Malmbergsiegel1613

Smoldering multiple myeloma (SMM) is a precursor disease state that precedes the development of symptomatic myeloma. As we have learned more about the disease biology of SMM and risk factors for progression, updated risk stratification models, such as the Mayo 2018 model, or 20/2/20, have been developed. More accurate risk stratification and the development of effective and well-tolerated therapeutic agents have led to the investigation of early treatment of select patients with high-risk SMM with the aim of delaying time to progression to multiple myeloma. Ongoing debate surrounds which subset of patients with SMM to target, as well as the best treatment approach preventative versus curative. Phase III data from the Spanish Myeloma Group/PETHEMA as well as the Eastern Cooperative Oncology Group (ECOG) E3A06 trial have shown the efficacy of lenalidomide with and without dexamethasone in high-risk SMM in delaying progression to symptomatic disease. Conversely, there exists an alternate strategy attempting to cure the disease prior to progression utilizing more intensive regimens similar to what is used for patients with newly diagnosed myeloma. selleck compound However, our understanding of the disease biology of SMM and the role of immune regulation in preventing malignant transformation provides a strong rationale for an interventional strategy. Here, we review the definition of SMM, the current models for risk stratification, and the current data available supporting the early treatment of patients with high-risk SMM.A new job is always a difficult step to take in one's career. Negotiating the optimal contract is paramount. The contract should be a reasonable agreement that satisfies both parties the enterprise and the prospective candidate. Some contract clauses are usually non-negotiable because these items are required for the job. Examples include board certification, insurance for liabilities, faculty standing for a specific position, and so forth. Other clauses are negotiable and should be negotiated, including salary, resources to perform the job, work hours, and so on. This article details what to expect in a contract, how to think about it, and how to act on it. Possible careers for an oncologist are reviewed and include academia, private practice, and industry at the largest sense. Recommendations are to be certain that the choice of career feels comfortable, to read and fully understand the contract, to obtain a few contracts from different job offers to draw comparisons, to ask questions until all items are clarified, and to not be shy in asking what is not reflected in the contract but would assuage the unknown of assuming the duties and deliverables of a new job.Since 1944, when Huggins and Hodges demonstrated the effectiveness of bilateral orchiectomy for metastatic prostate cancer (PCa), androgen deprivation therapy (ADT) has been the first-line treatment for men with advanced PCa. The proportion of PCa cases that are metastatic at diagnosis ranges globally, from 5%-20% in countries with widespread screening practices to upward of 30%-60% where screening is minimal. In the United States alone, there will be an estimated 191,000 new cases of PCa diagnosed in the year 2020, of which approximately 20% will be metastatic.1 Ongoing controversy around prostate-specific antigen (PSA) screening practices, increased access to novel imaging modalities, and a globally aging population will drive increased rates of metastatic castration-sensitive prostate cancer (mCSPC).2,3 At the same time, advances in upfront hormonal or chemohormonal therapy have driven a dramatic shift in treatment paradigms. In this article, we review recent advances in treatment choices for men with newly diagnosed mCSPC and the impact of upfront treatment on subsequent disease biology. Options include treatment with chemohormonal therapy, androgen receptor (AR)-directed therapy in addition to ADT, or, less commonly, ADT alone. Treatment choice must include consideration of clinical and disease characteristics, as well as patient preferences and limitations of geography and financial concerns.OBJECTIVES Only a few medications have a United States Food and Drug Administration indications for prevention and/or treatment of infections in patients with tympanic perforations or tympanostomy tubes. We examined 3 off-label agents that have become important in tympanostomy tube care hoping to demonstrate the effectiveness and safety of each in experimental assays and human application. METHODS Computerized literature review. RESULTS (1) Oxymetazoline nasal spray applied at the time of surgery is equivalent to fluoroquinolone ear drops in the prevention of early postsurgical otorrhea and tympanostomy tube occlusion at the first postoperative visit. (2) Topical mupirocin 2% ointment is effective alone or in combination with culture-directed systemic therapy for the treatment of tympanostomy tube otorrhea caused by community-acquired, methicillin-resistant Staphylococcus aureus. (3) Topical clotrimazole 1% cream is highly active against the common yeast and fungi that cause otomycosis. A single application after microscopic debridement will cure fungal tympanostomy tube otorrhea in most cases. None of these 3 agents is ototoxic in animal histological or physiological studies, and each has proved safe in long-term clinical use. CONCLUSIONS Oxymetazoline nasal spray, mupirocin ointment, and clotrimazole cream are safe and effective as off-label medications for tympanostomy tube care in children.OBJECTIVES Tonsillectomy (TE) and tonsillotomy (TO) due to recurrent episodes of acute tonsillitis (RAT) belong to the most frequent surgical procedures. However, an adequate objective marker predicting the outcome of TE/TO preoperatively is missing. METHODS Patients with RAT who underwent TE/TO (n = 31) were included in this pilot study. A panel of cytokines and chemokines in serum and saliva were determined preoperatively. Health-related quality of life was assessed pre- and postoperatively by the Tonsillectomy Outcome Inventory-14. RESULTS Health-related quality of life improved significantly after surgery. Increased serum levels of interleukin-8 (IL-8) and interferon gamma (IFN-γ) are associated with a less successful outcome. No correlation between the number of acute tonsillitis episodes and the health-related quality of life after TE or TO could be observed. CONCLUSIONS Tonsillectomy and TO improve health-related quality of life independently from the number of past acute tonsillitis episodes. Interleukin-8 and IFN-γ in serum may serve as promising markers, predicting the benefit of TE or TO for patients preoperatively.