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Mindful haiku poems to help us rediscover our natural surroundings, without travelling too far from home. Some flowers are the subject of nursery rhymes and childhood games while others help us celebrate love, remember our homelands or mark the passing seasons. These mindful haiku poems invite us to explore twenty-four flower species growing close to home, from wildflower meadows to urban window boxes. The nature-themed follow up to 'My Mindful A to Zen', this collection of poems teaches us that treating ourselves and our planet mindfully can also be a treat for the senses.

Inhibition of the master growth regulator mTORC1 (mechanistic target of rapamycin complex 1) slows ageing across phyla, in part by reducing protein synthesis. Various stresses globally suppress protein synthesis through the integrated stress response (ISR), resulting in preferential translation of the transcription factor ATF-4. Here we show in C. elegans that inhibition of translation or mTORC1 increases ATF-4 expression, and that ATF-4 mediates longevity under these conditions independently of ISR signalling. ATF-4 promotes longevity by activating canonical anti-ageing mechanisms, but also by elevating expression of the transsulfuration enzyme CTH-2 to increase hydrogen sulfide (H 2 S) production. This H 2 S boost increases protein persulfidation, a protective modification of redox-reactive cysteines. The ATF-4/CTH-2/H 2 S pathway also mediates longevity and increased stress resistance from mTORC1 suppression. Increasing H 2 S levels, or enhancing mechanisms that H 2 S influences through persulfidation, may represent promising strategies for mobilising therapeutic benefits of the ISR, translation suppression, or mTORC1 inhibition. The authors showed that, in C. elegans , inhibition of translation or mTORC1 increases ATF-4 expression independently of ISR signalling. ATF-4 promotes longevity by increasing hydrogen sulfide production by the enzyme CTH-2.

Bispecific antibodies (BsAbs) are emerging as an important novel class of immunotherapeutic agents for the treatment of multiple myeloma (MM), and are set to be more widely used in clinical practice. However, this new class of therapies is associated with a distinct adverse event (AE) profile that includes cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, as well as AEs leading to increased infection risk such as cytopenias and hypogammaglobulinemia, and infections themselves. As preliminary data with this class of agents shows an increased risk of infections as compared with conventional MM treatment regimens, such as immunomodulatory drugs, proteasome inhibitors, and anti-CD38 monoclonal antibodies (mAbs), guidance on infection monitoring, prophylaxis and treatment is required. This review provides consensus recommendations from a panel of 13 global experts, following a meeting in August 2022. The meeting objective was to review existing literature and identify relevant information on infections with all BsAbs in patients with MM, as well as to discuss clinical experience of experts in managing these infections. The recommendations outlined here can be used to guide management of infection risk factors, such as hypogammaglobulinemia and neutropenia. In addition, they can be used to guide the monitoring, prophylaxis, and treatment of bacterial, viral and fungal infections, including emerging infections of interest, such as coronavirus 2019 (COVID-19), and the use of vaccinations prior to and during BsAb treatment. The recommendations have been graded by the panel based on level of data available. Key recommendations include universal herpes simplex and varicella zoster virus prophylaxis, screening for hepatitis B virus reactivation risk in all patients, monthly intravenous immunoglobulin treatment for immunoparesis and in the absence of life-threatening infectious manifestations, use of colony-stimulating factors in patients with Grade 3 neutropenia, universal pneumocystis jirovecii pneumonia prophylaxis and no routine anti-fungal prophylaxis.Video SummaryBReUfrXvMgXdk_GdGVqcDi

Idecabtagene vicleucel (Ide-cel) has demonstrated excellent efficacy and durable responses in patients with relapsed/refractory multiple myeloma (RRMM). However, the outcomes with ide-cel in patients with extramedullary disease (EMD) remain incompletely characterized. We included patients with RRMM treated with ide-cel between May 2021 and April 2023 across 11 US academic institutions. Visceral or soft tissue lesions non-contiguous from bone was classified as EMD. Time-to-event analyses were performed from date of ide-cel infusion. Among 351 patients, 84 (24%) had EMD prior to infusion. The median follow-up from ide-cel infusion was 18.2 months (95% CI: 17-19.3). The day 90 overall response rates (ORR) were 52% vs. 82% for the EMD and non-EMD cohorts, respectively ( p  < 0.001). The median progression-free survival (PFS) was 5.3 months (95% CI: 4.1–6.9) for the EMD cohort vs. 11.1 months (95% CI: 9.2–12.6; p  < 0.0001) for the non-EMD cohort. In a multivariable analysis, EMD was an independent predictor of inferior PFS [hazard ratio 1.5 (1.1–2.2), p  = 0.02]. The median overall survival was 14.8 months [95% CI: 9-Not reached (NR)] vs. 26.9 months (26.3 vs. NR, p  = 0.006) for the EMD and non-EMD cohorts, respectively. Extramedullary disease represents an independent predictor of inferior day 90 ORR and PFS among patients treated with ide-cel.

