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101.
Soo Borson Joshua Chodosh Cyndy Cordell Beth Kallmyer Malaz Boustani Anna Chodos Jatin K. Dave Lisa Gwyther Susan Reed David B. Reuben Stephen Stabile Monica Willis-Parker William Thies 《Alzheimer's & dementia》2017,13(10):1168-1173
There is now an unprecedented opportunity to improve the care of the over 5 million people who are living with Alzheimer's disease and related dementias and many more with cognitive impairment due to brain injury, systemic diseases, and other causes. The introduction of a new Medicare care planning benefit—long sought openly by advocacy organizations and clinicians and badly needed by patients and families—could greatly improve health care quality, but only if widely and fully implemented. We describe the components of this new benefit and its promise of better clinical care, as well as its potential to create a new platform for clinical and health outcomes research. We highlight external factors—and some that are internal to the benefit structure itself—that challenge the full realization of its value, and we call for broad public and professional engagement to ensure that it will not fail. 相似文献
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Jorge J. Castillo Artur Jurczyszyn Lucie Brozova Edvan Crusoe Jacek Czepiel Julio Davila Angela Dispenzieri Marion Eveillard Mark A. Fiala Irene M. Ghobrial Alessandro Gozzetti Joshua N. Gustine Roman Hajek Vania Hungria Jiri Jarkovsky David Jayabalan Jacob P. Laubach Barbara Lewicka Vladimir Maisnar Elisabet E. Manasanch Philippe Moreau Elizabeth A. Morgan Hareth Nahi Ruben Niesvizky Claudia Paba‐Prada Tomas Pika Ludek Pour John L. Reagan Paul G. Richardson Jatin Shah Ivan Spicka Ravi Vij Anna Waszczuk‐Gajda Morie A. Gertz 《American journal of hematology》2017,92(8):746-751
IgM myeloma is a rare hematologic malignancy for which the clinicopathological features and patient outcomes have not been extensively studied. We carried out a multicenter retrospective study in patients with diagnosis of IgM myeloma defined by >10% marrow involvement by monoclonal plasma cells, presence of an IgM monoclonal paraproteinemia of any size, and anemia, renal dysfunction, hypercalcemia, lytic lesions and/or t(11;14) identified by FISH. A total of 134 patients from 20 centers were included in this analysis. The median age at diagnosis was 65.5 years with a male predominance (68%). Anemia, renal dysfunction, elevated calcium and skeletal lytic lesions were found in 37, 43, 19, and 70%, respectively. The median serum IgM level was 2,895 mg dL?1 with 19% of patients presenting with levels >6,000 mg dL?1. International Staging System (ISS) stages 1, 2, and 3 were seen in 40 (33%), 54 (44%), and 29 (24%) of patients, respectively. The malignant cells expressed CD20 (58%) and cyclin D1 (67%), and t (11;14) was the most common cytogenetic finding (39%). The median overall survival (OS) was 61 months. Higher ISS score was associated with worse survival (P = 0.02). Patients with IgM myeloma present with similar characteristics and outcomes as patients with more common myeloma subtypes. 相似文献
103.
Reed V Shah J Medeiros LJ Ha CS Mazloom A Weber DM Arzu IY Orlowski RZ Thomas SK Shihadeh F Alexanian R Dabaja BS 《Cancer》2011,117(19):4468-4474
BACKGROUND:
The objective of this study was to review the outcome of patients with solitary plasmacytoma (SP) after definitive radiation therapy.METHODS:
The authors retrospectively reviewed 84 patients with SP who were diagnosed and treated at The University of Texas MD Anderson Cancer Center during 1988 to 2008. The impact of tumor anatomic site, tumor size, and the presence of serum and urinary paraprotein at diagnosis was assessed on local control, survival, and the risk of developing multiple myeloma (MM).RESULTS:
Fifty‐nine patients (70%) had bone SP, and 25 patients (30%) had extramedullary SP. Serum paraprotein was present in 39 patients (46%). The median radiation dose was 45 grays (Gy) (range, 36‐53.4 Gy). Local control was achieved in 77 patients (92%). Neither radiation dose nor tumor size predicted local control. The 5‐year rate of progression to MM was 47% and was higher for patients with bone SP (56% vs 30% for extramedullary SP; P = .021), and patients who had serum paraprotein detected at diagnosis (60% vs 39%; P = .016). On univariate analysis, patients aged <60 years and men had higher rates of progression to MM, although the differences were not significant (P = .048 and P = .29, respectively). Multivariate analysis revealed that bone location and serum protein at diagnosis were associated statistically with progression to MM. The 5‐year overall survival rate for the entire patient cohort was 78%, and no difference was observed between patients who had bone SP versus extramedullary SP (76% vs 85%, respectively; P = .274).CONCLUSIONS:
The current results indicated that definitive radiation therapy for SP can provide excellent local control. Progression to MM remains the main problem and is more common among patients with bone SP and those who have serum paraprotein detected at diagnosis. Cancer 2011;. © 2011 American Cancer Society. 相似文献104.
