The objective of this guideline is to provide healthcare professionals with clear guidance on the anti-myeloma management of patients with newly diagnosed multiple myeloma. In all cases, individual patient circumstances may dictate an alternative approach. MethodologyThis guideline was compiled according to the BSH process at https://b-s-h.org.uk/media/16732/bsh-guidance-developmentprocess-dec-5-18.pdf.The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http:// www.gradeworkinggroup.org. Literature ReviewRecommendations are based on a review of the literature using Medline, PubMed, Embase, Central, Web of Science searches from the beginning of 2013 up to July 2019. The following search terms were used: myeloma; plasma cell leukaemia; AND risk;

Open or uncontrolled studies have suggested that providing cancer patients with audiotapes of their clinical interviews can improve information recall and reduce psychological distress. We tested these hypotheses in a 'clinician-blind', prospective, randomised controlled trial. A total of 117 patients newly referred to a medical oncology clinic who were to be given 'bad news' had their consultations audiotaped. Blind to the clinician, patients were randomly allocated to receive a copy of the tape to play at home or not (control group). At 6 months follow-up, tape group patients reported positive attitudes to the audiotape and were shown to recall significantly more information about their illness than did controls. Overall improvement in psychological distress at 1 and 6 months follow-up, as measured with the 30-item General Health Questionnaire and the Hospital Anxiety and Depression Scale was no different in the two groups. However, a second-order interaction suggested that poor-prognosis patients were disadvantaged specifically by access to the audiotape, with less improvement in psychological distress at 6 months follow-up than non-tape controls. Patient access to audiotapes of clinical interviews promotes factual retention but does not reliably reduce psychological distress and may be actively unhelpful in some subgroups of patients.

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Summary Delayed lymphocyte and T‐cell immune reconstitution following bendamustine‐rituximab (BR) for indolent non‐Hodgkin lymphoma (iNHL) has been described, but no information is available for chronic lymphocytic leukaemia (CLL). We present a population‐based retrospective analysis of immune reconstitution and risk of infection following BR. Outcomes included timing/correlates of CD4+ recovery and risk of ≥grade 3 infections. Consecutively treated patients (1 April 2014 to 31 January 2017) were included (n = 295),with a median age of 65 years (range 33–92); 57% were 1st line treatments. Median cumulative bendamustine dose was 1080 mg/m2 (range 140–1440 mg/m2). CD4/CD8/CD19/NK subsets were available for 148 patients. Median follow‐up was 24 months. Median times to lymphocyte count (ALC) recovery (≥1 × 109/l) and CD4+ recovery (≥0·2 × 109/l) were 26 and 24 months, respectively. Bendamustine total dose >1080 mg/m2 (hazard ratio [HR] 0·4; 95% confidence interval [CI]: 0·2–0·8), end‐of‐treatment ALC ≤0·4 × 109/l (HR 0·53; 95% CI: 0·3–0·9) and CD4+ <0·1 × 109/l 1‐year post‐BR (HR 0·03; 95% CI: 0·008–0·15) were covariables for delayed CD4+ recovery. ALC‐recovery ≥1 × 109/l was an unreliable predictor of CD4+ recovery (negative predictive vale 74%, positive predictive value 86%, likelihood ratio 3·3). CD4+ lymphopenia >3 years was a significant risk factor for ≥grade 3 infections (Odds ratio 3·4; 95% CI: 1·4–6·9). CD4+ recovery after BR is unexpectedly delayed and late recovery is associated with risk of serious infections. Monitoring CD4+ following BR could identify patients at high risk of delayed infections.

A common characteristic of the language deficits experienced by children with autism (and other developmental disorders) is their failure to acquire a complex intraverbal repertoire. The difficulties with learning intraverbal behaviors may, in part, be related to the fact that the stimulus control for such behaviors usually involves highly complex verbal stimuli. The antecedent verbal control of intraverbal behavior may involve discriminative stimuli (i.e., discriminated operants), conditional stimulus control, and/or control by compound stimuli. Distinctions among these different types of antecedent control are presented, along with recommendations for intervention procedures that may facilitate the acquisition of intraverbal behavior.

Endoscopic correction of vesicoureteral reflux is an attractive alternative to open repair. In terms of effectiveness and long-term successful results polytetrafluoroethylene (Polytef) is the most reliable injectable product. However, legitimate concerns regarding particle migration still exist for polytetrafluoroethylene. Polydimethylsiloxane (Macroplastique) was evaluated as an alternative to polytetrafluoroethylene. Seven mongrel female dogs underwent endoscopic suburothelial injections of 0.35 to 0.50 cc polydimethylsiloxane paste by the O'Donnell technique to a unilateral nonrefluxing ureteral orifice. To facilitate migratory surveillance the paste was mixed with 57carbon monoxide radiolabeled 80 microns. microspheres and injected in 5 of the 7 animals. Animals were sacrificed at 1, 3 and 6-month intervals. All major organs were retrieved and processed. After intensive histological evaluation the remaining tissue underwent dissolution and centrifugation in sodium hypochlorite. The resulting insoluble pellet was further analyzed. In dogs injected with radiolabeled paste tissue samples and insoluble pellets of each organ system were analyzed for gamma counts. Smears of the insoluble pellets of all animals were examined on light and phase contrast microscopy. At autopsy no gross abnormalities were noted. Tissue reaction at injection sites revealed a well encapsulated foreign body reaction with predominantly giant cells, fibroblasts and collagen deposition. Limited local migration of polydimethylsiloxane particles into the periureteral lymphatics of 1 animal sacrificed at 1 month was noted and a single particle visually indistinguishable from polydimethylsiloxane also was found within the splenic capsule. The endoscopic procedure in this animal was complicated in that 2 separate injections were required and histological evaluation confirmed that the injections were performed uniquely deep into the bladder muscularis. Radioactive counts and dissolution of all major organ systems demonstrated no migration in the remaining 6 animals. Endoscopic subureteral injection of polydimethylsiloxane is technically feasible, and it may prove to be biocompatible and without risk of distant migration if injected correctly.

This series represents the largest reported multi-institutional experience with the Snodgrass technique. When used in conjunction with vascularized dartos flap coverage, 2-layer closure of the neourethra and special attention to preservation of the periurethral vascular supply, this repair can be performed with a near 0 complication rate. We believe that this is the optimal repair for routine cases of hypospadias.

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