The six-minute walk test in patients with AL amyloidosis: a single centre case series.

The six-minute walk test (6MWT) has been widely used as an objective evaluation of functional exercise capacity and response to medical intervention in cardiopulmonary diseases. However, little is known about the 6MWT in evaluating patients with AL amyloidosis. We performed a retrospective study of 120 adults with systemic AL amyloidosis (60 with cardiac involvement and 60 without cardiac involvement) who had their initial evaluation at the Amyloidosis Center between 2013 and 2015 and had undergone 6MWT as a measure of functional exercise capacity. Forty-seven patients with cardiac involvement and 41 patients without cardiac involvement were included in the final analysis. The six-minute walk distances (6MWD) were 368 ± 105 m and 420 ± 116 m (mean ± SD), respectively (P = 0·03). Among AL amyloidosis patients with cardiac involvement, the 6MWD was associated with New York Heart Association class (P < 0·001), B-type natriuretic peptide (P = 0·003) and overall survival (hazard ratio 0·381, 95% confidence interval 0·215-0·676, P = 0·001). In conclusion, the 6MWT is a valuable tool in assessing functional exercise capacity in patients with AL amyloidosis.

Arriving at the Right Diagnosis in an Era of Precision Medicine.

In the era of precision medicine and targeted therapy, diagnostic inaccuracy can have tremendous ramifications. We present the case of a 61-year-old man initially diagnosed with small cell lung cancer by pathology. Prior to initiating chemotherapy, multidisciplinary discussions led to an amendment of the diagnosis to medullary thyroid cancer.

Risk Factors for Venous Thromboembolism Among Reproductive Age Women.

BACKGROUND: Venous thromboembolism (VTE) is rare among young women and is often presumed to occur in the setting of a genetic predisposition or during the use of estrogen-containing combined hormonal contraceptive or to have an unknown cause. This study aims to describe the distribution of VTE risk factors among women with a confirmed VTE. METHODS: We identified all women aged 15-46 years with a VTE diagnosis at Columbia University Medical Center from 2005 to 2012 using medical center databases. We then reviewed all electronic medical records to validate the diagnoses and identify risk factors associated with each confirmed case. RESULTS: We identified 315 cases and confirmed 186 (59%). The proportion of unconfirmed cases increased over time. Forty percent of confirmed cases were associated with hormonal contraceptives or pregnancy. Ninety-five percent of confirmed cases had identifiable major risk factors including a personal history, family history, malignancy or other predisposing illness, recent long-haul travel, trauma, hospitalization, and obesity; many had multiple simultaneous risk factors. None of the confirmed cases was associated with a previously known genetic predisposition, but in 10 confirmed cases a genetic predisposition was identified during evaluation. In only 10 of the 186 confirmed cases could we not identify any acquired risk factor, and only 2 of those 10 women had a genetic predisposition. CONCLUSIONS: Many reproductive age women experiencing a VTE have risk factors unique to this group, and most have multiple risk factors, confirming that this is a multifactorial disease. The large proportion of unconfirmed cases suggests the need for great caution in using administrative databases for research due to poor diagnostic specificity and due to lack of information about additional risk factors.

Robustness of the retinotopic attentional trace after eye movements.

With each eye movement, the image received by the visual system changes drastically. To maintain stable spatiotopic (world-centered) representations, the relevant retinotopic (eye-centered) coordinates must be continually updated. Although updating or remapping of visual scene representations can occur very rapidly, J. D. Golomb, M. M. Chun, and J. A. Mazer (2008) demonstrated that representations of sustained attention update more slowly than the remapping literature would predict; attentional benefits at previously attended retinotopic locations linger after completion of the saccade, even when this location is no longer behaviorally relevant. The present study explores the robustness of this "retinotopic attentional trace." We report significant retinotopic facilitation despite attempts to eliminate or reduce it by enhancing spatiotopic reference frames with permanent visual cues in the stimulus display and by introducing a different task where the attended location is the saccade target itself. Our results support and extend our earlier model of native retinotopically organized salience maps that must be dynamically updated to reflect the task-relevant spatiotopic location with each saccade. Consistent with the idea that attentional facilitation arises from persistent, recurrent neural activity, it takes measurable time for this facilitation to decay, leaving behind a retinotopic attentional trace after the saccade has been executed, regardless of conflicting task demands.