Hidradenitis suppurativa (HS) is an inflammatory disease affecting the pilosebaceous skin units and is linked to several autoimmune conditions. An area of exploration includes the connection between hyperthyroidism and HS. This study aims to investigate and establish the relationship between HS and hyperthyroidism. The relationship between hyperthyroidism and HS was evaluated using data from the National Institute of Health (NIH) All of Us Researcher Program. A cross-sectional study was performed to assess the prevalence of HS in individuals with and without a history of hyperthyroidism matched by age ranges and health surveys. Relative risk and significance were determined by using standard statistical methods. A total of 407,333 patients were matched by health surveys and age ranges in the control and experimental groups. Among patients with a history of hyperthyroidism, the prevalence of HS was 1.40% compared to 0.38% in the control group. This difference was statistically significant (p < 0.0001 with an OR = 3.717, 95% CI 3.038-4.548). This study demonstrates a statistically significant correlation between hyperthyroidism and increased prevalence of HS. These results justify the need for further research regarding hyperthyroidism's role in HS and the potential screening tools and lifestyle management techniques that may be prevalent for both conditions.

Chimeric antigen receptor (CAR) T-cell therapy (CAR T therapy) is a treatment option for patients with relapsed or refractory multiple myeloma that has led to unprecedented treatment outcomes. Among CAR T therapies available, ciltacabtagene autoleucel (cilta-cel) is a good candidate for outpatient administration due to its generally predictable safety profile. There are multiple advantages of outpatient administration of cilta-cel, including reduced healthcare burden, expanded access, and patient autonomy. This mixed methods qualitative study aimed to identify key factors for outpatient administration of CAR T and best practice recommendations by combining a targeted literature review with expert interviews and panels. The targeted review (Phase 1) aimed to identify factors for outpatient CAR T administration in the US and determine key topics for the exploratory interviews (Phase 2) and expert panels (Phase 3), which aimed to inform on best practices and challenges of outpatient CAR T administration (focusing on cilta-cel). Participants in clinical and administrative positions based in treatment centers that had experience with real-world outpatient administration of cilta-cel were recruited. Seventeen studies were identified in Phase 1. Key factors for outpatient administration included the development of protocols for CAR T complications, education for caregivers, outpatient specialists, hospital staff, and emergency services staff for identification and referral after possible adverse events, the creation of multidisciplinary teams for effective communication and management, straightforward patient intake processes encompassing financial eligibility review and provision of patient education materials, and close patient monitoring throughout the treatment journey. In Phase 2, 5 participants from 2 centers were interviewed. In Phase 3, 14 participants across 6 treatment centers were interviewed. Two 90-minute virtual panel discussions took place. All participants agreed that cilta-cel can be safely and effectively administered in an outpatient setting. Key recommendations included the creation of educational resources for patients and caregivers, the development of standard operating procedures, dedicated outpatient infrastructure and establishment of interdisciplinary teams, outpatient monitoring for toxicity management, and monitoring of the reimbursement landscape. This study offers a comprehensive understanding of the feasibility of outpatient cilta-cel administration in participating CAR T centers and provides actionable recommendations while acknowledging existing challenges.

Autologous stem cell transplantation (autoHCT) is considered standard of care for newly diagnosed multiple myeloma (MM). Although most patients eventually progress after autoHCT, a small proportion achieve a durable response. In this retrospective study we included 1576 patients, 244 (15%) of whom were long-term responders (LTR), defined as having a progression-free survival (PFS) of ≥8 years after transplant. Patients in the LTR group were younger than the non-LTR group (median age 58.4 vs. 59.5 years; p  = 0.012), less likely to have high-risk cytogenetics (4% vs. 14%; p  < 0.001), more often had <50% bone marrow plasma cells (67% vs. 58%; p  = 0.018) and R-ISS stage I disease (43% vs. 34%). More patients in the LTR group received post-transplant maintenance (63% vs. 52%; p  = 0.002). Patients in the LTR group had higher rates of complete response (CR) at day100 (41% vs. 27%; p  < 0.001) and at best post-transplant response (70% vs. 37%; p  < 0.001), compared to the non-LTR group. Patients in the LTR groups had a median PFS of 169.3 months and the median overall survival (OS) had not been reached. The leading cause of death in the LTR was disease progression. In conclusion, 15% of patients in the cohort were LTR after upfront autoHCT, with distinct characteristics and a median PFS of more than 14 years.

The objectives of this study were to evaluate the outcomes of patients with WM who previously received BTKi therapy (BTKi-discontinued), looking at their response to, and duration of, therapy, reasons for BTKi discontinuation, next-line treatment patterns, and associated outcomes. Response rate associated with next line therapy (G). AE adverse event, A-Fib atrial fibrillation, CR complete response, LBCL large B cell lymphoma, MR minor response, ORR overall response rate, PD progressive disease, PR partial response, Pt patient, RR relapsed/refractory, SD stable disease, T-Naïve treatment naïve, VGPR very good partial response, WM Waldenström macroglobulinemia. Major response rates were statistically comparable (all p > 0.05) between all next-line regimens (≥PR): BTKi (42%;10/24 patients, 1 NE), anti-CD20/chemo (52%;23/44, 1 NE), venetoclax