Risk Stratification and Treatment in Smoldering Multiple Myeloma

Smoldering multiple myeloma is a heterogeneous asymptomatic precursor to multiple myeloma. Since its identification in 1980, risk stratification models have been developed using two main stratification methods: clinical measurement-based and genetics-based. Clinical measurement models can be subdivided in three types: baseline measurements (performed at diagnosis), evolving measurements (performed over time during follow-up appointments), and imaging (for example, magnetic resonance imaging). Genetic approaches include gene expression profiling, DNA/RNA sequencing, and cytogenetics. It is important to accurately distinguish patients with indolent disease from those with aggressive disease, as clinical trials have shown that patients designated as “high-risk of progression” have improved outcomes when treated early. The risk stratification models, and clinical trials are discussed in this review.

Concordance rate of a four-quadrant plot for repeated measurements

Background To assure the equivalence between new clinical measurement methods and the standard methods, the four-quadrant plot and the plot’s concordance rate is used in clinical practice, along with Bland-Altman analysis. The conventional concordance rate does not consider the correlation among the data on individual subjects, which may affect its proper evaluation. Methods We propose a new concordance rate for the four-quadrant plot based on multivariate normal distribution to take into account the covariance within each individual subject. The proposed concordance rate is formulated as the conditional probability of the agreement. It contains a parameter to set the minimum concordant number between two measurement methods, which is regarded as agreement. This parameter allows flexibility in the interpretation of the results. Results Through numerical simulations, the AUC value of the proposed method was 0.967, while that of the conventional concordance rate was 0.938. In the application to a real example, the AUC value of the proposed method was 0.999 and that of the conventional concordance rate was 0.964. Conclusion From the results of numerical simulations and a real example, the proposed concordance rate showed better accuracy and higher diagnosability than the conventional approaches.

A Detailed Analysis Of Clinical Measurement Error In Ultrafiltration In Peritoneal Dialysis

BackgroundIt has been noticed for years that ultrafiltration is important for survival in peritoneal dialysis. On the other hand, ultrafiltration measurement is much more complicated than it thought to be. Both overfill and flush before fill used to be source of measurement error. However, controversy finding around ultrafiltration in peritoneal dialysis still exists.MethodsFour different brands of dialysate were purchased from the market. The freshest dialysate available in the market were intentionally picked. The dialysate were all 2L, 2.5% dextrose and traditional lactate buffered PD solution. They were stored in four different conditions with controlled temperature and humidity. The bags were weight at baseline, 6 months and 12 months of storage. Specific gravity was measured in mixed 24 hour drainage dialysate from 261 CAPD patients in a cross sectional manner. ResultsThere was significant difference in dialysate bag weight at baseline between brands. The weight declined significantly after 12 months storage. The weight loss was more significant in higher temperature and lower humidity. The dialysate in non-PVC package lose less weight than PVC package. The specific gravity of dialysate drainage was significantly higher than pure water and related to dialysate protein concentration.ConclusionStorage condition and duration, as well as the type of the dialysate package gave extra variance in overfill volume. The fact that specific gravity of dialysate drainage is higher than 1g/ml also contributes to systemic measurement error of ultrafiltration in manual exchanges.Trial Registration: ClinicalTrials.gov ID: NCT03864120 (March 8, 2019) (Understand the Difference Between Clinical Measured Ultrafiltration and Real Ultrafiltration)

Distribution of waist-to-height ratio and cardiometabolic risk in children and adolescents: a population-based study

This study was performed to evaluate the waist-to-height ratio (WHtR) distribution and assess its relationship with cardiometabolic risk in children and adolescents. A total of 8091 subjects aged 10–18 years were included from a nationally representative survey. Participants were classified into three groups: (1) < 85th, (2) ≥ 85th and < 95th, and (3) ≥ 95th percentile of WHtR. The WHtR distribution varied with sex and age. Whereas WHtR decreased from age 10–15 years in boys and from age 10–12 years in girls, it slightly increased thereafter. Compared to the < 85th percentile group, the WHtR ≥ 85th and < 95th percentile group had an odds ratio (OR) of 1.2 for elevated blood pressure (BP), 1.89 for elevated triglycerides (TGs), 1.47 for reduced high-density lipoprotein cholesterol (HDL-C) and 4.82 for metabolic syndrome (MetS). The ≥ 95th percentile group had an OR of 1.4 for elevated BP, 2.54 for elevated glucose, 2.22 for elevated TGs, 1.74 for reduced HDL-C, and 9.45 for MetS compared to the < 85th percentile group. Our results suggest that sex- and age-specific WHtR percentiles can be used as a simple clinical measurement to estimate cardiometabolic risk.

Invited commentary for asymmetric dimethylarginine (ADMA): Is it a risk factor in the repair of aortic coarctation?

Bas et al. report the clinical measurement, using High Performance Liquid Chromatography (HPLC), of asymmetric dimethyarginine in two groups of patients undergoing aortic coarctation repair.

Interrater reliability for unilateral and bilateral tests to measure the popliteal angle in children and youth with cerebral palsy

Background Short hamstring muscles can cause several problems for children with cerebral palsy. The results of the clinical measurement of hamstring length are often used in decision-making about treatment of children with cerebral palsy. There are different ways of performing this measurement. The aim of this study was to evaluate the interrater reliability of the unilateral and bilateral measurement of the popliteal angle in children and youth with cerebral palsy. Methods Two methods for estimating hamstring length using unilateral and bilateral measurements of the popliteal angle were applied in children with cerebral palsy. Both tests were applied bilaterally by two independent examiners on the same day for each child. The intraclass correlation coefficient (ICC) was calculated to evaluate the interrater reliability of both measurements. Seventy young people with cerebral palsy (32 females, 38 males, mean age 10 years 8 months, range 5–22 years) at Gross Motor Function Classification System levels I (n = 17), II (n = 31), III (n = 12) and IV (n = 10) were included. Results The interrater reliability was good for both measurements. The ICC values were 0.80 on the right and 0.86 on the left for the unilateral popliteal angle, and 0.82 on the right and 0.83 on the left for the bilateral popliteal angle. Conclusions Both unilateral and bilateral measurement of the popliteal angle is a reliable method for estimating hamstring length in children and youth with cerebral palsy.

Evaluation of Automated Segmentation Algorithm for Macular Volumetric Measurements of Eight Individual Retinal Layer Thickness

Background: We evaluated the performance of an automated algorithm available on a clinical OCT (Canon-HS100) for macular volumetric measurements of eight individual retinal layers. Methods and Analysis: Two consecutive three-dimensional scans were acquired on 29 subjects with healthy retinas. Thickness measurements were obtained from eight individual retinal layers in nine macular sectors based on Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. The repeatability was evaluated using the within-subject standard deviation from which the repeatability limits (Rlimit) and coefficient of variation (CoV) were calculated. Results: The repeatability metrics varied among different layers and sectors. The variation among the sectors was larger in two of the outer layers (plexiform and nuclear layer) and the retinal nerve fiber layer. For the other five layers, the repeatability limit was less than 5µm and CoV was less than 7.5% in all nine ETDRS sectors. Conclusions: The repeatability of the OCT-HS100 to measure eight individual retinal layers is good in general. Nevertheless, the repeatability is not homogeneous among different layers and sectors. This needs to be taken into account while designing clinical measurement protocols.