Lenalidomide is an antiangiogenic drug associated with hypothyroidism. We describe a case-series of lenalidomide use in hematological cancers and the prevalence of thyroid abnormalities. We reviewed medical records of patients treated with lenalidomide at a single center form 2005 to 2010 and extracted demographic, clinical, and laboratory data. Of 170 patients with confirmed lenalidomide use (age 64.9 ± 15 years), 148 were treated for multiple myeloma and 6% had thyroid abnormalities attributable only to lenalidomide. In patients with a previous diagnosis of thyroid dysfunction, the addition of lenalidomide therapy was associated with a higher incidence of subsequent TFTF abnormality (17%) as compared to patients with no previous diagnosis of thyroid dysfunction (6%) (P=0.0001). Many patients (44%) with pre-existing disease and a change in thyroid function before or while on lenalidomide had no further follow-up of their thyroid abnormalities, Of 20 patients who did not undergo any thyroid finction testing either before starting or while on lenalidomide for a median of 9.4 months ( ± 6.5), 35% developed new symptoms compatible with hypothyroidism, including worsened fating, constipation or cold intolerance. Symptoms of thyroid dysfunction overlap with side effects of lenalidomide. Thyroid hormone levele are not regularly evaluated in patients on lenalidomide. While on this treatment, thyroid abnormalities can occur in patients with no previous diagnoses and in patients with pre-existing abnormalities. Because symptoms of thyroid dysfunction could be alleviated by appropriate treatment, thyroid function should be evaluated during the course of lenalidomide to improve patients quality of life. Am. J. Hematol. 86:467-470, 2011. V
An analogue task of instrumental and hostile aggression during a competitive game, modified to minimize overlap between aggressive responses, was evaluated in 8- to 14-year-old clinically referred boys (n = 33). Postgame interviews indicated that the hostile response, an aversive noise, was perceived by over 80% of subjects as hostile and not instrumental. In contrast, the instrumental response, blocking the opponent's game, was perceived about equally as having instrumental and hostile functions. The hostile aggressive response was uniquely correlated with continuous performance task impulsive commission errors (r = .51), which supported the theoretical relation of hostile aggression to poor impulse control. These results suggest that instrumental and hostile aggression can be distinguished and when precisely defined are distinct in theoretically important ways.
Background Standing cone beam computed tomography (CT) provides cross‐sectional imaging of the caudal cervical articular process joints (CAPJs) in the sedated horse, though the clinical implications of osteoarthritis (OA) identified on CT in this location are unknown. Increases in concentrations of intra‐synovial cytokines could lend support to the clinical significance of CAPJ OA identified on this imaging modality. Objectives Investigate the presence and concentration of intra‐synovial inflammatory cytokines in CAPJs with and without standing cone beam CT evidence of OA using an equine specific multiplex assay. Study design Prospective clinical study. Methods Standing cone beam CT of C5‐6 and C6‐7 was performed on horses with CAPJ OA and control horses. Synovial fluid samples of the CAPJs of C5‐6 and C6‐7 were obtained bilaterally using ultrasound guidance and analysed for concentrations of IFN‐γ, IL‐1β, IL‐6, IL‐10, IL‐17 and TNFα with the Milliplex® multi‐analyte profiling kit. CT Images were retrospectively graded using a novel grading scheme. Significant differences between concentrations of inflammatory cytokines between joints with different categories of osteoarthritis severity were explored using a Wilcoxon rank‐sum test or Kruskal‐Wallis test. Results Concentrations of intra‐synovial cytokines were higher in joints with moderate to severe OA when compared to joints with no or mild OA, with differences in concentrations of IL‐17 reaching statistical significance (P = .007). Main limitations Limitations include discrepancy in number, age, and breed between control and OA populations, use of a novel grading scheme, and lack of a histologic gold‐standard to confirm the presence and severity of CAPJ OA. Conclusions Differences in inflammatory cytokines between caudal CAPJs with and without evidence of moderate to severe osteoarthritis on standing cone beam CT exist. This finding lends support to the clinical relevance of a diagnosis of moderate to severe CAPJ OA in the caudal cervical vertebral column as identified with this imaging modality.
Objective To report the long‐term outcome of horses treated with interspinous ligament desmotomy (ISLD) for pain associated with overriding dorsal spinous processes (ORDSP) and determine the influence of preoperative diagnostic analgesia on long‐term outcome. Study design Retrospective study. Animals Eighteen horses. Methods Data were collected from horses presenting for ISLD to the University of Pennsylvania New Bolton Center between January 2013 and May 2018. Follow‐up of ≥3 months postsurgically was obtained from the owner, trainer, or referring veterinarian. Long‐term improvement was compared between horses that improved with diagnostic analgesia presurgically and horses that did not undergo diagnostic analgesia presurgically by using a χ2 test. Univariate logistic regression was used to test associations between long‐term improvement and independent variables. Results Clinical signs had improved in 13 of 18 horses at long‐term follow‐up (median, 14.5 months; range, 3‐57). Clinical signs improved in nine of 10 horses responding to diagnostic analgesia but only in four of eight horses that did not undergo diagnostic analgesia (χ2[1], N = 18) = 3.55; P = .06). Although the likelihood of long‐term improvement increased with prior diagnostic analgesia (odds ratio = 6.3; 95% confidence interval = 0.73, 55.0; P = .09), it did not reach statistical significance. Conclusion A higher proportion of horses experienced long‐term improvement in clinical signs after ISLD when horses responding to preoperative diagnostic analgesia were compared with horses that were not tested. Clinical significance This study provides some evidence to support the use of diagnostic analgesia in conjunction with clinical examination for identification of clinically relevant ORDSP.
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