Prediction of early (4-week) mortality in acute myeloid leukemia with intensive chemotherapy

The progress with intensive chemotherapy and supportive care measures has improved survival in patients with newly diagnosed acute myeloid leukemia (AML). Given the recent development of effective low intensity therapies, an optimal decision on the therapy intensity may improve survival through the avoidance of early mortality. We reviewed the outcome of 3728 patients with newly diagnosed AML who received intensive chemotherapy between August 1980 and May 2020. Intensive chemotherapy was defined as a cumulative cytarabine dose ≥ 700 mg/m² during induction therapy. We divided the whole cohort into a training and validation group at a 3:1 ratio. The population was divided into a training (2790 patients) and a validation cohort (938 patients). The median age was 55 years (range, 15-99). Among them, 442 patients (12%) had core-binding factor AML. Binary logistic regression identified older age, worse performance status, hyperbilirubinemia, elevated creatinine, hyperuricemia, cytogenetic abnormalities other than CBF and -Y, and pneumonia as adverse prognostic factors for an early 4-week mortality. This risk classification for early mortality was verified in the validation cohort of patients. In the validation cohort of more recently treated patients from 2000 to 2017, the 4-week mortality rates with intensive chemotherapy were 2%, 14%, and 50% in the low-, high-, and very high-risk group, respectively. The mortality rates with low intensity therapies were 3%, 9%, and 20%, respectively. The risk classification guides treatment intensity by the assessment of age, frailty, organ dysfunction, cytogenetic abnormality, and infection to avoid early mortality.     

阴茎延长中使用V-Y成形术是否必要？介绍一种新的手术方式：单纯冠状沟下环形切口阴茎延长增粗术

本研究介绍了一种新的通过冠状沟下环形切口的悬韧带松解术，并确定其安全性和有效性。过去的7年中，我们连续做了82例阴茎增粗术。前35例男性患者接受下腹部V-Y成形切口韧带松解术（A组），后续47例男性患者接受冠状沟下环形切口韧带松解术（B组）。我们比较了两组手术时间、手术并发症和手术前后的阴茎长度和周径值以及手术前后的自信心、满意度评分。患者平均年龄为32岁（18—56岁）。79例患阴茎短小综合征，3例为小阴茎（牵拉长度〈7．5厘米）。A组和B组的平均手术时间分别为150．7分钟和125．2分钟（P=0．005）。4例（11％）A组患者和3例（6％）B组患者术后分别出现了阴茎回缩（P=0．453）。18例（51％）A组患者出现了手术瘢痕增生，而在环形切口手术组则未观察到明显切口并发症。两者阴茎长度和周径改善效果相当。但环形切口手术组满意度和自尊心和性关系问卷（SEAR）改善程度更高（P值分别为0．007和〈0．001）。在严格的病例筛选标准下，与V-Y成形术相比较，环形切口悬韧带松解术在安全性、手术时间、阴茎回缩率和外观方面均有改善，而在阴茎大小改善效果上无差异。     

On using contemporary motor theory for memory research with the aged

It was the goal of this study to determine whether there were age differences specifically associated with the ability to simultaneously execute two tasks, and whether cognitive costs correlated across different situations. Eighty-one young and 86 older adults underwent nine tasks, administered both in single and in dual conditions. Results showed large age differences in raw performances in all conditions. However, a larger cognitive cost in the older adults sample, as assessed by an Age 2 Condition interaction, was observed only for four out of the nine tasks. Furthermore, age effects were greatly diminished once performance in the single tasks was controlled for. Correlations between the dual tasks, or between the cognitive cost scores, were very low once age was partialled out. Results do not support the notion of general coordination costs and speak against a generalized increase in divided attention costs with advancing age.