SLiM CRAB criteria revisited: temporal trends in prognosis of patients with smoldering multiple myeloma who meet the definition of 'biomarker-defined early multiple myeloma'-a systematic review with meta-analysis.

Background: Biomarker-defined patients with smoldering multiple myeloma (SMM) were included in the diagnostic category of multiple myeloma (MM) by the International Myeloma Working Group (IMWG) in 2014. This includes ≥60% bone marrow plasma cells (BMPCs), free light chain ratio (FLCratio) ≥100, and >1 MRI-defined ≥5 mm focal lesion, also called SLiM CRAB MM. We examined whether the risk of progression of SLiM CRAB MM patients to CRAB positive MM described in recent studies differs from that reported in earlier studies published before the introduction of the new diagnostic criteria. Methods: We conducted a systematic review with meta-analysis, and included studies on Embase and PubMed (01/01/2010-01/11/2022), selecting studies with digitizable progression curves. Inconsistent studies were excluded. We created forest plots using random effects models from digitized and published data and Kaplan-Meier curves. Main outcomes were median time to progression (TTP), 2-year progression risk, and odds ratios (ORs) comparing 2-year progression risks. Findings: Our meta-analysis including 11 studies with 3482 patients found an approximately 3-fold longer TTP and 50% lower 2-year progression risk of SliM CRAB MM patients in recent (published after 2014) compared with earlier studies. Median TTP in patients with ≥60% BMPCs was 30.31 months [18.71-62.93] in recent compared with 9.20 months [6.02-15.56] in earlier studies; the 2-year progression risk was 45.45% [20.12-62.75] compared with 86.21% [65.74-94.45] in the respective time periods. In patients with a FLCratio ≥ 100, the median TTP was 48.06 months [40.51-64.91] vs. 15.33 months [9.38-19.10], and the 2-year progression risk was 31.61% [25.30-37.39] vs. 73.00% [62.39-80.62] in recent and earlier studies, respectively. Tests for heterogeneity showed that the two time periods differed significantly in their ORs when comparing patients who met the high-and low risk criteria. No appropriate recent studies on focal lesions have been published. Interpretation: Recent studies show significantly improved prognosis of biomarker-defined MM with ≥60% BMPCs and FLCratio ≥ 100. This warrants careful evaluation for signs of progression before treatment initiation. Funding: Funding was provided by the Austrian Forum against Cancer.

The microstructure and the origin of the Venus from Willendorf.

The origin and key details of the making of the ~ 30,000 year old Venus from Willendorf remained a secret since its discovery for more than a hundred years. Based on new micro-computed tomography scans with a resolution of 11.5 µm, our analyses can explain the origin as well as the choice of material and particular surface features. It allowed the identification of internal structure properties and a chronological assignment of the Venus oolite to the Mesozoic. Sampling numerous oolite occurrences ranging ~ 2500 km from France to the Ukraine, we found a strikingly close match for grain size distribution near Lake Garda in the Southern Alps (Italy). This might indicate considerable mobility of Gravettian people and long-time transport of artefacts from South to North by modern human groups before the Last Glacial Maximum.

Are natural scientists more masculine than humanists? The association patterns between 2D:4D ratio and field of study.

ABSTRACT: Natural sciences are still considered as typical male fields, while humanities are interpreted as typical female topics. Economic, social but also biological factors are discussed to influence the choice of study field. In the present study, the impact of prenatal sex hormone exposure - estimated by 2D:4D ratio - on the choice of study field was analyzed. Two hundred Viennese students between the ages 18 and 28 years were enrolled. Lengths of the index finger and the ring finger were measured directly from the hand of the participants. 2D:4D ratios were calculated. Male and female students differed significantly in 2D:4D ratio. As expected, female students showed significantly higher 2D:4D ratios than their male counterparts (p < 0.001). Male scientists and male humanists differed significantly in 2D:4D ratio. The 2D:4D of male humanists was significantly higher than that of scientists (p = 0.037). Female scientists and female humanists however, did not differ significantly in 2D:4D ratio. Both showed a typical female 2D:4D ratio. This was also true of male humanists. Consequently low prenatal androgen exposure may be associated with the choice of humanities among male students.

Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients.

BACKGROUND: Interventional closure of atrial septal defects (ASDs) with a transcatheter device is the preferred strategy in children and adults. This procedure has been proven in numerous studies, but X-ray and contrast agent exposure is still a major side effect. The aim of this study was to clarify whether the interventional closure of ASDs is possible and safe if it is guided by transesophageal echocardiography (TEE) alone. METHODS AND RESULTS: We retrospectively selected and studied pediatric and adult patients with interventional closure of ASDs at the Deutsches Herzzentrum Berlin (DHZB) without fluoroscopy between 1999 and 2010. We included 330 out of 1,605 patients; 254 had an ASD II, 30 a PFO and 46 multiperforated atrial septum. Median age was 8.92 (0.96-76.3) years and median body weight 32.6 (8.3-156) kg. Median stretched defect size was 13 (5-29) mm. Median procedure time was 50 (20-170) min. Closure was performed in the majority of patients with the Amplatzer(®) septal occluder or Amplatzer(®) PFO occluder. The procedure succeeded in 98.2 % of cases and closure rate was 94.9 % after 48 h. Complication rate was low and procedure time was similar to that necessary with studies using fluoroscopy. CONCLUSION: Interventional closure of ASDs is safe and effective if guided with TEE alone. The results can compete with those with the use of fluoroscopy. TEE-guided closure of ASD should be considered in more catheter laboratories to avoid unnecessary radiation exposure for the patient and the examiner.