A prospective study of tobacco use and multiple myeloma: evidence against an association

The relationship between the use of cigarettes and other tobacco products and the risk of multiple myeloma was examined in a cohort of nearly 250,000 American veterans followed prospectively for 26 years. Compared with men who had never used tobacco, the risk of death from myeloma was not increased among current (relative risk [RR]=0.9, 95 percent confidence interval [CI]=0.8–1.2) or former (RR=1.0, CI=0.8–1.3) cigarette smokers, nor among users of chewing tobacco or snuff (RR=1.0, CI=0.4–2.3). Risk was only slightly and nonsignificantly increased among pipe or cigar smokers (RR=1.2, CI=0.9–1.5). There was no indication of increasing risk with amount of tobacco used or earlier age at first use. With over 90 percent power to detect a 30 percent increased risk of this tumor occuring among current cigarette smokers, this study provides the strongest evidence to date against an association of cigarette smoking with multiple myeloma.Epidemiology and Biometry Program, Division of Cancer Etiology, National Cancer Institute. Westat, Inc. Rockville, MD. National Cancer Institute, 6130 Executive Blvd, Room 418, Rockville, MD 20892, USA.     

Vascular endothelial differentiation in sponge matrix allografts

These studies test the hypothesis that vascular endothelia in sponge allografts may develop a function and phenotype resembling the high endothelial venules (HEV) in lymph nodes, thus facilitating the lymphocytic infiltration that is characteristic of allograft rejection. Using limiting dilution analysis to quantitate helper-T-cell accumulation at graft sites, immunohistologic analysis of graft reactivity with the HEV-specific monoclonal antibody MECA 325, and ex vivo lymphocyte-endothelial adhesion assays with graft tissues, we obtained evidence to suggest that HEV-like endothelia may develop at a graft site but that the process whereby lymphocytes accumulate at a graft site is more complex than was initially expected.     

Single-agent versus combination chemotherapy in advanced non-small-cell lung cancer: the cancer and leukemia group B (study 9730).

PURPOSE: We compared the efficacy of combination chemotherapy versus single-agent therapy in patients with advanced non-small-cell lung cancer. PATIENTS AND METHODS: A total of 561 eligible patients were randomly assigned to receive paclitaxel alone or in combination with carboplatin. RESULTS: The response rate was 17% in the paclitaxel arm and 30% in the carboplatin-paclitaxel arm (P < .0001). Median failure-free survival was 2.5 months in the paclitaxel arm and 4.6 months in the carboplatin-paclitaxel arm (P = .0002). Median survival times were 6.7 months (95% CI, 5.8 to 7.8) and 8.8 months (95% CI, 8.0 to 9.9), and 1-year survival rates were 32% (95% CI, 27% to 38%), and 37% (95% CI, 32% to 43%), respectively. The overall survival distributions were not statistically different: hazard ratio = 0.91 (95% CI, 0.77 to 1.17; P = .25). Hematological toxicity and nausea were more frequent in the combination arm, but febrile neutropenia and toxic deaths were equally low in both arms. There was no significant survival difference in elderly patients. Performance status 2 patients treated with combination chemotherapy had a better survival rate than those treated with single-agent therapy (P = .019). CONCLUSION: Combination chemotherapy improves response rate and failure-free survival compared with single-agent therapy, but there was no statistically significant difference in the primary end point of overall survival. The results in elderly patients were similar to younger patients. Performance status 2 patients had a superior outcome when treated with combination chemotherapy.     

Losing control: Assaultive behavior as a predictor of impulse control disorders in young adults

Objective

Assaultive behaviors are common among young people and have been associated with a range of other unhealthy, impulsive behaviors such as substance use and problem gambling. This study sought to determine the predictive ability of single assaultive incidents for impulse control disorders, an association that has yet to be examined, especially in young adults.

Methods

The authors conducted a university-wide email survey in the spring of 2011 on 6000 university students. The survey examined assaultive behavior and associated mental health variables (using a clinically validated screening instrument, the Minnesota Impulsive Disorders Interview), stress and mood states, and psychosocial functioning.

Results

The rate of response was 35.1% (n = 2108). 109 (5.9%) participants reported that they had assaulted another person or destroyed property at some time in their lives. Compared with respondents without lifetime assaultive behavior, those with a history of assaultive or destructive behavior reported more depressive symptoms, more stress, and higher rates of a range of impulse control disorders (intermittent explosive disorder, compulsive sexual behavior, compulsive buying, and skin picking disorder).

Conclusions

Assaultive behavior appears fairly common among college students and is associated with symptoms of depression and impulse control disorders. Significant distress and diminished behavioral control suggest that assaultive behaviors may often be associated with significant morbidity. Additional research is needed to develop specific prevention and treatment strategies for young adults attending college who report problems with assaultive behaviors.     

Suicidality in Non-Treatment Seeking Young Adults with Subsyndromal Gambling Disorder

Gambling Disorder is associated with elevated rates of suicidal thoughts and acts. However, virtually nothing is known about suicidality in people with subsyndromal forms of gambling disorder. A total of 174 non-treatment seeking subjects were recruited for a study of impulsivity and met criteria for a subsyndromal form of DSM-5 gambling disorder (31.0 % females; mean age = 21.7 ± 3.61 years). Subjects were categorized as being ‘at risk of suicide’ or ‘no suicide risk’ based on the Mini-International Neuropsychiatric Interview (MINI). Those with and without suicidality were compared on clinical and cognitive measures. 32 (18.4 %) met MINI criteria for suicidality. Suicidality was significantly associated with mood and anxiety disorders, greater rates of nicotine consumption, and relative impairments in decision-making and cognitive flexibility. These findings suggest that decision-making impairments may be implicated in the development of both gambling problems and suicidality. Future work should address causality, neural correlates, and tailored suicide prevention strategies for people with, or at risk for, disordered forms of gambling.