Quantitative sudomotor abnormalities in clinically isolated rapid eye movement sleep behavior disorder.

BACKGROUND: Post-ganglionic sudomotor abnormalities are common in Parkinson's disease (PD), however data in clinically isolated REM sleep behavior disorder (iRBD) are limited. OBJECTIVE: To determine the prevalence of sudomotor abnormalities in a cohort of patients with iRBD. METHODS: We performed a retrospective review of patients seen in our autonomic clinic who underwent testing with the quantitative sudomotor axon reflex test (QSART). We identified three groups for comparison: 1.) iRBD, 2.) PD with RBD (PDwRBD) 3.) PD without RBD (PDwoRBD). RESULTS: PDwRBD (n = 27) patients demonstrated the greatest sudomotor abnormalities (sudomotor CASS 1.44 ± 1.24), followed by PDwoRBD (n = 23, 0.57 ± 0.5) and iRBD (n = 20, 0.55 ± 0.94) (p = 0.015). Twenty percent of patients with iRBD had an abnormal result, compared to 67% PDwRBD and 35% PDwoRBD. DISCUSSION: Sudomotor abnormalities are common in patients with iRBD, supporting the concept that peripheral autonomic impairment occurs early in the course of disease.

Consolidation and maintenance therapy with lenalidomide, bortezomib and dexamethasone (RVD) in high-risk myeloma patients.

Prior studies have shown that myeloma patients exhibiting either genetically defined high-risk disease or plasma cell leukemia have a poor outcome with a median overall survival (OS) of ≤3 years. Results of IFM 2005-01 and 02 suggest that relatively limited bortezomib-containing induction regimens did not produce a major survival benefit among these patients. However, results of recent studies suggest that combination therapy may benefit these patients when given early and again later in the treatment. We evaluated a combination maintenance/consolidation regimen (RVD) following autologous stem cell transplant (ASCT) for high-risk patients to evaluate the impact of this approach on outcome. Following initiation of RVD maintenance, 51% of patients achieved stringent complete response (sCR), with 96% achieving at least VGPR as best response. Median progression free survival (PFS) for all patients is 32 months with a 3-year OS of 93%. The regimen was well tolerated with no grade 3/4 neuropathy. Early ASCT followed by RVD maintenance is a promising strategy for high-risk myeloma patients and delivered excellent response rates, and promising PFS and OS.

Favorable impact of pre-transplant ATG on outcomes of reduced-intensity hematopoietic cell transplants from partially mismatched unrelated donors.

Reduced-intensity conditioning (RIC) permits allogeneic hematopoietic progenitor cell transplantation in patients who would not be considered candidates for transplantation using a myeloablative preparative regimen because of age, comorbidities or prior therapy. In the setting of myeloablative transplantation, use of antithymocyte globulin (ATG) can reduce the risk of GVHD without negatively affecting transplant outcomes; however, limited data exist on the impact of ATG in the setting of RIC, particularly when there is HLA-mismatch. We performed a retrospective analysis of 85 patients who received unrelated donor transplants at our institution for hematologic malignancies following conditioning with fludarabine and melphalan (FluMel), with or without rabbit ATG (6 mg/kg). ATG was targeted to patients receiving HLA-mismatched grafts. With a median follow-up of 36 months, those receiving ATG and a mismatched graft had similar rates of acute and chronic GVHD, relapse, and similar OS compared with those receiving HLA-matched grafts without ATG. In a multivariate analysis, HLA-mismatched donor was not associated with a decrement in OS. We conclude that this intermediate dose of ATG is effective in preventing severe GVHD in the setting of HLA-mismatch, without undue compromise of the graft versus tumor effects on which RIC transplants depend.

AIDS communication: role of knowledge factors on perceptions of risk.

PIP: The AIDS epidemic is a challenge for health practitioners, educators, mass media communicators, and social workers. The current absence of pharmacological, immunological, and medical interventions against HIV/AIDS demands that social and behavioral HIV/AIDS prevention interventions be given central focus. Efforts to reduce the practice of high-risk HIV behaviors are key to preventing or reducing HIV infection. However, effecting such changes poses many challenges since it must be addressed in the situational, social, cultural, and individual psychological contexts of different societies. While sexual abstinence is the most effective way to prevent the sexual transmission of HIV/AIDS, it is unrealistic to expect that most adults and adolescents will abstain from sex to avoid HIV infection. Rather, studies are needed to identify which factors influence the change of risk behaviors. Findings are presented from a study conducted to identify which factors contribute to the self-perception of risk for contracting HIV among 323 university students in a US midwestern city. At least 2 knowledge factors and the practice of safe sex behaviors were found to contribute to perceptions of lower risk of being infected with HIV. Media campaigns which deliver only accurate and comprehensive AIDS information from a medical and immunological perspective, and fail to address the subjective images people have about AIDS, may be less effective in reducing perceptions of risk than are message and educational strategies which also deal with people's subjective concerns.^ieng

Social and economic factors in an integrated behavioral and societal approach to communications in HIV/AIDS.

Health communication scholars have tried to understand how individuals process information and have identified the factors that contribute to appropriate behavior change. Some of these theorists have, implicitly or explicitly, assumed that if individuals were provided with the "right" information they would adopt the recommended behavior. Some others have endorsed the need to provide behavioral skills along with information so that individuals are able to carry out the desired behavior. Both approaches, however, are concerned with individual behavior change. Sociodemographic variables like class, gender, and race have seldom figured in sociopsychological analyses in the AIDS context. Limited attention has been paid to the manner in which political, economic, and social variables have constrained or enabled individual behavior related to AIDS. In this article, the various sociopsychological theories/models that inform AIDS prevention are delineated; the sociopsychological approaches in the context of class, race, and gender issues are critiqued; and an analytical framework that integrates behavioral and societal level variables to guide policy interventions is provided.