Essential Rewards - slide5

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i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource. This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and Associate Division Director for Ambulatory Operations The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma. STATEMENT OF NEED Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL. Target Audience Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL). Learning Objectives 1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL 2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults 3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection

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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo - Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI - Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html - Link to NephroTube website: www.NephroTube.com - Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html

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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram. Learning objectives: 1. Define an electrocardiogram (ECG) and electrocardiography 2. Describe how dipoles generated by the heart produce the waveforms of the ECG 3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II) 4. Differentiate between intervals and segments 5. Enlist some common indications for obtaining an ECG Study Resources: 1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition 2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition 3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition 4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/ 5. ECG in Medical Practice by ABM Abdullah, 4th edition 6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics

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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol that is rapidly distributed in the body and brain. Ethanol alters many neurochemical systems and has rewarding and addictive properties. It is the oldest recreational drug and likely contributes to more morbidity, mortality, and public health costs than all illicit drugs combined. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder (AUD), with mild, moderate, and severe subclassifications (American Psychiatric Association, 2013). In the DSM-5, all types of substance abuse and dependence have been combined into a single substance use disorder (SUD) on a continuum from mild to severe. A diagnosis of AUD requires that at least two of the 11 DSM-5 behaviors be present within a 12-month period (mild AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria). The four main behavioral effects of AUD are impaired control over drinking, negative social consequences, risky use, and altered physiological effects (tolerance, withdrawal). This chapter presents an overview of the prevalence and harmful consequences of AUD in the U.S., the systemic nature of the disease, neurocircuitry and stages of AUD, comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and pharmacotherapies for AUD.

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RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.

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