Resistance to Hypomethylating Agents in Myelodysplastic Syndrome and Acute Myeloid Leukemia From Clinical Data and Molecular Mechanism

The nucleoside analogs decitabine (5-AZA-dC) and azacitidine (5-AZA) have been developed as targeted therapies to reverse DNA methylation in different cancer types, and they significantly improve the survival of patients who are not suitable for traditional intensive chemotherapies or other treatment regimens. However, approximately 50% of patients have a response to hypomethylating agents (HMAs), and many patients have no response originally or in the process of treatment. Even though new combination regimens have been tested to overcome the resistance to 5-AZA-dC or 5-AZA, only a small proportion of patients benefited from these strategies, and the outcome was very poor. However, the mechanisms of the resistance remain unknown. Some studies only partially described management after failure and the mechanisms of resistance. Herein, we will review the clinical and molecular signatures of the HMA response, alternative treatment after failure, and the causes of resistance in hematological malignancies.

Comparison of Parametric and Non-Parametric Methods to Analyse the Data Gathered by a Likert-Type Scale

The aim of this chapter is to reveal whether the results of the analysis of the data obtained using Likert type scales (LTSs) with parametric and non-parametric methods in different response alternative (DRA) numbers will differ in terms of statistical significance. In this respect, the data were obtained from 271 university students with CETSCALE prepared using LTS in five different response alternatives (DRAs). The data were analysed using the one sample t test and Wilcoxon signed rank test. Significant findings of the study in the analysis of the data obtained using midpoint LTSs and with the normal distribution with both parametric and non-parametric methods couldn't be found. Similarly, the data obtained by four response alternative numbers with the normal distribution were analysed by both methods, and the significant findings were revealed. However, the results of the data obtained by six and eight response alternative numbers with parametric methods were found to be statistically significant while their analysis by non-parametric methods did not reveal significant findings.

Nerve ultrasound for diagnosing chronic inflammatory neuropathy

ObjectiveTo validate the diagnostic accuracy of a previously described short sonographic protocol to identify chronic inflammatory neuropathy (CIN), including chronic inflammatory demyelinating polyneuropathy (CIDP), Lewis Sumner syndrome, and multifocal motor neuropathy (MMN), and to determine the added value of nerve ultrasound to detect treatment-responsive patients compared to nerve conduction studies (NCS) in a prospective multicenter study.MethodsWe included 100 consecutive patients clinically suspected of CIN in 3 centers. The study protocol consisted of neurologic examination, laboratory tests, NCS, and nerve ultrasound. We validated a short sonographic protocol (median nerve at forearm, upper arm, and C5 nerve root) and determined its diagnostic accuracy using the European Federation of Neurological Societies/Peripheral Nerve Society criteria of CIDP/MMN (reference standard). In addition, to determine the added value of nerve ultrasound in detecting treatment-responsive patients, we used previously published diagnostic criteria based on clinical, NCS, and sonographic findings and treatment response (alternative reference standard).ResultsSensitivity and specificity of the sonographic protocol for CIN according to the reference standard were 87.4% and 67.3%, respectively. Sensitivity and specificity of this protocol according to the alternative reference standard were 84.6% and 72.8%, respectively, and of NCS 76.1% and 93.4%. With addition of nerve ultrasound, 44 diagnoses of CIN were established compared to 33 diagnoses with NCS alone.ConclusionsA short sonographic protocol shows high diagnostic accuracy for detecting CIN. Nerve ultrasound is able to detect up to 25% more patients who respond to treatment.Classification of evidenceThis multicenter study provides Class IV evidence that nerve ultrasound improves diagnosis of CIN.

The impact of the COVID-19 pandemic on medical education

The coronavirus pandemic has caused major disruption of systems worldwide, including education and health services. The duration and scale of the impact is yet to be established. The effect of the pandemic on medical education should be managed on the basis of early response, alternative education options and future changes and actions.

The internal/external debate: The tensions within social work supervision

INTRODUCTION: Supervision is crucial to social workers’ practice. Within the current managerial social services environment, the supervisor juggles organisational and professional accountabilities—organisational agendas often dominate practitioners’ reflection. In response, alternative types of supervision have emerged, one of which is external supervision.METHODS: This paper analyses qualitative discussions with key informants and supervisory dyads in community-based child welfare services regarding reflective practices in supervision. Internal and external supervision arrangements were discussed in depth relative to their impact on social work practice.FINDINGS: Analysis of discussions identified four themes: the significance of external supervision for building capacity, resilience and confidential reflective space; the role of internal supervision for managerial and organisational agendas; tensions associated with external supervision regarding funding and accountability; and important attributes of the supervisor in successful working relationships.CONCLUSIONS: External supervision is essential for professional competence but considerable inter-organisational variation exists in how this is utilised. Three key considerations emerged: accountabilities of external supervisor, supervisee and internal supervisor towards collaborative practice, evaluation and feedback; purchasing of external supervision; and the professional development of external supervisors. Further education connecting the importance of the supervisory relationship to realise critical thinking and practice development is essential for the future of social work.

Hemodynamic changes during orotracheal intubation using Airtraq video laryngoscope and direct laryngoscope: A randomized comparative study

Introduction: Direct laryngoscopy is associated with sympathetic stimulation and altered hemodynamics. A long intubation time may result in a greater in stress response. Alternative techniques using video laryngoscopes have been developed that do not require direct vocal cord visualization and may decrease the hemodynamic response. This study aimed to compare the difference between hemodynamic changes and intubation time with Airtraq video laryngoscope and conventionl Macintosh direct laryngoscope. Methods: A prospective randomized comparative study was conducted involving 100 adult patients who were undergoing elective surgeries under general anesthesia and endotracheal intubation. The patients were randomly assigned to group V (Video laryngoscope) or group D (Direct laryngoscope). In addition to the baseline vitals and vitals at various time intervals, intubation time was also recorded. We considered a difference in Heart Rate and Mean Arterial pressure of 20% to be clinically significant and statistical significance was p-value <0.05. Results: Significant difference was found in heart rates immediately after laryngoscopy (110.40 vs. 105.02 beats/minute; p<0.01) and 1 minute after intubation (109.30 vs. 106.20 beats/minute; p<0.01) with attenuation seen in video laryngoscopy group. Blood pressures were similar in both the groups at all times. Time for intubation was prolonged in video laryngoscopy group than that for direct laryngoscopy group (26.54 vs. 22.80 seconds; p<0.05). There were no adverse events associated with either of the techniques. Conclusions: The Airtraq video laryngoscopy resulted in lesser change in heart rate and longer intubation time. However, clinical impact of such a difference seemed to be insignificant.