Role of radiography, MRI and FDG-PET/CT in diagnosing, staging and therapeutical evaluation of patients with multiple myeloma

Multiple myeloma is a malignant B-cell neoplasm that involves the skeleton in approximately 80% of the patients. With an average age of 60 years and a 5-years survival of nearly 45% Brenner et al. (Blood 111:2516–2520, 35) the onset is to be classified as occurring still early in life while the disease can be very aggressive and debilitating. In the last decades, several new imaging techniques were introduced. The aim of this review is to compare the different techniques such as radiographic survey, multidetector computed tomography (MDCT), whole-body magnetic resonance imaging (WB-MRI), fluorodeoxyglucose positron emission tomography- (FDG-PET) with or without computed tomography (CT), and 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy. We conclude that both FDG-PET in combination with low-dose CT and whole-body MRI are more sensitive than skeleton X-ray in screening and diagnosing multiple myeloma. WB-MRI allows assessment of bone marrow involvement but cannot detect bone destruction, which might result in overstaging. Moreover, WB-MRI is less suitable in assessing response to therapy than FDG-PET. The combination of PET with low-dose CT can replace the golden standard, conventional skeletal survey. In the clinical practise, this will result in upstaging, due to the higher sensitivity

Internet Gaming Disorder: compensating as a Draenei in World of Warcraft

The diagnosis of Gaming Disorder (GD) has been recently proposed in the beta draft of the 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization (WHO). This follows the inclusion of Internet Gaming Disorder (IGD), as a condition requiring additional research in the Diagnostic Statistical Manual for Mental Disorders (DSM-5), issued by the American Psychiatric Association (APA). Further research has been recommended to enhance understanding of excessive gaming, especially in the context of user-avatar (in-game figure representing the gamer) relationships. The association between selecting the Draenei race, compensation of real-life deficits through gaming, and the gamer’s gender were investigated as IGD risk factors among players of the online game, World of Warcraft (WoW). A normative online sample of WoW gamers (N = 404 Mage = 25.56; 13–75; males = 299; 74%) completed the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) and the compensation subscale of the User-Avatar Questionnaire. Regression, mediation, and moderated mediation analyses were conducted. Overall, players with higher levels of compensation exhibited greater levels of IGD symptoms. Interestingly, choosing the Draenei race was associated with increased compensatory behavior, which in turn linked to higher IGD risk. These associations were mildly stronger among females. Findings suggest that virtual demographics, such as the Draenei race, and their interplay with compensatory behaviors should be carefully considered when creating prevention and intervention policies targeting excessive gaming, especially when it involves the use of avatars

Optimal management of fringe entry over time

In this paper, we investigate the problem of a dominant company facing entry of a "competitive fringe" (smaller competitor or fringe of smaller competitors). We seek to identify pricing and advertising (or other promotional strategies) that maximize long-term profits for the dominant firm, under possible reactions of the competitive fringe. Two main situations are considered: The firms in the fringe are price-takers, but they advertise. `` The firms in the fringe are not price-takers and advertise. The possibility of a passive reaction, in the case of a very small fringe, is considered as a particular case. We assume that the rate of change of fringe sales is dynamically related to the current sales, price and advertising efforts of both the dominant firm and the fringe. The higher the dominant firm price, the faster fringe entry. The higher dominant firm advertising effort, the slower fringe entry. Fringe advertising and pricing may counterbalance these effects. Formulating a dynamic game, with the dominant firm as a leader and the fringe as a follower, we present a new methodology for providing time-invariant feedback Stackelberg equilibrium. The methodology relies on finding the relationship between the co-state variables and the state variable. The equilibrium solution is obtained in an implicit form by solving a set of two backward differential equations. To show the applicability of our solution to real situations, we use data from the U.S. long-distance market and find optimal decision rules for AT&T facing the entry of MCI and Sprint during the 1980-1990 period. The feedback equilibrium indicates that while AT&T's price is decreasing when fringe (MCI and Sprint) sales increase, the fringe price is increasing. AT&T's advertising is increasing with fringe sales while the fringe's advertising increases and then decreases. The comparison with actual behavior indicates that AT&T has adhered closer to the optimal solution in both price and advertising than the fringe. (C) 2003 Published by Elsevier B.V