities, accessible pedestrian signals, and curb extensions.9 Communities can develop comprehensive or master plans to guide long-term development,10 and zoning policies can influence land use (eg, commercial vs. residential). Comprehensive or master plans often guide zoning codes and other regulations, which can promote physical activity by allowing a mix of residential and commercial development or requiring sidewalks.11 Promoting active travel to and from school can increase physical activity in elementary and middle school students. One approach is Safe Routes to School, which promotes environmental changes through infrastructure projects and noninfrastructure programing that make it easier for students to commute to school by walking, biking, or using other forms of active transportation. The Community Guide found that interventions designed to increase active travel to school can increase walking among students and reduce the risk of traffic-related injury. It also found that the economic benefits of these interventions can exceed their cost. Similar active travel initiatives have focused on improving the safety of routes to parks and senior centers.12 Access to Places for Physical Activity Making current places easier to access or providing new places for people to be active is a proven strategy to increase physical activity. Parks and recreation centers can increase access by providing safe and attractive facilities; free or reduced-cost programs; and convenient pedestrian, cyclist, and auto entry points. Workplaces can have policies that encourage time off to participate in an activity class, help employees create social support groups, and provide environmental supports, such as showers and gyms.13,14 Another approach is the use of shared-use agreements between 2 or more organizations that allow broader access to the organizations’ facilities. For example, churches or school districts may establish shared-use agreements that allow after-hours access to recreational facilities for community members.15,16 School and Youth Programs Well-designed physical education in schools has been shown to increase the level of moderate- and vigorous-intensity physical activity among young people. Proven strategies include physical education curricula that increase physical activity knowledge and skills among students, modify traditional games so that more students are active for longer periods of time, substitute less active games with more active ones, and train teachers how to develop and implement lesson plans that include activity. Successful strategies for increasing student physical activity during recess and in other classes have also been identified.13,17,18 In addition, before- and after-school activities, such as team and individual sports, activity clubs, and intramural and interscholastic sports, can contribute to an active student body.19 Community-Wide Campaigns Community-wide campaigns are sustained, high-intensity efforts designed to reach large numbers of people from a wide range of groups based on social, economic, and other factors, including age, sex, race, and ethnicity. They seek to promote physical activity by combining several strategies, such as media coverage and promotions, risk factor screening and education, community events, and policy and environmental changes. Community-wide campaigns typically include general and targeted media outreach, contests, counseling, support groups, and programmatic offerings such as classes.13 A campaign called Shape up Sommerville, which is described in a later section, is an example of a successful community-wide campaign.20 Social Support These strategies build support for social networks and friendships to help people start, maintain, or increase physical activity.13 They include group activities such as buddy systems and walking and activity clubs (eg, hiking, cycling, trekking). For example, GirlTrek is an organization that promotes pride, independence, and social support for African American women by sponsoring regular walking sessions.21 Walk with a Doc was formed by a doctor to encourage his patients to walk more by hosting walking sessions and serving as an active role model. It has since grown to over 500 chapters worldwide, including groups led by medical students.22 Individual Supports Individual supports or individually adapted health behavior change strategies focus on the specific needs of individuals and are delivered to individuals or groups.23 They build on a long history of effective behavior change interventions24 and are important complements to population-level strategies. They provide frequent feedback and various levels of reinforcement to help participants build skills, set goals, and solve problems. Programs can be promoted and delivered in multiple settings, including worksites, schools, churches, and social service organizations. Support and counseling can be provided by peer, lay, and professional counselors. Advances in technology allow feedback and motivational support through mechanisms such as telephone, text, and wearable activity monitors.23 Prompts to Encourage Physical Activity Signage or other prompts located at points where people make decisions about being active are an effective strategy to increase physical activity. Posters, signs, or media placed at elevators or escalators are associated with more people choosing an active option, such as taking the stairs.25,26 Prompts are an effective and enduring way for worksites and commercial locations, such as malls or airports, to help people make an active choice.27 These low-cost strategies can also be part of a larger campaign that includes additional programmatic, policy, and environmental interventions. Another strategy for encouraging active choices is wayfinding, which is the process by which a person determines his/her position in a physical space and navigates a route. Wayfinding strategies were successfully used in London before the Olympics as a way to reduce the burden on the subway system. Signs were installed throughout the city to encourage walking.6
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