Vedolizumab Serum Trough Concentrations and Response to Dose Escalation in Inflammatory Bowel Disease.

Serum vedolizumab concentrations are associated with clinical response although, it is unknown if vedolizumab concentrations predict response to dose escalation. The aim of this study was to identify if vedolizumab trough concentrations predicted the response to vedolizumab dose escalation. We assessed a retrospective cohort of patients on maintenance vedolizumab dosing at five tertiary care centers with vedolizumab trough concentrations. Multivariate logistic regression was used to control for potential confounders of association of vedolizumab concentration and clinical status. Those who underwent a dose escalation were further examined to assess if vedolizumab trough concentration predicted the subsequent response. One hundred ninety-two patients were included. On multivariate analysis, vedolizumab trough concentration (p = 0.03) and the use of immunomodulator (p = 0.006) were associated with clinical remission. Receiver operator curve analysis identified a cut off of 7.4 µg/mL for clinical remission. Of the fifty-eight patients with dose escalated, 74% of those with a vedolizumab concentration <7.4 µg/mL responded versus 52% of those with a vedolizumab trough concentration ≥7.4 µg/mL (p = 0.08). After adjustment for relevant confounders, the odds ratio for response with vedolizumab concentration <7.4 µg/mL was 3.7 (95% CI, 1.1-13; p = 0.04). Vedolizumab trough concentration are associated with clinical status and can identify individuals likely to respond to dose escalation. However, a substantial portion of patients above the identified cut off still had a positive response. Vedolizumab trough concentration is a potentially helpful factor in determining the need for dose escalation in patients losing response.

Teaching Spinal Cord Neuroanatomy through Drawing: An Interactive, Step-Wise Module.

INTRODUCTION: This interactive, case-based module was created to provide medical students with self-guided practice to improve their confidence with, and understanding of, neuroanatomy. The module was created to supplement neuroanatomy instruction. It is based on the idea that pictures and drawings are effective tools for teaching clinical neuroanatomy, especially when paired with a step-wise approach to solving clinical cases. METHODS: The learning module focuses on the basics of spinal cord anatomy and lesion localization, topics fundamental to neuroanatomy. Students who have had a basic introduction to these topics in their neuroanatomy course will find this module a useful educational supplement. A full version of the module, which includes a self-drawing component for additional reinforcement, can be completed in approximately an hour. A shorter version without the self-drawing component, can be completed in less time. The materials associated with the module include an answer packet to use as a guide through the module cases, and both pre- and postmodule practice questions for self-evaluation. Both modules were tested at our institution by separate groups of second-year medical students in the early portion of their neuroanatomy course. RESULTS: Both module versions showed significant improvement in confidence levels when describing spinal cord anatomy and lesion localization. Furthermore, students were highly satisfied with the material and reported they were likely to reuse it for additional studying. DISCUSSION: The use of this module by medical students during their neuroanatomy course provides a step-wise, case-based approach that simplifies the learning of learning neuroanatomy, and improves their confidence through pictures and drawings.

Mutational analysis of metastatic lymph nodes from papillary thyroid carcinoma in adult and pediatric patients.

BACKGROUND: Limited data are available on the analysis of somatic mutations in metastatic lymph nodes in adult and pediatric patients with papillary thyroid carcinomas. METHODS: A total of 92, microdissected, formalin-fixed, paraffin-embedded tissue specimens from 39 patients were analyzed for the presence of somatic mutations utilizing the ThyGenX next-generation sequencing test. RESULTS: Somatic mutations were detected in 67% of papillary thyroid carcinoma specimens. The majority of patients with synchronous and all 6 patients with radioactive iodine-resistant (metachronous) metastatic lymph nodes contained BRAF mutations. Four patients had mutations detected in their metastatic lymph nodes that were not detected in their primary tumors. For the most part, BRAF mutations were seen in adults, and RAS mutations were seen in children. CONCLUSION: Findings of different mutations in metastatic lymph nodes compared with the primary papillary thyroid carcinomas are probably the result of tumor heterogeneity. The presence of the BRAF mutation in metastatic lymph nodes might be responsible for the recurrence of papillary thyroid carcinomas and resistance to radioactive iodine therapy. The good prognosis observed in papillary thyroid carcinomas found in pediatric and young adult patients might be explained by the predominance of RAS rather than BRAF mutations.