AUTOSOMAL RECESSIVE INHERITANCE OF HYPOHIDROTIC ECTODERMAL DYSPLASIA

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all autliors, typewritten double spaced, and must not exceed two pages of text including references. Two copies of all letters should be submitted. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided.     

Effectiveness of erlotinib treatment in advanced KRAS mutation-negative lung adenocarcinoma patients: Results of a multicenter observational cohort study (MOTIVATE)

Objectives

Erlotinib is an epidermal growth factor receptor tyrosine-kinase inhibitor (EGFR-TKI), used for the treatment of non-small cell lung cancer. As the clinical significance of KRAS mutational status has not yet been clearly determined in this setting, our aim was to investigate the efficacy of erlotinib in advanced KRAS mutation-negative lung adenocarcinoma patients.

Materials and methods

MOTIVATE is an open-label, multicenter, observational trial with Tarceva^® (erlotinib) monotherapy. Enrolled patients with advanced (stage IIIB/IV) KRAS wild type (WT) lung adenocarcinoma refractory to one or two courses of prior chemotherapy were treated with erlotinib at 150 mg/day. The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS) and best tumor response rate (RR).

Results and conclusion

In total, 327 patients were included. Median PFS and OS were 3.3 and 14.4 months, respectively. Three patients (1.2%) had complete response, 51 patients (20.2%) had partial response and 123 patients (48.8%) had SD.Significantly longer median PFS and OS were observed in Eastern Oncology Cooperative Group Performance Status (ECOG PS) 0-1 patients, as compared to ECOG PS 2-3 patients. The longest median OS (20.5 months) was found in patients with ECOG PS 0-1 who received erlotinib as a second-line therapy. There was no difference in median OS in cohorts stratified to disease stage and smoking status. Female patients had both longer median PFS and OS. Disease control rate was 70.2%.Our results suggest that erlotinib represents a valid treatment option for patients with KRAS WT lung adenocarcinoma and, moreover, that KRAS mutation analysis could help to identify clinically relevant subgroups of NSCLC patients that may benefit from EGFR-TKI therapy.     

Novel SuperMap feature of dipole charge density mapping technique offers advantages for redo catheter ablation in highly symptomatic patients with inappropriate sinus tachycardia: A case series

Ablation procedures using classical sequential mapping systems may fail to eliminate IAST. The AcQMap dipole charge density mapping technique may offer improved accuracy and has a potential added value for the ultimate success of eliminating IAST. The use of the AcQMap should be considered for redo, as well as first line therapy for patients with symptomatic IAST.     

Accuracy of atrial fibrillation detection by an insertable cardiac monitor in patients undergoing catheter ablation: Results of the BioVAD study

BackgroundInsertable cardiac monitors (ICMs) are increasingly used to evaluate the atrial fibrillation (AF) burden after catheter ablation of AF. BioMonitor III (BM3) is an ICM with a long sensing vector, which enhances sensing capabilities. The AF detection algorithm of the BM3 is based on R–R interval variability.ObjectiveTo evaluate the performance of the AF detection algorithm of BM3 in patients before and after catheter ablation of AF using simultaneous Holter recordings.MethodsIn this prospective study, we enrolled patients scheduled for catheter ablation of paroxysmal or persistent AF. After BM3 implantation, patients had a 4 days Holter registration before and 3 months after ablation. All true AF episodes ≥2 min on the Holter were annotated and matched with BM3 detected AF detections.ResultsThirty‐one patients were enrolled (mean age 60 ± 8, 74% male, 68% paroxysmal AF). Fifty‐six Holter registrations were performed in 30 patients. Twelve patients demonstrated at least one true AF episode with a total AF duration of 570 h. The AF burden accuracy of BM3 before catheter ablation was 99.6%, with a duration sensitivity of 98.6% and a duration specificity of 99.9%. The AF burden accuracy of BM3 after catheter ablation was 99.8%, with a duration sensitivity of 90.2% and a duration specificity of 99.9%. Overall, the AF burden detected on the Holter and BM3 demonstrated a high Pearson correlation coefficient of 0.996.ConclusionBM3 accurately detects AF burden in patients before and after catheter ablation of AF.     

Elements Influencing Recruitment and Retention of Millennial Hospitalists Born in or after 1982: a Survey-Based Study

BackgroundHospitalist turnover is exceedingly high, placing financial burdens on hospital medicine groups (HMGs). Following training, many begin their employment in medicine as early-career hospitalists, the majority being millennials.ObjectiveTo understand what elements influence millennial hospitalists’ recruitment and retention.DesignWe developed a survey that asked participants to rate the level of importance of 18 elements (4-point Likert scale) in their decision to choose or remain at an HMG.ParticipantsThe survey was electronically distributed to hospitalists born in or after 1982 across 7 HMGs in the USA.Main MeasuresElements were grouped into four major categories: culture of practice, work-life balance, financial considerations, and career advancement. We calculated the means for all 18 elements reported as important across the sample. We then calculated means by averaging elements within each category. We used unpaired t-tests to compare differences in means for categories for choosing vs. remaining at an HMG.Key ResultsOne hundred forty-four of 235 hospitalists (61%) responded to the survey. 49.6% were females. Culture of practice category was the most frequently rated as important for choosing (mean 96%, SD 12%) and remaining (mean 96%, SD 13%) at an HMG. The category least frequently rated as important for both choosing (mean 69%, SD 35%) and remaining (mean 76%, SD 32%) at an HMG was career advancement. There were no significant differences between respondent gender, race, or parental status and ratings of elements for choosing or remaining with HMGs.ConclusionCulture of practice at an HMG may be highly important in influencing millennial hospitalists’ decision to choose and stay at an HMG. HMGs can implement strategies to create a millennial-friendly culture which may help improve recruitment and retention.KEY WORDS: Hospitalist, Hospital medicine group (HMG), Recruitment, Retention, Culture of practice, Millennial     

Late strut fracture of the Beall model 105 disc valve prosthesis

Strut fracture, with embolization of the disc occluder, caused the death of a 64-year-old man who had a Beall model 105 heart valve prosthesis in the mitral position for 13 years. Scanning electron microscopy of the fractured surface revealed evidence of a fatigue failure mechanism in the metal wire. The case is unique in that strut fractures affecting this prosthesis had only been observed previously in the range of 141 to 342 days after implantation. Morphological changes in this valve prompted reexamination of three other model 105 prostheses that had been recovered from the mitral area at necropsy or surgery 9 to 10 years after insertion in 1972 or 1973. All had been kept in dry storage. The three prostheses and the valve described above showed previously unrecognized cracks in the pyrolytic carbon coating of the struts, which form the cage that limits occluder movement. The defects were located at or near the base of struts, where they entered the sewing ring and were bent to pass into the strut supporting ring. We believe that the cracks in the carbon coating precede total strut fracture and postulate that they are needed for the metal wire to be subject to a fatigue failure mechanism.