Ravindra C. Savadi Jatin Agarwal Rolly Shrivastava Agarwal V. Rangarajan 《Journal of Indian Prosthodontic Society》2011,11(4):221-231
A three-dimensional Finite Element Method was used to study the influence of porous coated surface topography of an implant on stress and strain distribution pattern in the cortical and cancellous bone during axial and non-axial loading. Two implants, one with porous surface topography and one with smooth surface were embedded in separate geometric models of posterior mandibular region which was generated using a CT scan data. Material properties and boundary conditions were applied. Load of 100 and 50 N were applied on to the abutment from axial and non-axial directions respectively. Porous surface topography appeared to distribute stress in a more uniform pattern around the implant with near absence of stress in the apical region of implant. Smooth surfaced implant showed high punching stress at the apex of the implant. The porous coated interface was considered to simulate the shock absorbing behavior of periodontal ligament of natural dentition. Maximum amount of stress concentration was observed in the cortical bone which plays a major role in the dissipation of the stress. 相似文献
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Outcomes in patients with multiple myeloma with TP53 deletion after autologous hematopoietic stem cell transplant 下载免费PDF全文
Sameh Gaballa Rima M. Saliba Samer Srour Gary Lu Jonathan E. Brammer Nina Shah Qaiser Bashir Krina Patel Fabian Bock Simrit Parmar Chitra Hosing Uday Popat Ruby Delgado Gabriela Rondon Jatin J. Shah Elisabet E. Manasanch Robert Z. Orlowski Richard Champlin Muzaffar H. Qazilbash 《American journal of hematology》2016,91(10):E442-E447
TP53 gene deletion is associated with poor outcomes in multiple myeloma (MM). We report the outcomes of patients with MM with and without TP53 deletion who underwent immunomodulatory drug (IMiD) and/or proteasome inhibitor (PI) induction followed by autologous hematopoietic stem cell transplant (auto‐HCT). We identified 34 patients with MM and TP53 deletion who underwent IMiD and/or PI induction followed by auto‐HCT at our institution during 2008–2014. We compared their outcomes with those of control patients (n = 111) with MM without TP53 deletion. Median age at auto‐HCT was 59 years in the TP53‐deletion group and 58 years in the control group (P = 0.4). Twenty‐one patients (62%) with TP53 deletion and 69 controls (62%) achieved at least partial remission before auto‐HCT (P = 0.97). Twenty‐three patients (68%) with TP53 deletion and 47 controls (42%) had relapsed disease at auto‐HCT (P = 0.01). Median progression‐free survival was 8 months for patients with TP53 deletion and 28 months for controls (P < 0.001). Median overall survival was 21 months for patients with TP53 deletion and 56 months for controls (P < 0.001). On multivariate analysis of both groups, TP53 deletion (hazard ratio 3.4, 95% confidence interval 1.9–5.8, P < 0.001) and relapsed disease at auto‐HCT (hazard ratio 2.0, 95% confidence interval 1.2–3.4, P = 0.008) were associated with a higher risk of earlier progression. In MM patients treated with PI and/or IMiD drugs, and auto‐HCT, TP53 deletion and relapsed disease at the time of auto‐HCT are independent predictors of progression. Novel approaches should be evaluated in this high‐risk population. Am. J. Hematol. 91:E442–E447, 2016. © 2016 Wiley Periodicals, Inc. 相似文献